Stuvia 1507039 Test Bank For Community and Public Health Nursing 10th Edition by Rector PDF

TEST BANK For COMMUNITY AND
PUBLIC HEALTH NURSING 10TH

EDITION By RECTOR
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COMMUNITY AND PUBLIC HEALTH NURSING 10TH

EDITION RECTOR TEST BANK
Chapter 1 The Journey Begins: Introduction
1. After teaching a group of nursing students about the similarities and differences between
public health and community health, which of the following statements by a nursing student
would indicate knowledge of the similarities and differences between public health and
community health?
A) “Community health nursing is defined as

nursing care that is provided in a community setting, rather than an institutional setting.”
B) “Public health nursing is defined as nursing care that is provided in an institutional

setting.”
C) “Public health nursing is focused on the
health of individuals.”
D) “Community health nursing can shape the quality of community health services and
improve the health of the general public.”
Ans: D
Feedback:
Operating within an environment of rapid change and increasingly complex challenges,
this nursing specialty holds the potential to shape the quality of community health services and
improve the health of the general
public.
2. Which of the following statements would best

describe the difference between public health nursing and community health nursing?
A) Public health nursing is focused on the private aspects of health, and community health
nursing is focused on the public aspects of
health.
B) In our textbook, the term community health practice refers to a focus on specific,
designated communities and is a part of the
larger public health effort.
C) Public health nursing and community health nursing relate to the very same types of
services and perspectives.
D) Both public health nursing and community health nursing are practiced exclusively
within institutions.
Ans: B
Feedback:

In this textbook, community health practice refers to a focus on specific, designated

communities. It is a part of the larger public health effort and recognizes the fundamental
concepts and principles of public health as its birthright and foundation for practice. Public
health nursing is focused on the public aspects of health. Public health nursing and community
health nursing have distinctive types of services and perspectives. Neither public health nursing
nor community health nursing is practiced exclusively within
institutions.
3. Which of the following is most accurate about

the concept of community?
A) A community is a collection of people who
share some important features of their lives.
B) Community members live in the same
geographic location.
C) Community members are biologically related.
D) A community is made up of people who do not necessarily interact with one another and
do not necessarily share a sense of belonging
to that group.
Ans: A
Feedback:
The broad definition of a community is a collection of people who share some important
features of their lives. Community members may not live in the same geographic location as in a
common-interest community or a community of solution. A population is made up of people
who do not necessarily interact with one another and do not necessarily share a sense of
belonging to that
group.
4. A group of students are reviewing material for a test on populations, communities, and
aggregates. Which of the following indicates
that the students understand these concepts?
A) Members of a population share a sense of
belonging.
B) Communities and populations are types of
aggregates.
C) Individuals of a community are loosely
connected.
D) Members of an aggregate share a strong bond.
Ans: B
Feedback:
An aggregate refers to a mass of grouping of distinct individuals who are considered as a
whole and who are loosely associated with one another. Communities and populations are types
of aggregates. A population is made up of people who do not necessarily interact with one
another and do not necessarily share a sense of belonging to the group. A community is a

collection of people who chose to interact with one another because of common interests,
characteristics, or goals, which form the basis for a sense of unity or
belonging.
5. Which of the following would a community health nurse identify as a community of

common interest?
A) The global community
B) Small rural town in a northern state

C) National professional organization
D) Counties addressing water pollution
Ans: C
Feedback:
A common-interest community shares a common interest or goal that binds the members
together. Membership in a national professional organization is one example. The global
community and a small rural town in a northern state would be examples of a geographic
community. Counties addressing a water pollution problem would be an example
of a community of solution.
6. The nurse is working with a community of solution. Which of the following would the
nurse expect to find?
A) A health problem affecting the group
B) Common goal binding members together
C) Sharing of a similar goal
D) Locational boundaries
Ans: A
Feedback:
A community of solution involves a group of people coming together to solve a problem
that affects them. A common-interest community involves a collection of people widely
scattered geographically who have an interest or goal that binds the members together. A
geographical community is one defined by its geographical or locational
boundaries.
7. Which one of the following statements made by a student would the nurse educator
recognize as evidence that a student
understands the health continuum?
A) The distinction between health and illness is
well demarcated.
B) Illness refers to a state of being relatively
unhealthy.
C) The term health is limited to reflect an

individual's state.
D) Treatment of acute conditions reflects the
current focus of health care.
Ans: B

Feedback:
Although society typically depicts an absolute line of difference between being either
well or ill, health is considered a relative term. Thus, illness is viewed as a state of being
relatively unhealthy. Health is typically described as a continuum that involves a range of
degrees from optimal health at one end to total disability or death at the other. The line of
demarcation is not clear. Health applies to individuals, families, and communities.
Traditionally, most health care has focused on the treatment of acute and chronic conditions at
the illness end of the continuum, but this emphasis is shifting to focus on the wellness
end.
8. When discussing the concept of the health continuum with a class, the nurse educator
would be certain to include which statement
in the description?
A) Wellness is a relative concept, not an absolute, and illness is a state of being

relatively unhealthy.
B) A client's placement on the health continuum
is static throughout time.
C) Health is best described as cyclic.
D) The health continuum can only be applied to
individuals.
Ans: A
Feedback:
Wellness is a relative concept, not an absolute, and illness is a state of being relatively
unhealthy. The continuum can change. Because health involves a range of degrees from optimal
health at one end to total disability or death at the other, it is often described as a continuum. The
health continuum applies not only to individuals but
also to families and communities.
9. After discussing the leading health indicators with a class, which condition if stated by
the class as one of these indicators suggests that
the class has understood the information?
A) Cardiac disease
B) Mental health
C) Sedentary lifestyle
D) Maternal health care
Ans: B
Feedback:
Mental health is a leading health indicator. Other leading health indicators include
physical activity, overweight and obesity, tobacco use, substance use, responsible sexual
behavior, injury and violence, environmental quality, immunization, and access to health
care.

10. Which of the following statements about

health promotion and disease prevention is the most accurate?
A) Health promotion and disease prevention include all efforts that seek to move people
closer to optimal well-being or higher levels
of wellness.
B) Disease prevention differs from health promotion in that disease prevention is

targeted toward a specific disease or diseases.
C) Health promotion can be described in terms of
primary, secondary, and tertiary prevention.
D) The goal of disease prevention is to raise levels of wellness for individuals, families,
populations, and communities.
Ans: B
Feedback:
Health promotion includes all efforts that seek to move people closer to optimal well-
being or higher levels of wellness. The goal of health promotion is to raise levels of wellness for
individuals, families, populations, and communities. Disease prevention is targeted toward a
specific disease or diseases and consists of primary, secondary, and tertiary
prevention.
11. A group of community health nursing students design a health education program for a
group of pregnant teens that includes teaching nutrition during pregnancy, demonstrating helpful
exercises, and discussing their concerns. This is an example
of which of the following?
A) Health promotion
B) Treatment of disorders
C) Rehabilitation
D) Evaluation
Ans: A
Feedback:
The student nurses are engaging in health promotion activities. Health promotion
incorporates all efforts that seek to move people closer to optimal well-being or to higher levels
of wellness. Treatment of disorders would include direct care for issues involving the group,
such as complications that might arise in this population.
Rehabilitation would involve activities to minimize disability or restore or preserve function.
Evaluation would involve an analysis of the effectiveness of these
activities.
12. plan of primary prevention activities. Which of the following might the nurse include?
Select all that apply.
A) Teaching about safe-sex practices to high

school students
B) Encouraging older adults to install safety
devices in the bathroom
C) Providing regular immunization programs for
communicable diseases
D) Participating in cholesterol screening
programs at health fairs
E) Providing skin testing for tuberculosis for
children over 1 year of age
F) Working with a group testing water samples
for contamination
Ans: A, B, C
Feedback:
Primary prevention activities are those taken to keep illness or injuries from occurring.
These include teaching about safe-sex practices, encouraging older adults to use safety devices in
the bathroom, and providing regular immunization programs for communicable diseases.
Cholesterol screening programs, skin tests for tuberculosis, and working with a group testing
water samples for contamination are examples of secondary prevention activities.
13. A community health nurse is preparing a presentation for a group of nursing students
about community health nursing. Which of the following descriptions about community health
nursing would the nurse most likely
include in the presentation?
A) Focusing on addressing continuous needs
B) Working with the client as an equal partner
C) Engaging in tertiary prevention as the priority
D) Encouraging clients to reach out to the nurse
Ans: B
Feedback:
The community health nurse works with the client as an equal partner, encouraging
autonomy. At any time, the nurse deals with continuous and episodic needs simultaneously.
Primary prevention is the priority for community health nurses. The community health nurse
engages in primary prevention as the priority, having the obligation to actively reach out to all
who might benefit from a specific activity or
service.
14. A community health nurse is working with other members of a team that will be
implementing a citywide immunization program. The nurse is coordinating the services and
addressing the needs of the population groups to ensure which of the
following?
A) Involvement of the community
B) Client participation
C) Continuity of service
D) Plan for follow-up
Ans: C
Feedback:

Working in cooperation with other team members and coordinating services and
addressing the needs of population groups are essential to interprofessional collaboration. In
doing so, the community health nurse is preventing fragmentation and gaps thereby ensuring
continuity of service. Involvement of the community and client participation are important but
these help to ensure that the clients are viewed as equal partners of the health care team. A plan
for follow-up may or may not be appropriate. In addition, it is the only aspect that may be
addressed with the
program.
15. A community health nurse works to ensure the greatest good for the greatest number of
people by applying which of the following?
A) Secondary prevention activities
B) Autonomy
C) Justice
D) Utilitarianism
Ans: D
Feedback:
The ethical theory of utilitarianism promotes the greatest good for the greatest number.
Primary prevention activities, not secondary prevention, are the priority. Autonomy refers to the
freedom of choice. Justice involves
treating people fairly.
16. When working in the community, the community health nurse adopts the teaching plan to
ensure that the population understands the basic information provided to address
which of the following?
A) Self-care
B) Health disparities
C) Health literacy
D) Episodic needs
Ans: C
Feedback:
Consumers are often intimated by health professionals and are uninformed about health
and health care affecting the quality of care.
Adopting a teaching plan to ensure that the population understands the basic information
addresses health literacy, the ability to read, understand, and use health care information
appropriately. Doing so helps to ensure that the teaching plan will be effective. Self-care refers to
the process of taking responsibility for developing one's own health potential by actively
participating in promoting one's own health. Health disparities reflect differences in all aspects of
health care related to vulnerable populations. Episodic needs are one-time
specific negative health events that arise and are not an expected part of life.

17. Which of the following would be crucial for the community health nurse to address as the
priority when dealing with policy makers about the development of community health
programs?
A) Research-based best practices
B) Population's make up
C) Amount of services to be provided
D) Scarcity of the available resources
Ans: A
Feedback:
Decisions for programs or services are often made on the basis of cost-effectiveness or
cost–benefit. Therefore, community health nurses must provide policy makers with information
about best practices, grounded in research. Although population make up, amount of services to
be provided, and scarcity of resources are factors that may need to be considered, the community
health nurse
must demonstrate evidence-based practice.
18. After a class that described the differences between acute care nursing and community
health nursing, which statement by the class about community health nurses indicates
successful teaching?
A) Use a reactive approach.
B) Seek out potential health problems.
C) Concentrate on the illness end of the
continuum.
D) Emphasize curative care.
Ans: B
Feedback:
Community health nurses, in contrast to acute care nurses, seek out potential health
problems, identifying high-risk groups and instituting preventive programs; use a proactive
approach; concentrate on the wellness end of the health continuum; and put
less emphasis on curative care.
19. Which of the following activities would be associated with a community health nurse?
A) Examining infants in a city well-baby clinic
B) Caring for elderly stroke victims in their
homes
C) Providing emergency care in an acute care
facility
D) Carrying out epidemiologic research
E) Participating in health policy analysis
Ans: A, B, D, E
Feedback:
Community health nurses work in every conceivable kind of community agency, from a
state public health department to a community-based advocacy group. Their duties rang from
examining infants in a well- baby clinic or teaching elderly stroke victims in their homes to

carrying out epidemiologic research or engaging in health policy analysis and decision making.
Providing care in an acute care facility would not be an activity
associated with a community health nurse.
20. The term health can be described in many different ways. A community health nurse
would view health as which of the following?
A) The absence of disease
B) The potential to lead a productive life
C) An environment free of toxins
D) A holistic state of well-being
Ans: D
Feedback:
Community health nurses view health as a holistic state of well-being, which includes
soundness of mind, body, and spirit. Along with this foundational view is the emphasis on
wellness, which includes the definition of health as well as the capacity to develop a person's
potential to lead a fulfilling and productive life. Health is more than just the absence of disease or
an environment free of
toxins.
21. While interviewing a client, which of the following statements would a nurse identify as
reflecting an objective dimension of
health?
A) “I'm feeling better since I started taking that
medication.”
B) “Life is pretty good right now, except for an
occasional upset stomach.”
C) “I'm able to wash myself in the mornings with
just a bit of help.”
D) “Sometimes when I wake up, I don't even
want to face the day.”
Ans: C
Feedback:
The objective dimension of health involves one's ability to function in daily activities.
The statement about being able to care for one's self is an example. The statements of feeling
better with medication, life being pretty good, and not wanting to face the day are examples of
the subjective dimension of
health, which involves how people feel.
22. When employing a population-oriented focus, the community health nurse would do
which
of the following?
A) Assess the groups' relationships looking for a
common need.
B) Consider the members individually for

similarities.
C) Focus on the geographical area of the
population.
D) Promote the groups' dependency for
improving health.
Ans: A
Feedback:
A population-oriented focus requires the assessment of relationships, considering the
groups or communities in relationship to the rest of the community to discover common needs or
risks for a common health problem. The nurse does not consider the groups or communities
separately but rather in context. The population may or may not be delineated by the
geographical area. The community health nurse encourages individuals' participation to promote
their autonomy rather
than permitting dependency.
23. A community health nurse is involved in a project to evaluate the health of a city. Which
of the following findings would suggest that the city would most likely need additional
programs?
A) Citizens are actively involved in the city's department of recreation and after-school
programs.
B) The construction of affordable organized

housing developments and communities is nearing completion.
C) Approximately one third of the people are recently unemployed due to closure of the
automotive factory.
D) Several new recreational facilities for adults and children have been created at several
locations.
Ans: C
Feedback:
A healthy city is one in which there is continual creation and improvement the physical
and social environments with expansion of community resources so that people can mutually
support one another. It is characterized by the meeting of basic needs for all of the city's people.
This would include food, water, shelter, income, safety, and work. Loss of employment of one
third of the city's workforce would be a threat to the health of the city and necessitate
intervention. Active involvement in the city's functioning, affordable housing, and recreational
facilities
are suggestive of a healthy city.
Chapter 2 Public Health Nursing in the Community

1. A community health nurse is engaging in assurance activities. Which of the following
would best explain these activities?

A) Gathering and analyzing information that will

affect the health of the people to be served
B) Providing leadership in facilitating community groups toward meeting their needs, often
involving changes in and
additions to existing laws
C) Being involved in activities to make certain that necessary services are being provided to
the community
D) Accessing relevant data that enable identification of strengths, weaknesses, and

needs within the community
Ans: C
Feedback:
Assurance activities are those activities that make certain that services are provided and
include focusing on the availability of necessary health services throughout the community,
maintaining the ability of public health agencies and private providers to manage day-to-day
operations as well as the capacity to respond to critical situations and emergencies. Assessment
involves gathering and analyzing information that will affect the health of those to be served and
accessing relevant data to enable the nurse to identify strengths, weaknesses, and needs. Policy
development involves providing leadership in
facilitating community groups.
2. When fulfilling the function of assessment, which of the following would be most
important for the community health nurse to
do?
A) Secure the trust of the clients
B) Gather appropriate information
C) Interact with key community leaders
D) Use a variety of assessment tools
Ans: A
Feedback:
Although securing and maintaining the trust of others is pivotal to all nursing practice, it
is even more critical when working in the community. Trust can afford a nurse access to client
populations that are difficult to engage, to agencies, and to health care providers. As difficult as
it may be for the nurse to gain the trust and respect of the community, if it is ever lost, these
attributes can be difficult if not impossible to regain. Gathering information, interacting with key
community leaders, and using a variety of assessment tools are important, but they can only
occur
after trust is established.

3. The community health nurse is engaging in the core function of policy development.
With which of the activities would the nurse most
likely be involved?
A) Monitoring health status to identify
community health problems
B) Empowering communities about important
health issues
C) Linking individuals to needed personal health
services
D) Ensuring a competent health care workforce
is available
Ans: B
Feedback:
With policy development, the community health nurse would be involved in informing,
educating, and empowering people about health issues. Monitoring health status is associated
with the assessment function.
Linking individuals to needed personal health services and ensuring a competent public health
and personal health care workforce are
associated with assurance.
4. A community health nurse is collaborating with local community leaders to prepare a

community disaster plan. Which function is
the nurse fulfilling?
A) Research
B) Assurance
C) Policy development
D) Assessment
Ans: B
Feedback:
Community health nurses perform the assurance function at the community level when
they collaborate with community leaders in the preparation of a community disaster plan.
Research is demonstrated by gaining new insights and innovative solutions to health problems.
Policy development would involve client information, education and empowerment,
mobilization of community partnerships, and the development of plans and policies to support
community health efforts. Assessment involves monitoring health status for community health
problems and diagnosing and investigating health problems and hazards in the
community.
5. A community health nurse has collected data for several months on the birth weights of
newborns to mothers who smoked throughout their pregnancy. This nurse is acting in which
role?
A) Collaborator
B) Manager
C) Researcher
D) Clinician

Ans: C
Feedback:
The nurse is assuming the role of a researcher, that is, engaging in systematic
investigation that includes data collection. In the collaborator role, the nurse would work with
numerous members of the health team, working jointly with others in a common endeavor. In the
manager role, the nurse exercises administrative direction toward the accomplishment of
specified goals. In the clinician role, the nurse ensures the provision of health care services to
individuals,
families, groups, and populations.
6. A nurse in community health nursing setting works with police officers, social workers,
health educators, and other nurses to promote the health of clients. The nurse is acting in
which role?
A) Clinician
B) Educator
C) Researcher
D) Collaborator
Ans: D
Feedback:
The nurse is assuming the role of collaborator. In this role, the community health nurse
works jointly with many individuals to benefit client care. In the clinician role, the nurse ensures
the provision of health care services to individuals, families, groups, and populations. As an
educator, the nurse is the health teacher and provides information to community clients. In the
researcher role, the community health nurse engages in systematic investigation, collection, and
analysis of data for solving problems and
enhancing community health practice.
7. A community health nurse is interviewing for employment. The interviewer describes

some of the typical activities that the nurse would be involved in, such as making home visits to
families, holding immunization clinics for infants and children, and setting up flu-shot clinics for
elders. The interviewer is
describing which role?
A) Educator
B) Advocate
C) Clinician
D) Manager
Ans: C
Feedback:
The interviewer is describing direct care activities associated with the clinician role. As
an educator, the nurse is the health teacher and provides information to community clients. In the
advocate role, the nurse pleads for the clients' cause or acts on their behalf. In the manager role,
the nurse exercises administrative direction toward the
accomplishment of specified goals.

8. A community health nurse is reviewing his or her schedule for the day. Included in his or
her activities are planning client care, leading a staff conference, and supervising a new staff
member. This nurse is fulfilling which role?
A) Advocate
B) Manager
C) Collaborator
D) Researcher
Ans: B
Feedback:
When functioning in the manager role, the nurse exercises administrative direction
toward the accomplishment of specified goals. Overseeing client care as a case manager,
supervising ancillary staff, managing caseloads, running clinics, or conducting community health
needs assessment projects are examples of activities associated with the manager role. In the
advocate role, the nurse pleads for the clients' cause or acts on their behalf. In the collaborator
role, the nurse would work with numerous members of the health team, working jointly with
others in a common endeavor. In the researcher role, the community health nurse engages in
systematic investigation, collection, and analysis of data for solving problems and enhancing
community health practice.
9. While providing care to a family at a local center, the community health nurse contacts
the local department of social services to help the family attain assistance with health insurance
coverage. The nurse also gives the family a list of pharmacies where they can get their
prescriptions filled. The nurse is acting
in which role?
A) Educator
B) Leader
C) Clinician
D) Advocate
Ans: D
Feedback:
The nurse is acting in the role of advocate, by pleading their cause and acting on their
behalf. The nurse acts as an advocate by showing clients what services are available, the ones to
which they are entitled, and how to obtain them. As an educator, the nurse is the health teacher
and provides information to community clients. As a leader, the nurse directs, influences, or
persuades others to effect change that will positively impact people's health and move them
toward a goal. In the clinician role, the nurse ensures the provision of health care services to
individuals, families, groups, and populations.

10. Which of the following best exemplifies the attributes of a community health nurse in the
researcher role?
A) Gaining the trust and respect of the staff
members
B) Interpreting abstract ideas so others can
understand
C) Implementing a staff development program
for a technique
D) Evaluating the correlation between variables
in specific health conditions
Ans: D
Feedback:
Attributes of a researcher include a spirit of inquiry, careful observation, analytic skills,
such as evaluating the possible cause and effect of a situation, and tenacity. Gaining the trust and
respect of staff, interpreting abstract ideas, and implementing a staff development program are
examples of the management
skills used in the role of manager.
11. Which of the following statements about the

role of educator within the framework of public health nursing functions is true?
A) The educator role has the potential for finding greater receptivity and providing higher-
yield
results.
B) People are unable to recognize the value of

health and are not well motivated to achieve higher levels of wellness.
C) It is only possible for a nurse to reach a
limited number of persons.
D) The public's higher level of health
consciousness hinders the educator's role.
Ans: A
Feedback:
The educator role has the potential for finding greater receptivity and providing higher-
yield results. People are recognizing the value of health and are increasingly motivated to
achieve higher levels of wellness. With an emphasis on populations and aggregates, the
educational efforts of community health nursing are appropriately targeted to reach many people.
One factor that enhances the educator role is the public's higher level of
health consciousness.

importance of the role of collaborator is true?
A) Community health nurses frequently practice
in isolation.

B) Successful community health practice depends on multidisciplinary collegiality and

leadership.
C) Community health nurses must assert themselves as the most powerful person on the
health care team to ensure each client
receives services that are necessary.
D) It is best for community health nurses to focus on what they, as nurses, can do for their
clients.
Ans: B
Feedback:
Community health nurses seldom practice in isolation. As collaborators, nurses work

jointly with others in a common endeavor, cooperating as partners. Successful community health
practice depends on multidisciplinary collegiality and leadership. The community health nurse's
collaborator role requires skills in communicating, in interpreting the nurse's unique contribution
to the team, and in acting assertively as an equal
partner.
13. Which of the following statements about the community health nurse's selection and
practice of each role is true?
A) Within a given time, a community health
nurse may practice multiple roles.
B) The knowledge that vulnerable populations need someone to guide them through the
complexities of the health care system and the
nurse can serve as an advocate for them
C) The researcher role for community health

nurses involves only the use of quantitative statistics.
D) The leadership role consists solely of
managing staff.
Ans: B
Feedback:
Community health nurses wear many hats while conducting day-to-day practice. At any
given time, however, one role is primary.
They need someone to guide them through the complexities of the system and assure the
satisfaction of their needs. This is particularly true for minorities and disadvantaged groups.
Although research technically involves a complex set of activities conducted by persons with
highly developed and specialized skills, research also means applying that technical study to
real-practice situations. As leaders, community health nurses seek to initiate changes that
positively
affect people's health.

14. A community health nurse is involved in education, screening, referral, and support for
the individuals of a specific religious congregation. The nurse is practicing in which
setting?
A) Occupational health nursing
B) Faith community nursing
C) School nursing
D) Residential institution nursing
Ans: B
Feedback:
In faith community nursing, the practice focal point is the faith community and the
religious belief system provided by the philosophical framework. It may be called church-based
health promotion, parish nursing, or primary care parish nursing practice. Occupational health
nursing occurs in business and industry settings. School nursing, as the name implies, involves
practicing in the school system, including from preschools to colleges and universities.
Residential institution nursing occurs in any facility where the clients reside such as a halfway
house or continuing care
center.
15. Which of the following differentiates the home setting for community health nursing
from other settings?
A) The nurse acts primarily as an educator.
B) The client is viewed within his or her
environment.
C) Technologically advanced care is limited.
D) The home is being used less frequently today.
Ans: B
Feedback:
In the home, unlike most other health care settings, clients are on their own “turf,” such
that the client is the host, comfortable and secure in familiar surroundings, and the nurse is a
guest. Although education may be a major component of care in the home, all community health
nursing roles are performed to varying degrees. In addition, technologically advanced care in the
home is increasing in demand, with the home being the most frequently used setting for
community health nursing.
16. After teaching a group of students about the various settings for community health
nursing, the instructor determines that this teaching was successful when the students identify
which of the following as an example
of ambulatory service setting?
A) Local preschool
B) Halfway house
C) Continuing care center
D) Family planning clinic
Ans: D

Feedback:
Ambulatory service setting includes a variety of venues for community health nursing in
which clients come for day or evening services that do not include overnight stays. One example
is a family planning clinic. A local preschool would be an example of a school setting. A
halfway house and continuing care center are examples of
residential institutions.
17. After teaching a group of students about the changing roles of the community health
nurse in the occupational setting, the instructor determines that the students need additional
teaching when they state which of the
following?
A) Occupational health nurses are increasing

their role as employee advocates.
B) Health education is a key function of the
occupational health nurse.
C) There is a greater emphasis on the
occupational health nurse's role as a clinician.
D) Collaboration with other health care providers
fosters the offering of better services.
Ans: C
Feedback:
The clinician role was primary for many years, as nurses continued to care for sick or
injured employees at work. However, recognition of the need to protect employees' safety and,
later, to prevent their illness led to the inclusion of health education in the occupational health
nurse role. Occupational health nurses also act as employee advocates, assuring appropriate job
assignments for workers and adequate treatment for job- related illness or injury. They
collaborate with other health care providers and company management to offer better services to
their clients. They act as leaders and managers in developing new health services in the work
setting, endorsing programs such as
hypertension screening and weight control.
18. A community health nurse is working as a lobbyist for health legislation for AIDS
research at the state capital. This nurse is
practicing in which setting?
A) Faith community
B) Ambulatory service
C) Residential institution
D) Community at large
Ans: D
Feedback:
The community at large is not confined to a specific philosophy, location, or building. It

serves as the setting for practice of a nurse who serves on health care planning committees,
lobbies for health legislation at the state capital, runs for a school board position, or assists with

flood relief in another state or country. Faith community nursing focuses on activities involving
the faith community and religious belief system.
Ambulatory service settings include a variety of venues in which clients come for day or evening
services that do not include overnight stays. Residential institutions include any
facility where clients reside.
19. Which of the following is included in the

most accurate description of school nursing?
A) This is one community health setting where
the role is static.
B) The primary role of school nurses is clinician.
C) The practice of school nurses is widening.
D) School nurses rarely act as advocates.
Ans: C
Feedback:
School nurses, whose primary role initially was that of clinician, are widening their
practice to include more health education, interprofessional collaboration, and client
advocacy.
20. A community health nurse is assuming the role of a manager. Which function would be
most important for the nurse to address first?
A) Planning
B) Organizing
C) Leading
D) Controlling
Ans: A
Feedback:
The management process incorporates a series of problem-solving activities or function:

planning, organizing, leading, and controlling and evaluating. Although these activities occur
simultaneously, they are sequential with
planning being the first activity.
21. A nursing student is interviewing a community health nurse about the various roles the
nurse assumes and the skills and behaviors necessary to perform each role. Which of the
following would the community health nurse identify as being essential to the
role of an advocate? Select all that apply.
A) Assertiveness
B) Ability to plan
C) Ability to negotiate
D) Risk taking
E) Holistic view
F) Questioning attitude
Ans: A, C, D
Feedback:

As an advocate, the community health nurse must be assertive, willing to take risks, be
able to communicate and negotiate well, and be able to identify resources and obtain results. The
ability to plan is associated with the manager role. A holistic view is critical to the community
health nurse acting as a clinician. A questioning attitude is necessary
for the role as a researcher.
22. A community health nurse works in a busy community health nursing practice. Today,
the nurse is devoting the day to the educator role. With which of the following activities would
the nurse be involved? Select all that apply.
A) Planning seven home visits today
B) Working on a new curriculum for high-risk
teens
C) Meeting with colleagues to discuss
organizational changes in the office
D) Ordering pamphlets over the Internet to be

used in a parenting class
E) Tabulating data from surveys distributed to
elders during a flu-shot clinic
F) Going to social services to speak up for a
family in his or her caseload
Ans: B, D
Feedback:
In the educator role, the nurse would work on a new curriculum for high-risk teens and
order pamphlets for use in a parenting class. Planning seven home visits would be part of the
clinician role. Meeting with colleagues to discuss organizational changes would be part of the
manager role. Tabulating data from surveys would be part of the researcher role. Speaking up for
a family in the nurse's caseload would be an example of the advocate
role.
23. A community health nurse is devoting the day to being a manager. Which activities
would the nurse expect to perform? Which of the following activities are part of this role?
A) Orienting three new community health nurses
in the agency
B) Attending a strategy meeting for a new
service the community will be offering
C) Working with a team to direct a smoking
cessation program in public areas
D) Investigating an outbreak of Salmonella in the
community
E) Tabulating the findings of exploring
immunization practices among teens
F) Reviewing the staff evaluations to assist with
planning future in-services
Ans: A, B, F

Feedback:
As a manager, a community health nurse would be involved in orienting new nurses in

the agency, attending meetings for new services to be offered, and reviewing staff evaluations.
Working with a team to direct a smoking cessation program in public areas exemplifies the
leadership role. Investigating an outbreak of Salmonella and tabulating the findings of
immunization practices depict the
researcher role.
24. Of all the nursing roles assumed by community health nurses, which role must be
assumed in every situation?
A) Researcher
B) Manager
C) Leader
D) Clinician
Ans: B
Feedback:
The type and number of roles that are practiced vary with each set of clients and each
specific situation, but the nurse should be able to successfully function in each of these roles as
the particular situation demands. The role of manager is one that the nurse must play in every
situation, because it involves assessing clients' needs, planning and organizing to meet those
needs, directing and leading clients to achieve results, and controlling and evaluating the
progress to ensure that the goals and clients' needs are
met.
25. Which of the following are core values of

professional behavior that are unique to public health nursing? Select all that apply.
A) Community/population as client
B) Prevention
C) Rehabilitation
D) Partnership
E) Healthy environment
F) Diversity
Ans: A, B, D, E, F
Feedback:
Core values of professional behavior emphasize community/population as client,
prevention, partnership, healthy environment, and diversity. Rehabilitation is not population
centered.
Chapter 3 History and Evolution of Public Health Nursing

1. A group of students are reviewing the various historical events associated with the
evolution of community health nursing in preparation for a test. They identify the time from
1970 to the present as the era known as community health nursing based on the understanding
that which of the following influences

contributed most to this change?

A) The settings and the nurses delivering health
care in the community
B) Decisions made by the American Nurses
Association
C) Decisions made by physicians in a variety of
community settings
D) The demand to eliminate the word “public”
from health services
Ans: A
Feedback:
The numbers, increasing variety of settings, and many nurses coming to work in the
community settings since the 1970s have contributed most significantly to the change. As a
result, professional associations supported the broader term of community health nursing.
Physician decisions played no role in the change. The term public health
nursing still remains.
2. Before the mid-1800s, early home care nursing was best recognized by which of the
following?
A) Technical advances with the Industrial
Revolution making major changes
B) Care provided by family members, friends,
and religious groups in the home
C) Accomplishments stemming from the work of
Florence Nightingale
D) Formal organization of visiting nursing to
provide care to the sick poor
Ans: B
Feedback:
Before the mid-1800s, early home care was characterized by care of the sick in the home
by family members, friends, and religious groups. Technical advances came after 1850, as did
the work of Florence Nightingale and the formal organization of visiting nurses to
provide care to the sick poor.
3. Community health nursing has a long history of contributing to the health of populations.
Which of the following forms of service would the nurse identify as being most
recent?
A) Voluntary home nursing care for the sick poor
via district nursing
B) Care provided termed public health nursing
C) Lay and religious groups providing care to the
sick poor in their homes
D) Focus on populations with community health
nursing seen as a specialty field
Ans: D

Feedback:
The four stages of community health nursing followed from lay and religious groups
providing care in the early years before 1850, the more specialized “health nurses” or district
nursing after the mid-1800s, concern for the health of the general public from 1900s to 1970, and
finally community health nursing as a specialty with a focus on
populations since 1970.
4. Which factor was the most significant feature

associated with district nursing?
A) Caring for the sick
B) Teaching hygiene and cleanliness
C) Preventing illness
D) Gathering statistical data
Ans: B
Feedback:
Although district nurses primarily cared for the sick, they also taught cleanliness and
wholesome living to their clients. This early emphasis on prevention and health became one of
the distinguishing features of district nursing and later of public health nursing.
Preventing illness and gathering statistical data were key contributions of Florence Nightingale
during the Crimean War of the
early 1850s.
5. In their early stages, district nursing was

sponsored by which of the following?
A) Religious organizations
B) Private philanthropy
C) Contributions
D) Public funding
Ans: A
Feedback:
Early district nursing services were founded by religious organizations that served as
their sponsors. Later sponsorship shifted to private philanthropy. Funding came from
contributions and fees charged to clients on an ability-to-pay basis. Finally, visiting nursing
began to be supported by public money.
6. Which of the following would characterize the public health stage of community health
nursing?
A) Voluntary health agencies emphasizing
disease prevention
B) Family considered as the primary unit of care
C) Service provision to the sick poor population
D) Primary health care as the key to health for all

Ans: B
Feedback:
The public health nursing stage was characterized by service to the public, with the
family targeted as a primary unit of care. Official health agencies, which placed a greater
emphasis on disease prevention and health promotion, provided the chief institutional base.
Primary health care as the key to health for all characterizes the
community health nursing stage.
7. At which time did the focus of district nursing broadened to include the health and
welfare of
the general public?
A) Beginning of 20th century
B) In the late 19th century
C) Prior to the 1850s
D) By the early 1970s
Ans: A
Feedback:
The focus of district nursing broadened to include the health and welfare of the general
public by the beginning of the 20th century or the early 1900s. In the late 19th century, district
nurses were ill-prepared to cope with their clients' multiple health and social problems resulting
from widespread immigration and filled tenement housing that led to inadequate sanitation,
unsafe and unhealthy working condition, and barriers adding to poverty and disease. District
nursing did not develop until after 1850. The
early 1970s is associated with the emergence of community health nursing.
8. A student is planning a presentation about the evolution of public health nursing. As part
of the presentation, the student would identify which person as being the first one to use the
term “public health nursing”?
A) Jessie Sleet
B) Lillian Wald
C) Lina Rogers
D) Margaret Sanger
Ans: B
Feedback:
Lillian Wald, a leading figure in the expansion of district nursing, was the first to use the
term “public health nursing” to describe the specialty. Jessie Sleet was credited as being the first
Black public health nurse. Lina Rogers was credited with being the first school nurse. Margaret
Sanger was the nurse who opened the first birth control clinic in America that eventually resulted
in the formation of the International Planned
Parenthood Federation.

9. Which of the following are important contributions made by Lillian Wald to the
profession of public health nursing? Select all
that apply.
A) Demonstrating the effectiveness of placing school nurses in public schools to reduce

absenteeism and improve follow-up of
problems identified in school children
B) Promoting the use of birth control
C) Convincing the Metropolitan Life Company that nurse intervention could reduce death
rates
D) Providing rural “frontier nursing” to serve
mountain families in Kentucky
E) Founding the National Organization for
Public Health Nursing (NOPHN)
Ans: A, C, E
Feedback:
Lillian Wald contributed to the profession of public health nursing by demonstrating the
effectiveness of placing school nurses in public schools to reduce absenteeism and improve
follow-up of problems identified in school children, convincing the Metropolitan Life Company
that nurse intervention could reduce death rates, and Founding the National Organization for
Public Health Nursing
(NOPHN).
10. After a class discussion about the contributions of Lillian Wald to the advancement of
community health nursing, which of the following if stated by the class
indicates that the discussion was effective?
A) Establishment of family-centered nursing and outreach services in New York City at the
turn
of the 20th century
B) Use of clean and safe nursing care practices to
soldiers during the Crimean War in the 1850s
C) Assistance to high-risk populations experiencing tropical diseases in Central

America and the Caribbean in the late 1800s
D) Creation of home nursing services in London, marking the beginning of district nursing
in
the 1860s
Ans: A
Feedback:
Lillian Wald worked with immigrant families in the Lower East Side of New York City,
providing home visits, a neighborhood center, and general sanitation improvement for families

and health care services to children in schools. Florence Nightingale was responsible for
providing clean and safe nursing care practices to soldiers during the Crimean War. Mary
Seacole helped high-risk populations who experienced tropical diseases in Central America and
the Caribbean. William Rathbone was responsible for establishing a
visiting nurse service for the sick in London.
11. A group of nursing students are studying for an examination on influential nursing
leaders involved in the advancement of community health nursing. The students demonstrate that
they are prepared for the examination when they identify which person as the first
community health nurse in the United States?
A) Frances Root
B) Mary Robinson
C) Mary Seacole
D) Reba Thelin
Ans: A
Feedback:
In the United States, Frances Root was the first community health nurse who was hired
by the Women's Branch of the New York Mission in 1877. Mary Robinson was the nurse who
cared for William Rathbone's wife and was hired by Rathbone to visit the sick poor in their
homes in England. Mary Seacole, the “Black Nightingale,” practiced Creole or Afro-Caribbean
medicine in Jamaica and helped populations who experienced tropical diseases in Central
America, Panama, and the Caribbean. Reba Thelin was a nurse hired by Johns Hopkins
Hospital to visit the homes of tuberculosis clients in 1903.
12. Which of the following nurses openly defied a law that she saw as unjust and eventually
resulted in the formation of The International
Planned Parenthood Federation?
A) Lillian Wald
B) Florence Nightingale
C) Margaret Sanger
D) Mary Brewster
Ans: C
Feedback:
Margaret Sanger openly defied a law that she saw as unjust (the Comstock Act that
prohibited the provision of any information on contraception to women). This defiance
eventually resulted in the formation of The International Planned Parenthood Federation. During
the same period that Lillian Wald and her contemporaries were working to alleviate the suffering
caused by disease and poverty, Margaret Sanger began a different battle.

Florence Nightingale wrote a series of papers on the need for “home missioners” and “health
visitors” and endorsed the view that prevention was better than cure. Mary Brewster was a nurse
and a friend of Lillian Wald who both together started the Henry
Street Settlement.
13. The community health nurse is preparing a presentation for a group of nursing students
about the societal influences on the development of community health nursing. Which factors
should the nurse include that have influenced the growth of community
health nursing? Select all that apply.
A) Advances in the technology
B) The recognition that one single agent could be
considered a cause of illness
C) Access to education being limited to the
privileged few
D) Continued increase in the number of women entering nursing because it is recognized as

a
choice career for women and not men
E) Consumer demand for quality services

coupled with community health nurses provision of holistic care
Ans: A, E
Feedback:
Many factors have influenced the growth of community health nursing, including
advances in technology, progress in causal thinking (relating disease or illness to its cause and
recognition that many factors might contribute to a disease or health disorder), and the consumer
movement with consumers demanding quality services. Education is now widely available and is
considered a basic right and necessity for a vital society.
Changing demographics and the role of women have influenced community health nursing;
however, the number of women
entering nursing has decreased.
14. Which of the following actions by the community health nurse exemplifies the societal
influence of causality on the practice
of community health nursing?
A) Using computer-based education programs
for client education

B) Engaging in video conferencing to share

research findings
C) Identifying multiple factors associated with
promoting wellness
D) Developing a plan to address the rapid
increase in older adult population
Ans: C
Feedback:
Causal thinking relates disease or illness to its cause and includes areas such as
epidemiology; interactions among an agent, host, and environment; and recognition of multiple
factors contributing to a disease, health disorder, or wellness. Using computer- based education
programs and engaging in video conferencing are examples reflecting the advancement of
technology. Developing a plan to address the rapid increase in the older adult population
involves application of the change in demographics affecting community
health nursing.
15. A community health nurse who is teaching a group of nursing students about the various
societal influences on community health nursing is explaining the effects of the consumer
movement. Which of the following student responses would lead the community health nurse to
determine that the teaching
was successful?
A) Individuals are considered passive members
of the health care team.
B) Consumers are demanding more coordinated
comprehensive care.
C) People are expecting community health
nurses to develop new programs.
D) Consumers are identifying a greater need for
care by a variety of care providers.
Ans: B
Feedback:
The consumer movement has led to changes in community health nursing. Consumers are
demanding more humane, personalized health care, seeking more comprehensive coordinated
care. They are viewed as active members of the health care team. The need to develop new
programs is a response to the economic forces that have affected the practice of community
health nursing.
Consumers desire more coordinated care, not
care from a variety of care providers.

16. Which of the following most accurately reflects the response of community health
nursing to economic forces?
A) Decreased competition with other community
health service providers
B) Reduction in available programs and services
C) Development of new services for generating
revenue
D) Switch to a more illness-oriented philosophy
for service
Ans: C
Feedback:
Economic forces have led community health nursing to respond by developing new
revenue-generating services to augment depleted budgets. Other responses include directly
competing with other community health service providers and developing new programs and
service emphases. Although some public health agencies have been drawn into more illness-
oriented services, community health nursing continues to be resourceful in finding ways to foster
the
community's optimal health.
17. A prospective nursing student is interested in working in community health nursing after
graduation. Which type of education would be
most appropriate for this student to choose?
A) Diploma program
B) Associate degree
C) Baccalaureate degree
D) Graduate degree
Ans: C
Feedback:
Community health nursing is a challenging specialty in nursing. The demands of this type
of nursing require additional courses in liberal arts and science, along with courses in community
health nursing practice as a student. The minimum preparation for community health nurses in
many states is a baccalaureate degree. The diploma and associate degree level prepares students
for basic nursing practice. Students can build on this basic knowledge by entering a BSN
completion program, which will prepare them to enter the specialty of community health
nursing. In order to stay current and to build skills in this specialty, advanced courses or a
graduate (masters) degree is needed.

18. A community health nurse desires to attain a tenure-track position at a local university to
teach community health nursing. Which of the
following would this nurse need?
A) Certification
B) Master's degree
C) Doctoral degree
D) Nurse practitioner license
Ans: C
Feedback:
A doctoral degree would be the required education needed to obtain a tenure-track
teaching position at a university. Certification provides additional education for specialization
and may result in a promotion or higher salary accompanied by additional responsibilities and
opportunities. A master's degree can lead to management positions, private community health
ownership, agency teaching, or research positions. Nurse practitioners can run well-child clinics
and direct a school-based clinic if a school nurse. Advanced practice can open doors into
leadership positions in community health
nursing.
Chapter 4 Evidence-Based Practice and Ethics in Community/Public Health

1. A nursing instructor is preparing a teaching plan for a class comparing evidence-based
practice and critical thinking. Which of the
following would the instructor include?
A) Evidence-based practice and critical thinking
are polar opposites.
B) Both involve problem clarification of central
concepts.
C) Interpretation of accumulated evidence is
unique to evidence-based practice.
D) Problem exploration is unique to evidence-
based practice.
Ans: B
Feedback:
Evidence-based practice and critical thinking share commonalities including exploring a
problem, addressing a purpose or goal, making assumptions, clarifying the problem around
central concepts or indicators, accessing data, interpreting accumulated evidence, using
reasoning, processing, defining, planning and documenting, acting on the problem, and
evaluating, adjusting, generalizing, and applying to a broader problem set. In addition, critical
thinking is an important component of evidence-based
practice.
2. According to the Institute of Medicine's landmark report, The Future of Nursing,

nurses should: Select all that apply.

A) work independently from other health professionals to promote the profession of

nursing.
B) work collaboratively with other health
professionals to promote health care.
C) attempt to redesign health care.
D) improve practices through evidence-based
means.
E) The Future of Nursing report does not express

the importance of evidence-based nursing.
Ans: B, C, D
Feedback:
The Future of Nursing highlights the need for nursing to work with other health
professionals in “redesigning health care” by “conducting research” and improving
practices through evidence-based means.
3. Which of the following statements about evidence-based practice has been identified by
multiple reports over the past decade, such as To Err Is Human: Building a Safer Health System
(2000), Crossing the Quality Chasm: A New Health System for the 21st Century (2001), and
Priority Areas for National Action: Transforming Health Care Quality
(2003)?
A) We must continue to cling to “the way we've
always done it.”
B) We have spent billions of dollars each year researching new treatments and have
translated that knowledge into clinical
practice.
C) We are not translating the knowledge that we
are gaining into clinical practice.
D) We have continued to spend more than a trillion dollars a year providing care and do
translate that capacity into improved clinical
practice.
Ans: C
Feedback:
To Err Is Human: Building a Safer Health System (2000), Crossing the Quality Chasm: A
New Health System for the 21st Century (2001), and Priority Areas for National Action:
Transforming Health Care Quality (2003). These reports draw attention to the fact that we spend

billions of dollars each year researching new treatments, and more than a trillion dollars are spent
annually on health care, but “we repeatedly fail to translate that knowledge and capacity into
clinical practice.”

steps of the EBP process is most accurate?
A) One of the last steps of the EPB process is to search for and collect the most relevant best
evidence.
B) One of the earliest steps in the EBP process is

to disseminate the outcomes of the EBP decision or change.
C) It is optional to integrate the best evidence with one's clinical expertise and patient
preferences and values in making a practice
decision or change.
D) The first step in the EBP process is to
cultivate a spirit of inquiry.
Ans: D
Feedback:
The steps of the EBP process in order are cultivating a spirit of inquiry; asking the
burning question in PICOT format; searching for and collecting the most relevant best evidence;
critically appraising the evidence for its validity, reliability, and applicability and then
synthesizing that evidence; integrating the best evidence with one's clinical expertise and patient
preferences and values in making a practice decision or change; evaluating outcomes of the
practice decision or change based on evidence; and disseminating the outcomes of the EBP
decision or change.
5. Which one of the following statements about cultivating a spirit of inquiry is most
accurate?
A) It is not very important; research will be
performed anyway.
B) In order for effective change to occur, current practices must be continually examined,
questioned, and challenged.
C) It involves “asking the burning clinical
question.”
D) The agency does not have an important role in
cultivating a spirit of inquiry.
Ans: B
Feedback:

In order for effective change to occur, current practices must be continually examined,
questioned, and challenged. It is very important that the spirit of inquiry is cultivated. “Asking
the burning clinical question” is part of the next step of asking the question. The agency does
have a role in cultivating a spirit of inquiry. The organization must be open to a cultural shift
from the status quo. The foundations of this spirit of inquiry are ongoing curiosity and a
culture that supports it.
6. A nurse is planning a research study to answer a clinical question. Which of the following
would be most appropriate for qualitative
research approach?
A) Evaluating the reported cases of post vaccination complications after varicella

immunization
B) Determining the use of complementary and alternative health care by middle-aged adults
in rural areas
C) Ascertaining the effect of using calming

music on older adults with dementia in extended care facilities
D) Assessing the emotional responses and

feelings of individuals requiring isolation due to a highly communicable illness
Ans: D
Feedback:
Qualitative research is used to study those areas that need a broader focus or that do not
lend themselves to objective measurement. This type of research emphasizes subjectivity and the
meaning of the experiences to individuals. Thus, qualitative research would be most appropriate
for assessing the emotional responses and feelings of individuals who require isolation for a
communicable illness. Quantitative research would be used to evaluate the reported cases of post
vaccination complications, to determine the use of complementary and alternative health care,
and to ascertain the
effect of calming music.
7. Which of the following research studies would most likely use a quantitative research
approach?
A) The relationship of maternal age and history of parents' vaccine-preventable disease and
parents' efforts to have their children
immunized

B) The experience of parents whose children

have had serious complications subsequent to immunization
C) The experience of parents whose children

were not properly immunized and developed a vaccine-preventable illness
D) Reasons that parents who practice a particular religion do not have their children properly
immunized
Ans: A
Feedback:
Quantitative research is helpful in identifying a problem or a relationship between two or

more variables, such as type of treatment. A more subjective or qualitative approach is needed to
study those areas that need a broader focus or that do not lend themselves to objective
measurement. Qualitative research emphasizing subjectivity asks “how”
or “why.”

impact of research on community health nursing are true? Select all that apply.
A) It is important to conduct research to affect
public policy.
B) Public policy will continue to have a negative
effect on the community's health.
C) Research will affect the effectiveness of
community health nursing practice.
D) Research will affect the status and influence
of nursing as a profession.
E) The impact that research has on community
health nursing is negligible.
Ans: A, C, D
Feedback:
Research has the potential to have a significant impact on community health nursing in
three ways: by affecting public policy and the community's health, the effectiveness of
community health nursing practice, and the status and influence of nursing as a profession.
Community health nurses have been involved in research
addressing all three of these dimensions.
9. Application of nursing research results to community health nursing practice is essential.

Which of the following must occur

first before results can be applied?

A) Be informed about research findings
B) Demonstrate skill in examining research
reports
C) Assess abstracts of relevant research studies

D) Check if the study was funded by a drug
company
Ans: A
Feedback:
Community health nurses have many opportunities to apply the results of other
investigator's research, but a necessary prerequisite is that the nurse must be informed about
research findings. Critically examining research reports and assessing abstracts are all part of
evaluating relevant research studies.
However, the nurse needs to know what the research findings are before he or she can evaluate
the research. Checking if the study was funded by a drug company might indicate that the results
of the study could be
questioned due to a conflict of interest.
10. After teaching a class on values, which of the

following, if stated by the class, indicates the need for additional teaching?
A) Some values are descriptive, while others are
evaluative.
B) Keeping a promise is an example of a
terminal value.
C) Values persist, remaining relatively stable
over time.
D) Certain values have more importance than
others.
Ans: B
Feedback:
Terminal values refer to end states of existence such as spiritual salvation, peace of mind,
or world peace. Instrumental values refer to modes of conduct such as confidentiality, keeping
promises, and honesty. Some values are descriptive or capable of being true or false, while other
values are evaluative, involving judgments of good and bad. Values remain relatively stable over
time and persist to provide continuity to personal and social existence. A hierarchical system of
values occurs in which certain values have more weight or importance than
others.

11. Which of the following would the community health nurse do first when making an
ethical
decision?
A) Engage in critical thinking
B) Choose a value
C) Identify isolated values
D) Clarify one's values
Ans: D
Feedback:
Clarification of a person's values is the first step in the process of ethical decision
making. Critical thinking is a strategy that can be used to help clarify values. Choosing a value is
the first step in the process of valuing. Identifying isolated values are those which are organized
into a hierarchical system where certain values have more weight or importance than
others.
12. After a class discussion on moral evaluations, which characteristic if identified by the
class would lead the instructor to determine that the
discussion has been effective?
A) There is specificity that applies to an
individual person.
B) A special place is given to a person's own
welfare.
C) Other values cannot override the moral

evaluation.
D) They relate to a matter of individual taste.
Ans: C
Feedback:
Moral evaluations have distinctive characteristics: the evaluations are ultimate, having a
preemptive quality, meaning that other values or human ends cannot, as a rule, override them;
they possess universality or reflect a standpoint that applies to everyone, such that everyone in
principle ought to be able to make and understand, even if some individuals, in fact, do not;
moral evaluations avoid giving a special place to a person's own welfare, having a focus that
keeps others in view, or at least considers one's own welfare on a par with that of others. Moral
evaluations are prescriptive–proscriptive beliefs that have certain characteristics separating them
from
other evaluations including matters of taste.
13. A group of students are reviewing for an examination on values. Identification of which
of the following as an instrumental

value indicates the need for continued study?

A) Spiritual salvation
B) Confidentiality
C) Honesty
D) Promise keeping
Ans: A
Feedback:
Spiritual salvation is an example of a terminal value, which refers to end states of
existence. An instrumental value refers to a mode of conduct, such as confidentiality, promise
keeping, and honesty.
14. A community health nurse obtains a client's informed consent for care demonstrating the
understanding that this is derived from which
value?
A) Self-interest
B) Well-being
C) Equity
D) Self-determination
Ans: D
Feedback:
Informed consent derives from self- determination. Self-interest refers to a deterioration
of self-determination in which the person focuses on fulfilling one's own desires without regard
for the greater good. Well-being is a state of positive health, the intent of all therapeutic
interventions. Equity
refers to justice or fair and equal treatment.

basic values that guide decision making in community health nursing is true?
A) Client empowerment means that the provider must use a paternalistic approach to health
care.
B) Self-interest does not interfere with self-
determination.
C) When matters of well-being are considered,

the client's preferences and needs should not be considered.
D) Equity is not possible in times of limited
resources.
Ans: D

Feedback:
In times of limited technical, human, and financial resources, however, it may be

impossible to fully respect the value of equity. Client empowerment is an approach that differs
from the paternalistic approach to health care in which decisions are made for, rather than with,
the client; instead, it enables patients and professionals to work in partnerships. When self-
determination deteriorates into self-interest, it poses a major roadblock to equitable health care.
Well- intended interventions sometimes fall short if they are in conflict with clients' preferences
and needs.
16. Situations in which self-determination should be restricted include which of the

following?
A) When some objectives of individuals are contrary to the public interest or the interests
of others in society
B) When a person's decision making is so defective or mistaken that the decision fails to
promote the person's own values or goals
C) When it interferes with self-interest
D) Self-determination and personal autonomy
must never be restricted.
E) When self-determination deteriorates into self-interest and poses a major roadblock to

equitable care
Ans: A, B
Feedback:
There are two situations in which self- determination should be restricted: when some
objectives of individuals are contrary to the public interest or the interests of others in society
(e.g., endangering others with a communicable disease) and when a person's decision making is
so defective or mistaken that the decision fails to promote the person's own values or goals.
When self-determination deteriorates into self-interest, it poses a major
roadblock to equitable health care.
17. A community health nurse is applying the value of equity in decision making with
clients. Which of the following best describes
this value?
A) Forming, revising, and pursuing personal life
plans
B) Promoting clients' health and a sense of well-

being
C) Fulfilling one's desires over those of others
D) Treating similar cases in the same fair fashion
Ans: D
Feedback:
Equity is defined as the value directing like cases to be treated alike and that all
individuals be treated fairly. Self- determination refers to a person's exercise of the capacity to
shape and pursue personal plans for life. Well-being involves promoting clients' health and sense
of well-being. Self- interest is the fulfillment of one's own desires
without regard for the greater good.
18. When working with clients, a community health nurse promotes the clients' self-concept
and health promoting behaviors. The nurse is
attempting to achieve which outcome?
A) A value system
B) Prescriptive–proscriptive beliefs
C) Individual autonomy
D) Values clarification
Ans: C
Feedback:
Promoting clients' self-concept and health- promoting behaviors are associated with the
value of self-determination that promotes individual autonomy. Value system, prescriptive–
proscriptive beliefs, and values clarification are not associated with self- determination. A value
system is an organized set of beliefs that guide individual behavior. Prescriptive–proscriptive
beliefs are viewed as desirable or undesirable beliefs. Values clarification is a process that helps
identify the personal and professional values that
guide actions.
19. A community health nurse discovers that a bill in the legislature would eliminate a state
law that currently funds child health promotion services for low-income children. Which action
at the primary level of
prevention would be most appropriate?
A) Advocate for amendment to the passed law to
allow some funding for children to remain
B) Once the bill has been passed, seek private resources to support funding of health
promotion services for low-income children.

C) Gather a group of health professionals to volunteer to provide the health promotion

services eliminated by the passed bill
D) Advocate through active lobbying against the
bill and gather community support
Ans: D
Feedback:
Appropriate activities at the primary level of prevention would include actively lobbying
against the bill, garnering community support in favor of the revised bill, and advocating for the
clients. Advocating for amendments would be appropriate at the secondary level. Seeking private
resources and gathering volunteers to provide the health services
would be appropriate at the tertiary level.
20. the instructor determines that the class needs additional instruction when they identify
which of the following as an ethical principle?
A) Respect
B) Autonomy
C) Morality
D) Justice
Ans: C
Feedback:
Morality is the behavior or judgment that conforms to a standard that is right and good.
When judgments involve moral values, conflicts are inevitable. There are seven fundamental
ethical principles that guide decision making. These include respect, autonomy, beneficence,
nonmaleficence,
justice, veracity, and fidelity.
21. A community health nurse is working to support programs to encourage preschool

immunizations. The nurse is integrating
which ethical principle in his or her practice?
A) Beneficence
B) Autonomy
C) Nonmaleficence
D) Justice
Ans: A
Feedback:
Beneficence means doing good or benefitting others, such as supporting programs to
encourage preschool immunizations.
Autonomy means freedom of choice and exercise of people's rights, such as promoting
individuals' and groups' rights to and involvement in decision making.
Nonmaleficence means avoiding or preventing harm to others as a consequence of a person's
own choice and actions, such as encouraging physicians to prescribe drugs with the fewest side
effects. Justice refers to treating people fairly, such as ensuring equal
access to health care.

22. A community health nurse working with a group of families who come to local
community health care center tells them that she is going to be setting up child care so that the
families can participate in the various classes being offered by the center. Three months have
passed, and the nurse still has not instituted the child care program. The
nurse has violated which ethical principle?
A) Veracity
B) Fidelity
C) Justice
D) Respect
Ans: B
Feedback:
Fidelity means keeping promises or commitments to foster trust and trustworthiness. By
failing to set up the child care program, the nurse has violated this fidelity. Nurses who follow
through on what they have said earn their clients' respect and trust. In contrast, when a
commitment is not kept, community members may lose faith and interest in participation.
Veracity refers to telling the truth, giving clients accurate information in a timely manner.
Veracity involves treating clients as equals. Justice refers to treating people fairly, such as by
ensuring equal access to health care and not limiting the amount or quality of services due to
income level. Respect involves acknowledging clients as valued participants in shaping their
own and the community's health outcomes.
23. A public health nurse is faced with an ethical dilemma. Which question should the nurse
consider first when deciding how to resolve
the dilemma?
A) “What exactly is the ethical dilemma?”
B) “What are the alternative courses of action?”
C) “What are the consequences of each

alternative courses of action?”
D) “How should this dilemma be solved?”
Ans: A
Feedback:
A framework is applied in public health ethics inquiry. Three core functions of this
inquiry include (1) identifying and clarifying the ethical dilemma, (2) analyzing it in terms of
alternative courses of action and their consequences, and (3) resolving the dilemma by deciding
which course of action best incorporates and balances the guiding
principles and values.

Chapter 5 Transcultural Nursing

1. After discussing the meaning of cultural diversity and its significance for community
health nursing, the nursing instructor recognizes that some points need to be clarified when a
student makes which of the
following comments?
A) “Dominant values are those held by the male

head of the household in most American families.”
B) “The percentages of White European descent Americans are rising, while the percentages
of other ethnicities are declining and this is projected to continue into the year 2050 at
least.”
C) “Nurses maintain their original culture as they are socialized throughout the educational
process.”
D) “America has become an amalgamation of people who have different values, ideals, and
behaviors, rather than the melting pot that was
once envisioned.”
Ans: A
Feedback:
The beliefs and sanctions of the dominant or majority culture are called dominant values.
The proportion of the population identified as White is projected to continue to fall below other
ethnicities between 2010 and 2050.
Nurses will still have the same culture as they did before they were socialized in the nursing
educational process, but they may be able to see things differently. America is not the ideal
melting pot once described, but rather an amalgamation of people who have different
values, ideals, and behaviors.
2. The population that community health nurses serve in the United States is changing.
Because of population shifts, nurses must become sensitive to the cultural differences and
language differences among new community members. Which minority group
currently represents the largest group?
A) African Americans
B) Hispanic Americans
C) Asian Americans
D) American Indians
Ans: B

Feedback:
Significant minorities include Hispanic Americans, numbering more than 35 million in
2000 and over 42 million in 2005 and currently representing over 14% of the population; African
Americans, numbering over 37 million or approximately 12.8% of the population; Asian
Americans, numbering more than 12 million or approximately 4.3% of the population; and
American Indians and Alaska Natives, numbering 2.8 million or 1%
of the population.
3. While providing care to a community group, a community health nurse provides

culturally sensitive care by avoiding which of the
following?
A) Ethnocentrism
B) Ethnorelativism
C) Enculturation
D) Ethnicity
Ans: A
Feedback:
Ethnocentrism is the belief or feeling that one's own culture is best causing the person to
believe that his or her way of doing things is right and to judge others' methods as inferior,
ignorant, or irrational. It blocks effective communication by creating biases and misconceptions.
Ethnorelativism is seeing all behavior in a cultural context. Enculturation refers to the process of
each person learning his or her culture through socialization with the family or significant group.
Ethnicity refers to the group of qualities that mark a person's association with a particular ethnic
group (collection of people who have common origins and a shared culture and
identity).
4. As a community health nurse, you overhear a colleague say, “I don't understand why the
Yang's take their young teenage daughters to the Hmong New Year celebration and have them
play these match-making games. The girls meet boys every day at school and they are too young
to be looking for husbands.” Which of the following would be the most
appropriate response?
A) “The Yang's are very different from us; maybe

in time we can convince them that their practices are not right.”
B) “Every culture has its differences; I think it is valuable that the Yang's are keeping their

cultural practices alive.”
C) “I know what you mean, I was thinking the same thing. You wouldn't catch me doing
something similar with my teens.”
D) “I feel sorry for those girls; they must feel funny in those cultural costumes. Let's talk to
the parents and tell them how teens in
America feel about such things.”
Ans: B
Feedback:
Community health nurses need to develop cultural sensitivity, becoming aware of own
biases and preconceived values and beliefs. This would be evidenced by the statement about
every culture having differences. The celebration is a part of the family's culture, and the nurses
should not attempt to convince them that it is not right nor should they attempt to impose their
views, feelings, or
beliefs on the family.
5. What is the most serious negative effect of a

nurse maintaining ethnocentric views but not recognizing or acknowledging this?
A) The nurse fails to understand the views of other cultures because of his or her
ethnocentrism.
B) The nurse does not communicate effectively

with members of other cultures because of his or her ethnocentrism.
C) The nurse's ethnocentrism causes damage to interpersonal relationships and interferes

with
the effectiveness of nursing interventions.
D) Nurses are immune to the effects of
ethnocentrism.
Ans: C
Feedback:
The most negative effect of nurses maintaining ethnocentric views but not recognizing or
acknowledging this is that the nurse's ethnocentrism causes damage to interpersonal relationships
and interferes with the effectiveness of nursing interventions. The nurse who is ethnocentric and
doesn't realize it will fail to understand the views of other cultures, but this is not the most
serious negative effect. If the nurse is ethnocentric, he or she may not communicate effectively
because of his or her ethnocentrism, and this can lead to impaired relationships and interference
with the effectiveness of nursing interventions. All nurses hold ethnocentric views, but it is

important for the nurse to be aware of them and acknowledge them to avoid having it damage
relationships and interfere with the effectiveness of nursing interventions.
6. When describing culture as shared, which of

the following would be most accurate?
A) It is acquired, not inherited.
B) It is a product of aggregate behavior.
C) It is interrelated and interdependent.
D) It undergoes change.
Ans: B
Feedback:
When describing culture as shared, it means that it is a product of aggregate behavior, not
an individual habit. The customs are phenomena shared by all members of the group. Culture is
learned; that is, the patterns of cultural behavior are acquired, not inherited. Culture is integrated;
that is, it is a functional, integrated whole where all parts are interrelated and interdependent.
Culture is dynamic; that is, it is changeable and not
entirely static.
7. by all cultures. Which description of culture being tacit indicates that the teaching was
successful?
A) Culture is mostly unexpressed.
B) Cultures do not remain static.
C) Culture is a functional and integrated whole.
D) Patterns of cultural behavior are acquired.
Ans: A
Feedback:
Culture is tacit, that is, mostly unexpressed and at the unconscious level. Culture is
dynamic, undergoing change and never
entirely static. It is integrated and learned.
8. Which of the following statements is an accurate description of the characteristic

shared by all cultures, culture is integrated?
A) A person's culture is an interrelated and
interdependent web of ideas and practices.
B) In order to describe a person's culture, it is
necessary to describe each trait independently.
C) Aspects of a person's culture are best

described as unrelated to other aspects of the person's culture.
D) A person's culture is an assortment of various
customs and traits.
Ans: A

Feedback:
A person's culture is an integrated web of ideas and practices. To understand culture,
single traits should not be described independently. As in any system, all parts of a
culture are interrelated and interdependent.
9. A community health nurse is working with several Native American groups in Arizona.
Which of the following would the nurse be
most likely to assess? Select all that apply.
A) The value of competition
B) Respect for advancing age and elders
C) Focus of living in the future
D) Frequent dialogue and discussion

E) Each tribe or nation has its own distinct
language, beliefs, customs, and rituals.
Ans: B, C, E
Feedback:
Although there are differences among Native American tribes, most have respect for
advancing age and they live in the present and not the distant future (making primary prevention
activities more difficult). Each tribe or nation has its own distinct language, beliefs, customs, and
rituals. Competition and frequent dialogue and discussion are not
values held by Native Americans.
10. A community health nurse working a large metropolitan city has a large Asian American
client base. Which of the following would the nurse be least likely to assess in this
population?
A) Belief that illness results from a body
imbalance
B) Reliance on Western medical practices
C) Use of traditional self-care practices
D) A focus on patriarchal family structures
Ans: B
Feedback:
Asian Americans believe illness results from an imbalance of yin and yang forces. They
use traditional healers and also exercise traditional self-care practices before using
Western medical practices.

11. While visiting an Asian American family in their home, the community health nurse
inspects the skin of the 3-year-old child and notices a bruise-like lesion on the child's abdomen.
The mother states that the child has been experiencing diarrhea for 2 days. Which
of the following would the nurse do next?
A) Report the family to the local child abuse
agency
B) Recognize this as a normal skin variation

C) Question the family about the use of cupping
D) Obtain a blood test for clotting function
Ans: C
Feedback:
The nurse needs to gather additional information about the lesion. Practicing transcultural
nursing would require the nurse to perform a cultural assessment and question the family about
their use of dermabrasive techniques such as cupping that would leave a bruise-like lesion on the
skin and be mistaken for physical abuse. The nurse would report the family to the local child
abuse agency if further investigation provides additional information to support that decision.
The lesion is not a normal skin variation.
Obtaining a blood test for clotting function would be warranted only if further assessment reveals
additional bruising or other signs of clotting problems.
12. The community health nurse is working in the health department of a major city that has
a large Hispanic/Latino population. Which of the following would the nurse need to integrate
into the plan of care for this
population?
A) View of the female as superior to the male
B) Importance of an extended, cohesive family
C) Males as the binding force of the family
D) Adherence to strict time schedules
Ans: B
Feedback:
Hispanic people value extended, cohesive families. Families have been patriarchal, with
male members perceived as superior and female members seen as a family-bonding life force.
Many Latinos tend to be oriented to the present and are not as concerned as the mainstream
culture about keeping time
schedules or preparing for the future.

13. A group of nursing students are studying for a test about various cultural communities.
The students demonstrate that they understand the material when they identify which cultural
group as believing in predestination?
A) Hispanic/Latinos
B) African Americans
C) Muslims
D) Native Americans
Ans: C
Feedback:
Muslims believe in predestination, that life is determined beforehand, and they attribute
the occurrence of disease to the will of Allah.
Hispanic/Latinos believe that illness may be a form of punishment for sins. Some African
Americans believe that illness is evidence of disharmony possibly due to evil spirits, punishment
of God, or a hex placed on a person. Native Americans believe that health
reflects living in total harmony with nature.
14. A community health nurse is developing health promotion programs for a local
community that consists predominantly of African Americans. Which of the following areas
would be a priority for health promotion
with this group?
A) Cardiac health
B) Respiratory care
C) Mental health
D) Skin care
Ans: A
Feedback:
Leading causes of death for African Americans include heart disease, cancer, and stroke.
Heart disease is also a major health problem. Thus programs emphasizing cardiac health would
be a priority. African Americans show a lower incidence in suicide and chronic obstructive
pulmonary disease. They may experience skin problems such as keloids and melasma. However,
all of these conditions would be of lesser importance than cardiac
health.
15. A community health nurse is providing care to a family in the community who are
Muslim.
Which of the following would be most important for the nurse to integrate when

providing care for this family?

A) Rules are stricter for boys than for girls.
B) Modest dressing is key for both men and
women.
C) Most Arabic women work outside the home.
D) Most adhere to the three tenets of Islam.
Ans: B
Feedback:
For Muslims, modesty in dress is a core value for both men and women, although it is
expressed more evidently by women. Rules are stricter for girls than for boys and most Arabic
women stay at home and are not in the workplace. All practicing Muslims adhere to
the five tenets of Islam.
16. A community health nurse is providing care to an Asian American family who believes
that a member's current illness is due to an excess of yin. The nurse integrates knowledge of this
belief, expecting the family to avoid which
foods?
A) Rice
B) Eggs
C) Chicken
D) Fruits
Ans: D
Feedback:
If the imbalance is an excess of yin, then “cold” foods, such as vegetables and fruits, are
avoided, and “hot” foods, such as rice,
chicken, eggs, and pork, are offered.
17. What is the most important reason for the

nurse to conduct a cultural assessment?
A) Because it is often assigned by nursing faculty
B) Because usually there is some culturally

based reason that causes clients to engage in or avoid certain actions
C) To meet the nurse's professional learning
needs
D) Because understanding the values, beliefs,

and practices of a designated cultural group is critical to effective nursing action
Ans: D

Feedback:
The most important reason for the nurse to conduct a cultural assessment is that because
understanding the values, beliefs, and practices of a designated cultural group is critical to
effective nursing action. There is usually some culturally based reason that causes clients to
engage in or avoid certain actions but that is not the most important reason for the nurse to
conduct a cultural assessment. The nurse does not necessarily collect a cultural assessment to
meet his or
her own needs primarily.
18. When developing an in-service program for a group of community health nurses about
culture, which of the following would the
presenter expect to include?
A) All members of a cultural group are alike.
B) Intraethnic variations underscore a
population's cultural diversity.
C) Ethnicity has a major impact on the
effectiveness of health care.
D) Ethnocentric attitudes are key to working with

different cultures.
Ans: B
Feedback:
Intraethnic variations, differences within microcultures, underscore the range of
culturally diverse clients served by community health nurses. Subcultures and microcultures
have their own distinctive characteristics even within fairly homogenous cultural groups.
Culture, not ethnicity, has a major impact on the effectiveness of health care. Ethnocentric
attitudes are to be avoided. All members of a cultural group are not alike. In general, individuals
who are members of a specific culture are more alike than unlike but
still not totally alike.
19. When applying the principles of transcultural

nursing, which of the following must the nurse do first?
A) Cultivate cultural sensitivity
B) Develop cultural awareness
C) Learn the client's group culture
D) Demonstrate respect for culture
Ans: B
Feedback:
Applying the principles of transcultural nursing involves the following: (1) developing
cultural self-awareness, (2) cultivating cultural sensitivity, (3) assessing the client group's

culture, (4) showing respect and patience while learning about other cultures, and (5) examining
culturally derived
health practices.
20. A community health nurse implements a plan of care that combines aromatherapy and
acupuncture with medication therapy and surgery. The nurse is applying which of the
following?
A) Holistic health care
B) Folk medicine care

C) Herbalistic health care
D) Integrated health care
Ans: D
Feedback:
Integrated health care is defined as the combination of complementary therapies such as
aromatherapy and acupuncture with biomedical or Western health care such as medication
therapy and surgery. Holistic health care vies the world as being in harmonious balance in which
all facets of the individual's natures (physical, mental, emotional, and spiritual) must be in
balance. Folk medicine involves treatment practices that have been handed down from
generation to generation. Herbalism is the use of
medicinal herbs.
21. A community health nurse is providing care to several cultural groups in the community.
When providing transcultural nursing, which
of the following would be the priority?
A) Examining one's own culture carefully and

recognizing that alternative viewpoints are possible
B) Recognizing that cultural values, beliefs, and practices influence people's health and
lifestyles
C) Obtaining health-related information about a

cultural group concerning their values, beliefs, and practices
D) Actively and attentively listening to demonstrate respect while learning about

other cultures
Ans: A
Feedback:

The first step in providing transcultural nursing is to develop cultural self-awareness by

examining one's own culture carefully and recognizing that alternative viewpoints are possible.
Next, the nurse would need to cultivate cultural sensitivity by recognizing that cultural values,
beliefs, and practices influence people's health and lifestyle. Then the nurse would assess the
client group's culture by obtaining health-related information and actively and attentively
listening to demonstrate respect.
22. A community health nurse is assessing a family during a home visit. The nurse is
examining the mother who is pregnant with her second child. The nurse asks the mother to raise
her arms above her head. The mother replies, “I can't do this because it will cause the umbilical
cord to strangle the baby.” The nurse interprets this statement as reflective of
A) Home remedy
B) Herbalism
C) Folk medicine
D) Alternative therapy
Ans: C
Feedback:
The mother's statement reflects folk medicine, a body of preserved treatment practices
that has been handed down verbally from generation to generation. One example is not reaching
above your head if you are pregnant, because doing so will cause the umbilical cord to strangle
the baby. Home remedies are caregiving practices passed down between families, for example,
ice on a cold sore, baking soda paste on a bee sting. Herbalism involves the use of medicinal
herbs.
Alternative therapy or complementary therapy is designed to promote comfort, health, and well-
being and includes, for example, aromatherapy, music therapy, acupuncture,
and yoga.
23. When working with different cultural groups in the area of health care practices, the
nurse acts as an effective advocate for the client.
Which of the following must the nurse do
first?
A) Prepare to teach clients about the limits and
benefits of cultural health practices

B) Assess the client or family adequately to

ascertain their belief system and choices
C) Individualize caregiving for the client within
his or her culture
D) Be knowledgeable about health care practices
and choices
Ans: D
Feedback:
When working with different cultural groups in the area of health care practices, the
community health nurse can be an effective advocate for the client. First, however, the nurse
must be prepared to speak knowledgeably about health care practices and choices. The nurse also
must be able to assess the client or family adequately so as to know what belief system motivates
their choices. Finally, the nurse must be prepared to teach clients about the limits and benefits of
cultural health care practices. The community health nurse should always individualize
assessment and caregiving for the client within his or her culture and should not
generalize about the client based on cultural group norms.
24. When working with immigrant groups in community health care, which of the following
would be least appropriate for the
community health nurse to do?
A) Permit ample time for interviewing to allow
time to evaluate beliefs
B) Develop educational programs to correct
misconceptions
C) Assume that the client has a basic
understanding of health issues
D) Ensure an appropriate interpreter for
communication if needed
Ans: C
Feedback:
When working with immigrant groups in the community, do not make assumptions about
a client's understanding of health care issues; permit more time for interviewing; allow time to
evaluate beliefs and provide appropriate interventions; provide educational programs to correct
any misconceptions about health issues; provide an appropriate interpreter to improve
communication with immigrants
who do not speak English well.
Chapter 6 Structure and Economics of Community/Public Health Services

1. After a class on important historical influences on community health care, the students
are asked to describe the impact of the Shattuck Report. Which response indicates that the
students have understood

the information?
A) “It influenced the speed with which health-
focused bills pass the legislature.”
B) “The report set up the organizational structure
of the U.S. Public Health Service.”
C) “It emphasized sanitary progress forming the
basis for current public health practice.”
D) “It de-emphasized the issues addressed in the
Hebrew hygienic code.”
Ans: C
Feedback:
The Shattuck Report, a landmark document, made a tremendous impact on sanitary
progress addressing public health concepts and methods that form the basis of public health
practice today. It had no effect on getting bills passed by the legislation nor was it involved in
setting up the organizational structure of the U.S. Public Health Service.
The Hebrew hygienic code, probably the first
written code, was the prototype for personal and community sanitation.
2. Over the past century, many health-related changes have occurred affecting morbidity
and mortality. As community health nurses assess and plan for services in the community, an
understanding of which of the following changes would the nurses need to integrate
into their plans? Select all that apply.
A) High levels of chronic disease
B) Shortened life spans
C) Increased teen pregnancies
D) Abuse of multiple substances
E) Increased maternal mortality

F) Multidrug-resistant diseases
Ans: A, C, D, F
Feedback:
Issues today include high levels of chronic disease, increase in teen pregnancies, abuse of
multiple substances, and multidrug-resistant disease. Shortened life spans and increased maternal
mortality were real issues in the 1900s but are significantly different today.
With the shortened life span over 100 years ago, people were not living long enough to develop a
long history of chronic disease. Maternal mortality was high 100 years ago as prenatal care and
the technology of today did
not exist.

3. During a presentation at a local health department, a community health nurse discusses

how society has changed over the past 100 years and the influence that these changes have had
on the community's health care needs. Which of the following would the
nurse include as a current societal event?
A) Large disparity in male/female wages
B) Rural to urban migration
C) Rampant child labor
D) Widespread violence
Ans: D
Feedback:
Today, society is faced with widespread violence and terrorism. Populated urban areas
continue to loose people to the suburbs, while 100 years ago, people were leaving rural areas for
urban areas. A century ago child labor laws were just forming and child labor was
rampant.
4. When seeking employment, a community health nurse decides to focus the search on
official health care agencies, based on the
understanding that these agencies are
A) voluntary.
B) tax supported.
C) proprietary.
D) privately funded.
Ans: B
Feedback:
Official health care agencies, later called public health agencies, are tax supported; thus,
they must provide services determined by the federal, state, or local government.
Voluntary or private agencies are privately funded. Proprietary health services are privately
owned and managed and may be for
profit or nonprofit.
5. After describing the Public Health Service to a group of students, which description
would
indicate the need for additional discussion?
A) It offers consultation through national

advisory health councils and special advisory committees made up of lay experts.

B) The Secretary of Health and Human Services

is ultimately responsible for it.
C) The Secretary of Health and Human Services
is an elected position.
D) A major function is to administer grants and
contracts with other government agencies.
Ans: C
Feedback:
The Secretary of Health and Human Services is a cabinet position. Cabinet positions are
appointed by the President. The Public Health Service does offer consultation through national
advisory health councils and special advisory committees made up of lay experts. The Secretary
of Health and Human Services is ultimately responsible for the Public Health Service. A major
function of the Public Health Service is to administer grants and contracts
with other government agencies.
6. provision of care to clients in a clinic setting

at the local health department. This nurse is engaging in which core public health function?
A) Clinical
B) Assessment
C) Policy development
D) Assurance
Ans: D
Feedback:
The three core public health functions are assessment, policy development, and
assurance. Assessment would involve assessing the community, policy development would
involve helping to establish policies that will address the problems assessed, and assurance
would involve making sure that the services indicated by policies (following assessment) are
available to the community. Clinical is not a core public health function.

core public health functions are true?
A) Public health nurses practice as partners with other public health professionals within
these
core functions.
B) Assessment involves the actual provision of
services.
C) Policy development relates to assessment.
D) Assurance means that the public health

agency must directly provide the needed services.
Ans: A
Feedback:

Public health nurses practice as partners with other public health professionals within
these core functions. Assessment does not involve the actual provision of services (assurance
does). Public policy development builds on data from the assessment function. Assurance is the
process of translating established policies into services. This function ensures that population-
based services are provided, whether by public health agencies or private
sources.
8. Which one of the following groups of actions fulfills the three core public health
functions
in their proper order?
A) Counting the number of kindergarten students who are fully immunized, encouraging the
school officials to exclude children who are not fully immunized, and offering
immunization clinics at the school
B) Identifying a source of pollution in the community, educating local residents about

precautions that should be taken when the pollution exceeds minimum standards, and asking
legislators to apply sanctions to the
responsible party for the source of pollution
C) Providing prenatal care for pregnant adolescents, determining how many pregnant
adolescents currently attend the school, and encouraging school officials to provide an
alternative school setting for the pregnant
adolescents
D) Lobbying for a citywide ban on smoking in public, providing smoking cessation services
in the community, and reviewing mortality data to determine the number of people in the
community who die each year from lung
cancer
Ans: A
Feedback:
The three core public health functions are assessment, policy development, and
assurance. Assessment is data collection, the policy development would be based on the
assessment, and assuring is the process of translating established policies into services. Counting
the number of kindergarten students who are fully immunized would be assessment, encouraging
the school officials to exclude children who are not fully immunized would be policy
development, and offering immunization clinics at the school would be assurance. Identifying a
source of pollution in the community would be assessment, educating local residents about

precautions that should be taken when the pollution exceeds minimum standards would be
assurance, and asking legislators to apply sanctions to the responsible party for the source of
pollution would be policy development. Providing prenatal care for pregnant adolescents would
be assurance, determining how many pregnant adolescents currently attend the school would be
assessment, and encouraging school officials to provide an alternative school setting for pregnant
adolescents would be assurance.
Lobbying for a citywide ban on smoking in public would be policy development, providing
smoking cessation services in the community would be assurance, and reviewing mortality data
to determine the number of people in the community who die each year from lung cancer would
be assessment.
9. A community health nurse primarily works with mothers and their high-risk children,
often referring them to various voluntary agencies for services. Which of the following would be
examples of voluntary health
agencies? Select all that apply.
A) American Diabetes Association
B) The U.S. Public Health Service
C) The National Institutes of Health

D) Women, Infant, and Children Program (WIC)
E) National Society for Autistic Children
F) Planned Parenthood Federation of America
Ans: A, E, F
Feedback:
The American Diabetes Association, National Society for Autistic Children, and Planned
Parenthood Federation are examples of voluntary agencies supported by nonfederal funds and
are nonprofit organizations. The
U.S. Public Health Service, the National Institutes of Health, and the WIC program are federal
agencies or receive federal funds to
operate; thus they are not voluntary agencies.
10. Which of the following most well describes a

public health care agency?
A) The agency most often has a very specific
focus.
B) The agency is responsible for promoting and protecting the health of all within their
jurisdiction.
C) The agency only employs nurses and
environmental health practitioners.

D) The agency is able to perform its work

independently with complete autonomy.
Ans: B
Feedback:
Unlike private organizations that tend to have a specific focus, government health
agencies exist to accomplish a broad goal of protecting and promoting the health of the total
population under their jurisdiction. Public health requires interdisciplinary and
interorganizational collaboration.
11. Which of the following statements best describes the difference between the function of
public sector health care agencies and
private sector health care agencies?
A) Private sector health services are complementary and supplementary to

government health agencies.
B) Public sector health care agencies usually
meet the needs of people with special needs.
C) Private sector health agencies usually are constrained in developing innovations in

health care.
D) Public health sector agencies generally satisfy
the health care needs of a community.
Ans: B
Feedback:
Private sector health services are complementary and supplementary to government
health agencies, but this is not a difference between the two types of agencies. Private sector
health care agencies usually meet the needs of people with special needs (rather than public
sector health care agencies that focus on the entire population within their jurisdiction). Private
sector health care agencies are less constrained than public sector health care agencies in
developing innovations in health care. A part of the reason for the development of private sector
health care agencies is the impatience or dissatisfaction with government (public
health) programs.
12. Which of the following statements best describes the difference between the function of
public sector health care agencies and
private sector health care agencies?
A) Public sector health care agencies are more likely to pilot or subsidize demonstration
projects.

B) Private sector health care agencies are more

likely to promote health legislation.
C) Public sector health care agencies are more likely to generate new research and
innovation.
D) Private sector health care agencies usually
focus on needs that are met.
Ans: B
Feedback:
Private sector health agencies are more likely to promote health legislation, whereas
public sector health care agencies are more likely to be responsible for carrying out health
legislation. Private sector health care agencies (not public) are more likely to pilot or subsidize
demonstration projects and generate new research and innovation. Private sector health care
agencies strive to detect unmet
needs rather than met needs.
13. Which of the following statements about the international health organization is most
accurate?
A) PAHO is completely separate from the WHO.
B) UNICEF promotes child and maternal health
and welfare globally.
C) WHO focuses primarily on developing
countries.
D) WHO and UNICEF are agencies of the
United Nations.
Ans: B
Feedback:
United Nations International Children's Emergency Fund (UNICEF) promotes child and
maternal health and welfare globally. The Pan American Health Organization (PAHO) is the
oldest continually functioning international health organization in the world and predates the
World Health Organization (WHO). Initially, the PAHO was independent from the WHO but is
now the WHO regional office for the Americas and receives part of its funding from WHO.
WHO focuses on the promotion of health worldwide, not just developing countries. The United
States Agency for International Development (USAID) focuses on developing countries.
WHO and UNICEF are both agencies of the United Nations.
14. An instructor is preparing a class presentation on landmark health legislation. Which of

the following would the instructor include as the most significant legislation that attempts to
ensure access to health care for Americans?

A) Social Security Act

B) Hill-Burton Act
C) Patient Protection and Affordable Care Act
D) Omnibus Budget Reconciliation Act
Ans: C
Feedback:
Patient Protection and Affordable Care Act is expected to provide access to health care
for 30 million Americans when fully enacted. The Social Security Act had tremendous
consequences for public health with revolutionary welfare insurance and assistance programs,
the provision of financial assistance to form state and local health agencies. The Hill-Burton Act
(1946), Occupational Health and Safety Act (1970), and the Omnibus Budget Reconciliation Act
(1981) are important acts that brought about changes in health care planning, safety, and
funding.
15. A group of students are preparing for an examination on the various events serving as
landmarks for health care legislation. The students demonstrate understanding of these events by
identifying which of the following statements about particular landmark health
legislation are true? Select all that apply.
A) The Occupational Safety and Health Act provided protection to workers against personal
injury or illness resulting from
hazardous working conditions.
B) The Shepard-Towner Act provided funds to
states for hospital construction.
C) The Hill-Burton Act provided funds to states for administration of programs to support
the
health and welfare of mothers and infants.
D) The Social Security Act Amendments of 1965 addressed a concern for some version of
national health insurance.
E) The Omnibus Budget Reconciliation Act attempted to shift more power to states by
consolidating categorical grants into four
block grants.
F) The Patient Protection and Affordable Care Act attempted to ensure the privacy of
medical records.
Ans: A, D, E
Feedback:

The Occupational Safety and Health Act provided protection to workers against personal
injury or illness resulting from hazardous working conditions. The Hill- Burton Act provided
funds to states for hospital construction. The Shepard-Towner Act provided federal funds to
states for administration of programs to support the health and welfare of mothers and infants.
The Social Security Act Amendments of 1965 addressed a concern for some version of national
health insurance. The Omnibus Budget Reconciliation Act attempted to shift more power to
states by consolidating categorical grants into four block grants. The Health Insurance Portability
and Accountability Act attempted to ensure the
privacy of medical records.
16. A community health nurse working at the local level is attending an in-service program
about health care economics. The nurse asks the presenter, “Why do I need to know this
information? My focus is my clients.” Which response by the presenter would be most
appropriate?
A) “You are required to know this information because your agency receives government
funding.”
B) “You might be in management one day and have to deal with cost control and
reimbursement.”
C) “Although it seems foreign to you, it's an important topic that you might have to deal
with someday.”
D) “This knowledge is important to the success

of your practice and for the agency's survival.”
Ans: D
Feedback:
At the local level (the community health nurse and the employing agency), health care
economics is very important for survival.
Resourceful use of time, talent, and materials will ensure that the services will be able to
continue and that the agency stays viable.
Government funding, a future role in management, and dealing with the issue in the future are
inappropriate and do not emphasize the importance of the effect of health care
economics.

17. When discussing the economics of health care with colleagues, the community health
nurse addresses macroeconomic theory. Which of
the following would the nurse include?
A) Quantity of services available
B) Consumer's willingness to buy services
C) Aggregate perspective of economic stability
D) Allocation of the available resources
Ans: C
Feedback:
Macroeconomic theory is concerned with the broad variables that affect the status of the
economy as a whole, such as factors affecting aggregate consumptions, production, investment,
and international trade. The focus is on the larger view of economic stability and growth,
providing a global or aggregate perspective. Microeconomic theory addresses supply (quantity of
services available) and demand (consumer's willingness to buy services) and study how
allocation and distribution affect consumer demand for
goods and services.
18. As part of a community wide education program, a community health nurse is developing
a teaching plan about Medicare. Which of the following would the nurse
include in the plan? Select all that apply.
A) It is a state health insurance program for
elderly and the disabled.
B) Medicare Part A covers medically necessary hospitalization, home care, hospice services,
and limited-skilled nursing services.
C) Medicare Part D covers prescription drug
costs.
D) Medicare Part A is supplementary and
voluntary.
E) Medicare beneficiaries can make changes to
their coverage at any time.
Ans: B, C
Feedback:
Medicare is a federal health insurance program and covers citizens and some legal aliens
who are over 65 years old (not a State program). It also covers people with permanent disabilities
or chronic renal disease at any age. Medicare Part A covers medically necessary hospitalization,
home care, hospice services, and limited-skilled nursing service. Prescriptions are covered under
Medicare Part
D. Medicare Part B is supplementary and voluntary. Medicare beneficiaries can make changes to
their coverage during open

enrollment periods.
19. After teaching a community group about the Medicaid program, which of the following
would indicate to the nurse that additional
teaching is necessary?
A) Medicaid has a monthly fee that recipients
must pay.
B) Medicaid is administered individually by each
state.
C) Medicaid focuses on preventative services.
D) It is possible to be on both Medicare and
Medicaid.
Ans: A
Feedback:
Medicaid monies come to the states from the federal government. Each state determines
who will receive what kinds of health care services. This makes it a uniquely different program
in each state. Medicaid is a free program available to individuals on the basis of financial need
and legal residency status. Medicaid has a major focus on preventative services, namely, infant,
childhood, and elder immunization programs. Eligibility is determined on the basis of financial
need and residency status. Finally, some low-income
Medicare eligible people also receive Medicaid.
20. health nurse identify as a drawback to retrospective reimbursement?

A) Spending was limited to the most necessary
tests and treatments.
B) Services for sickness were encouraged rather
than wellness.
C) Consumers had to bear the increased
accountability for cost containment.
D) Payments for services were based on rates
calculated from predictions.
Ans: B
Feedback:
Retrospective payment is associated with encouraging sickness care rather than wellness
services. Physicians and other providers were rewarded financially for treating illness and
providing for additional tests and services. Patients and providers often insisted on expensive or
unnecessary tests and treatment. Neither consumers nor providers were accountable for
containing costs. Retrospective payment involves reimbursement for a service after it has been
rendered with payment of a fee occurring after the fact.

21. Which of the following statements about trends and issues influencing health care
economics and community health services
delivery are true? Select all that apply.
A) The United States has the most cost effective
health care system in the world.
B) One explanation for the high cost of US Health Care System is the need to practice
defensive medicine by ordering excessive
tests and x-rays.
C) In the United States, the health-related quality
of life is lower than for most other countries.
D) The United States ranks first among all WHO countries on a measure of how respectfully
clients are treated.
E) In a survey published in 2009, most US physicians identified that their health care
system worked well.
Ans: B, C, D
Feedback:
The United States has one of the least cost effective health care systems in the world. One
explanation for the high cost of US Health Care System is the need to practice defensive
medicine by ordering excessive tests and x-rays. In the United States, the health-related quality
of life is lower than for most other countries. The United States ranks first among all WHO
countries on a measure of how respectfully clients are treated. In a survey published in 2009,
most US physicians did not identify that their health care system
worked well.

Health Care Rationing is most accurate?
A) It will not occur in the United States because
of our country's values.
B) A danger of rationing is compromising quality
and effectiveness.
C) Rationing in health care has never been
practiced.
D) Advances in knowledge and technological

capabilities will eliminate the need for rationing in the future.
Ans: B
Feedback:
A danger of rationing is compromising quality and effectiveness. Rationing is already
practiced in this country to some extent and for many years. Advances in knowledge and
technological capabilities compound rationing

decisions.
23. When describing managed competition as a potential solution to resolve the health care
crisis, which of the following would be
included? Managed competition would
A) promote cost containment and universal
access to health care.
B) eliminate burdensome government
regulations.
C) reduce state and federal control over health
care delivery.
D) discourage consumers from making
responsible choices.
Ans: A
Feedback:
Managed competition ideally would promote cost containment and universal access to
health care. Governmental regulations and control would still be present as would insurance
companies. Managed care would encourage consumers to make responsible
choices.
24. Which statement regarding the potential

impact of health care reform on community health nursing is most accurate?
A) Health care reform does not affect community
health nursing.
B) Community health nurses know that outcomes
research is unnecessary.
C) Public health nurses can lead the effort in making health care more accessible to all
citizens.
D) Community health nurses will only be able to
work in public health agencies.
Ans: C
Feedback:
Public health nurses can lead the effort in making health care more accessible to all
citizens. Health care reform definitely affects community health nursing. Community health
nurses recognize the importance of outcomes research to document the value of nursing
interventions with at-risk populations.
Community health nursing has important ties
to both private and public health agencies.
Chapter 7 Epidemiology in the Community

1. An instructor is discussing the worldwide

distribution of AIDS. Which term would the instructor use to describe this situation?
A) Epidemic
B) Pandemic
C) Endemic
D) Pathogenicity
Ans: B
Feedback:
Pandemic is the term used to describe an epidemic that is distributed worldwide. An
epidemic refers to a disease occurrence that clearly exceeds the normal or expected frequency in
a community or region. Endemic is used to describe the continuing presence of a disease or
infectious agent in a given geographic area. Pathogenicity refers to an
agent's capacity to cause disease in a host.
2. After a class describing the contributions of Florence Nightingale to epidemiology, the

instructor determines that the class needs additional instruction when they state which of the
following is associated with
Nightingale?
A) Establishment of the need for a clean
environment
B) A sophisticated coding system for medical
conditions
C) Proper wound cleansing and bandaging

techniques
D) Separation of infected individuals from those
injured
Ans: B
Feedback:
Nightingale's colleague, William Farr, is credited for developing a more sophisticated
system for coding medical conditions.
Nightingale's contributions included establishing the need for a clean environment, properly
cleaning wounds and bandaging them, and separating infected soldiers from
those who were injured.
3. When applying the epidemiologic triad model to a community's plan of care, which of the
following would the community health nurse
address?

A) Incidence, prevalence, and case fatality

B) Health, illness, and injury
C) Host, agent, and environment
D) Immunity, causation, and risk
Ans: C
Feedback:
The purpose of this model is to demonstrate the relationship among host, agent, and
environment. Each component has to be present to a certain degree in order for any disease,
illness, or injury to exist or happen. If one component is missing, illness or injury will not occur.
Incidence, prevalence, case fatality, health, illness, injury, immunity, causation, and risk are
terms used in epidemiology but do not refer to the
epidemiologic triad model.
4. Which of the following would the community health nurse identify as a key component
of
the host?
A) Infectivity
B) Antigenicity
C) Virulence
D) Inherent resistance
Ans: D
Feedback:
The host, a susceptible human or animal, can sometimes have an ability to resist
pathogens. This is called inherent resistance. Infectivity, antigenicity, and virulence are
characteristics
of the agent.
5. Which of the following statements apply to

the concept of causality? Select all that apply.
A) Causality is the relationship between cause
and effect.
B) The chain of causation is the most recent
theory of causality.
C) The web of causation theory is the most
recent theory of causality.
D) The chain of causation clearly explains
causation in noninfectious disease.
E) Epidemiology has changed its view of
causality over time.
Ans: A, C, E

Feedback:
Causality is the relationship between cause and effect. The web of causation theory is the
most recent theory of causality. Epidemiology has changed its view of causality over time.
The chain of causation was the first theory of causality. The chain of causation could not
sufficiently explain causation in noninfectious disease because the chain of causation is too
linear.
6. A community health nurse is explaining the chain of causation to a family that includes a
child who has developed Lyme disease. The nurse correctly describes the opening in the child's
skin caused by the actual tick bite as
the
A) reservoir.
B) mode of transmission.
C) portal of entry.
D) host.
Ans: C
Feedback:
The opening in the child's skin caused by the actual tick bite is the portal of entry in the
chain of causation. The mode of transmission would be the tick biting the child. The reservoir
would refer to the tick. The host would be the child who has been bitten by the
tick.
7. A community health nurse is integrating the epidemiology of wellness into practice.

Which of the following would the nurse
include?
A) Lifestyle with its self-created risks
B) Communicable disease control
C) The natural history of disease
D) Vital statistics and reportable diseases
Ans: A
Feedback:
Today there is an increased focus on lifestyle behaviors and how they relate to a person's
state of wellness or illness. It is a basic component of a wellness model.
Communicable disease control focuses on an illness state, not a wellness state, and is not part of
a wellness model. The four states of the natural history of a disease or health condition is not part
of the wellness model. Vital statistics and reportable diseases are not
part of the wellness model.

8. The nurse is examining the possibility that multiple factors are involved in the
development of a disorder. The nurse is
applying which of the following?
A) Chain of causation
B) Web of causation
C) Strength of association
D) Temporality
Ans: B
Feedback:
The web of causation is being used to apply the concept of multiple causes to explain the
existence of health and illness states. It was a refinement of the chain of causation, such that it
looked at the combination of multiple factors as implicated in the development of poor
outcomes. The chain of causation focuses on one factor in the development of a condition. The
strength of association is an element of causation in noninfectious disease that refers to the ratio
of disease rates in those with and without the causal factor.
Temporality, also involved with the causation of noninfectious disease, is an element in which
the exposure to the suspected factor must precede the onset of the disease.
9. The nurse is reviewing a research article that describes the use of the bacille Calmette-
Guerin (BCG) vaccine to prevent tuberculosis that was given to individuals who were exposed to
leprosy. The individuals did not develop the leprosy. The nurse interprets this as most accurately
demonstrating which type
of immunity?
A) Herd immunity
B) Passive immunity
C) Cross-immunity
D) Active immunity
Ans: C
Feedback:
Cross-immunity refers to a situation in which a person's immunity to one agent provides
immunity to a related agent as well. This immunity can be active or passive. Herd immunity
describes the immunity level present in a population group. Passive immunity refers to short-
term resistance acquired naturally or artificially. Active immunity is long-term and can be
acquired
naturally or artificially.

10. The nurse educator knows that a nursing student understands the basics of immunity
when the student nurse states
A) herd immunity only pertains to cows.
B) active immunity can be attained via the use of
vaccines.
C) passive immunity can be attained via the use
of vaccines.
D) cross-immunity is immunity that causes a person who is immune to one disease to be also
immune to a completely different
infectious agent.
Ans: B
Feedback:
Active immunity can be attained via the use of vaccines. Passive immunity is immunity
that is given to a person, either by maternally provided protection for newborn infants or from
antibody products that provide temporary resistance. Herd immunity describes the immunity
level that is present in a population group. Cross-immunity is immunity that causes a person who
is immune to one disease to be also immune to a related
infectious agent.
11. When assessing several populations, the nurse notes each population's relative risk. Using
the relative risk ratios below, which population would require a major emphasis
for risk reduction intervention?
A) 0.59
B) 1.13
C) 1.79
D) 2.45
Ans: D
Feedback:
A relative risk >1.0 indicates that those with the risk factor have a greater likelihood of
acquiring the disease than do those without it. For example, a relative risk ratio of 2.45 means
that the exposed group is 2.45 times more likely to acquire the disease than the unexposed group.
Therefore, interventions to reduce this population's risk would be most
important.
12. Which of the following statements about risk

is true? Select all that apply.

A) Risk is the probability that a disease or

unfavorable health condition will develop.
B) Risk means that the person who has the most

negative influences will definitely develop the disease or unfavorable health condition.
C) Risk refers to positive and negative influences on a person's likelihood of developing a

specific disease.
D) Risk can be measured using the relative risk ratio, which is based on the ratio of
incidence in an exposed group to incidence rate in
unexposed group.
E) Risk is unimportant when determining the

most effective points for community health intervention.
Ans: A, C, D
Feedback:
Risk is the probability that a disease or unfavorable health condition will develop. Risk
also refers to positive and negative influences on a person's likelihood of developing a specific
disease. Relative risk ratio is a calculation of risk consisting of the ratio of incidence in an
exposed group to incidence rate in unexposed group. Risk does not mean that the person who has
the most negative influences will definitely develop the disease or unfavorable health condition,
but it refers to the probability that the person will develop the disease or unfavorable health
condition. The relative risk ratio assists in determining the most effective points for community
health intervention in regard to
particular health problems.
13. While visiting a family's home, the community health nurse finds out that the two
children in the home were exposed to chickenpox. Assessment of the children reveals no signs of
fever or lesions. The nurse determines that the children may be in which
stage of the disease?
A) Susceptibility
B) Subclinical disease
C) Clinical disease
D) Resolution
Ans: B
Feedback:
The children have been exposed but have not yet developed the signs of chickenpox.

Therefore, they are in the subclinical disease stage. During the susceptibility stage, the disease is
not present and individuals have not been exposed. During the clinical stage, signs and
symptoms are beginning to develop.
During the resolution stage, the disease causes
sufficient anatomic or functional changes to produce recognizable signs and symptoms.
14. communicable disease would quarantine be most effective?

A) Susceptibility stage
B) Subclinical disease stage
C) Clinical disease stage
D) Resolution stage
Ans: A
Feedback:
Quarantine is the isolation of persons who are susceptible to a communicable disease and
have been exposed to that communicable disease until the incubation period of the subclinical
disease stage has passed.
Quarantining persons during the susceptibility stage itself is not indicated as individuals have not
been exposed. The proper action for persons who are in the clinical disease stage and beyond is
isolation until the danger of spreading the communicable disease has
passed.
15. The nurse is reviewing actual census data for information for use in an epidemiologic
study. Which of the following would the nurse be
least likely to find?
A) Occupational status
B) Housing quality
C) Births recorded
D) Educational level
Ans: C
Feedback:
Vital statistic data provides information about the number of births recorded. Census data
includes information about age, sex, race, ethnic background, type of occupation, income
gradient, marital status, educational level, and other standards such as housing quality. If the
nurse is reviewing actual census data, the nurse would be least likely to find
births recorded, which is vital statistics.
16. on the use of nursing home services and the common diagnoses of those using these
services. Which source of information would be most appropriate for the nurse to
investigate?
A) National Center for Health Statistics
B) Consumer Product Safety Commission
C) Environmental Protection Agency
D) Cancer disease registries

Ans: A
Feedback:
The National Center for Health Statistics furnishes valuable health prevalence data from
surveys of Americans. Among the information available is the National Nursing Home Survey,
which provides information on those who are using these services and the diagnoses and other
characteristics. The Consumer Product Safety Commission and Environmental Protection
Agency would provide information about environmental issues. Cancer disease registries would
provide information specific to the diagnosis of cancer.
17. Which of the following is true about

incidence and prevalence? Select all that apply.
A) Prevalence is the number of new cases of a
disease or health condition.
B) Incidence is the number of new cases of a
disease or health condition.
C) Prevalence refers to all of the people with a

particular health condition existing in a given population at a given point in time.
D) Incidence refers to all of the people with a particular health condition existing in a given
population at a given point in time.
E) When determining if a disease is endemic in a

specific area, the statistic that is most helpful is prevalence.
Ans: B, C, E
Feedback:
Incidence is the number of new cases of a disease or health condition. Prevalence refers
to all of the people with a particular health condition existing in a given population at a given
point in time. When determining if a disease is endemic in a specific area, the
statistic that is most helpful is prevalence.
18. A community health nurse is preparing to carry out an experimental epidemiologic study.
Which of the following would be most
important for the nurse to do?
A) Focus the study on evaluating the cause of a
disease
B) Ensure carefully controlled conditions during
the study
C) Expose both groups to the same factor or
condition

D) Ensure that there are a substantial number of

subjects
Ans: B
Feedback:
Experimental studies are carried out under carefully controlled conditions. In human
populations, experimental studies should focus on disease prevention or health promotion rather
than testing the cause of disease. The investigator exposes an experimental group to some factor
and simultaneously observes a control group similar in characteristics to the experimental group
but without the exposure factor. An experimental study need not be elaborate to
provide important data.
19. A community health nurse is participating in a case–control observational study. Which

of the following would most likely explain this
type of study?
A) Description of patterns of occurrence of
illness and injury in a population
B) Investigation of development of health–illness

conditions over a long period of time
C) Studying of a cohort with evaluation of
variables associated with the disease or injury
D) Comparison of persons with and without a
health–illness condition
Ans: D
Feedback:
Comparing persons with and without a certain condition is known as a case–control
study. A study that describes patterns of occurrence in a population is a descriptive study.
Following people over a long period of time is a longitudinal study. And cohorts are groups
studied over time.
20. After teaching a group of students about the various types of epidemiologic research
studies that can be done, the instructor determines that the teaching was effective when the
students describe a community trial
as which of the following?
A) A type of experimental study conducted at the
community level
B) An inexpensive type of analytic research
study
C) A study that gathers volunteers for the

experimental group
D) A way to locate health problems in a variety
of communities
Ans: A
Feedback:
A community trial is conducted as an experimental study design with large populations.

Some of the community receives a treatment, while the other part does not.
This is probably the most expensive type of experimental study. It involves a great number of
subjects, the support of the governmental forces as well as the population involved, a large
number of staff over a long period of time, and the cost of the intervention itself.
When a whole community is involved, individuals are not approached to be volunteers. What
makes it a community study is that the entire community is part of the study. The health problem
is identified prior to the implementation of the study. The introduction of an intervention in one
community with no introduction in a similar community forms the study population, and the
health problem being studied is then monitored between the two populations. The health problem
has to be identified first in this
type of study.
21. When using descriptive epidemiology, which type of study would the community health
nurse expect to include?
A) Prevalence study
B) Case–control study
C) Cohort study
D) Count study
Ans: D
Feedback:
Descriptive epidemiology includes investigations that seek to observe and describe
patterns of health-related conditions that occur naturally in a population. The simplest measure of
a description is a count. Prevalence, case–control, and cohort studies are types of studies
involved with analytical
research.
22. epidemiologic study from the first step to the last.

A) Collect the data.
B) Identify the problem.
C) Analyze the findings.
D) Disseminate the findings.
E) Review the literature.
F) Develop conclusions and applications.

G) Design the study.

Ans: B, E, G, A, C, F, D
Feedback:
The proper order of the steps in the epidemiologic study from the first step to the last is to
identify the problem, review the literature, design the study, collect the data, analyze the
findings, develop conclusions and
applications, and disseminate the findings.
23. When implementing an epidemiologic research study, which of the following would the
community health nurse complete as the
final step?
A) Analyze the data
B) Design the study
C) Disseminate findings
D) Review the literature
Ans: C
Feedback:
The last step in the research process is to disseminate the findings. After identifying the
problem and reviewing the literature, the researcher designs the study, collects the data, analyzes
the findings, and develops
conclusions and applications.
Chapter 8 Communicable Disease

1. When reporting the identification of a communicable disease and need for investigation,
which of the following must be
notified first?
A) Centers for Disease Control (CDC)

B) State health department
C) Local health department
D) National Reported Disease list
Ans: C
Feedback:
The local health department is the initial point of notification of a communicable disease
investigation. Each local health department or agency will investigate the specific disease.
The CDC is the federal agency that provides guidance and recommendations for each state health
department. The state health department may be the primary agency or the guiding agency for
local disease control policies. States use the National Reported Disease list as the guidance for
State
reportable diseases.

2. Which of the following are appropriate communicable disease prevention interventions

that may be implemented by community health nurses? Select all that
apply.
A) Immunization of children and adults
B) Disease investigation and case/contact finding
C) Diagnosing cases of communicable diseases
D) Prescribing treatment for communicable
diseases
E) Environmental interventions
F) Community Education
Ans: A, B, E, F
Feedback:
Appropriate interventions that may be implemented by community health nurses include
immunizations of children and adults, environmental interventions, community education,
screening programs, and disease
investigation and case/contact finding.
3. Which of the following statements accurately describes important steps that a community
health nurse must take prior to contacting an individual for an interview regarding
communicable disease? Select all that apply.
A) Review the information received from the
news media reporter for completeness
B) Review disease information including the reservoir, incubation period, infectious period,
symptoms, and treatment
C) Take all appropriate treatments to the
interview site
D) Investigate only laboratory confirmed
E) Eradicate the disease
Ans: A, B
Feedback:
Steps to take prior to contacting an individual regarding communicable disease include

reviewing the information received from the reporters for completeness (this refers to the
individual reporting the communicable disease to the public health agency and not the news
media reporter); clarifying that the disease is suspect or lab confirmed (some infections can be
reported if they meet a set of clinical criteria or are part of a larger outbreak for which the case
definition has been identified even without laboratory confirmation); review the case definition;
review the disease information (including reservoir, incubation period, infectious period,
symptoms, and treatment); and identifying the specific questionnaire for the reported disease or

using a generic disease investigation form and reviewing the questionnaire. It is not appropriate
for the community health nurse to take all treatments to the interview site as the goal of this
interview is to assess. Community health nurses may investigate laboratory confirmed or
suspected diseases. Eradication of the disease is the last step in investigating a disease, and
interviewing an individual regarding communicable disease is one of the first steps in the process
of investigation.
4. Which of the following entities would the community health nurse know are required to
report known or suspected cases of reportable diseases in every state in the United States?
A) Physicians, dentists, and nurses
B) Laboratory directors
C) Any individual who knows of or suspects the
existence of a reportable disease
D) Medical examiners
E) Administrators of schools and child care
centers
Ans: A, D, E
Feedback:
In most states, reporting known or suspected cases of a reportable disease is generally

considered to be an obligation of physicians, dentists, nurses, and other health professionals;
medical examiners; administrators of hospitals, clinics, nursing homes, schools, and child care
centers. Some states also require or request reporting from laboratory directors; and any
individual who knows of or suspects the existence of a
reportable disease.
5. A community health nurse is presenting a program about hepatitis prevention and risk
reduction to a local community group. The nurse determines that the group has understood the
program when they identify which method as the major mode of
transmission for hepatitis B?
A) Oral–fecal route
B) Exposure to contaminated blood
C) Airborne droplet nuclei
D) Infected rodents, such as mice and rats
Ans: B
Feedback:

Hepatitis B can occur in certain high-risk groups, including injected drug users,
heterosexuals with multiple partners, and homosexual men. Hepatitis A is transmitted by the
fecal–oral route. TB is transmitted by airborne droplet nuclei. Hantavirus is
transmitted via infected rodents.
6. When reviewing the trends in communicable diseases for a county, the community health
nurse notes that there was an increased incidence of Lyme's disease. The nurse develops a plan
for prevention and control integrating the understanding that this disease
is most likely transmitted by which mode?
A) Vector
B) Airborne
C) Vehicle-borne
D) Direct
Ans: A
Feedback:
In the United States, vector-borne illnesses have received renewed attention with
accumulating information about Lyme's disease, transmitted to humans by a tick vector.
Airborne transmission occurs through droplet nuclei, such as sneezing or coughing. Indirect or
vehicle-borne transmission occurs when the infectious agent is transported via contaminated
inanimate objects such as air, water, or food. Direct transmission occurs via the immediate
transfer of infectious agents from a reservoir to a new susceptible host such as through touching,
biting, kissing, or
sexual intercourse.
7. After a community health nurse implements an educational program for a local

community group about food safety, which statement
indicates that the teaching was successful?
A) “Handwashing is unnecessary if we use
gloves.”
B) “After cooking the meat, we'll put it on the
same platter that we used for the raw meat.”
C) “Our cooked foods should be cooled quickly.”
D) “If we peel the carrots, we don't need to wash
them before eating.”
Ans: B
Feedback:

Cooked foods should be cooled quickly. Surfaces, hands, and utensils should be washed
in warm soapy water (even when gloves are used as gloves do not prevent cross-contamination
by themselves). Foods when cooked should not come in contact with dishes, utensils, or
containers used when the foods were raw and uncooked. Foods that are to be eaten raw and
uncooked should be washed thoroughly in clean water. This includes foods (e.g., carrots) that are
to be peeled that grow on the ground or come in
contact with soil.
8. A community health nurse is teaching a group of clients about infection control and
mentions the role of vectors in transmitting diseases. Which of the following would be examples
of some common vectors? Select all
that apply.
A) Chemicals
B) Mosquitoes
C) Salmonella
D) Fleas
E) Roaches
Ans: B, D, E
Feedback:
A vector is a nonhuman carrier of disease organisms that can transmit diseases directly to
humans. Examples would include mosquitoes, fleas, and roaches. Various chemicals are not
vectors and Salmonella is
an infectious agent.
9. Which of the following statements about modes of transmission are true? Select all that
apply.
A) Direct transmission requires contact with a
contaminated inanimate material.
B) Indirect transmission is also known as
vehicle-borne illness.
C) Food- and water-related illnesses are considered to be spread by indirect

transmission.
D) Vector transmission requires contact with a
nonhuman carrier such as an animal or insect.
E) Airborne transmission commonly occurs from
coughing and sneezing.
Ans: B, C, D, E

Feedback:
Direct transmission occurs by immediate transfer of infectious agents from a reservoir to
a new susceptible host. Indirect transmission requires contact with a contaminated inanimate
material and is also known as vehicle-borne illness. Food- and water-related illnesses are
considered to be spread by indirect transmission. Vector transmission requires contact with a
nonhuman carrier such as an animal or insect. Airborne transmission commonly occurs from
coughing and sneezing.
10. Community health nurses practice within the three levels of prevention. Which of the
following would the community health nurse engage in at the primary level of prevention for
communicable disease control? Select all
that apply.
A) Providing TB skin test to children entering
kindergarten
B) Administering immunizations to senior
citizens
C) Teaching kindergarten students to wash their
hands
D) Encouraging parents to complete their
children's immunizations
E) Providing chest x-rays to people with positive
TB skin tests
F) Administering prompt treatment for the
symptoms of gonorrhea
Ans: B, C, D
Feedback:
Primary prevention interventions include administering immunizations, teaching about

hand washing, and encouraging adherence to the recommended schedule for childhood
immunizations. Providing TB skin testing and chest x-rays, and promptly treating symptoms of
gonorrhea are examples of interventions at
the secondary level of prevention.
11. The nurse educator has just discussed education of aggregates using mass media with
targeting health messages. Which of the following statements by the nursing student would
demonstrate the student's ability to
analyze and apply the information?

A) Television would be the most important venue of mass media to educate the aggregate as
everyone has a television.
B) The target audience must be assessed for educational level, salience of the issue,
involvement in the issue, and access to the
media channel used.
C) Pamphlets should be assessed to make sure
they are at a twelfth grade reading level.
D) It is unnecessary to consider culture when
planning the health message.
Ans: B
Feedback:
To effectively deliver a health promotion and disease-prevention message, the message

must reach the target (at-risk) population.
This requires correct identification of the characteristics of the target audience in terms of
educational level, salience of the issue, involvement of the target audience with the issue, and
access of the target audience to the media channels used. Cultural issues affect people's
interpretation of messages and must be considered in the presentation of a disease- prevention
message to ethnic and racial minority groups. Television may not be the most important venue of
mass media to educate the aggregate. Pamphlets may not be the best way to educate the
aggregate, and the reading level of any literature must be specific for the target audience.
Cultural issues affect people's interpretation of messages and must be considered in the
presentation of a disease- prevention message to ethnic and racial minority groups.
12. A community health nurse has identified the index case. The nurse is involved in which
of
the following?
A) Contact investigation
B) Screening
C) Isolation
D) Quarantine
Ans: A
Feedback:
The index case (diagnosed person) results from contact investigation and partner
notification. Screening describes programs that deliver a testing procedure to detect disease in
groups of asymptomatic apparently health individuals. Isolation refers to the separation of the
infected person from others for a period of communicability to limit transmission; quarantine
refers to restrictions placed on healthy contacts of an infectious case for the duration of the
incubation period. Contact investigation and notification is one
of two approaches to secondary prevention of communicable diseases.

13. The three main approaches to the tertiary

prevention of communicable disease include which of the following?
A) Education, immunization, and screening
B) Screening, immunization, and isolation and
quarantine
C) Case and contact investigation, notification,
and treatment
D) Care and treatment, isolation and quarantine, and safe handling and control of infectious
wastes
Ans: D
Feedback:
The three main approaches to the tertiary prevention of communicable disease include
care and treatment, isolation and quarantine, and safe handling and control of infectious wastes.
The primary prevention techniques for communicable disease include education, immunization,
and screening. The secondary prevention techniques for communicable disease include case and
contact investigation,
notification, and treatment.
14. If an agency discards used needles and syringes in plastic milk jugs, which of the four
key elements of an infectious waste management program that are applicable to community
practice would the agency be
violating?
A) Health professionals must be able to correctly distinguish biohazardous waste from

biomedical waste.
B) The waste management program must have administrative support and authority to
institute practice guidelines.
C) Handling of the infectious wastes must be

minimized. Containers should be rigid, leak resistant, and impervious to moisture.
D) An enforcement or evaluation mechanism

must be in place to ensure that the potential for exposure to infectious waste is met.
Ans: C
Feedback:
Handling of the infectious wastes must be minimized. Containers should be rigid, leak
resistant, and impervious to moisture; they should have sufficient strength to prevent rupture or
tearing under normal conditions; and they should be sealed to prevent leakage. Containers for
sharps must also be puncture resistant. Other key elements of an infectious waste management

program that are applicable to community practice include that health professionals must be able
to correctly distinguish biohazardous waste from biomedical waste; the waste management
program must have administrative support and authority to institute practice guidelines; and an
enforcement or evaluation mechanism must be in place to ensure that the potential
for exposure to infectious waste is met.
15. The community health nurse determines that the adult population in the community has
an increased incidence of vaccine preventable disease. Which of the following are factors that
may contribute to low vaccination levels
among adults? Select all that apply.
A) Lack of comprehensive vaccine delivery systems to the public and private sectors for
adults (similar to the Vaccines for Children
program for children)
B) Lack of statutory requirements for vaccination
of adults
C) Health care providers may lack current information about recommended adult
immunizations and may miss opportunities to vaccinate adults during contacts in offices,
outpatient clinics, and hospitals.
D) Adults fear injections for immunizations but do not worry about adverse effects after
vaccination.
E) A multitude of comprehensive vaccination programs exist in settings where healthy

adults congregate such as workplaces and
other locations.
Ans: A, B, C
Feedback:
Low vaccination levels among adults are associated with several factors: limited
comprehensive vaccine delivery systems that are available; lack of statutory requirements for
vaccination of adults; and frequently missed opportunities for vaccinating adults during contacts
in offices, outpatient clinics, and hospitals. Additionally there is a lack of comprehensive
vaccination programs in settings where healthy adults congregate; and clients and providers may
fear adverse
reactions after vaccination.
16. A community health nurse would recommend

pneumococcal vaccine for which group?
A) 1-year-old children

B) 30-year-old adults who have simple

respiratory tract infections
C) Adults over age 65 who have COPD
D) Healthy adults in their 50s
Ans: C
Feedback:
Primary prevention includes a pneumococcal vaccine, especially for the high-risk groups,
ages 2 years old and up, including those with chronic diseases, immune-suppressing health
conditions, or those who are asplenic.
Reimmunization is recommended only for high-risk children, or adults over 65 years old who
had their first vaccination before age 65. The vaccine is not effective in children younger than 2
years of age and is not recommended for the healthy population
between the ages of 2 and 65 years.

immunization is most accurate?
A) Immunization is helpful in the spread of all
communicable diseases.
B) Immunization cannot provide herd immunity.
C) Immunization is the process of introducing a form of a disease-causing organism into a

person's system to promote the development
of antibodies that will resist the disease.
D) Immunization is the process of administering
antibodies to a person.
Ans: C
Feedback:
Immunization is the process of introducing a form of a disease-causing organism into a
person's system to promote the development of antibodies that will resist the disease. There are
many communicable diseases that a vaccine is not known for. Immunization can help to promote
herd immunity. Immunization does not involve the administration of
antibodies to a person.
18. A family member has developed tuberculosis

(TB) and the remainder of the family members are undergoing tuberculosis skin testing to
determine their status. The nurse assesses the indurations and determines that a family member
with which size induration is positive for TB?
A) 2 mm
B) 3 mm
C) 4 mm
D) 5 mm

Ans: D
Feedback:
An induration of 5 mm or more is considered positive for individuals in close contact
with others who have TB. Indurations <5 mm are
not considered positive.
19. The community health nurse observes an increase in the development of multidrug-
resistant tuberculosis. The nurse understands that a major reason for this occurrence for
individual clients would most likely be
A) political and social response to declining rates
of TB over the past decade.
B) a reduction in funding for surveillance and
research.
C) noncompliance with the therapy for the full,
recommended period.
D) a premature sense that TB has been defeated.
Ans: C
Feedback:
On an individual case basis, the most common means by which resistant organisms are
acquired is by noncompliance with therapy for the full, recommended period.
Factors that seem to contribute to the overall increase in multidrug-resistant tuberculosis include
the political and social response to declining rates of TB over past decades, which has resulted in
funding cuts for surveillance, treatment, and research, and a
premature sense that TB was defeated.
20. Which of the following statements about the prevention of sexually transmitted diseases
is
true? Select all that apply.
A) Many persons who have HIV infection can stave off AIDS by the use of medications
during the HIV stage of the spectrum.
B) Screening programs have actually reduced the

incidence of Chlamydia as infected persons are identified and treated.
C) The proper use of condoms prevents transmission of all sexually transmitted

infections.
D) Expedited partner treatment can prevent the
spread of Chlamydia and gonorrhea.

E) It is not possible for a person who has a HSV-2 infection to transmit the infection to other
sex partners if sexual contact is only practiced when the person does not have any
visible sores.
Ans: A, B, D
Feedback:
Many persons who have HIV infection can stave off AIDS by the use of medications
during the HIV stage of the spectrum.
Screening programs have actually reduced the incidence of Chlamydia as infected persons are
identified and treated. Expedited partner treatment can prevent the spread of Chlamydia and
gonorrhea. The proper use of condoms reduces the risk of sexually transmitted infection
transmission but does not eliminate the transmission of all sexually transmitted infections. It is
possible for a person who has HSV-2 infection to transmit the infection to other sex partners if
sexual contact is practiced even when the infected
partner does not have a visible sore.
21. Which one of the following statements is true about the consequences of biologic
terrorism
with anthrax and smallpox?
A) Anthrax is not usually spread by person to person contact and so is not a good agent of
biological terrorism.
B) Smallpox is globally eradicated and therefore
does not present a problem.
C) Most adults are immune to smallpox due to
routine immunization.
D) As many as one in five persons who become ill with cutaneous anthrax die and inhalation
anthrax can cause death in 3 to 5 days.
Ans: D
Feedback:
The case–fatality rate for cutaneous anthrax is 5% to 20%. Inhalation anthrax initial
symptoms are mild and nonspecific but progress to respiratory distress, fever, shock, and
expected death within a matter of days.
Anthrax is not usually spread by person to person contact, but it has been demonstrated to be an
agent of biologic terrorism via spores that were placed in mail right after the 2001 terrorist
attacks. Many adults are not immune to smallpox as it has not been used for routine
immunization for 40 years.


confidentiality, privacy, and discrimination is the most accurate?
A) It is permissible for a community health nurse to reveal the name and any other personal
health information of a person who has a communicable disease to the public health
authorities.
B) It is permissible for a community health nurse to tell the contacts of a person who is
infected with a communicable disease which disease they have been exposed to and the name of
the source.
C) It is permissible for any health care provider

to report any cases of known or suspected communicable diseases to the news media.
D) Only the identity of the index case of a
communicable disease needs to be protected.
Ans: A
Feedback:
It is permissible and necessary for a community health nurse to reveal the name and any
other personal health information of a person who has a communicable disease to the public
health authorities. It is important that the contacts of a person who is infected with a
communicable disease which disease they have been exposed to but is not acceptable for the
community health nurse to reveal the identity of the source. It is permissible and often helpful for
a community health nurse to involve the news media in informing the public of information
about the specific disease including mode of transmission, prevention, and treatment options but
not the identity(ies) of the cases. It is important to assure the individual being interviewed that
the information will be maintained in a confidential manner, and the goal is care and treatment.
Chapter 9 Environmental Health & Safety

1. A community health nurse is presenting an in- service for a group of other community
health nurses about ecological perspective of environmental health. Which of the following
would the nurse incorporate into the program
when describing this concept?
A) The study of governmental and private sector
regulations of the environment
B) A technological view of strategies for
preventing illness and injury
C) Identification of not only the physical environment but also the social and cultural
factors that exist for populations
D) The role of the community health nurse in
preventing injury, disease, and illness
Ans: C

Feedback:
The ecological perspective identifies not only the physical environment but also the
social and cultural factors that exist for populations. Nurses who display this type of approach
provide a more comprehensive level of care. It is not a study of the governmental and private
sector regulations, a technological view, or the nurse's role in preventing injury,
disease, and illness.
2. When applying the ecological perspective to environmental health, a community health

nurse integrates which of the following
concepts as most essential?
A) Primary prevention is limited in this area.
B) The need for foresight in designing
innovations
C) No one factor can be viewed in isolation.
D) Implications of scientific advances are fully
understood.
Ans: C
Feedback:
With the ecological perspective, no one factor can be viewed in isolation. The preventive
approach involves all three levels of prevention, of which primary prevention is the most
important. This approach also requires foresight in designing innovations and involves
implications associated with the unprecedented advances in science and
technology.
3. Which of the following concepts is used by public health professionals to illustrate that
the determinants of health interact to affect
health?
A) Precautionary principle
B) Ecological perspective
C) Sustainability
D) Upstream focus
Ans: B
Feedback:
The ecological perspective is used by public health professionals to illustrate that the
determinants of health interact to affect health. The precautionary principle states that in the
absence of clear data that indicates the safety of an action, chemical or material that poses a
threat to human health, it should not be used. Sustainability is “the ability to meet the needs of

the present without compromising the ability of future generations to meet their own needs.”
Upstream focus identifies the root causes of
disease and manufacturers of illness.
4. Which of the following statements about an

upstream focus is the most accurate?
A) The upstream approach does not focus on

socioeconomic factors and the environmental origins of disease and health problems.
B) The focus of an upstream approach is the
institution and system level.
C) The upstream approach pertains to the purity
of water supplies.
D) The focus of an upstream approach is healthy
lifestyle issues.
Ans: B
Feedback:
The focus of an upstream approach is the institution and system level, and not just
healthy lifestyle issues. The upstream approach does focus on socioeconomic factors and the
environmental origins of disease and health problems. The upstream approach does not pertain to
the purity of
water supplies.
5. When the public health nurse uses an upstream approach to improve heart health, the
nurse would examine which one of the
following factors?
A) Unhealthy diets
B) Decreased physical activity
C) Smoking tobacco
D) Lack of safe places to exercise
Ans: D
Feedback:
The upstream approach focuses on the factors at the institutional and system level rather
than looking at healthy lifestyle issues.
Healthy diets, increased physical activity, and smoking cessation are all healthy lifestyle issues.
The root causes of the decreased physical activity would include lack of safe
places to exercise.

6. A public health nurse who uses the upstream approach would likely focus on which one
of the following contributors to unhealthy diets
in the community?
A) Consumer preference for sweet, greasy, and
salty foods
B) Marketing strategies of fast food businesses
C) Busy lifestyles within the community
D) Individual acceptance of obesity
Ans: B
Feedback:
A public health nurse who uses the upstream approach would likely focus on factors that
are at the institutional and system level rather than looking solely at healthy lifestyle issues.
Consumer preference for sweet, greasy, and salty foods; busy lifestyles within the community
and individual acceptance of obesity are lifestyle issues. The marketing strategies of fast food
businesses are one root
cause of unhealthy diets in the community.
7. The nursing student is preparing a report for class relating to Healthy People 2020 and
environmental health. Which of the following should be included in this report? Select all
that apply.
A) The agency that prepared this initiative is the
World Health Organization.
B) The overall goal is to “promote health for all

through a healthy environment.”
C) The document provides instructions for persons in the community regarding how to
protect their own health.
D) One of the six focus areas is global
environmental health.
E) The document provides guidance for nurses to
identify targets for health.
Ans: B, D, E
Feedback:
The overall goal of Healthy People 2020 is to “promote health for all through a healthy
environment.” The document does provide guidance for nurses to identify targets for health (not
instructions for individuals). The six areas that are focused on include outdoor air quality, surface
and ground water quality, toxic substances and hazardous wastes, homes and communities,
infrastructure and surveillance, and global environmental health. The agency that prepared this
initiative is the
U.S. Department of Health and Human

Services.
8. Which one of the following statements about assessment (one of the core public health
functions) and how it can be applied to
environmental health is most accurate?
A) Assessment includes the investigation of

health hazards, surveillance of health issues, examining causes, and assessing needs.
B) Assessment is least valuable when related to
where the person attends school.
C) It is not necessary for nurses to have a background in the environmental health

sciences.
D) Assessment should be limited to the general population and should not include the
increased vulnerability of certain groups.
Ans: A
Feedback:
Assessment includes the investigation of health hazards, surveillance of health issues,

examining causes, and assessing needs. With assessment, priority should be given to locations
where people spend the majority of their time (home, work, school). Where persons attend
school is too limiting as many people do not go to school and the priority should be given to
home and work. The ability to perform critical assessments for environmental health requires
background in the environmental health sciences. Public health nurses must also be aware of the
increased vulnerability of certain groups.
9. The core public health function of policy development related to environmental health
includes which one of the following?
A) Policy development is best left to legislators.
B) To be an effective advocate for change, it is
only necessary that the nurse speak out.
C) There are many ways for public health nurses

to participate in policy development related to environmental health.
D) Public health nurses are public servants and
therefore cannot advocate for public policy.
Ans: C
Feedback:

There are many ways for a public health nurses to participate in policy development
related to environmental health that start with the nurse being informed about the hazards in the
community, existing legislation that protects people in the community, and governmental and
nongovernmental groups in communities that can be partners in the efforts to protect health.
They may write letters to their legislators, inform community members, and write letters to the
editors of local newspapers and periodicals. Nurses can also present testimony at public forums
or hearings. Policy development is not best left to legislators. It is important for nurses to
advocate for policy development to care for the environment. Public health nurses are public
servants and that is why they must advocate for policy development that favors the environment.
10. A community health nurse is enacting policy development by preparing a presentation for
a group of state health officials about the issue of water pollution in the United States. Which of
A) Globally, the availability of clean water is becoming a very serious threat to human
survival.
B) Water pollutants consist solely of chemicals.
C) Recently, there has been an increase in the concern about pharmaceuticals contaminating
water supplies.
D) All water that is to be consumed is regulated
through the EPA.
E) The people most vulnerable to serious health problems are the very young, the very old,
and the immune-compromised.
Ans: A, C, E
Feedback:
Globally, the availability of clean water is becoming a very serious threat to human
survival. Recently, there has been an increase in the concern about pharmaceuticals
contaminating water supplies. The people most vulnerable to serious health problems are the
very young, the very old, and the immune-compromised. Water pollutants consist of organic and
inorganic chemicals, contamination with microbes, pharmaceuticals, pesticides and insecticides,
and radionuclides. The EPA only regulates
public water systems.

11. A community health nurse is working with the local health departments to educate the
citizens about the effects of radon exposure and its link to possible illness. Which of the
following would the nurse identify as being a
major health concern associated with radon?
A) Skin cancer
B) Lung cancer
C) Diarrhea
D) Cardiovascular disease
Ans: B
Feedback:
Radon is a leading cause of death from lung cancer. Skin cancer is associated with sun
exposure. Diarrhea and cardiovascular disease
are not associated with radon exposure.
12. During a community program about food safety, a participant asks, “I know it is
important to use safe food practices to avoid microbial contamination, but what other possible
risks are there with our food supply?” Which response by the nurse would
be most appropriate?
A) “Nothing is more of a problem than food-
borne illness.”
B) “Risks occur only at food production and not
handling or consumption.”
C) “Radiating food is something that really

doesn't occur in the United States.”
D) “A recent concern has been raised about
genetically modified foods being marketed.”
Ans: D
Feedback:
There are many possible risks to the food supply, some even having more serious effects
than food-borne illness. Risks occur at all points from food production to food consumption.
Radiating food does occur in the United States. A recent concern has been raised about
genetically modified foods being marketed. Genetically modified foods may interfere with the
safety of food for human consumption and also questions about the ecological impact and
sustainability have
been raised.

13. Which of the following groups of persons have increased vulnerability to environmental
hazards to human health related to food?
A) Pregnant women are likely to transmit their exposure to chemicals, pesticides, and toxins
to the unborn fetus.
B) Persons who have altered immunity are more
likely to be affected by food exposures.
C) Middle-aged males
D) Children are more susceptible to hazards due

to their immature gastrointestinal systems and increased food intake per size.
E) Adult women who are nonchildbearing
Ans: A, B, D
Feedback:
Pregnant women are likely to transmit their exposure to chemicals, pesticides, and toxins
to the unborn fetus. Persons who have altered immunity are more likely to be affected by food
exposures. Children are more susceptible to hazards due to their immature gastrointestinal
systems and increased food intake per size. Middle-aged males and adult women who are
nonchildbearing are not especially vulnerable to environmental
hazards to human health.
14. Which of the following are variables that occur in nature and could have a negative
impact on humans? Select all that apply.
A) The effect of climate change upon weather
extremes (droughts, floods, and storms)
B) Changes in rainfall and water supply for soil
C) Ecology of microbial growth
D) Risks for waterborne and food-borne pathogens in drinking water, seafood, and
fresh produce because of climate variability
E) There is adequate food supply and always will
be.
Ans: A, B, C, D
Feedback:
The variables related to the food supply that occur in nature and could have a negative
impact on humans include the effect of climate change upon weather extremes (droughts, floods,
and storms); changes in rainfall and water supply for soil; ecology of microbial growth; risks for
water-borne and food-borne pathogens in drinking water, seafood, and fresh produce because of
climate variability. There are currently food shortages in parts of the world, and this is likely to
continue and may worsen.

15. An instructor is reviewing the evolution of environmental health and the development of
various agencies designed to protect health. As part of the review, the instructor includes the
Environmental Protection Agency (EPA), describing its primary goal as which of the
following?
A) Identify and address world health issues
B) Protect occupational safety and health
C) Monitor food and drug production and
availability
D) Set standards and monitor and enforce
environmental protection
Ans: D
Feedback:
The EPA was established for the purpose of standard setting, monitoring, and
enforcement of environmental protection. The World Health Organization (WHO) identifies and
addresses world health issues. The Occupational Safety and Health Administration (OSHA)
protects occupational safety and health. The Food and Drug Administration (FDA) is responsible
for monitoring food and drug production and
availability.
Chapter 10 Communication, Collaboration, and Technology

1. When educating clients, which of the following parts of the communication process
would be most important for the nurse to
ensure?
A) Limit setting
B) Feedback loop
C) Goal direction
D) Nonverbal expression
Ans: B
Feedback:
A major component of the communication process is the feedback loop, which allows
both the sender and the receiver to check on the success of the transference of meaning and to
renegotiate the message to allow for clarity and better understanding. Limit setting may or may
not be appropriate. Although therapeutic communication is goal directed and involves nonverbal
expressions, these are not parts of the communication and they are not as important as making
sure the message
has been understood correctly.

2. A community health nurse sends an e-mail stating a request to the local health
department. This is an example of which part
of communication?
A) Sender
B) Message
C) Decoding
D) Channel
Ans: D
Feedback:
A channel is the medium through which the sender conveys the message. It may be
written, spoken, or nonverbal. Sending an e- mail is an example. The sender is the person
conveying the message. The message is the expression of the purpose of the communication.
Decoding is the translation of the message into an understandable form by
the receiver.
3. Which of the following steps of the communication process does the community health
nurse who is serving as the sender have
the most control of? Select all that apply.
A) The receiver
B) The decoding
C) The message
D) The channel
E) The feedback loop
F) The encoding
Ans: C, D, F
Feedback:
The community health nurse who is serving as the sender in the communication process
has the most control over the sender, the message, the channel (the medium through which the
sender conveys the message), and the encoding (the sender decides which specific signals or
codes such as language, words, gestures, and body language to use). The community health nurse
does not have much control over the receiver, the decoding (the receiver's interpretation of the
message), or the feedback loop (a way for the sender and receiver to check on the success of the
transference of meaning and to renegotiate the message to allow for clarity and better
understanding), all of which are controlled by
the receiver.
4. Which of the following would a community

health nurse identify as most important to sending skills involved with communication?
A) Active listening

B) Paraphrasing
C) Nonverbal messages
D) Rapport
Ans: C
Feedback:
Sending skills involve the ability to transmit the messages effectively. Two main
channels to send messages are nonverbal and verbal messages. Active listening and paraphrasing
are involved with receiving skills. Rapport is
an interpersonal skill.
5. When communicating with a group of clients, which of the following would the nurse
identify as a barrier to the communication
process?
A) The nurse's sharing of complete and accurate

information with the clients
B) The clients' use of medical terminology in the
discussion
C) The clients' offering of feedback to allow the
nurse to learn what the client understands
D) The clients' interpretation of the message
through their own perceptions
Ans: D
Feedback:
Selective perception is the interpretation of a message through their own perceptions, and
projects this onto the communication process as they decode a message. Sharing complete and
accurate information, client's use of medical terminology, and the clients' offering of feedback to
allow the nurse to learn what the client understands are important skills of
effective communication.
6. A community health nurse is dealing with a family in crisis. The nurse remains calm and
firmly reassuring when communicating with them. This nurse is avoiding which barrier to
communication?
A) Filtering information
B) Emotional influence
C) Language barrier
D) Selective perception
Ans: B
Feedback:

The nurse is avoiding emotional influence, that is, how a person feels at the time a
message is sent or received, which can influence its meaning. Senders can distort messages and
receivers can interpret messages incorrectly when emotions cloud their perception. Emotions can
interfere with rational and objective reasoning, thus blocking communication. Filtering
information means manipulating information by the sender to influence the receiver's response.
Language barriers involve the different interpretations of words by people. Selective perception
involves the receivers interpreting a message through their own perceptions, which are
influenced by their own experiences, interests, values, motivations, and expectations.

filtering messages is most accurate?
A) Filtering is always intentional.
B) Filtering is never intentional.
C) Only clients use filtering.
D) Filtering leads to miscommunication and
misinterpretation.
Ans: D
Feedback:
Filtering leads to miscommunication and misinterpretation. Filtering can be intentional or
unintentional and may be used by clients or
nurses.
8. During an interview with several clients, the community health nurse assumes
responsibility for and strives to understand the feelings and thoughts of the client. The nurse
is demonstrating which of the following?
A) Reflection
B) Respect
C) Empathy
D) Active listening
Ans: D
Feedback:
Active listening is the skill of assuming responsibility for and striving to understand the
feelings and thoughts in a sender's message. The nurse actively works to discover what the
clients mean. Reflection involves restating what clients or others have said to clarify the received
meaning. Respect involves conveying an attitude that clients and others have importance,
dignity, and worth.
Empathy is the ability to communicate understanding and to vicariously experience
the feelings and thoughts of others.

9. Which action by a community health nurse

demonstrates respect to the client?
A) Feeling the same emotion that the client has
B) Addressing the client as “Mr.” or “Mrs.”
C) Being open and genuine with the client
D) Having self-awareness
Ans: B
Feedback:
Showing respect means conveying the attitude that clients and others have importance,
dignity, and worth, such as by the manner in which the nurse addresses people—for instance, by
using the courtesy titles of “Mr.” or “Mrs.” until it is determined how the client wants to be
addressed. Putting one's self in the client's shoes demonstrates empathy; this is not the same as
feeling the same emotion that the client has. Being open and genuine establishes rapport. Having
self-awareness is a part of empathy that allows an individual to
accurately demonstrate this understanding to the client.
10. Which one of the following statement about health literacy and health outcomes is most
accurate for clients who have low literacy?
A) It is important to make the message as basic and simple as possible because the client
likely has low intelligence.
B) It is best to use written materials for clients
who have low literacy.
C) It is very important for clients who have low literacy to have ample opportunity to
provide
feedback.
D) Health literacy is not a very important factor
in mortality and morbidity.
Ans: C
Feedback:
It is very important for clients who have low literacy to have ample opportunity to
provide feedback that will demonstrate understanding. Communication with low-literacy, high-
risk groups should be simplified and easy-to-read materials. At the same time, there is the danger
of making the communication so simple that the reader feels insulted. It has been well
documented that most health information pamphlets, brochures, and other materials cannot be
read or comprehended by adults who have low literacy. Those who have the lowest literacy
levels have the highest
mortality and morbidity.

11. Which of the following are key issues related

to health literacy? Select all that apply.
A) Health literacy is characterized as critical to
health promotion and disease prevention.
B) Limited health literacy only affects those who
have low educational levels.
C) Poor health literacy skills can contribute to
increased health care costs.
D) Health literacy involves the ability to read,
understand, and act on health information.
E) Health literacy goes beyond the basic
definitions of literacy.
Ans: A, C, D, E
Feedback:
Health literacy is characterized as critical to health promotion and disease prevention.

Limited health literacy affects people of all races, incomes, ages, and educational levels. Poor
health literacy skills have been associated with poorer health status and increased health care
costs because people with a low-literacy level are less knowledgeable about their health
conditions and are less likely to seek preventative care. Health literacy involves the ability to
read, understand, and act on health information.
Health literacy goes beyond the basic definitions of literacy and includes cultural literacy,
computer literacy, scientific, media,
and technological literacy.
12. While working with a community group, a community health nurse observes the group
sharing ideas and opinions and being creative. The nurse determines that the group is in
which stage?
A) Forming
B) Storming
C) Norming
D) Performing
Ans: C
Feedback:
During the norming stage, trust and openness are more apparent, and there is a sharing of
ideas and opinions and creativity. The forming stage is characterized by members becoming
oriented to each other. The storming stage involves conflict and competition with the group
getting down to sharing more sensitive issues. The performing stage is characterized by the
ability to work as

a total group, in subgroups, or independently.
13. Which of the following descriptions of the

five stages in group development are accurate? Select all that apply.
A) All groups eventually reach the performing

stage.
B) The storming stage is detrimental to group
development.
C) Loss of group affiliation often occurs with
adjourning.
D) The group begins to focus more on maintenance rather than just tasks during the
norming stage.
E) Conflict is inherent in the forming stage.
Ans: C, D
Feedback:
During the adjourning stage, the group must disengage, and this may cause feelings of
loss. The group begins to focus more on maintenance rather than just tasks during the norming
stage. Not all groups do reach the performing stage. The storming stage is necessary to allow
group members to identify roles, expectations, and get a feel of how the group will work
together. Conflict is to be avoided at the forming stage but must occur at
the storming stage.
14. A community health nurse is part of a group dealing with health issues. During one of the
meetings, the nurse states, “Let's all take about 5 minutes to share ideas so that everybody will
have a chance to be heard.” The nurse is demonstrating which of the
following?
A) Encouraging
B) Gatekeeping
C) Blocking
D) Mediating
Ans: B
Feedback:
The nurse is demonstrating the maintenance role behavior of gatekeeping, by trying to

make it possible for another member to make a contribution to the group such as by saying, “We

haven't heard from Jim yet” or suggesting limited talking time for everyone so that all will have a
chance to be heard.
Encouraging is demonstrated by being friendly, warm, and responsive to others, praising others
and their ideas, and agreeing with and accepting the contributions of others. Blocking is
demonstrated by going off on a tangent, citing personal experiences unrelated to the problem,
arguing too much on a point, or rejecting ideas without consideration.
Mediating involves attempts to harmonize, conciliate differences in point of view, or
suggest compromises.
15. A community health nurse working as part of group uses the group as a sounding board,
often expressing personal, nongroup-related feelings. This nurse is demonstrating which of
the following nonfunctional behaviors?
A) Self-confession
B) Aggression
C) Competition
D) Sympathy seeking
Ans: A
Feedback:
Self-confession involves using the group as a sounding board, expressing personal,

nongroup-oriented feelings or points of view. Aggression involves working for status by
criticizing or blaming others, showing hostility toward the group or some individual and
deflating egos or status of others.
Competition involves vying with others to produce the best idea, talk the most, play the most
roles, and gain favor with the leader.
Sympathy seeking involves trying to induce other group members to be sympathetic to one's
problems or misfortunes, for example, deploring one's own situation, or disparaging
one's own ideas to gain support.
16. When the community health nurse encourages the group members of a collaborative
partnership of interdisciplinary teams to effectively share ideas and frustrations on an equal,
reciprocal basis, the community health nurse is focusing on which of the five characteristics of
collaboration in community
health?
A) Maximized use of resources
B) Clear responsibilities
C) Shared goals

D) Mutual participation
Ans: B
Feedback:
When the community health nurse encourages the group members of a collaborative
partnership of an interdisciplinary team to effectively share ideas and frustrations on an equal,
reciprocal basis, the community health nurse is focusing on the mutual participation
characteristic. The characteristic of maximized use of resources involves designing the
collaborative partnership of those who are most knowledgeable and in the best positions to
influence a favorable outcome. The characteristic of clear responsibilities involves each member
in the partnership plays a specific role with related tasks. The characteristic of shared goals
involves each member of the team entering the collaborative relationship with broad needs or
purposed to be met and specific objectives to accomplish.
17. A collaborative community health group working with the teenage population to improve
health draws on the expertise of school nurses and others working with adolescents to develop a
plan. The group is demonstrating which characteristic of
collaboration?
A) Shared goals
B) Mutual participation
C) Maximized use of resources
D) Clear responsibilities
Ans: C
Feedback:
Maximizing the use of community resources involves drawing on the expertise of those
who are most knowledgeable and in the best positions to influence a favorable outcome. In this
case, it would be school nurses and others working with adolescents. Shared goals are
demonstrated by recognition of the specific reasons for entering into the relationship, that is, the
improved health of adolescents. Mutual participation involves the reciprocal exchange among
team members, with all team members contributing and receiving mutual benefit.
Clear responsibilities involve each member playing a specific role with related tasks.
18. Several community health agencies are collaborating on health promotion strategies. The
community health nurse observes that the team is working on assessment, planning,
implementation, and evaluation. The nurse
correctly concludes that

A) the team is made up solely of nurses.

B) the team is in the beginning phase.
C) the team is determining the goals they will
work toward.
D) the team is working together to accomplish
desired goals.
Ans: D
Feedback:
The three phases common to the collaboration process are the beginning phase when the
team relationship is being established and are identifying the project needs and determine the
goals toward which they will work. The second phase occurs when team members start working
together to accomplish desired goals. The work of the second phase may include assessment,
planning, implementation, and evaluation that will recur cyclically until the goals are
satisfactorily accomplished. The third phase occurs when the need for team members to work
together
has ended.
19. The student nurse correctly identifies the four characteristics of contracting as: Select all
that apply.
A) format.
B) partnership and mutuality.
C) negotiation.
D) commitment.
E) legal fees.
Ans: A, B, C, D
Feedback:
The four features of contracting in community health nursing are partnership and
mutuality, commitment, format, and negotiation. Legal fees are not involved as contracting in
community health nursing is not legally
binding.
20. When the nurse and client enter a contract in community health nursing and the nurse and
client share participation and agreement between them, which characteristic of
contracting is being enacted?
A) Partnership and mutuality
B) Commitment
C) Format
D) Negotiation
Ans: A

Feedback:
The four features of contracting in community health nursing are partnership and
mutuality (the nurse and the client share participation and agreement), commitment (the involved
parties make a decision that binds them to fulfilling the purposed of the contract), format
(outlining of specific terms of the relationship), and negotiation (the parties propose to accept
certain responsibilities that
are agreed upon by both parties).
21. contracting would be effective to use with

client groups based on the understanding that this method is beneficial for which of the
following?
A) Encouraging client participation in the
decision-making process
B) Contributing to a trusting nurse–client
relationship
C) Decreasing client stress during home visits
D) Reducing client visit time by over 50%
Ans: A
Feedback:
The nurse and the client contribute to the formulation of the contract, thus fostering client
participation in decisions regarding the direction and activities within the contract.
Contracting also involves commitment, format, and negotiation. Contributing to trust, decreasing
client stress, and reducing visit time are not considered benefits associated
with contracting.
22. A community health nurse is contracting with a client receiving services in the home. The
nurse and client are negotiating the activities for which each will be responsible. This correlates
with which phase of the nursing
process?
A) Assessment
B) Nursing diagnosis
C) Planning
D) Evaluation
Ans: C
Feedback:
Dividing responsibilities via negotiation would be part of the planning/intervention phase
of the nursing process. The assessment phase would involve exploration of needs.
The nursing diagnosis phase would correlate with goal establishment. Evaluation would involve
formative and summative assessments of progress toward goals and renegotiation or
termination.

23. After teaching a group of students about the

process of contracting, which statement by the group indicates successful teaching?
A) The process is dynamic as it moves through
various phases.
B) Contracting involves a unidirectional client–
nurse relationship.
C) The process must move backward before it
can move forward.
D) Once the contract is developed, it remains
relatively stable.
Ans: A
Feedback:
Contracting is a dynamic process that moves through phases. It forms a reciprocal
relationship between clients, nurse, and other persons. The process moves forward, focused on
meeting clients' needs, and enables the collaborating group to facilitate ultimate
achievement of clients' goals.
Chapter 11 Health Promotion Through Education
1. After teaching a class about the stages of change, the instructor determines that the class
understands the information when they identify the following as the proper sequence
of stages?
A) Unfreeze, plan, and integrate
B) Plan, organize, and coordinate
C) Plan, relearn, and integrate
D) Unfreeze, change, and refreeze
Ans: D
Feedback:
According to Lewin, change occurs in the following stages: unfreezing the old behavior,
implementing the change, and then refreezing the new change in place to integrate it into the
system. Planning, relearning, integrating, and
coordinating are not stages of change.
2. When implementing a program for teaching parenting to a group of teenagers, the

community health nurse determines that the group is in the changing/moving stage of change
when the group demonstrates which
of the following?
A) Motivation for change
B) Integration of the change
C) Lack of resistance to the change
D) Beginning adoption of the change
Ans: D
Feedback:

During the changing or moving stage, people experience a series of attitude

transformations, ranging from early questioning to full acceptance and commitment to
accomplishing the change.
They examine, accept, and try the innovation and the nurse helps them see the value of the
change, encourages them to try it, and assists them in adopting it. Motivation for the change is
part of the unfreezing stage. Showing a lack of resistance to the change and integration of
the change characterize the refreezing stage.
3. A client who needs to lose weight as part of an overall plan to become healthier has
contracted with a nurse for behavior change. The client is working on increasing fruits and
vegetables in his or her diet and currently consumes less than one fruit or vegetable per day. The
nurse knows that the client is in the unfreezing stage of change when the client
stated:
A) “I have been reading a lot about the healing powers of many fruits and vegetables. I never
ate many fruits and vegetables as a child so I am not sure how to prepare them. Can you
refer me to some sources of information?”
B) “I have started to try one serving of fruits and

one serving of vegetables at each meal. I am starting to discover some of my favorites.”
C) “I still hate fruits and vegetables and I don't think I will be successful at integrating them
into my diet.”
D) “Today I ate a total of 10 servings of fruits and vegetables. I really do like them and I feel
great!”
Ans: A
Feedback:
In the first stage, a disequilibrium develops and the system is more vulnerable to change.
People in this stage have a sense of dissatisfaction and have a void that they would like to fill.
When the client stated, “I have been reading a lot about the healing powers of many fruits and
vegetables…,” he or she was expressing disequilibrium. When the client stated, “I have started to
try one serving of fruit and one serving at vegetables at each meal…,” he or she was indicating
that he or she is changing. When the client stated, “I still hate fruits and vegetables…,” he or she
was expressing opposition to change which is not a part of the change process. When the client
stated, “Today I ate a total of 10 servings of fruits and vegetables…,” the client was expressing
that the change has become established as an accepted and permanent part of the system.

4. A community health nurse is applying the normative–reductive strategy of change when

working with clients. In doing so, the nurse engages them into changing their behavior in
addition to providing education, based on
which assumption?
A) Information alone is not enough, and
behaviors change through persuasion.
B) Compliance by the client system will occur
through the use of power to effect change.
C) People are rational and will adopt a new

practice because it is in their best interest.
D) The clients can assume a high degree of
responsibility for their own help.
Ans: A
Feedback:
Normative–reductive strategies not only give information but also directly influence
people to change attitudes and behaviors through persuasion. Use of power or coercion is
associated with the power–coercive change strategy. The Empiric–rational change strategy is
based on the assumption that people are rational and, when presented with empiric information,
will adopt new practices that appear to be in their best interest. The empiric–rational strategy is
best used with clients who can assume a relatively high
degree of responsibility for their own health.
5. The community health nurse is presenting sexuality education to a group of sixth grade
students. The community health nurse tells the students that they must never have unprotected
sexual intercourse or they will die from a sexually transmitted infection and displays pictures of
people dying from AIDS.
The nurse is using which change strategy?
A) Normative–reeducative
B) Rational–empiric
C) Power–coercive
D) Planned change
Ans: C
Feedback:
The community nurse in this scenario is using power–coercive change strategies that are
based on fear. Normative–reeducative change strategies present new information and directly

influence people's attitudes and behaviors through persuasion. Empiric– rational change
strategies are based on the assumption that people are rational and, when presented with empiric
information, will adopt new practices that appear to be in their
best interest.
6. As part of a community-wide program addressing the needs of seniors in the county, the
nurse engages the seniors as well as their families in the program. The nurse is demonstrating
which principle for effecting
positive change?
A) Participation
B) Proper timing
C) Resistance to change
D) Interdependence
Ans: A
Feedback:
The principle of participation requires involvement of the persons who will be affected
by the change. The principle of proper timing requires that it be the right time to introduce the
change. The principle of resistance to change involves responding to the instinctive nature of the
desire to preserve the status quo because change poses a threat to stability and security. The
principle of interdependence requires the view that every system has many subsystems intricately
related such that a change in one part of the
system may affect other parts.
7. unsuccessful attempts before quitting 1 year ago today. The nurse decides to share this
information with the group and tells them that all the attempts he or she had made before
stopping smoking were necessary steps for his or her eventual success. Which principle of
change was the nurse enacting?
A) Principle of flexibility
B) Principle of self-understanding
C) Principle of interdependence
D) Principle of proper timing
Ans: B
Feedback:
The principle of self-understanding relates to the change agent (the community health
nurse) should be able to clearly define his or her role and learn how others define it. The
principle of flexibility is the ability of the change agent to adapt to unexpected events and make
the most of them. The principle of interdependence is that a change in one part of a system
affects other parts and a change in one system may affect other systems. The principle of proper
timing relates to the knowledge that even the right change may not occur if the timing is not
right.

8. The community health nurse is talking to a group of clients about the health importance
of consuming a low-fat diet. The clients are members of a particular cultural group that grows
their own food and consumes a lot of animal protein. The clients state that their forefathers ate a
diet that was high in animal protein and they had lived into their 90s. The community health
nurse expects this argument and points out that their ancestors did not have the luxury of modern
machines and they had to engage in a lot more activity than the current generation. This is an
example of which principle of effecting change?
A) Principle of participation
B) Principle of proper timing

C) Principle of self-understanding
D) Principle of resistance to change
Ans: D
Feedback:
The nurse was aware that all systems instinctively resist change and was prepared to
discuss aspects of the clients' cultural background that related to their current state of health. This
is the principle of resistance to change. The principle of participation means that persons affected
by the proposed change should participate as much as possible in every step of the planned
change process. The principle of proper timing requires that it be the right time to introduce the
change. The principle of self-understanding relates to the change agent (the community health
nurse) should be able to clearly define his or her role
and learn how others define it.
9. Which of the following are examples of a community health nurse providing health
promotion teaching? Select all that apply.
A) The community health nurse teaches a class

of kindergartners how to properly wash their hands.
B) The community health nurse is a guest on a radio talk show to provide information how
to
avoid an infection that is endemic.
C) The community health nurse encourages an individual whose blood pressure screening
was elevated to have his or her blood pressure
rechecked in 1 week.

D) The community health nurse teaches a group

of preschoolers about different fruits and vegetables that they might like to try.
E) The community health nurse teaches a mother
and baby exercise group.
F) The community health nurse leads a group of
stroke survivors in soft exercise.
Ans: A, D, E
Feedback:
Health promotion is behavior that is motivated by the desire to increase well-being and
actualize human potential. This is different from disease prevention/health protection, which is
behavior motivated by a desire to actively avoid illness, detect it early, or maintain functioning
within the constraints of illness. The activities of teaching a class of kindergartners how to
properly wash their hands, teaching a group of preschoolers about different fruits and vegetables
that they might like to try, and teaching a mother and baby exercise group are focused on well-
being and not a particular illness. The activities of being a guest on a talk show to provide
information how to avoid an infection that is endemic, encouraging an individual whose blood
pressure screening was abnormal to have their blood pressure rechecked in 1 week, and leading a
group of stroke survivors in soft exercise are focused on avoiding specific illnesses and not on
improved general health.
10. Which of the following statements most accurately describes the nurse's role as an
educator related to the social determinants of
health?
A) The nurse must focus on individual behavior

and encourage people to take responsibility for their own behavior.
B) The nurse must examine one or two factors
that contribute to our state of health.
C) The nurse must look at the root causes of
disease and health inequities.
D) The nurse must lecture people about what is
right and wrong behavior.
Ans: C
Feedback:
Community health nurses must look at the social determinant of health as the root causes
of disease and health inequities. This requires that nurses look beyond the individual behavior
and have a broader scope of what
underlies illness.

11. A community health nurse has been teaching nutrition to a group of seniors in a local
senior center. After attending the nurse's class on nutrition, the nurse determines the group's
cognitive level of learning. Which of the
following indicates knowing?
A) Comparing the nutrient value in foods
B) Eating well-balanced meals
C) Planning recipes that are low in fat
D) Naming three foods high in iron
Ans: D
Feedback:
Naming three foods reflect the knowledge level of the cognitive domain of learning.
Comparing nutrient values reflects analysis; eating well-balanced meals reflects application; and
planning recipes reflects
synthesis.
12. A teaching plan for a group of new mothers has the following objective: “The mothers
will describe the principles that relate to safety while diapering their newborn.” The nurse is
attempting to achieve learning at
which level of the cognitive domain?
A) Knowledge
B) Comprehension
C) Application
D) Analysis
Ans: C
Feedback:
At the application level, the learner not only understands the material but can apply it to
new situations, transferring understanding into practice. This is reflected by words such as
practice, demonstrate, use, illustrate, and employ. Knowledge level learning would be reflected
by words such as define, repeat, list, name, or recall. Comprehension level learning would be
reflected by words such as restate, describe, explain, identify, and discuss.
Analysis level learning would be reflected by words such as distinguish, debate, question,
compare, examine, or calculate.
13. Which of the following interventions by the nurse is most likely to have a positive
influence on the client's adoption of a new
healthy behavior?

A) Providing feedback about what the client is

doing incorrectly
B) Providing feedback about what the client is
doing correctly
C) Not providing feedback
D) Not providing role modeling of the desired
change
Ans: B
Feedback:
The nurse who recognizes clients' participation in a group praises them for completing
assignments or commends them for sticking to diet plans will have more success than the nurse
who only criticizes
failures.
14. To ensure learning in the psychomotor domain, which of the following would be most
important for the nurse to ensure about
the learner?
A) Has a sensory image of how to do the skill
B) Has the ability to perform the necessary skill
C) Is willing to listen to the information about
the skill
D) Can continue to practice the skill

independently
Ans: B
Feedback:
For psychomotor learning to occur, the nurse must ensure that the learner is physically,
intellectually, and emotionally capable of performing the skill. Otherwise, the other two
conditions, having a sensory image and practicing the skill, would not occur. A willingness to
listen is an important aspect for all learning, especially learning in the
affective domain.
15. A community health nurse develops a written teaching plan for a community education
program about nutrition and salt-reduction.
Which objective would reflect synthesis
learning in the cognitive domain?
A) The client will create an enjoyable meal using
low-sodium foods.
B) The client will compare the salt content in a

variety of packaged foods.

C) The client will practice eating meals that
contain low-sodium foods.
D) The client will list foods that are low in
sodium.
Ans: A
Feedback:
Synthesis, the fifth level of cognitive learning, is the ability not only to break down and
understand the elements of a situation but also to form elements into a new whole. Synthesis
combines all of the earlier levels of cognitive learning to culminate in the production of a unique
plan or solution. The objective with the verb create demonstrates this level. Being able to
compare foods of varying salt content reflects analysis. Practicing eating meals demonstrates
application. Listing foods
demonstrates knowledge.
16. good attendance and group participation in her Saturday class on newborn care for young
mothers. The participants receive free transportation and a $10 food voucher for attending. When
they participate, prizes are distributed. This nurse is using behavioral theory to encourage clients,
focusing the teaching on which of the following concepts?
A) Meeting a hierarchy of needs
B) The learner's self-confidence and personal
mastery
C) A person's natural tendency to learn
D) Changes in response to a stimulus
Ans: D
Feedback:
Behavioral theory is grounded in stimulus– response behaviors, and changes occur in
response to stimuli. The nurse is also using conditioning through reinforcement as described by
Skinner. Meeting a hierarchy of needs is based upon Maslow, a humanistic theorist. Self-
confidence and personal mastery reflect social learning theory. A person's natural tendency to
learn is based upon humanistic theories.
17. A 32-year-old wife and mother of two children was a bank manager before entering the
nursing program. She is finishing a Baccalaureate nursing program in a few months. She learns
best when she can plan and carry out her own learning activities, uses past experiences to help
with current learning, and applies learning immediately. Which learning theory best fits this
woman's learning
style?

A) Knowles' adult learning theory

B) Bandura's social learning theory
C) The Gestalt–Field family of theories
D) Maslow's Hierarchy of Needs theory
Ans: A
Feedback:
The woman's behaviors support the tenets of Knowles' adult learning theory. She is a
self- directed learner, experienced, ready to learn, and is problem centered rather than
theoretically oriented. Bandura's social learning theory attempts to explain behavior and facilitate
learning. With social learning theory, learners are benefitted by role models, building self-
confidence, persuasion, and personal mastery. The Gestalt–Field family of cognitive theories
assumes that people are neither good nor bad; they simply interact with their environment and
their learning is related to perception. Maslow's hierarchy of needs requires lower level basic
needs to be
met before working toward self-actualization.
18. A community health nurse is preparing a teaching program for a group of elementary
school-aged children about substance abuse awareness. The nurse would implement strategies
that address which cognitive phase
of development?
A) Preconceptual
B) Intuitive thought
C) Concrete operations
D) Formal operations
Ans: C
Feedback:
Elementary school-aged children would most likely be in the concrete operations stage of
cognitive development where the child can solve concrete problems and recognize others'
viewpoints. The preconceptual stage would apply to children between the ages of 2 to 4 years
when language development is rapid and everything is related to “me.” The intuitive thought
stage would apply to children between the ages of 4 to 7 years when egocentric thinking
diminishes and words are used to express thoughts. Formal operations stage would apply to
adolescents when the child uses rational thinking and can develop ideas from general principles
and
apply them to future situations.

19. When choosing an appropriate model for health education, community health nurses
often select the PRECEDE–PROCEED model
for which reason?
A) It emphasizes the desired outcome of the
teaching.
B) The steps are similar to those of the nursing
process.
C) The nurse's perception of the problem is the
key to this model.
D) Evaluation of outcomes is the final step.
Ans: B
Feedback:
The steps of the PRECEDE–PROCEED model are similar to the nursing process, and
thus this model has become a useful tool for nurses teaching in the community. It does
emphasize outcomes with evaluation of the outcomes as the final step. But these are not reasons
for nurses selecting this model. The client's or community's perception of the
problem is key to this model.
20. Which of the following statements accurately

describe Pender's Health Promotion Model? Select all that apply.
A) It has been revised to reflect a number of
major theoretical changes.
B) It is not effective.
C) It is unrelated to interpersonal influence of
others.
D) It allows the community health nurse to predict health promotion behaviors which
enhances the ability to work with clients.
E) Individual characteristics and experiences are seen to interact with behavior-specific

cognitions and affect to influence specific
behavioral outcomes.
Ans: A, D, E
Feedback:
Pender's Health Promotion Model has been revised from the earlier framework that was
published in 1980 and has been revised to reflect a number of major theoretical changes. It is
viewed as an effective model. It focused on predicting behaviors that influence health promotion
and includes the variable of
interpersonal influence of others.
21. Which of the following statements about teaching at three levels of prevention is most
accurate?

A) Ideally, the community health nurse would

focus at the tertiary level of prevention.
B) The outcome of focusing on the tertiary level of prevention is to help diminish years of
morbidity and limit subsequent infirmity.
C) It is ideal to focus on the primary level of
prevention.
D) Community health nurses do not spend a significant share of time teaching at the
secondary level.
Ans: C
Feedback:
Ideally, the community health nurse focuses on the primary level. Because the primary
level of prevention is not possible in all cases, a significant share of the nurse's time is spent
teaching at the secondary or tertiary level.
22. Which of the following is the best example of a community health nurse focusing on the
secondary level of prevention?
A) Teaching clients how to navigate the health
care system to receive prompt treatment
B) Teaching clients about the importance of
immunization
C) Teaching stroke survivors about the

importance of diet, rest, and exercise to prevent a secondary health problem
D) Teaching a class on sensible nutrition for
adolescents
Ans: A
Feedback:
The secondary level of prevention would be exemplified by the community health nurse
when teaching clients how to navigate the health care system to receive prompt treatment.
Teaching clients about the importance of immunization is focused on the primary level of
prevention. Teaching stroke survivors about the importance of diet, rest, and exercise to prevent
a secondary health problem is focused on the tertiary level of prevention. Teaching a class on
sensible nutrition for adolescents is focused on the
primary level of prevention.
23. When developing an educational program for the community, which of the following
must

the community health nurse do first?

A) Assess the clients' readiness to learn
B) Ensure a conducive environment for learning
C) Assess the client's perception of the problem
D) Determine the appropriate subject matter
Ans: A
Feedback:
Before any teaching can begin, it is essential to assess the clients' readiness to learn. Once
this is determined, the nurse can determine the clients' perceptions of the problem and identify
the appropriate subject matter.
Ensuring a conducive environment occurs
when the teaching begins.
24. A community health nurse is providing informal teaching to groups of parents about
typical childhood developmental milestones. Which of the following would the nurse
mostly likely be using?
A) Lecture
B) Demonstration
C) Anticipatory guidance
D) Visual images
Ans: C
Feedback:
Informal teaching such as anticipatory guidance and counseling requires the teacher to be
prepared, but there is no defined plan of presentation. Lecture and demonstration are formal
methods of teaching. Visual images
also are often used with formal teaching.
25. Which question would the community health

nurse use as a guide to determine a client's participation in a teaching program?
A) “What does the client know about the current
problem?”
B) “How does the client view the current
situation?”
C) “Does the client need special seating?”
D) “What does the client want to learn?”
Ans: D
Feedback:

To determine client participation, one of the first questions that need to be answered is,
“What does the client want to learn?” This directly influences the client's participation in the
educational process. Asking the question about what the client knows about the problem
determines the client's readiness to learn. Asking about the client's view of the problem helps
identify the client's perceptions. Asking about special seating helps to ensure that the educational
environment is conducive to the client's
needs.
26. Which of the following is the best example of a positive learning environment for a group
of
developmentally disabled adults?
A) A local diner, seated near the door to the
kitchen during lunchtime
B) A brightly lit conference room with
comfortable chairs
C) A kindergarten classroom with small chairs
that are low to the ground
D) A park on a beautiful, sunny day
Ans: B
Feedback:
A brightly lit conference room with comfortable chairs would be the best example of a
positive learning environment among the choices listed. A local diner, seated near the door to the
kitchen during lunchtime would not be a good choice as it is likely very noisy. A kindergarten
classroom with small chairs that are low to the ground would not be a good choice as the adults
could not comfortably sit in the chairs. A park on a beautiful, sunny day would not be a good
choice as there would be too many distractions making it difficult for the clients
to focus.
27. non-English speaking country about the need for immunizations, the nurse should include
which in his or her plans?
A) Using a lot of pictures
B) Guessing about the native language and
attempting to speak it
C) Using an interpreter
D) Talking clearly and slowly, being sure to
enunciate each word
Ans: C
Feedback:
Planning to use an interpreter when presenting information to a group of new immigrants
from a non-English speaking country is the best option among those listed. Pictures will not
effectively convey the meanings that the clients need. Guessing about the native language and
attempting to speak it will not be effective either, as the nurse should never assume anything and
unless the language is native to the nurse, the nurse will not be any more effective at

communicating with the clients. Talking clearly and slowly, being sure to enunciate each word,
might be appropriate for a group of immigrants from a non-English speaking country who have
been in this country for a while and have been learning the language.
28. Which of the following are factors to consider related to the social determinants of
health?
A) Being marginalized
B) Access to safe housing
C) Safe workplaces
D) Being related to a politician
E) Access to social and economic opportunities
Ans: B, C, E
Feedback:
Factors that influence an individual's ability to maintain good health include social
factors, such as access to social and economic opportunities and equitable social interactions, and
physical factors, such as access to safe housing and safe workplaces.
Being related to a politician may or may not have a positive impact on the social
determinants of health.
29. Which of the following endings to this sentence most accurately describes the reason a
community health nurse must consider the social determinants of health? The community health
nurse must consider the social
determinants of health
A) because the social determinants of health

affect a wide range of health, functioning, and quality-of-life outcomes and risks.
B) because in our country all people are treated
equally.
C) because it is the right thing to do.
D) because the community health nurse believes
in social justice.
Ans: A
Feedback:
The social determinants of health affect a wide range of health, functioning, and quality-
of-life outcomes and risks. There is a growing inequity in the distribution of disease, illness, and
wellness across our society and not all people are treated equally. It is not enough to do this
because it is the right thing to do. If the community health nurse believes in social justice, this is
one

thing but really implementing social justice in considering outcomes and risks is more
accurate.
Chapter 12 Planning, Implementing, and Evaluating Community/Public

Health Programs
1. appropriate source of information for the nurse to investigate when attempting to
determine the importance of an issue for a community-based intervention?
A) Special interest groups
B) Client's concern
C) State health department
D) Local community priorities
Ans: B
Feedback:
A client's concern may be the initial spark that leads the nurse to identify a need, but this
would be most restrictive source of information and thus would be limited in scope. Therefore,
when determining the feasibility of a community-based intervention, several methods can be
used to determine the importance of the issue including federal agencies, special interest groups,
state health departments, and local community priorities. These sources would provide
information about whether or not a problem has affected a sufficient percent of the population to
warrant intervention.
2. A community health nurse is attempting to identify a target group for a program using
geographic information system (GIS). Which type of information would the nurse be able to
obtain?
A) Family status
B) Past interventions used
C) Previous health problems
D) Areas needing more study
Ans: A
Feedback:
GIS information includes information about race, age, and family status. Information
about past interventions used or previous health problems can be obtained from talking with
other nurses and health professionals.
Areas needing more study can be obtained from the Guide to Community Preventive Services:
Systematic Reviews and evidence- based recommendations, a federally sponsored initiative that
provides recommendations about population-based
interventions.

3. A community health nurse has just moved to your community. Which might be good
ways for this community health nurse to identify group and community health problems?
A) Interview health professionals in the agency
and other agencies to determine the needs
B) Read about it in a national magazine
C) Refer to the geographic information system
(GIS) data for the community
D) It is not necessary for the community health nurse to do so. It is best for the community
health nurse to just pitch in and work to solve
the problems of the community.
Ans: A, C
Feedback:
Interviewing health professionals in the area about the problems, what should be done,
and what has been tried in the past and their input on why past interventions failed. Referring to
the geographic information system (GIS) data for the community can look at groups of people by
race, age, and family status.
Reading about it in a national magazine is too broad of an approach as factors that affect the
nation may or may not reflect what is happening in your community. It is critical for the
community health nurse to identify group and community health problems in order to effectively
influence the health of the
community.
4. Which of the following change strategies would be most effective in maximizing the
cooperation of the target population? Select
all that apply.
A) Use only one strategy that the nurse is most
familiar with
B) Knowing that as a nurse, the nurse knows more about the health topic than their
audience
C) Employ multiple strategies to promote health, prevent disease, and ensure a safe
environment for populations
D) Learning about the target population's beliefs
regarding the health topic
E) Focusing on health promotion and not disease
prevention
Ans: C, D
Feedback:

Standard 5B of the Public Health Nursing: Scope and Standards of Practice calls on the
public health nurse to “employ multiple strategies to promote health, prevent disease, and ensure
a safe environment for populations.” It is not enough for the nurse to use only one strategy that
the nurse is most familiar with. Interventions that fail to engage the target population by learning
about the target population's beliefs will be unsuccessful because clients hold just as strongly to
their belief systems as the nurse does. It is important for the nurse to focus on
health promotion and disease prevention and ensure a safe environment for populations.
5. A community health nurse has identified the target population and is determining an
appropriate intervention. Which of the following would be most important for the
nurse to do next?
A) Develop an intervention based on the nurse's
previous experiences
B) Review the literature for research on
previously attempted interventions
C) Access the National Center for Health
Statistics Web site for data
D) Learn about the target population's beliefs and
ideas
Ans: D
Feedback:
Nurses may think that they know more about a topic, and therefore, their solutions are
better than the target population's solutions. However, if nurses don't learn about the target
population's beliefs and only consider their own, they will not be able to work out a solution with
the target population that is acceptable and appropriate for them. Thus, the interventions will
most likely be unsuccessful. Although reviewing the literature for research would be helpful on
identifying possible strategies, the nurse needs input from the target population.
Accessing the NCHS Web site would provide information about whether a problem has affected
a sufficient percent of the population to warrant intervention. It would not be helpful in
determining an appropriate intervention.
6. In an effort to ensure success of a proposed community intervention program, the

community health nurse would include which
of the following?
A) Formal leaders
B) Advisory group
C) Target population

D) Local knowledge
Ans: B
Feedback:
A key factor for ensuring the success of any intervention is to appoint an advisory group
that includes representatives from the target and service communities. Formal leaders are
important in obtaining information about the possible target population. The target population is
important in making sure that the planned intervention is appropriate.
However, it does not ensure that the intervention will be successful. Local knowledge provides
information about possible environmental and social factors influencing the problem. However,
it also does not help to ensure the success of the
planned intervention.
7. Which of the following interventions targeting health problems is most likely to be

effective?
A) Teaching about prenatal care to a group of
men in a men's homeless shelter
B) Teaching about prenatal care in a home for
unwed mothers
C) Teaching about prenatal care to a group of
cub scouts
D) Teaching about prenatal care to a group of
senior citizens
Ans: B
Feedback:
It is crucial to analyze the extent to which individuals and families are affected by the
problem. It would be a waste of resources to provide teaching about prenatal care to any of the
listed groups except the home for unwed
mothers.
8. In order to evaluate a health program, which

of the following should the community health nurse focus on when planning the program?
A) Measurement of goal attainment
B) Creation of objectives that are specific,
measurable, attainable, relevant, and timely.
C) Patient satisfaction
D) Measurement of consistency with standards
Ans: B
Feedback:

When planning a health program, the community health nurse should focus on the
creation of objectives that are specific, measurable, attainable, relevant, and timely (acronym
SMART). The other options describe what must be measured in the
evaluation of the health program.
9. A review of factors influencing a population's behavior related to childhood obesity

reveals several reinforcing factors. Which of the following would the community health nurse
identify?
A) Children's belief that they like to be similar to
other children of the same age
B) Children's view of themselves as becoming
independent from adults
C) Offering of incentives to students' modeling
positive food choices
D) Proposed monitoring of children's behavioral
changes by the local PTA
Ans: C
Feedback:
Reinforcing factors include the knowledge, values, beliefs, and attitudes of the family and
friends of the target population. It also includes authority figures such as teachers or managers,
as well as agency and community decision makers, as these individuals also influence the target
population. In this case, it would be the offering of incentives to student's modeling positive food
choices. The children's belief in being similar to others and view as becoming independent are
examples of predisposing factors. Proposed monitoring
would be an example of enabling factors.
10. Which of these behaviors is most likely

changeable?
A) Smoking cessation among a group of people
who have smoked for 20 or more years
B) Smoking cessation at a work place where
smoking is common and deeply imbedded
C) Smoking cessation in a school for students
who have only recently started smoking
D) Smoking cessation in a public environment

where cigarettes are openly sold and persons are allowed to smoke
Ans: C
Feedback:
The behaviors that are easiest to change include those that are still in the developmental
stage and have only recently been established (as would students who have only recently started
smoking and not among a group of people who have each smoked for 20 or more years or at a

work place where smoking is common); are not deeply imbedded in cultural patterns or lifestyle
(not in a workplace where smoking is deeply imbedded nor in a public environment where
cigarettes are openly sold and persons are
allowed to smoke).
11. The community health nurse is identifying factors that would influence behavior change.
identify as enabling factors?
A) Attitudes of the target population
B) Knowledge of the family of the target
population
C) Availability of resources
D) Values of the authority figures
Ans: C
Feedback:
Enabling factors include the availability of resources, the accessibility of resources, laws,
and government support for the health behaviors or for the health program, as well as skills.
Predisposing factors include the knowledge, beliefs, values, attitudes, and confidence of the
target population that influence their behavioral choices.
Reinforcing factors include the knowledge, values, beliefs, and attitudes of the family and friends
of the target population. It also includes authority figures such as teachers or managers, as well
as agency and community decision makers, as these individuals also influence the target
population. These factors must be addressed as they can interfere with successful behavioral
change and create
barriers to behavioral change.
12. When the community health nurse is examining barriers to successful behavioral change,
the nurse identifies that there are no laws in the community that prohibit smoking in public areas,
which leads to increased smoking and increased risks to health related to secondhand smoke. The
nurse believes that a possible solution is to advocate for a citywide bans on smoking in public
locations. Which type of factor is affecting the behavior
in the community?
A) Enabling factors
B) Predisposing factors
C) Reinforcing factors
D) Unrelated factors

Ans: A
Feedback:
Enabling factors include the availability of resources, the accessibility of resources, laws,
and government support for the health behaviors or for the health program, as well as skills.
Predisposing factors include the knowledge, beliefs, values, attitudes, and confidence of the
target population that influence their behavioral choices.
Reinforcing factors include the knowledge, values, beliefs, and attitudes of the family and friends
of the target population. These factors must be addressed as they can interfere with successful
behavioral change and create
barriers to behavioral change.
13. Several quality management models are helpful in measuring and improving the quality
of care. They are designed differently but are developed to enhance care giving.
Which of the following uniquely places the
client within the model?
A) Quality Health Outcomes model
B) Donabedian model
C) Omaha System model
D) QSEN project
Ans: A
Feedback:
The Quality Health Outcomes model includes the client in the model and proposes a two-
dimensional relationship among components. The Donabedian model consists of three
components: environment structure, processes, and outcomes. The Omaha System model
addresses process indicators, client outcome measures, and satisfaction with care. The QSEN
project was spurned by the IOM report To Err is Human and focuses on the knowledge skills and
attitudes for competencies that include patient-centered care, teamwork and collaboration,
evidence- based practice, quality improvement, safety
and informatics.
14. A community health nurse is assisting with the evaluation of outcomes of a program. The
client's response to care is being measured quantitatively. The nurse identifies this as
A) Benchmarking
B) Quality indicators
C) Process
D) Structure
Ans: B

Feedback:
Quality indicators are quantitative measures of a client's response to care. Benchmarking
uses continuous, collaborative, and systematic processes for measuring and examining internal
programs' strengths and weaknesses and includes studying another's processes in order to
improve one's own. Process refers to activities and behaviors used to improve or maintain the
client's status. Structure refers to the care environment, such as client mix,
philosophy, facility, and staff.
15. When participating in quality improvement activities, a community health nurse would be
least likely to engage in which of the
following?
A) Daily prioritizing of care needs for a caseload
of clients
B) Completing necessary documentation
efficiently
C) Seeking supervision for a difficult client case
D) Reviewing organizational personnel
Ans: D
Feedback:
Nursing administration would be responsible for developing a formalized quality

management program that would include a review organizational structure, personnel, and
environment. Quality improvement activities for community health nurses include daily
prioritizing of care needs for a caseload of clients, seeking supervision or skills development for
a difficult case, and systematizing charting so that needed
documentation is efficiently completed.
16. A community health nurse is engaged in the

process aspect of quality management when the nurse does which of the following?
A) Contribute to the revision of standards
B) Ensure an adequate amount of resources
C) Determine additional sources of funding
D) Review services provided for client needs
Ans: A
Feedback:
As part of the process aspect of quality management, staff is encouraged to contribute to
evaluation of the standards and revise them as needed. Adequate resources and funding are
components of the structure aspect.
Reviewing services provided is a component
of the outcome aspect.

17. After teaching a group of students about the various models used in program evaluation,
the instructor determines that the students have understood the teaching when they state which of
the following as the model most
basic?
A) Quality Health Outcomes model
B) Donabedian model
C) Quality and Safety Education for Nurses
D) Omaha System model
Ans: B
Feedback:
The Donabedian model is recognized as a simplistic and basic method of measuring

quality that has been used widely over the past 35 years. The Quality Health Outcomes model
takes the Donabedian model a step further by including the client in the model. The QSEN
project was spurned by the IOM report To Err is Human and focuses on the knowledge skills and
attitudes for competencies that include patient-centered care, teamwork and collaboration,
evidence- based practice, quality improvement, safety and informatics. The Omaha System
model
focuses on process indicators, client outcome measures, and satisfaction with care.
18. A community health nurse who is part of a committee that is deciding on which model to
use for program evaluation reviews the Omaha System model. The nurse needs additional review
of this model after identifying which of the following as an
aspect for rating outcomes?
A) Client knowledge
B) Client behavior
C) Client status
D) Client ownership of problem
Ans: D
Feedback:
Ownership of the problem is component of the community, the group that shares a
physical environment and ownership of a health-related problem. Knowledge, behavior, and
status are how outcomes are rated in this
model.

19. A community health nurse is participating in an agency program evaluation using the
Quality Practice Settings Attributes model. The nurse is assisting with evaluation of the
professional system. Which of the following
would the nurse need to address?
A) Communication with clients

B) Staffing ratios
C) Safety of practice
D) Continuing education
Ans: D
Feedback:
Using the Quality Practice Settings Attributes model, evaluation of the professional
system would address hiring, orientation, training, and continuing education. Communication
with clients, families, and professionals are areas evaluated in the communication system.
Staffing ratios are addressed in the care delivery process. Collaboration is addressed
with the leadership element.
20. One community health agency has developed a clinical pathway that has proved useful
with clients with heart failure. After review, another community health agency providing care to
similar clients decides to implement that pathway. This reflects which of the
following?
A) Structure
B) Process
C) Outcomes
D) Benchmarking
Ans: D
Feedback:
Benchmarking uses continuous, collaborative, and systematic processes for measuring
and examining internal programs' strengths and weaknesses and includes studying another's
processes in order to improve one's own. The example reflects external benchmarking which
occurs between similar agencies providing like services. Structure is reflected in the agency's
organization, facility, personnel, and philosophy. Process reflects the standards, attitudes, and
activities.
Outcomes reflect the expected results, goals,
efficiency, and satisfaction.

21. A group of students are reviewing material in preparation for test on program evaluation
models. The students demonstrate understanding of the material when they identify which model
as dynamic with interventions always acting through the
system and client?
A) Donabedian model
B) QSEN project
C) Quality Health Outcomes model
D) Quality Practice Setting Attributes model
Ans: C
Feedback:
The Quality Health Outcomes model includes the client in the model and proposes a two-
dimensional relationship among components. Interventions always act through the system and
the client, creating a dynamic model. The Donabedian model is recognized as a simplistic and
basic method of measuring quality. Structure, process, and outcome can be depicted in a box-
shaped model. The QSEN (Quality and Safety Education in Nursing) project was spurned by the
IOM report To Err is Human and focuses on the knowledge skills and attitudes for competencies
that include patient-centered care, teamwork and collaboration, evidence- based practice, quality
improvement, safety and informatics. The Quality Practice Setting Attributes model is used as a
tool to assist in ensuring the quality of nursing practice and the nursing profession by promoting
continuing competence.
22. When devising a social marketing strategy for a community health issue, which of the
following concepts is being integrated when the selection of one option inherently requires
giving up on another option?
A) Self-interest
B) Competition
C) Consumer orientation
D) Exchange
Ans: B
Feedback:
The concept of competition is being integrated by selecting one option that inherently
involves the giving up of another option. Self-interest is demonstrated when people act in their
own interests. Consumer orientation is reflected in the problem-solving process directed at the
target. Exchange is demonstrated when an individual gives
something to get something.

23. A community health nurse is seeking seed money to set up a health promotion program
for pregnant adolescents. The nurse would
seek which type of grant?
A) Planning
B) Start-up
C) Management
D) Facility
Ans: B
Feedback:
The type of grant would be a start-up grant, for example, seed money. Other types of
grants include planning grants (i.e., initial project development), management or technical
assistance grants (e.g., for fund raising or marketing), and facilities or equipment grants (e.g.,
money for a building,
computer, or van).
24. When composing a letter of inquiry, which of the following would a community health
nurse include?
A) Names and academic credentials of all the personnel who will be involved in
implementing the program
B) An extensive literature review of the evidence
that supports the planned interventions
C) Other funding sources for the project or

program (prospective and committed)
D) Lengthy description of the organization
Ans: C
Feedback:
The letter of inquiry is normally only two to three pages in length and includes a concise
overview of the project. For example, it would likely include an overview of the organization
and its purpose, the reason for the funding request, clearly stated need or problem to be
addressed, overview of the proposed project or program, and other funding sources for your
project or program (prospective and committed). The letter is brief, yet clearly lays out your
plan. Names and academic credentials of all the personnel who will be involved in implementing
the program, an extensive literature review of the evidence that supports the planned
interventions, and a lengthy description of the organization would make the letter of inquiry
unnecessarily long when it should be concise.

25. As the community health nurse engages in the process of seeking grant funding, the nurse
ensures that the appropriate steps are followed. Place the following in their proper sequence.
A) Contact funders
B) Acquire proposal guidelines
C) Define the project
D) Identify the proper funding source
E) Be aware of submission deadline
Ans: C, D, A, B, E
Feedback:
When seeking grant funding, define the project, identify the right funding sources,
contact the funders (think of the funder as a resource), acquire proposal guidelines, and
know the submission deadline.
Chapter 13 Policy Making and Advocacy
1. When developing a teaching plan for a class that describes health policy, which of the
following would the instructor include as an
example of a regulatory health policy?
A) Licensure of health professionals
B) Federal subsidies for nursing education
C) Benefits for needy groups
D) Allocating resources among groups
Ans: A
Feedback:
Regulatory health policy regulates or licenses services or people providing services in the
community. Distributive health policy subsidizes nursing education, benefits the needy, and
allocates resources among and
between groups.
2. Which of the following is an example of a

distributive health policy?
A) Reporting of communicable disease
B) Federal funds for nursing education
C) Medicare
D) Arms control agreement
Ans: B
Feedback:
Distributive health policy promotes nongovernmental activities that are thought to be
beneficial to society as a whole. An example of a distributive policy is the Nurse Training Act,
Title VIII of the Public Health Service Act, which was established in 1965 and provided federal
subsidies for nursing education in an effort to address the need for a more nurses. Reporting of
communicable diseases and arms control agreement are examples of regulatory health policy at
the national and international levels respectively.
Medicare is an example of a redistributive health policy.

3. Which of the following effects of a health system in disarray have the most direct
influence for a public health nurse at this
present time?
A) The United States is often touted as having
the best health care system in the world.
B) Fewer jobs for nurses
C) Crisis in public health related to underfunding and underappreciation of the core

functions of public health leading to substantial reduction
in public health programs
D) Changes in the Medicare payment system
Ans: C
Feedback:
Currently, there is serious underfunding and underappreciation of the core functions of
public health, which has led to massive layoffs of staff and substantial reduction in public health
programs. The United States is often touted as having the best health care system in the world.
However, this may be in question related to the expense of our current health problems and the
lack of benefit to the health of all Americans. There is currently a serious nursing shortage that is
projected to only get worse in the coming decades. There are changes in the Medicare payment
system and this does affect health care in general but most public health programs do not receive
Medicare support.
4. Community health nurses are attending an in- service program about health policy.
Which of the following would the nurses expect to be
included in the description?
A) Reflection of a community's values
B) Creation for several influential people
C) Development by those outside of the
community
D) Indication of needs of the community's poor
Ans: A
Feedback:
Health policy should reflect a community's values and should not only be created for
certain groups such as the influential or the poor. It needs to come from the people within
the community and be for all of them.

5. A group of community health nurses are discussing health care policy in the United
States. Which of the following reflects the
consensus view?
A) Market forces should solve the problem.
B) The government should assume responsibility.
C) Health care policy needs to change.
D) Health care policy is flawed but adequate.
Ans: C
Feedback:
Most people agree that health care policy in the United States must change, but there is
little agreement among policy makers and citizens about how this should occur. Some believe
market forces should be allowed to work this problem out; others believe the government should
assume responsibility. Health care policy is not viewed as being
adequate.
6. When describing public health nursing to a group of community health nurses, which of
the following would be identified as its
foundation?
A) Social marketing
B) Social justice
C) Social disparities
D) Advocacy
Ans: B
Feedback:
The concept of social justice is seen as the very foundation of public health nursing.
Social marketing is the means to influence behavior of target populations for program
development. Addressing social disparities or inequalities are one component of public health
nursing. Advocacy involves pleading the case of another and pursuing influencing
outcomes.

special interest groups and policy making are true? Select all that apply.
A) Others will be persuaded by facts alone.
B) Power is wielded by special interest groups,
business, and industry.
C) Nurses need to provide input to policy circles
through advocacy.
D) Nurses need to provide leadership at decision-
making tables.

E) There are power struggles behind all

legislation and health care regulation.
Ans: B, C, D, E
Feedback:
Nurses need to provide input to policy circles through advocacy and leadership at
decision- making tables. It is naïve to believe that others will be persuaded by facts alone.
Power is wielded by special interest groups, business, and industry. There are power struggles
behind all legislation and health care
regulation.
8. The community health nurse is reviewing how managed care today has changed from its
initial proposal. Which of the following would the nurse identify as an important
change?
A) Current emphasis on cost containment
B) Focus on choosing a practitioner
C) Expansion in types of care provided
D) Increase in nonprofit agencies
Ans: A
Feedback:
Managed care has evolved and the emphasis has shifted from prevention to cost
containment. Reductions in reimbursement particularly for disadvantaged patients (e.g., those
covered under Medicaid and Medicare), reductions in the choice of practitioners, and limitations
on the types of care available transformed this system as originally envisioned. Most managed
care today is for profit, setting up a dichotomy between the
insured and the owners/investors.
9. Which of the following statements about professional organizations and public policy
is the most accurate?
A) Professional organizations increase

polarization and cause a group to be more united and strong.
B) Professional organizations encourage
selfishness and self-interest.
C) Professional organizations focus solely on
“protecting their turf.”
D) A united voice on public policy is more powerful than individuals pleading with
legislators.

Ans: D
Feedback:
A united voice on public policy is more powerful than individuals pleading with
legislators. The other statements about professional organizations are not true. They do not
increase polarization and if they did, it would not cause the group to be more united and strong.
Professional organizations do not increase selfishness and self-interest, and professional nursing
organizations do not
focus solely on “protecting their turf.”
10. Which of the following statements reflect progress in public policy that can be attributed
to professional nursing organizations? Select
all that apply.
A) Professional nursing organizations have
elevated nursing professionalism.
B) Professional nursing organizations have given voice to the inequalities that affect our
society.
C) Professional nursing organizations have

developed the paradigms that influence and affect public health.
D) Nursing is regarded as a major player in

Washington when discussing health care policy.
E) Professional nursing organizations have a

long and consistent relationship with public policy.
Ans: A, B, C
Feedback:
Professional nursing organizations have elevated nursing professionalism, have given
voice to the inequalities that affect our society, and have developed the paradigms that influence
and affect public health.
Despite nursing's early history of political activism and the fact that nurses are the largest group
of health care providers in the United States, widespread political
involvement has yet to be fully realized.
11. Which is the best way for any nurse to

advocate for change and exert power?
A) Pursuing an advanced degree
B) Running for state congressional seat
C) Actively participating in a professional
nursing organization
D) Becoming a member of a local not-for-profit
agency board of directors

Ans: C
Feedback:
A major way in which nurses have been successful with advocacy is through membership
in their professional organization. Influencing policy may be achieved by obtaining advanced
education, which would be helpful in pursuing higher level positions, and political office
whether at the local or state level. Influencing policy is
not the same as advocating.
12. After a class on nursing and political activism, which statement by the nursing student
would indicate that the teaching was
successful?
A) “Nurses have just now become increasingly
active in the political arena.”
B) “Nurses are the smallest group of providers
with the largest voice.”
C) “Nurses are considered major political players
in Washington.”
D) “The ANA provides nurses with a collective
political voice.”
Ans: D
Feedback:
A professional nursing association such as the ANA builds a collective voice for nurses.
Despite nursing's early history of political activism and the fact that nurses are the largest group
of health care providers in the United States, widespread political involvement has yet to be
realized. Nursing also is not thought of as a major player in Washington when discussing health
care
policy.

power and empowerment are true accurate? Select all that apply.
A) Power is the ability to act or produce an effect and possess control, authority, or influence
over others.
B) Empowerment is a process of assisting communities to come together to express their

values and ideas to those outside the
community.

C) If power is the ability to control, predict, and participate in one's environment, then
empowerment is the process whereby individuals and communities take power and
transform their lives.
D) All of the power belongs to the legislators.
E) Nurses have a responsibility to ensure community participation in issues affecting them,

and they must continually examine the relationship and position they hold within
these communities.
Ans: A, B, C, E
Feedback:
Power is the ability to act or produce an effect and possess control, authority, or influence
over others. Empowerment is a process of assisting communities to come together to express
their values and ideas to those outside the community. If power is the ability to control, predict,
and participate in one's environment, then empowerment is the process whereby individuals and
communities take power and transform their lives.
Professionals hold the power and authority by virtue of their place in the bureaucracy.
Nurses have a responsibility to ensure community participation in issues affecting them, and they
must continually examine the relationship and position they hold within
these communities.
14. A community health nurse integrates understanding of power and empowerment when
working with clients by demonstrating
A) Partnership with clients
B) Hierarchical relationship
C) Authority over clients
D) Client autonomy
Ans: A
Feedback:
The various definitions of empowerment and the expansion of the definition of health,
which now includes the social, political, and economic determinants of health, have changed our
thinking on how best to interact with the communities we serve. This also suggests a change in
the relationship between professionals and communities; a change from the customary
hierarchical patient/
provider relationship to one of a partnership.

15. How can nursing fulfill the potential to transform nursing and take the power to influence
policy development? Select all that
apply.
A) Practicing to the full extent of their education
and training
B) Achieving higher levels of education and training through an improved education system
that promotes seamless academic
progression
C) Act as full partners, with physicians and other health professionals, in redesigning health
care in the United States
D) Improve data collection and an improved information infrastructure to ultimately

influence effective workplace planning and
policy making
E) Most nurses are already involved in the
regulatory framework development.
Ans: A, B, C, D
Feedback:
The four key messages from The Future of Nursing: Leading Change, Advancing Health
include the following:
1. Nurses should practice to the full extent of their education and training.
2. Nurses should achieve higher levels of education and training through an improved
education system that promotes seamless academic progression.
3. Nurses should be full partners, with physicians and other health professionals, in
redesigning health care in the United States.
4. Effective workforce planning and policy making require better data collection and an
improved information infrastructure.
It is not yet true that most nurses are already involved in the regulatory framework
development.
16. Organize the following stages in the policy process in the order they should be
considered.
A) Policy Adoption
B) Policy Evaluation
C) Policy Formulation
D) Policy Implementation
Ans: C, A, D, B
Feedback:

The order of the stages in the policy process is formulation, adoption, implementation,
and
evaluation.
17. Which stage in the policy process is exemplified by the activities of identifying the health
problem and/or using a goal-oriented
approach?
A) Policy adoption
B) Policy evaluation
C) Policy formulation
D) Policy implementation
Ans: C
Feedback:
Policy formulation involves identifying goals, problems, and potential solutions. Policy
adoption involves the authorized selection and specification of means to achieve goals, resolve
problems, or both. Policy implementation follows adoption and occurs when the policy is put to
use. Policy evaluation compares policy outcomes or
effects with the intended or desired effects.
18. When involved in the policy process, the community health nurse must keep in mind that
which of the following should be the
strongest influence?
A) Social conditions
B) Political conditions
C) Public need
D) Health planning
Ans: C
Feedback:
The social and political conditions that affect policy formulation are limitless, but public
need and public demand should be the strongest influences. Health planning may be
an approach to policy formulation.
19. A community health nurse identifies a problem of increased infant mortality with
adolescent pregnancies. The nurse decides to address this problem with a health policy. The
nurse is engaging in which stage of the policy

process?
A) Formulation
B) Adoption
C) Implementation
D) Evaluation
Ans: A
Feedback:
Health policy formulation is the stage at which a policy is conceptualized and ultimately
defined. Policy adoption involves the authorized selection and specification of means to achieve
goals, resolve problems, or both. Implementation follows adoption and occurs when the policy is
put to use. Policy evaluation means comparing policy outcomes
or effects with the intended or desired effects.
20. A community health nurse is involved in assessing the community's capacity to define
strategies to enhance compliance with a policy. The nurse is working in which stage of
the policy process?
A) Formulation
B) Adoption
C) Implementation
D) Evaluation
Ans: C
Feedback:
Implementation of health policy occurs when an individual, group, or community puts the
policy into use. It involves overt behavior changes as the policy is put into nursing practice. As
an implementer, the community health nurse assesses the capacity of the community to formulate
and define strategies that will enhance the community's compliance with the policy. Health
policy formulation is the stage at which a policy is conceptualized and ultimately defined. Policy
adoption involves the authorized selection and specification of means to achieve goals, resolve
problems, or both. Policy evaluation means comparing policy outcomes or effects
with the intended or desired effects.
21. When engaging in the policy process, which of the following would the community
health
nurse do last?
A) Define the problem
B) Gather information
C) Look for alternatives

D) Choose the approach

Ans: D
Feedback:
Policy analysis involves the following sequential steps: define the problem, information
gathering, looking for alternatives to the approach, and choose the most
appropriate approach.
22. When analyzing health policy, which question would be most important for the
community
health nurse to ask?
A) “How much does it cost?”
B) “What is the result?”
C) “Why is it in place?”
D) “Who benefits from it?”
Ans: D
Feedback:
When analyzing policy, nurses need to answer two general questions: Who benefits from
this policy? and who loses from this policy?
Whether the policy should be advocated by the community as a whole depends on the degree to
which the policy benefits the community without being detrimental to individuals or the country.
Cost, results, and reasons why are not key elements to address
in policy analysis.
23. Which of the following statements about advocacy and lobbying and the influence of
both on policy are true? Select all that apply.
A) Advocacy can be defined as pleading the case
of another or championing a cause.
B) Lobbying is the act of influencing legislators.
C) Nurses can gain access to legislators individually or through the services of a

professional lobbyist or PAC.
D) Policy and politics are not related to each
other.
E) Public policy is a rational process.

Ans: A, B, C
Feedback:
Advocacy can be defined as pleading the case of another or championing a cause.
Lobbying is the act of influencing legislators. Nurses can gain access to legislators individually

or through the services of a professional lobbyist or PAC. Policy and politics go hand in hand;
neither exists without the other. Public policy
is not a rational process.
24. Which of the following would be important for a politically involved nurse to do? Select
all that apply.
A) Communicate ideas effectively
B) Get to know local representatives
C) Avoid involvement with community boards
D) Be firm and unyielding in approach
E) Stay current about health care issues
Ans: A, B, E
Feedback:
The politically involved nurse should aim to accomplish three primary goals: (1) generate
support for one's views by communicating ideas effectively and getting to know and influence
representatives at local, state, and national levels; (2) create professional legitimacy by keeping
abreast of current issues in health care and nursing and becoming involved in professional
nursing organizations, community boards or committees, or political office at the local, state or
national level; and (3) resolve conflict
and effectively negotiate and compromise.
Chapter 14 Family as Client

1. Which of the following would be most appropriate for the community health nurse to do
first when planning an initial home visit to
a family?
A) Obtain the basic supplies that will be needed
B) Gather appropriate educational materials
C) Contact the family via telephone
D) Review the referral information
Ans: D
Feedback:
The first step is to obtain the referral and review it to gather information about the
possible needs of the family and the reason for the visit. Once this is done, then the nurse would
obtain the basic supplies and education materials that might be needed and contact the
family to arrange the visit.
2. When planning for a home visit, which of the following would be most helpful to ensure
a
successful home visit?

A) Documentation in a timely manner

B) Summarizing the main visit points
C) Providing incidental teaching
D) Scheduling an appropriate visit time
Ans: D
Feedback:
As part of planning the community health nurse would contact the family to set up an
appropriate time for the visit. Documenting in a timely manner ensures successful evaluation.
Providing incidental teaching and summarizing the main visit points help to
ensure successful implementation.
3. A community health nurse arrives at a family's home. Which of the following would
behaviors by the nurse would be
nontherapeutic?
A) Maintaining eye contact with the family
members
B) Paging through paperwork for information
C) Sitting on the furniture near the family

members
D) Placing car keys in the nurse's carryall bag
Ans: B
Feedback:
Community health nurses, like all nurses, need to be aware of their own body language.
Fidgeting with car keys during the entire visit, noisily chewing gum, giving minimal eye contact,
continuously looking at or paging through paperwork, appearing rushed, and refusing to sit on
any of the furniture are behaviors that tell the family a great deal about the nurse, including how
he or she feels about being in their home. These actions are nontherapeutic. Sitting on the
furniture near family members demonstrates interest in the family. Placing car keys in the
carryall bags
prevents inadvertent distractions.
4. A community health nurse is about to make the first home visit to a family based on a
referral from the hospital where the high-risk infant was born to an adolescent mother about 6
days ago. The nurse plans to assess the family and home environment and provide anticipatory

guidance. On arrival, the mother sleepily answers the door after the nurse rings the bell and
knocks several times. The mother lets the nurse in but is not happy to see the nurse. She gets the
infant and places him in the nurse's arms, then sits across the room and
turns on the TV. Which response by the nurse would be most appropriate?
A) “You must be very tired caring for a newborn
baby.”
B) “I wasn't planning to hold the baby. You
should hold him, you are the mother.”
C) “I need to talk to you, so please turn off the
TV.”
D) “How do you feel being a mother at 17?”
Ans: A
Feedback:
It is always best to acknowledge a client's feelings, and from the scenario, observations
and referral information, being fatigued 6 days after having a baby is very possible. The option
about holding the baby is not the best way to respond to the mother or the first comment to make,
but holding the baby gives the nurse an opportunity to role model infant interaction and caring
and assess his or her cleanliness and clothing appropriateness.
However, the nurse may want to say that he or she would like to wash his or her hands before
holding the baby. This gives the nurse an additional opportunity to teach and assess another room
when washing hands. Asking to turn off the TV might be appropriate after a few moments of
introductory conversation. It would be best to ask the mother to turn the TV down because of
difficulty hearing her.
The nurse will win the mother's favor with this approach better than by asking her to turn off the
TV. Asking how she feels being a mother at 17 might be information to gather, but asking it
directly as a first comment sounds like a put-down. There are better ways to obtain this
information a bit later in the
visit.
5. While making a family health visit, an older relative who is visiting has been drinking
and becomes verbally abusive and increasingly loud. Which action by the community health
nurse would be best?
A) Continue the visit with caution
B) Suggest the relative go in another room and
take a nap
C) Ask the sober family members to take the
visitor home
D) Terminate the visit, making plans for another
visit
Ans: D
Feedback:

Terminating the visit is the best choice. It appears the problem is escalating, and the
nurse's safety should always come first.
Continuing the visit puts the nurse and possibly the other family members at risk. Making a
suggestion to go into another room and take a nap may agitate the relative and make a
deteriorating situation worse. Making a suggestion for a family member to take the visitor home
may agitate the relative and make a deteriorating situation worse.
Additionally, this is the client's home and the
suggestion should be the client's.
6. Which of the following things does a nurse

who is traveling by automobile to make a home visit need? Select all that apply.
A) A full gas tank and well-operating vehicle
B) A map that includes the geographic location
where the home visit will be made
C) A cellular telephone
D) A bus schedule
E) Exact change
Ans: A, B, C
Feedback:
A nurse who is traveling by automobile to make a home visit needs the following: a full
gas tank and well-operating vehicle, a map that includes the geographic location where the home
visit will be made, and a cellular telephone. If the nurse is not using public transportation, the
nurse does not need exact
change for each bus trip or a bus schedule.
7. Which of the following are specific safety measures the nurse should apply when
making a home visit? Select all that apply.
A) Plan to reschedule the visit if you find a large group of people assembled between you
and
the client's door.
B) Immediately leave the home when family members begin to physically fight with one
another.
C) Enter the residence before you determine that the family you are intending to visit does
live
there and is home.

D) Travel only in pairs for all home visits.
E) If someone approaches you and indicates that they want your nursing bag, throw your
bag away from where you are and run in the
opposite direction.
F) Leave an itinerary of your planned travels, the telephone numbers of families you will
attempt to visit and your cellular phone
number at your base of operation.
Ans: A, B, E, F
Feedback:
It is most important to leave an itinerary of your planned travels, the telephone numbers
of families you will attempt to visit, and your cellular phone number at your base of operation.
Specific safety measures the nurse should apply when making a home visit include planning to
reschedule the visit if you find a large group of people assembled between you and the client's
door; immediately leaving the home when family members begin to physically fight with one
another; and if someone approaches you and indicates that they want your nursing bag, throw
your bag away from where you are and run in the opposite direction. It is not appropriate for the
nurse to enter the residence before determining that the family that is to be visited does live there
and is home. It is not necessary to travel only in pairs for all home visits.
8. Which one of the following has a negative influence on family health and individual
health?
A) The level at which a family functions significantly affects the individual's level of
health.
B) A healthy family fosters individual growth
and sustains members during times of crisis.
C) Family patterns dictate whether members
participate in their own health care.
D) Individuals can obstruct the family's health

and families can obstruct individual family members' health.
Ans: D
Feedback:
A negative influence on family health and individual health is that individuals can
obstruct the family's health and families can obstruct individual family members' health. The
level at which a family functions significantly affects the individual's level of health; that a
healthy family fosters individual growth and sustains members during times of crisis; and the
influence of families that dictate whether members participate in their
own health care are all positive influences.

9. When assessing a family, which of the following would lead the nurse to question the
health of a family?
A) Role relationships are inflexible.
B) Coping is actively attempted.
C) Family members communicate regularly.
D) The family lacks regular links with the
broader community.
Ans: D
Feedback:
In a healthy family, role relationships are structured effectively so that they can change
with changing family needs. Active coping, regular family communication, and regular links
with the broader community reflect a
healthy family.
10. community health nurse to take his or her

shopping to purchase some of the food items he or she needs for his or her diet. Which response
by the nurse would be most appropriate?
A) “I can't, I'm going in a totally different
direction.”
B) “You need to find some other way to get to
the store.”
C) “I'll help you find a way to get to the store.”
D) “Use the foods you have in the house and
shop next week.”
Ans: C
Feedback:
The nurse needs to empower the client and helping the client find a way to get to the store
promotes the skill of planning so that the client can begin to manage her own needs effectively.
Telling the client that the nurse is going in a different direction, telling him or her to find some
other way to get to the store, and telling him or her to use the foods in the house are neither
therapeutic nor do they promote empowerment.
11. A community health nurse, visits an 81-year- old newly diagnosed insulin-dependent
diabetic who lives alone. The nurse has visited the family three previous times and is visiting
early in the morning to observe his client's insulin administration technique. The nurse finds the
client depressed over his or her situation one morning. The nurse suggests that together they list
positive points about his or her situation and discuss his or her feelings.

This is an example of which of the following?

A) Strengthening
B) Data collection
C) Goal-directed questioning
D) Measuring family functioning
Ans: A
Feedback:
The nurse is demonstrating a communication technique called strengthening which is

used to assist the family in becoming independent of the nurse's services. Data collection, goal-
directed questioning, and measurement of family function are methods used for
assessment.
12. Which one of the following is a principle that

guides and enhances family nursing practice?
A) The nurse should expect that the family will
be normal and will not change.
B) The nurse should start where the family is at

the present time and not the ideal level of functioning.
C) The nurse should focus on each family
member individually.
D) The nurse should evaluate the family based on
consistency with traditional family patterns.
Ans: B
Feedback:
When working with families, community health nurses begin at the present, not the ideal
level of functioning. This is accomplished after the nurse views the family collectively, not
individually. The nurse should expect that what is normal for one family is not necessarily
normal for another and that families are constantly changing. The nurse should recognize the
validity of family
structure variations.
13. A community health nurse is attempting to empower a family to become independent.

Which of the following would be most
appropriate?
A) Focus attention on the problem areas
B) Do for the family what they cannot
C) Emphasize the family's strengths
D) Reinforce positive traits
Ans: C

Feedback:
To help empower families, the community health nurse needs to emphasize the family's
strengths. It is the nurse's job to recognize the strengths in families and to help families recognize
them as well. Focusing on problem areas portrays a negative view and can undermine the nurse's
efforts. Doing for the family what they cannot fosters dependency. Reinforcing positive traits
may be appropriate if those positive traits are strengths. Not all
positive traits are strengths.
14. A community health nurse is applying an interactional framework to assess a family's

health. Which of the following would the
nurse do?
A) View them in terms of the family's internal
relationships
B) Look at them from a life-cycle perspective
C) Evaluate the members' changing roles and
tasks
D) Assess them as a social system relating to
other social systems
Ans: A
Feedback:
An interactional framework describes the family as a unit of interacting personalities and
emphasizes communication, roles, conflict, coping patterns, and decision-making processes. A
developmental framework studies the family from a life-cycle perspective by examining the
members' changing roles and tasks in each progressive stage. A structural–functional framework
describes the family as a social system relating to other social systems in the
environment.
15. A community health nurse constructs an eco-

map for a family based on the understanding that this tool is useful for which reason?
A) Family relationships over three or more

generations are depicted.
B) The ecological system of a family's
neighborhood is charted.
C) It was originally devised to depict the
complexity of the client's story.
D) Directions for gathering data about
neighborhoods are provided.
Ans: C

Feedback:
An eco-map depicts the complexity of the client's story. Lines are drawn to indicate
connections to other systems with arrows signifying the direction of energy or flow of resources,
and the absence of lines indicates a lack of connections. The family's neighborhood is one
component, but not the central focus of the eco-map. A genogram displays family information
about complex family patterns such as family relationships over three or more generations,
arrows signify the direction of energy or flow of resources, and absence of lines indicates a lack
of
connections.
16. A community health nurse is collecting data about the family's demographics. Which of
the following would the nurse include? Select
all that apply.
A) Dietary patterns
B) Housing
C) Climate
D) Socioeconomic status
E) Education of members
F) Ethnicity
Ans: D, E, F
Feedback:
Family demographics refer to such descriptive variables as a family's composition, its

socioeconomic status, and the ages, education, occupation, ethnicity, and religious affiliations of
members. Dietary patterns, housing, and climate are variables assessed
with the physical environment.
17. When a community health nurse is conducting a family assessment on an assigned

family, which of the following
would be most appropriate?
A) Use quantitative data only to maintain and
preserve objectivity
B) Interview one family member to avoid
confusion and repeated information
C) Use a checklist format, completing the tool in
the family's presence
D) Make several visits and accumulate data from
all family members
Ans: D
Feedback:

Completing a family assessment takes time. It is better to keep notes from several visits
with the family and observe the family as a group during some family activity. The nurse should
not use obtrusive questionnaire techniques or take notes in the family's presence.
Quantitative data will give a one-sided view of family data. It is best to interview all family
members over time. The nurse should collect both quantitative and qualitative data,
which will provide a rich family assessment.
18. During a home visit and assessment of an infant and new mother, the nurse determines
that the infant looks healthy. The mother asks several questions and listens attentively. One
question she asks is whether the nurse is going to visit her again. Which response
A) “Your baby looks healthy. You should not

have any further questions.”
B) “The agency limits the number of visits I can
make; I will let you know.”
C) “I plan to visit again. What would you like to
accomplish at the next visit.”
D) “I can come weekly for the next 16 weeks,
and then a staff nurse will visit.”
Ans: C
Feedback:
The response about what the client wants to accomplish together represents a mutual
approach, giving power to the client and hints at accomplishing things together on subsequent
visits. Noting that the infant looks good and that the mother should not have further questions is
closed-ended and nurse- focused and does not promote open communication between the client
and the nurse. The option about limiting visits is inaccurate; the nurse has more control over the
number of visits than this response implies, unless the visit is part of a special and very limited
program. Even then it would not be phrased this way. The final option about 16 weekly visits
followed by a staff nurse sounds overwhelming and unrealistic. Very few clients receive this
much service
from public health agencies.
19. A community health nurse determines that it is time for teaching a family about health
promotion activities when they say which of
the following?
A) “Is there a place we can go for the medicine?”
B) “It's time we do something about eating

right.”
C) “When are you coming back to visit?”
D) “Our grandchildren visit every summer.”
Ans: B
Feedback:
Teaching health promotion activities should begin only after family members express an
interest and recognize a need, such as the statement about eating right. Asking about where to get
medicine and when the nurse is coming back do not reflect an interest or need. The statement
about grandchildren reflects information about the family structure and
demographics.

health nurse use when conducting an outcome evaluation?
A) Organization
B) Family progress
C) Timing
D) Performance
Ans: B
Feedback:
Outcome evaluation involves determining the change in the family's health status or
progress. Organization and timing are components of the structure–process evaluation.
Performance is part of self-
evaluation.
21. The nurse educator knows that the nursing student has grasped the concept of self-
evaluation when the nursing student makes
which one of the following statements?
A) It is important for the family to evaluate itself.
B) It is important for the nurse's growth and
effectiveness as a community health nurse.
C) Evaluations by others are not helpful.
D) Individuals can always see their own
strengths or flaws.
Ans: B
Feedback:
Self-evaluation is important for the nurse's growth and effectiveness as a community

health nurse. Self-evaluation is referring to the nurse's growth and not the family's.
Sometimes, we cannot see our own strengths or flaws, and evaluations by others are

helpful.
Chapter 15 Community as Client
1. Which of the following statements about competent communities are accurate? Select
all that apply.
A) A competent community is able to collaborate effectively identifying community needs

and
problems.
B) A competent community is able to achieve a
working consensus on goals and priorities.
C) A competent community is able to agree on

ways and means to implement the agreed- upon goals.
D) A competent community has no problems.
E) A competent community is able to collaborate
effectively to take the required actions.
Ans: A, B, C, E
Feedback:
A competent community is able to collaborate effectively identifying community needs
and problems. A competent community is able to achieve a working consensus on goals and
priorities. A competent community is able to agree on ways and means to implement the agreed-
upon goals. A competent community is able to collaborate effectively to take the required
actions. All communities have
problems.
2. Which of the following are overarching goals

for the health of the nation presented in Healthy People 2020? Select all that apply.
A) To attain high-quality, longer lives free of

preventable disease, disability, injury, and premature death
B) To achieve health equity, eliminate disparities,
and improve the health of all groups
C) To create social and physical environments
that promote good health for all
D) To promote quality of life, healthy development, and healthy behaviors across all
life stages
E) Healthy People 2020 does not address the health of the nation but does address the
health of individuals.
Ans: A, B, C, D
Feedback:
The four overarching goals for the health of the nation are the following:

To attain high-quality, longer lives free of preventable disease, disability, injury, and premature
death
To achieve health equity, eliminate disparities, and improve the health of all groups
To create social and physical environments that promote good health for all
To promote quality of life, healthy development, and healthy behaviors across all
life stages
3. When the nursing student identifies the three dimensions of the health of a community,
the nurse educator is aware that the student has
grasped which of the following concepts?
A) Status/people, structure, and process
B) Assessment, policy development, and
assurance
C) Primary, secondary, and tertiary
D) Function, structure, and process
Ans: A
Feedback:
The three dimensions of the health of the community are status/people, structure, and
process. Assessment, policy development, and assurance are the three core public health
functions. Primary, secondary, and tertiary are the levels of prevention. Function, structure, and
process are the descriptions of Human
Anatomy and Physiology.
4. A community health nurse is working as part of a health planning team to determine the
needs of pregnant teenagers in the community. Which of the following population variables
would be important to
assess? Select all that apply.
A) Rate of growth or decline among those in
need
B) Health needs and practices of subculture
groups
C) Geographic placement of proposed health
services
D) Functions of community organizations
E) Social class of the community
F) Level of agreement on community goals
Ans: A, B, E
Feedback:

Population variables include size, density, composition, rate of growth or decline, cultural
characteristics, social class structure, and mobility. Pregnant teens are a subculture of teenagers.
Cultural differences are population variables along with the numbers, social class, and mobility.
Health needs vary among subculture and ethnic populations.
Geographic placement reflects location. Functions of community organizations and
social class reflect the social system.
5. A community health nurse avoids focusing care on illness and health problems,
considering clients as which of the following?
A) Aggregate
B) Agent
C) Community
D) Total system
Ans: D
Feedback:
It was proposed by Mundinger and Jauron that the use of nursing diagnoses in the
community could be formulated by substituting the terms, client, family, group, or aggregate for
the word patient. Community health nurses look for evidence of all kinds of needs that relate to
or influence a client's levels of wellness. Needs cover the whole span of the health–illness
continuum and the total person, family, group, aggregate, population, or community—the total
system. Not all clients are communities. They may be individuals or families. Not all clients are
in the category of groups, aggregates, or populations. A client can be an individual or a family.
When using the epidemiological triad, there are three components: host, agent, and environment.
A client would be considered the host. An agent is a factor that causes or contributes to a health
problem or condition.
6. When the nursing student identifies the concept of community as client as which of the
following the instructor knows that the
student has grasped this concept?
A) The community is comprised of individual
clients.
B) The community is comprised of families.
C) The community is a group or population of
people as the focus of nursing service.
D) The community cannot be a client. Persons
who are hospitalized are patients.
Ans: C
Feedback:
The concept of community as client refers to a group or population of people as the focus

of nursing service.
7. Which of the following statements about the structural dimension of the community as
client are accurate? Select all that apply.
A) Structure of a community refers to its services
and resources.
B) Community associations, groups, and organizations provide a means for accessing

needed services.
C) Adequacy and appropriateness of health services can be determined by examining

patterns of use, number and types of health
and social services, and quality measures.
D) Demographic data, such as socioeconomic and racial distribution, age, gender, and
educational level, are important indicators of
community structure.
E) Structure is the most common measure of the
health of a community.
Ans: A, B, C, D
Feedback:
Structure of a community refers to its services and resources. Community associations,
groups, and organizations provide a means for accessing needed services. Adequacy and
appropriateness of health services can be determined by examining patterns of use, number and
types of health and social services, and quality measures. Demographic data, such as
socioeconomic and racial distribution, age, gender, and educational level, are important
indicators of community structure. Status/people is the most common
measure of the health of a community.
8. The community health nurse is determining the health of a community by examining

status. Which of the following would the
nurse examine?
A) Leading causes of death and illness
B) Adequacy of health services
C) Socioeconomic distributions
D) Strengths of the community
Ans: A
Feedback:
Status typically comprises morbidity and mortality data identifying the physical,
emotional, and social determinants of health. Physical and social indices include vital statistics,

leading causes of death and illness, suicide rates, and rates of drug and alcohol addiction. Social
determinants can be identified by crime rates and functional ability level, or by high school
dropout rates or average income levels. Adequacy of health services and socioeconomic
distributions reflect structure. Strengths of the community
involve process.
9. The community health nurse is assessing the health of a community by reviewing the
dimension of process. Which of the following
is true of this dimension?
A) Process of a community refers to its services
and resources.
B) Process reflects the community's ability to
function effectively.
C) It usually consists of morbidity and mortality
data.
D) It refers to the physical, emotional and social
determinants of health.
Ans: B
Feedback:
Process reflects the community's ability to function effectively. Structure of a community
refers to its services and resources. Status/ people dimension usually refers to the morbidity and
mortality data and the physical,
emotional, and social determinants of health.
10. As part of an orientation for a group of newly hired nurses for a community agency, a
community health nurse emphasizes which of
the following as crucial?
A) Cyclic nature
B) Client focus
C) Interaction
D) Flexibility
Ans: C
Feedback:
Although the nursing process is cyclical, deliberative, flexible (adaptable), client focused,
and need oriented, interaction is an essential first consideration for community health nursing.
All steps of the nursing
process depend on interaction.

11. When building a coalition, which of the following would the community health nurse
do first?
A) Conduct a community assessment
B) Identify key players
C) Identify potential members
D) Define goals and objectives
Ans: D
Feedback:
Steps to coalition building include defining goals and objectives, conducting a
community assessment, identifying key players or leaders,
and identifying potential coalition members.
12. When assessing a community's needs, which of the following would the nurse most likely
complete first?
A) Familiarization assessment
B) Problem-oriented assessment
C) Community subsystem assessment
D) Comprehensive assessment
Ans: A
Feedback:
A familiarization assessment is a common starting place in evaluation of a community. It

involves studying data already available on a community and then gathering a certain amount of
firsthand data in order to gain a working knowledge of the community. A problem-oriented
assessment begins with a single problem and assesses the community in terms of that problem. It
is commonly used when familiarization is not sufficient and a comprehensive assessment is too
expensive. A community subsystem assessment focuses on one dimension of community life. It
is a useful way for a team to conduct a more thorough community assessment. A
comprehensive assessment seeks to discover all relevant community health information.
13. When completing a community assets assessment, the community health nurse would
gather information about which of the
following?
A) Key informants
B) Strengths of the community
C) Specific problem of the community
D) Overall life of the community
Ans: B

Feedback:
An assets assessment focuses on the strengths and capacities of a community rather than
its problems. Key informants are important sources of information with a comprehensive
assessment. Information about a specific health problem is gathered during a problem- oriented
assessment. Information about an overall view of the community and its life is gathered with a
familiarization or windshield
survey.
14. Nursing students in a community health nursing course identified toxic waste disposal to
be a major problem in their community.
The most cost-effective type of community assessment to determine the extent of the problem
and the resources available to handle
it would be a
A) familiarization assessment.
B) community subsystem assessment.
C) problem-oriented assessment.
D) comprehensive community assessment.
Ans: C
Feedback:
The problem-oriented assessment is commonly used when familiarization is not sufficient
and a comprehensive assessment is too expensive and not needed and a subsystem assessment is
too narrow to
determine the extent of the problem.
15. A community health nurse involved in assessing community health needs is planning to
get a group of approximately 10 similar individuals together to obtain information about
opinions on first pregnancies. The nurse
is using which assessment method?
A) Survey
B) Community forum
C) Focus group
D) Descriptive epidemiology
Ans: C
Feedback:
The nurse is using a focus group, similar to the community forum or town hall meeting in
that it is designed to obtain grassroots opinion. Focus groups usually have only a small group of
participants, usually 5 to 15 people and the members chosen for the group are homogeneous with
respect to specific demographic variables. A survey involves a series of questions, often to

provide a broad range of data. Community forum is a qualitative method to obtain community
opinions; the members typically represent all segments of the community involved with the
issue. Descriptive epidemiologic studies examine the amount and distribution of a
disease or health condition in a population by person, place, and time.
16. A community health nurse obtains data about

the community from primary sources, including which of the following?
A) World Health Organization
B) Community members
C) State health department
D) Other community health nurses
Ans: B
Feedback:
Primary sources of information include community members, including formal leaders,
informal leaders, and community members, and can frequently offer the most accurate insights
and comprehensive information. Information gathered by talking to people provides primary
data, because the data are obtained directly from the community. The World Health Organization
is an international source of information. State health department is a state source of data.
Other community health nurses as well as health team members, client records, community
health (vital) statistics, census bureau data, reference books, and research
reports are secondary sources of information.
17. When developing community diagnoses,

which of the following would the community health nurse do?
A) Focus primarily on deficits of the community
B) Use broad statements to guide a range of
interventions
C) Employ a revised nursing diagnosis format
D) Substitute the terms client, family, group, or
aggregate for the word patient
Ans: D
Feedback:
Community diagnoses should include statements about the strengths of the community
and possible sources for community solutions, as well as the community's weaknesses or
problem areas. In addition, they should portray a community focus, include the community
response, and identify any related factors that have potential for change through community
health nursing. These may also include wellness diagnoses, which indicate maintenance or
potential change responses (due to growth and development), when no deficit is present.
Diagnoses statements should be narrow enough to guide interventions and use the standard
nursing diagnosis format.

18. During which stage of the health planning process would the community health nurse
create a plan?
A) Assessment
B) Analysis and design
C) Implementation
D) Evaluation
Ans: B
Feedback:
During the health planning process, a community health nurse creates a plan during the
analysis and design stage, which correlates to the planning phase of the nursing process.
Assessment involves data collection, interpretation, and goal setting.
Implementation involves how to operationalize the plan and a design for monitoring progress.
Evaluation involves examining the costs and benefits, judging the potential outcomes, modifying
the plan, presenting the plan to the sponsoring group or
agency, and obtaining acceptance.
19. A community health nurse is engaged in evaluation of a health plan using a formative
evaluation. The nurse would focus on which
of the following?
A) Process during the actual intervention
B) Outcomes of the interventions
C) Development of performance standards
D) Impact on the clients' health
Ans: A
Feedback:
The focus of formative evaluation is on process during the actual interventions. It uses
performance standards that are developed to determine what is working and not working.
Summative evaluation focuses on the outcome of the interventions and examines
the programs' impact on clients' health.
20. When applying community development

theory, which of the following would most likely be considered the agent of change?
A) Clients
B) Nurse
C) Families

D) Community leaders
Ans: B
Feedback:
When applying community development theory, the agent of change is most often the
community health nurse who is considered a partner rather than an authority figure responsible
for the community's health.
Clients, families, and community leaders
would be the care recipients.
Chapter 16 Global Health Nursing
1. When describing the global framework,

which of the following would the community health nurse be least likely to include?
A) Population
B) Provider
C) Procedure
D) Physician
Ans: D
Feedback:
The global framework is bounded by a context and includes three parts, the three “Ps.”
These are the population, the provider, and the procedure. Physician would be
included as a provider.
2. When applying the Universal Imperatives of
Care, which of the following would be the priority?
A) Mortality
B) Daily functioning
C) Decision making
D) Cost
Ans: A
Feedback:
The Universal Imperatives of Care include mortality, morbidity, daily functioning,
decision making, and cost. This paradigm underscores the notion of first things first. That is, one
must be alive and well before interventions focus on functioning or decision
making.
3. A nursing student is considering a career in international community health nursing.

Which of the following statements are accurate regarding the context of international community
health nursing? Select all that
apply.
A) Global community health care is complex and is affected by multiple factors relating to
geography, history, politics, culture, religion,
and economy.

B) The types of services that can be provided include a range from providing clinical
services to policy making at an international
level.
C) People's conception of health, wellness, and
illness are static from culture to culture.
D) By looking through a computer window, the student is able to see almost anyplace,
connect to about any person, and access
information about almost any concept.
E) The ways in which people view nurses and other health care providers are affected by
their attitudes toward women, their culture,
and belief systems.
Ans: A, B, D, E
Feedback:
The following statements are true: Global community health care is complex and is
affected by multiple factors relating to geography, history, politics, culture, religion, and
economy; The types of services that can be provided include a range from providing clinical
services to policy making at an international level; By looking through a computer window, the
student is able to see almost anyplace, connect to about any person, and access information about
almost any concept; The ways in which people view nurses and other health care providers are
affected by their attitudes toward women, their culture, and belief systems. The statement that
people's conceptions of health are static from culture to culture is false.
Indeed, people's conceptions of health, wellness, and illness vary from culture to culture.
4. A community health nurse is preparing a presentation for a community group about
tuberculosis (TB) and its current epidemic status. Which of the following would the nurse
include in the presentation about this
disease?
A) TB kills about 1.7 million people each year.
B) All persons who are infected by the causative organism become ill and can spread the
causative organism to others throughout the
remainder of their lifetime.
C) Three fourths of the world's population is thought to be currently infected by the

causative organism.
D) The highest number of deaths is in Eastern
Europe.
Ans: A
Feedback:
TB kills approximately 1.7 million people each year. Only 5 to 10 of those infected
become ill or can spread the causative organism to others within their lifetime. One third of the
world's population is thought to be currently infected by the causative organism (tubercle
bacillus). The highest number of

deaths occur in Africa.
5. A community health nurse has identified noise as an environmental hazard. Using the
Blumenthal classification, the nurse would
identify this as which of the following class?
A) Infectious agents
B) Asphyxiates
C) Poison
D) Physical agents
Ans: D
Feedback:
The Blumenthal classification lists classes of environmental hazards. They include
infectious agents (e.g., bacteria and viruses), respiratory fibrotic agents (e.g., coal dust),
asphyxiates (e.g., carbon monoxide), poison (e.g., pesticides), physical agents (e.g., noise),
psychological agents (stressful synergisms such as crowding combined with noise), mutagens
(e.g., dioxin), teratogens (e.g., cadmium), and carcinogens (e.g., cigarette
smoke).
6. Which one of the following factors has resulted in the Era of Chronic Long-Term
Health Conditions?
A) Decreased usage of tobacco by young
populations
B) Despite programs of control, many infectious diseases persist with many people surviving
to experience chronic, long-term conditions
secondary to the infectious disease.
C) Shorter life expectancies due to chronic
diseases
D) Death from infectious diseases results in a

decrease in degenerative diseases.
Ans: B
Feedback:
Despite the programs of control, many infectious diseases persist. However, populations
now survive and also experience chronic, long-term conditions. These conditions affect mortality
and morbidity, daily functioning, decision making, and cost. Thus, the longevity that has resulted
from meeting the challenges of the Era of Infectious Diseases compounds the more recent
emergence of chronic diseases in the many countries. The emergence of multidrug resistant
diseases, continued persistence of infectious disease, and urbanization with deforestation have
resulted in new and
emerging infectious diseases and conditions.

7. When reviewing statistics about illnesses worldwide, which of the following would the
nurse identify as the most common and a
leading cause of mortality?
A) Tuberculosis
B) Smallpox
C) Acute respiratory tract infection
D) Infectious diarrheal disease
Ans: C
Feedback:
The most common illness in the world and a leading cause of mortality is acute
respiratory tract infection (ARI). Three million deaths annually are attributed to ARI among
children younger than 5 years of age, usually from pneumonia. Tuberculosis is considered
epidemic today. Smallpox has been eradicated. Infectious diarrheal disease has been reduced due
to oral rehydration therapy
and improvements in water and sanitation.
8. help achieve a reduction in the number of measles deaths worldwide?

A) Integrated Management of Childhood Illness
(MCI)
B) Global Alliance for Vaccine and
Immunization
C) Oral rehydration therapy
D) Geographical information systems
Ans: A
Feedback:
The MCI is the intervention considered to have the greatest impact in reducing measles.
It provides wide immunization coverage, rapid referral of serious cases, prompt recognition of
secondary conditions, and improved nutrition and vitamin A supplementation. The Global
Alliance for Vaccine and Immunization is an interagency initiative that seeks to protect every
child against vaccine-preventable diseases. This initiative addresses all of these types of diseases.
Oral rehydration therapy has been used to reduce mortality associated with diarrheal diseases.
Geographical information systems is not a program but a means to monitor diseases.
9. Which one of the following statements about

poliomyelitis is the most accurate?
A) Polio is not endemic in any countries at
present.
B) Polio has been eliminated worldwide.
C) Rotary International has contributed no funds but many hours of manpower to eradicate
polio.
D) Polio has been eliminated from the Western
hemisphere.
Ans: D
Feedback:

Polio has been eliminated from the Western Hemisphere. It is now almost eliminated
worldwide. Polio is endemic in Afghanistan, India, Pakistan, and Nigeria. Rotary International
has contributed over $900
million dollars to help eradicate this disease.
10. A community health nurse is reading a journal article about global health and
communicable diseases. The article states that elimination is the goal. The nurse interprets this to
mean
A) There are no further cases of the disease
anywhere.
B) No further preventive efforts are necessary.
C) The disease is no longer a public health threat.
D) The disease has been interrupted in a
geographic area.
Ans: D
Feedback:
The term elimination is used when a disease has been interrupted in a defined geographic
area. In 1991, WHO defined elimination as a reduction of prevalence to less than one case per 1
million population in a given area.
Eradication means interruption of person-to- person transmission and limitation of the reservoir
of infection so that no further preventive efforts are required; it indicates a status whereby no
further cases of a disease occur anywhere. The term control indicates that a specific disease has
ceased to be a
public health threat.
11. A community health nurse instructs a local community group on how to prepare
homemade oral rehydration solution. Which of the following ingredients would the nurse
include?
A) Sea water
B) Table salt
C) Baking soda
D) Crushed bananas
Ans: B
Feedback:
Oral rehydration solution consists of 1 L of safe water to which is added half small
teaspoon of salt, and four large spoons of sugar. In addition, bananas or green coconut water are
encouraged to compensate for the
loss of potassium.

12. Communicable disease is a global health concern with a primary goal of eradicating
communicable diseases worldwide.
Achievement of this goal would involve
A) interrupting disease in a limited, defined
geographic area.
B) reducing the incidence and/or prevalence of
C) establishing primary health care services for
all people on the globe.
D) interrupting transmission and reservoir of
infection to prevent further cases.
Ans: D
Feedback:
Eradication is an ambitious and expensive goal and has occurred with smallpox in 1977
and is under way with other diseases such as poliomyelitis, guinea worm, leprosy, and measles
so that many diseases can be eradicated early in the 21st century. One major means of
eradicating communicable diseases is to interrupt the transmission and reservoir, thereby
preventing the development of new cases. Interrupting disease in a limited area may be a starting
point, but more widespread involvement is needed. Reducing the incidence or prevalence would
provide indications about the effects of attempting to eradicate the disease. Establishing primary
health care services is the goal of Alma-Ata
“health for all.”
13. immunization is true?
A) The World Health Organization estimates that

a billion more lives could be saved each year with immunizations.
B) Vaccines are one of the most cost-effective
interventions found in public health.
C) Half of the world's children are being reached
with essential vaccines.
D) In the United States, toddlers are thoroughly
vaccinated.
Ans: B
Feedback:
Vaccines are one of the most cost-effective interventions found in public health. The
World Health Organization estimates that 3 million more lives could be saved each year with
immunizations. Three fourths of the world's children are being reached with essential vaccines.
In the United States, only 10% of toddlers are protected against measles,
mumps, and rubella via vaccinations.

14. A community health nurse is working with an international agency in Australia. The
nurse would most likely encounter which type of
health care system?
A) Entrepreneurial
B) Welfare-oriented
C) Comprehensive
D) Socialist
Ans: B
Feedback:
Australia subscribes to a welfare-oriented health care system in which statutory programs

drive these systems to support the cost of health care for all, or almost all, of the population
through their “national health insurance.” An Entrepreneurial Health Care System, found in the
United States, is one in which the country's health care system is based, in part, on its political
economy. A Comprehensive Health Care System is a step away from the welfare-oriented type
in that substantial modifications exist in delivery and financing that result in universal
entitlements. These systems are found in Scandinavian countries, Great Britain, and New
Zealand.
Socialist Health Care Systems came about through social revolutions that abolished free- market
economies and replaced them with socialism where the health care system is also socialized.
They are found in countries such as Russia, Eastern Europe, Albania, Bulgaria, Czechoslovakia,
East Germany, Hungary,
Poland, Romania, Yugoslavia, and China.
15. Which of the following are factors that influence populations' perceptions of health and
health status and their receptivity to community health nursing programs? Select
all that apply.
A) Their perceptions of healthy food
B) Their attitudes toward women
C) Their culture
D) Their belief systems
E) Their geographic location
Ans: B, C, D
Feedback:
The factors that influence populations' perceptions of health and health status and their
receptivity to community health nursing programs include their attitudes toward women, their
culture, and their belief systems. Their perceptions of healthy food or their geographic location
would not have a direct bearing on their perception of health and health status or receptivity to
community
health nursing programs.

16. A community health nurse is preparing to work in a country in which women are viewed
as weak and ineffectual. Which of the
following would the nurse need to do first?
A) Determine his or her own position and beliefs
about this view
B) Develop a basic plan to change the view of
women
C) Become aware of possible areas that might
impact care
D) Avoid situations involving the care of women
Ans: A
Feedback:
Community health nurses first, need to determine their own position on this issue and
come to terms with it, realizing that it may impact their care. Once aware, the nurses can then
prepare appropriately for situations in which their care may be affected. It would be
inappropriate and probably impossible to attempt to change the view or avoid situations
involving the care of women.
17. Which of the following statements about the personal and professional perceptions that
nurses bring to providing community health nursing interventions within an international
context is most accurate?
A) Community health nurses are not susceptible
to preconceived perceptions and biases.
B) It is not necessary for community health

nurses to face their own beliefs.
C) Community health nurses are universally opposed to female circumcision, the use of
nonlicensed personnel to carry out medical treatments, and the use of Western interventions used
simultaneously with other
methods of treatment.
D) It is critical for community health nurses to face their own beliefs when confronting
female circumcision, the use of nonlicensed personnel to carry out medical treatments, and the
use of Western interventions used simultaneously with other methods of
treatment.
Ans: D
Feedback:
It is critical for community health nurses to face their own beliefs when confronting
female circumcision, the use of nonlicensed personnel to carry out medical treatments, and the
use of Western interventions used simultaneously with other methods of treatment. Community
health nurses are as susceptible as any other group of people to preconceived perceptions and
biases.

Community health nurses may not be universally opposed to female circumcision, the use of
nonlicensed personnel to carry out medical treatments, and the use of Western interventions used
simultaneously with other
methods of treatment.
18. Community health nurses need to be knowledgeable about the World Health
Organization because its mission reflects
A) Collaboration in health development to free
the world from poverty
B) Service as an independent agency providing economic and humanitarian assistance

overseas
C) Representation of the global interests and

concerns of the nursing profession
D) Global health promotion by supporting development efforts of governments,

organizations, and universities throughout the
world
Ans: D
Feedback:
WHO's mission reflects global health promotion by supporting development efforts of
governments, organizations, and universities throughout the world.
Collaboration to free the world from poverty reflects the mission of the World Bank.
Service as an independent agency for economic and humanitarian assistance describes the
mission of the United States Agency for International Development (USAID). Representation of
global interests and concerns of nurses describes the mission
of the International Council of Nurses (ICN).
19. An instructor in community health nursing teaches a group of students about the role of
the World Health Organization and global health, reviewing the importance of the Declaration of
Alma-Ata. The instructor determines that the students have grasped the importance when they
describe it as which of
the following?
A) The beginning of the Carter Center's work in
disease prevention and agriculture
B) A formal document written by 134 nations in
1978 to achieve “health for all”
C) Participatory development activities, working
in partnership with voluntary organizations
D) Alliance building and communicating best
practices for global health development

Ans: B
Feedback:
The declaration represents the work of 134 nations during a WHO/UNICEF conference
in 1978 to achieve primary health care for all. The Carter Center was founded in 1986 and is not
related to the work at Alma-Ata.
Participatory development activities describe the work of the United States Agency for
International Development (USAID). Alliance building and communicating best practices
describe the Global Health Council, which is a leading private, voluntary, American
nongovernmental organization.
20. Which of the following statements about the International Council of Nurses (ICN) are
accurate? Select all that apply.
A) ICN represents the global interests and
concerns of the nursing profession.
B) The mission of ICN is to maintain the role of

nursing in health care through its global voice.
C) ICN has, as members, nursing organizations from 130 countries representing 13 million
nurses.
D) ICN is a governmental organization.
E) ICN employs Regional Nursing Advisors.
Ans: A, B, C
Feedback:
The following statements about ICN are accurate: ICN represents the global interests and
concerns of the nursing profession; the mission of ICN is to maintain the role of nursing in health
care through its global voice; and ICN has, as members, nursing organizations from 130
countries representing 13 million nurses. ICN is a nongovernmental organization. Regional
Nursing Advisors are employed at the international level of the
World Health Organization.
21. After teaching a class of community health nursing students about the World Health
Organization, the instructor determines that the teaching was successful when the class identifies
which of the following as the
highest governing body?
A) World Health Assembly
B) WHO Collaborating Centers
C) The European Union
D) U.S. Agency for International Development
Ans: A

Feedback:
The World Health Assembly is the highest governing body within WHO. WHO
Collaborating Centers are networks of centers focusing on specific areas of expertise and carry
out the work of the member countries in these areas. The European Union is an organization that
provides funding for many projects including health. The U.S. Agency for International
Development is an independent bilateral agency of the executive branch that works to enhance
long-term and
equitable economic growth.
22. A group of students are reviewing for an examination on nongovernmental organizations

that provide global interventions. The students demonstrate the need for additional study when
they identify
which of the following as an example?
A) Global Health Council
B) CARE
C) Carter Center
D) World Bank
Ans: D
Feedback:
The World Bank is an agency that focuses on economic development. It partners with
countries, WHO, and other organizations. It is not a nongovernmental organization.
Examples of nongovernmental organizations include Global Health Council, The Center for
International Health and Cooperation,
CARE, and the Carter Center.
23. Which organization would be most appropriate for the community health nurse to contact
for assistance when dealing with countries shattered by war and ethnic
violence?
A) Center for International Humanitarian
Cooperation
B) CARE
C) Global Health Council
D) International Council of Nurses
Ans: A
Feedback:
The Center for International Humanitarian Cooperation (CIHC), founded in 1992,
promotes healing and peace in countries shattered by war, regional conflicts, and ethnic violence.

CARE intervenes by responding to famines and disasters worldwide with emergency food,
supplies, and rehabilitative efforts. The GHC advocates for needed policies and resources, builds
networks and alliances among those working to improve health, and shares innovative ideas,
knowledge, and best practices in health.
The ICN represents the global interests and concerns of the nursing profession.

World Health Organization is accurate?
A) The World Health Organization does not provide technical support for interventions or
provide assistance developing nursing
knowledge and skills.
B) The World Health Organization can help a member state determine the drugs that are
essential and will assist in developing health
policy, project plans, and programs.
C) The World Health Organization provides medicines and other tangible resources to its
member states.
D) The World Health Organization focuses on professional issues to support the

development of particular health-related
practitioners, such as nurses.
Ans: B
Feedback:
The World Health Organization can help a member state determine the drugs that are
essential and will assist in developing health policy, project plans, and programs. The World
Health Organization does focus on providing technical support related to the interventions and
provides assistance developing nursing knowledge and skills. The World Health Organization
does not provide medicines and other tangible resources to its member states but does help
member states determine the drugs that are essential and assist in developing health policy,
project
plans, and programs.
25. Which of the following statements regarding

WHO Collaborating Centers is most accurate?
A) One or two Regional Nursing Advisors carry

out the work of a region that might be the home to thousands of nursing personnel.

B) The World Health Organization Collaborating Centers in Nursing and other fields focus
on specific areas of expertise and carry out the
work of the member countries in these areas.
C) It is referred to a philosophy, a movement, a

way of thinking, a setting for health services, or a set of principles.
D) It focuses on professional issues to support

the development of particular health-related practitioners.
Ans: B
Feedback:
The World Health Organization Collaborating Centers in Nursing and other fields focus
on specific areas of expertise and carry out the work of the member countries in these areas.
Regional Nursing Advisors work in collaboration with WHO Collaborating Centers to
accomplish the work within each region. Primary Health Care is referred to a philosophy, a
movement, a way of thinking, a setting for health services, or a set of
principles.
Chapter 17 Disasters and Their Impact
1. A community health nurse is working with people who experienced a tornado and have
been forced to leave their homes to escape the effects of a disaster. The nurse would identify
these people as which of the following?
A) Indirect victims
B) Refugees
C) Displaced persons
D) Casualties
Ans: C
Feedback:
Displaced persons are those who have been forced to leave their homes to escape the
effects of a disaster. Indirect victims are the relatives and friends of direct victims.
Refugees are direct victims who are forced to leave their homeland, usually due to war, religious
persecution, or political turmoil. A casualty is a human being who is injured or
killed by or as a direct result of an accident.
2. A community health nurse working as a part of a disaster response team is told that the
disaster is classified as a multiple-casualty incident. The nurse would interpret this to
mean which of the following?
A) There is more than 1 but less than 10
casualties.
B) The number of casualties is between 2 and
100.
C) Casualties number over 100.

D) There are too many casualties to count.

Ans: B
Feedback:
If casualties number more than two people but fewer than 100, the disaster is
characterized as a multiple-casualty incident. A mass- casualty incident involves100 or more
casualties.
3. A community health nurse is part of a disaster response team that is first to respond to an
earthquake. The team evaluates the level of destruction and devastation, identifying this
as which of the following?
A) Intensity
B) Scope
C) Casualty
D) Range of effect
Ans: A
Feedback:
The intensity of a disaster is the level of destruction and devastation it causes. The scope
of a disaster is the range of its effect, either geographically or in terms of the number of victims.
Casualty refers to the human being(s) injured or killed by or as a
direct result of an accident.
4. Which of the following examples of disasters

are natural disasters? Select all that apply.
A) The Earthquake and tsunami in Japan in 2011
B) The 2008 shootings at Virginia Tech
C) The terrorist attacks on the United States on

September 11, 2001
D) Wildfires that affected California in October
2007
E) The oil spill in the gulf coast in 2010 that
threatened hundreds of species of wildlife
Ans: A, D
Feedback:
Examples of natural disasters include the earthquake and tsunami in Japan in 2011 and
wildfires that affected California in October 2007. The following disasters are man-made: the
2008 shootings at Virginia Tech; the terrorist attacks on the United States on September 11,
2001; and the oil spill in the gulf coast in 2010 that threatened hundreds of
species of wildlife.

5. After teaching a class about the factors that contribute to disasters, the instructor
determines that the teaching was successful when the students identify which of the
following as the agent?
A) Population's age
B) Radiation
C) Level of preparedness
D) Flood-prone location
Ans: B
Feedback:
The agent is the natural or technologic element that causes the disaster. For example, the
high winds of a hurricane and the lava of an erupting volcano are agents, as are radiation,
industrial chemicals, biologic agents, and bombs. The population's age is an example of host
factor. The level of preparedness and flood-prone location are
examples of environmental factors.
6. Which of the following federal agencies would a community health nurse expect to be
contacted to assist with a disaster in the
United States?
A) American Red Cross
B) Federal Emergency Management Agency
(FEMA)
C) WHO's Emergency Relief Operations
D) Pan American Health Organization
Ans: B
Feedback:
The Federal Emergency Management Agency (FEMA) is the federal agency responsible
for assessing and responding to disaster events in the United States. The American Red Cross is
authorized to provide disaster assistance free of charge across the country through its more than
1 million volunteers. It is not supported by the federal government. The World Health
Organization's Emergency Relief Operations provide disaster assistance internationally, and the
Pan American Health Organization works to coordinate relief efforts in Latin America
and the Caribbean.
7. The nurse is using the epidemiological triad to explain the factors contributing the
disaster.
Which one of the following statements about
the environment factors that contribute to disasters is most accurate?

A) The environment is the natural or technologic

element that causes the disaster.
B) The environment is the human being who
experiences the disaster.
C) Factors that could potentially contribute to or
mitigate a disaster are environmental.
D) Examples of environmental factors that cause

a disaster are high winds of a hurricane and the lava of an erupting volcano.
Ans: C
Feedback:
Factors that could potentially contribute to or mitigate a disaster are environmental. The
agent factor is the natural or technologic element that causes the disaster, for example the high
winds of a hurricane and the lava of an erupting volcano. The host is the human
being who experiences the disaster.
8. A community health nurse is working with a community that is involved with identifying
risk factors for program development in case of a disaster. This community is in which
phase of disaster management?
A) Prevention
B) Preparedness
C) Response
D) Recovery
Ans: A
Feedback:
During the prevention phase, no disaster is expected or anticipated. The task during this
phase is to identify community risk factors and to develop and implement programs to prevent
disasters from occurring. Disaster preparedness involves improving community and individual
reaction and responses so that the effects of a disaster are minimized. The response phase begins
immediately after the onset of the disastrous event. During the recovery phase, the community
takes actions to repair, rebuild, or relocate damaged homes
and businesses and restore health and economic vitality to the community.
9. A community health nurse is working with a community that is involved with improving
community and individual reaction and responses, so that the effects of a disaster are minimized.
This community is in which phase
of disaster management?

A) Prevention
B) Preparedness
C) Response
D) Recovery
Ans: B
Feedback:
Disaster preparedness involves improving community and individual reaction and
responses so that the effects of a disaster are minimized. During the prevention phase, no disaster
is expected or anticipated. The task during this phase is to identify community risk factors and to
develop and implement programs to prevent disasters from occurring. The response phase begins
immediately after the onset of the disastrous event. During the recovery phase, the community
takes actions to repair, rebuild, or relocate damaged homes and businesses and restore health and
economic vitality to the community.
10. When would the nurse expect the response

phase of a disaster to occur?
A) When no disaster is expected or anticipated
B) Immediately after the onset of the disastrous
event
C) Long-term phase occurring after the
disastrous event
D) Prior to the disastrous event
Ans: B
Feedback:
The response phase of disaster occurs immediately after the onset of the disastrous event.
During the prevention phase no disaster is expected or anticipated. Long-term phase occurring
after the disastrous event is the recovery phase. Prior to the disastrous event
is the preparedness phase.

disaster planning is most accurate?
A) Disaster planning is essential for a
community, business, or hospital.
B) A disaster plan must be lengthy and detailed.
C) A disaster plan should be created by the person responsible for the emergency
management of the community.
D) It is assumed that all professionals have
addressed their personal preparation.
Ans: A

Feedback:
Disaster planning is essential for a community, business, or hospital. A disaster plan need
not be lengthy. A disaster plan should be created by all involved, including community leaders,
health and safety professionals, and lay people. All nurses should address their own personal
preparedness to respond in a disaster, but this
may not be assumed.
12. Which of the following are necessary components of a nurse's personal

preparedness? Select all that apply.
A) Workplace and community disaster plans
have been reviewed by the nurse.
B) An individual disaster plan for the nurse's
own family has been developed.
C) The nurse participated in disaster drills at the workplace and had a family disaster drill to
practice what actions to take in the event of a
disaster.
D) It is not necessary for the nurse to bring

copies of their nursing license and driver's license.
E) In the case of an actual disaster, the nurse will be able to use equipment made available to
them.
Ans: A, B, C
Feedback:
To be personally prepared, a nurse should have read and understood workplace and
community disaster plans, should have developed a disaster plan for his or her own family, and
should have participated in disaster drills. Nurses preparing to work in disaster areas should
bring copies of their nursing license and driver's license and bring
basic equipment.
13. As part of secondary prevention, the community health nurse engages in crisis
intervention to achieve which of the
following?
A) Reestablish equilibrium to the lives of those
involved
B) Prevent the crisis altogether
C) Involve as many people as possible in the
resolution

D) Triage clients during the recovery phase of

the crisis
Ans: A
Feedback:
The stated goal of crisis intervention is to reestablish equilibrium. Prevention is the best
approach, but some crises, such as natural disasters, cannot be prevented. They can, however, be
prepared for to decrease the negative effects of the crisis as much as possible. It is important to
have an adequate number of people needed to come to resolution. However, too many people
involved in resolution may cause additional confusion, chaos, and unnecessary delays.
Triage decisions need to be made during the response phase of the disaster or crisis and not
deferred until the recovery phase. Triage is an ongoing process throughout the response
phase.
14. A community health nurse is engaged in primary prevention activities related to disasters.
Which of the following would be examples of appropriate activities? Select all
that apply.
A) Providing anticipatory guidance
B) Practicing an escape plan
C) Providing emergency assistance
D) Planning disaster drills
E) Providing immediate response
F) Reducing the degree of disability
Ans: A, B, D
Feedback:
Anticipatory guidance, practicing escape plans, and planning disaster drills all constitute
primary prevention activities. Providing emergency assistance and immediate response reflect
secondary prevention activities. Reducing the degree of disability or damage resulting from the
disaster reflects tertiary level prevention
activities.
15. When describing primary prevention activities that would occur in the preparedness
phase of a terrorist attack involving biologic weapons like smallpox or anthrax to a local
community group, which of the following
would the nurse include?
A) Investigating outbreaks to determine source
B) Administering vaccines
C) Screening suspected cases
D) Treating persons who have been infected
Ans: B
Feedback:

Primary prevention activities that would occur in the preparedness phase of a terrorist
attack involving biologic weapons like smallpox or anthrax would include administering
vaccines. Investigating outbreaks to determine the source, screening suspected cases, and treating
persons who have been infected
would be secondary prevention activities.
16. A community health nurse is assisting the local community in preparing a disaster plan.
expect to be addressed? Select all that apply.
A) Chain of command
B) Routes for transportation
C) Triage
D) Basic equipment
E) Copies of licenses
Ans: A, B, C
Feedback:
A disaster plan should address the chain of command, routes and modes of transportation,
and triage methods. Basic equipment and licenses are items that a nurse should bring along when
preparing to work in a disaster
area.
17. A community health nurse is responding to a disaster. Which of the following would
most likely be the least appropriate area for the
nurse to be located?
A) The disaster site
B) Triage
C) Victim treatment area
D) Local hospitals
Ans: A
Feedback:
Usually, the immediate disaster site is not the best place for the disaster nurse, who can
be far more effective in triage and treatment of victims. One of the lessons of the World Trade
Center bombing was that the greatest need for medical professionals was at the
local hospitals, not at the disaster site.
18. When performing triage during a disaster, which color would indicate that the victim is
in urgent need of care?

A) Red
B) Yellow
C) Green
D) Black
Ans: A
Feedback:
During triage, red indicates that the victim has injuries or medical problems that will
likely lead to death if no treated immediately.
Yellow indicates that the person has injuries that require medical attention but time to treatment
is not yet critical. Green indicates that the victim has minor injuries or are presenting with
minimal signs of illness.
Black indicates that the victim is dead or has
suffered mortal wounds.
19. A community health nurse responding to a disaster is involved with caring for the bodies
of the casualties who have died. Which of the following would be an appropriate method for
documentation?
A) Making a note on the triage tag
B) Using a toe tag for identification
C) Placing the name on a casualty list
D) Recording the name on the victim's body
Ans: B
Feedback:
Toe tags make documentation visible and accessible and are the most appropriate means
for documentation. Making a note on the triage tag, placing the name on a casualty list and
recording the name on the victim's body
are inappropriate.
20. Which time after the disaster would be the

ideal time for this to occur?
A) Within 18 hours
B) 1 to 3 days
C) 4 to 6 days
D) 7 to 10 days
Ans: B
Feedback:
The ideal time for CISD is between 24 and 72
hours after the disaster event.

21. When providing secondary prevention activities for individuals experiencing

psychological consequences of a disaster, which of the following would the nurse do as
a generic approach?
A) Providing situational support for stress relief
B) Conveying warmth and concern for the client
C) Teaching about expected emotional reactions
D) Reunifying family members who were
separated
Ans: C
Feedback:
The generic approach is designed to reach high-risk individuals and large groups who
have experienced the same disaster, teaching them about the expected emotional reactions to the
type of disaster they have experienced and promoting adaptive responses.
Environmental manipulation results in the change of a person's physical or interpersonal
situation, providing situational support to relieve stress. An example of environmental
manipulation is when a community health nurse coordinates the reunification of family members
separated by the disaster. General support is defined as the caring, warmth, and concern the
community health nurse conveys
to the client as she or he delivers services.
22. A community health nurse suspects that a client who was a victim of a disaster 3 months
ago is experiencing post-traumatic stress disorder. Which of the following would the
nurse expect to find? Select all that apply.
A) Diminished startle response
B) Hypervigilance
C) Feelings of detachment
D) Flashbacks
E) Full range of affect
Ans: B, C, D
Feedback:
Signs and symptoms of post-traumatic stress disorder include increased startle response,
hypervigilance, feelings of detachment,
flashbacks, and restricted affect.

23. A group of ten people from the commune in the hills come into town dressed in robes and
have their faces covered. They have weapons hidden in their clothing and begin entering the
three banks in town to rob them. These actions can be classified as which of the
following?
A) Natural disaster
B) Terrorism
C) Casualty
D) Adventitious crisis
Ans: B
Feedback:
The actions resemble terrorism, the unlawful use of force and violence against persons or
property to intimidate or coerce a government, the civilian population or any segment thereof in
furtherance of political or social objectives. The actions are not a natural disaster. Casualty refers
to the person who is injured or killed by or as a direct result of an accident. An adventitious crisis
is an event that is out of the ordinary in magnitude and
personal experience.
24. After teaching a group of students about agents associated with chemical warfare, the
instructor determines that additional teaching is needed when the students identify which as
an example?
A) Explosives
B) Nerve agents
C) Anthrax
D) Jet fuel
Ans: C
Feedback:
Anthrax is considered a bioweapon. Explosives, nerve agents, and jet fuel are
considered agents of chemical warfare.
25. Which of the following would be most appropriate for community health nurses to
encourage when helping communities cope
with the anxiety associated with terrorism?
A) Maintaining high levels of alertness and fear
B) Spending time with children and young
people

C) Spending more time indoors

D) Keeping a fear journal
Ans: B
Feedback:
Most young people carry a charge of positive energy that is infectious. Maintaining high
levels of alertness and fear are not healthy.
Instead individuals should be a little afraid because a certain level of fear is healthy if the person
learns to use it as positive energy.
Spending more time outdoors is helpful remedy. Individuals should keep a courage journal; fear
immobilizes and courage takes
action.
26. A community health nurse is preparing a presentation for a community group about
possible agents of terrorism. Which of the following would the nurse include as an example of a
bioweapon? Select all that
apply.
A) Mustard gas
B) Sarin
C) VX gas
D) Nerve agents
E) Bombs
Ans: A, B, C
Feedback:
Bioweapons include mustard gas, sarin, VX gas, and anthrax. Nerve agents and bombs
are
examples of chemical warfare agents.
Chapter 18 Violence & Abuse

1. A community health nurse is reviewing the medical records of several families in the
community who have experienced varying crises. The nurse identifies which of the following as
developmental crises? Select all
that apply.
A) A windstorm that damaged 20 homes in a
community
B) Grandpa Jones dying at age 82 years
C) A couple getting engaged
D) The Smiths getting a divorce
E) The Jones experiencing a home invasion
F) Seven people dying in an automobile crash
Ans: B, C, D

Feedback:
Developmental crises are periods of disruption that occur at transition points during
normal growth and development. Developmental crises, as a rule, do not occur suddenly. They
are more evolutionary than revolutionary. Even the advancing, age, illness, or death of a
grandparent or parent is a developmental expectation. However, the actual event may occur
suddenly.
Experiencing damage from a windstorm, a home invasion, or an automobile crash are
situational crises.
2. A community health nurse is preparing a presentation for a community center group

about crisis. Which of the following concepts about situational crises should be included in
the presentation? Select all that apply.
A) A situational crisis is a stressful, disrupting event arising from external circumstances that
occur suddenly to a person, group, aggregate,
or community.
B) Situational crises can be predicted, expected,
and planned.
C) Situational crises are never positive.
D) Situational crises often occur without
warning.
E) Situational crises occur to people because of
where they are in time and space.
Ans: A, D, E
Feedback:
A situational crisis is a stressful, disrupting event arising from external circumstances that
occur suddenly to a person, group, aggregate, or community. Situational crises often occur
without warning. Situational crises occur to people because of where they are in time and space.
Situational crises cannot be predicted, expected, or planned. Some situational crises arise from
positive events such as significant job promotion or sudden acquisition of great wealth because
the change makes increased demands on individuals who must make
major life adjustments.

primary prevention for family violence is most accurate?
A) The cycle of violence within the family
cannot be interrupted.
B) Persons who have been victims of family
violence will repeat the behavior with others.
C) Primary prevention includes planned

activities undertaken by the nurse to prevent an unwanted event from occurring.

D) It is not possible for the community health

nurse to foster healthful practices that will counteract unhealthful influences.
Ans: C
Feedback:
Primary prevention includes planned activities undertaken by the nurse to prevent an

unwanted event from occurring. The cycle of violence within the family can be interrupted, and
persons who have been victims of family violence can learn to use more appropriate coping
strategies. It is possible for the community health nurse to foster healthful practices that will
counteract
unhealthful influences.
4. The nursing student reads the textbook in preparation for a class meeting about primary,
secondary, and tertiary prevention related to families in crisis. The student determines which one
of the following statements as most
accurate regarding the levels of prevention?
A) Often people in crisis are temporarily helpless

and unable to cope on their own but are receptive to outside influence.
B) Secondary prevention interventions include taking action to prevent the unwanted event
from occurring.
C) Tertiary prevention focuses on moving past
the crisis and returning to the precrisis state.
D) Primary prevention is the least effective level

of intervention in terms of promoting client's health and containing costs.
Ans: A
Feedback:
Often people in crisis are temporarily helpless and unable to cope on their own, but
understand the need for outside help and are receptive to other people's suggestions.
Primary prevention, not secondary prevention, involves actions that help to prevent an unwanted
event from occurring. Tertiary prevention focuses on moving past the crisis, although returning
to the precrisis state may not be possible. Primary prevention is the most effective level of
intervention in terms of promoting client's health and
containing costs.

5. After teaching a class about family and domestic violence directed toward children as a
community health problem, which of the following if stated by the class indicates to the
instructor that the teaching was effective?
A) Family violence is new and occurs as a result
of our fast-paced technological society.
B) Family violence has occurred in most countries for centuries as children have been
thought of as the property of their parents.
C) Family violence occurs mostly in the urbanized areas of the United States mostly in the
urbanized areas where exposure to crime
is more prevalent.
D) Family violence is decreasing in industrialized countries in the world as a

result of more public awareness.
Ans: B
Feedback:
The history of family and domestic violence is long. For centuries, children were thought
of as the property of their parents, and any treatment doled out by the parents was their
prerogative. It is only fairly recently in history (early 1900s) that groups have become concerned
and begun to do something about family violence. Family violence is brought to the attention of
officials more frequently today than in yesteryear, especially in urban areas where more people
live, but it occurs throughout the world—in urban, rural, and remote areas with no signs of
decreasing.
Family violence in the United States occurs mostly in the urbanized areas where exposure to
crime is more prevalent. Family violence is decreasing in industrialized countries in the
world as a result of more public awareness.
6. After teaching a group of students about abuse and families, the instructor determines that
the students have an understanding of this
issue when they state which of the following?
A) Less than 10% of women worldwide reported being physically abused by an intimate
partner at some point in their lives.
B) A woman's risk of intimate partner violence decreases during pregnancy, but increases
once the baby is born.
C) Intimate partner violence is a leading cause of
morbidity and mortality in women worldwide.
D) Intimate partner violence is a private matter
and not a public health issue
Ans: C
Feedback:
Intimate partner violence is a leading cause of morbidity and mortality in women
worldwide and is a public health issue. It is estimated that between 10% and 52% of women

report being physically abused by an intimate partner at some point in their lives worldwide. A
woman's risk of intimate partner violence increases during pregnancy with 44% to 48% of all
women being abused at least once
during the pregnancy.
7. In preparation for an examination on the history of family violence, a group of students

reviews the various laws enacted for protection. The students demonstrate understanding when
they identify which of the following as one of the earliest laws
enacted?
A) Child Abuse Prevention and Treatment Act
B) Family Violence Prevention and Services Act
C) Keeping Children and Families Safe Act
D) Child Abuse Prevention and Treatment and
Adoption Reform Act
Ans: D
Feedback:
In 1974, the Child Abuse Prevention and Treatment Act was passed, becoming Public
Law 93-247 (PL 93-247). The Child Abuse Prevention and Treatment and Adoption Reform Act
of 1978 was followed by the Family Violence Prevention and Services Act of 1984. Later, all
three acts were consolidated into the Child Abuse Prevention, Adoption, and Family Services
Act of 1988 (Public Law 100-294), and most recently, the Act was amended and reauthorized as
the
Keeping Children and Families Safe Act.
8. A community health nurse suspects

Munchausen syndrome by proxy when a child
A) experiences “seizures” only when a parent is
present, not if a third party is present.
B) has stunted growth and shortened limbs that
have been noticeable since birth.
C) has a noticeable limp when wearing shoes but
not in bare feet.
D) has periods of “acting out” and misbehaving,
especially when there is company.
Ans: A
Feedback:
Experiencing seizures only when a parent is present would be a “red flag” for this
syndrome if it were occurring in a child.

Stunted growth, limp, or acting out are not associated with Munchausen syndrome by
proxy.
9. Which of the following would lead a

community health nurse to suspect possible child neglect? Select all that apply.
A) 15-year-old Lucy misses school once a week
to watch her baby sister while mom works.
B) 6-year-old Sam plays in the yard with a
sweater on when it is 60 degrees outside.
C) Twins, Bobby and Billy arrive at school in
dirty and smelly clothing most school days.
D) 11-year-old Samantha comes to school

without lunch or lunch money each day.
E) 9-year-old Tommy misses school two or three
times a month due to asthma attacks.
F) 14-year-old Jennifer watches her neighbor's 2-
year-old every Saturday.
Ans: A, C, D
Feedback:
Educational neglect involves Lucy missing school to watch her baby sister and general
neglect is evident for the twins and Samantha. Sam may be appropriately dressed based on how
hard and long he is playing—he may be comfortable. Although Tommy is missing a number of
days of school, he has a legitimate excuse. Fourteen is an appropriate and legal
age to babysit.
10. Which of the following would the community health nurse identify as an act of sexual
exploitation of a child?
A) Child pornography
B) Child molestation
C) Fondling of child's genitals
D) Vaginal penetration with an object
Ans: A
Feedback:
Sexual exploitation of children includes conduct or activities related to pornography that
depict minors in sexually explicit situations and promotion of prostitution by minors. Sexual
assault includes rape, gang rape, incest, sodomy, lewd, or lascivious acts with a child younger
than 14 years of age (in most states), oral copulation, fondling of the child's genitals, penetration
of the genital or anal opening by a foreign object, and child
molestation.

11. A community health nurse assesses a child during a home visit. Which of the following
would lead the nurse to suspect that the child
is a victim of sexual abuse?
A) Bruising of the arms and back
B) Evidence of numerous dental caries
C) Complaints of pain on urination
D) Burns on the hands and feet
Ans: C
Feedback:
A sign of sexual abuse would be complaints of pain on urination or defecation. Bruising
on the arms and back and burns on the hands and feet would suggest physical abuse.
Numerous dental caries may suggest neglect.
12. A group of families are attending a local community group for a class on Internet safety
and children. Which of the following statements by the group indicates effective
teaching?
A) “It's not so much the time they spend but the
sites they use.”
B) “We'll move the computer to the family room so we can easily observe the child's internet
use.”
C) “We'll set the Internet browser feature to
medium.”
D) “The firewall program that we have from 2
years ago should still be good.”
Ans: B
Feedback:
To promote Internet safety with children, the computer should be placed in a high traffic
area in the home so that others can easily observe what is going on. Parents need to monitor the
time as well as the sites that the child uses. The Internet security browser should be set to high.
With the advances in technology, a firewall program that is 2 years old may not be adequate to
protect the child. However, it would be better than no firewall
program at all.
13. While visiting a family in their home, a community health nurse hears a parent screaming
who says, “Everything you do is wrong. Can't you do anything right ever?”

The nurse suspects which of the following?

A) Neglect
B) Emotional abuse
C) Sexual abuse
D) Physical abuse
Ans: B
Feedback:
Emotional abuse involves psychological mistreatment or neglect and may involve verbal
abuse such as statements like, “Everything you do is wrong. Can't you do anything right?”
Neglect occurs when physical, emotional, medical, educational resources necessary for healthy
growth and development are withheld or unavailable. Sexual abuse involves acts of sexual
assault or sexual exploitation of a minor. Physical abuse is intentional harm that results in pain,
physical injury, or death.
14. When describing the cycle of violence to a group of students, the instructor includes
which of the following as occurring as the
cycle continues?
A) Frequency of the cycle slows
B) Tension-building occurs less often
C) Loving reconciliation lasts longer
D) Acute battering occurs more often
Ans: D
Feedback:
As the cycle of violence continues, the frequency of the cycle increases, with the tension-
building phase and the acute battering incident occurring more often, and elimination of the
loving reconciliation phase. Without intervention, this shorter, more violent cycle becomes
increasingly risk-filled, for outcomes that may lead to injury or maiming of a partner,
incarceration, or death
of a partner.
15. Which of the following would a community health nurse expect to assess in a perpetrator
of intimate partner violence?
A) Occasional marijuana use
B) High academic achievement
C) Belief in male dominance
D) Desire for complacency
Ans: C
Feedback:

Characteristics of perpetrators of intimate partner violence include a belief in strict

gender roles, such as male dominance, heavy alcohol and drug use, low academic achievement,
and desire for power and control
in relationships.
16. When discussing elder abuse with a senior

citizen group, which of the following would the community health include?
A) Older men experienced abuse at a higher rate
than elderly women.
B) Types of elder abuse include physical abuse,
emotional abuse, neglect, and exploitation.
C) The majority of cases of elder abuse are
perpetrated by persons unknown to the victim.
D) Elders with dementia are less likely to be abused since they have less social
interactions.
Ans: B
Feedback:
Types of elder abuse include physical abuse, emotional abuse, neglect, and exploitation.
Older women experienced abuse at a higher rate than elderly men. The perpetrators of elder
abuse may be either known or unknown to the elder. Some elders are especially
vulnerable to elder abuse.
17. A community health nurse is designated as a

“mandated reporter.” Which of the following best describes this designation?
A) The nurse must witness abuse and neglect
before being mandated to report.
B) The nurse commands that battered women
report the abuse.
C) The supervising community health nurse is responsible for reporting only known cases of
elder abuse.
D) The nurse must report any case of known or

suspected abuse and neglect in children or elders.
Ans: D
Feedback:
The abuse or neglect simply needs to be suspected in order for the nurse to report. In
most states the nurse can receive a jail sentence and a fine for not reporting suspected abuse.

Reporters may never witness the actual abusive event, but they can often see the resulting
damage. Each nurse follows through with reporting abuse and neglect cases she or he suspects
according to the
community's laws.
18. A community health nurse is providing a community education program about suicide.
Which of the following would the nurse include as a common method used by
women?
A) Hanging
B) Firearms
C) Vehicle crash
D) Overdose
Ans: D
Feedback:
Women usually choose less violent methods, such as overdosing on medications. Men
choose more violent forms of suicide, such as
hanging, use of firearms, or vehicle crashes.
19. Which of the following would be least appropriate for a community health nurse to
include in a plan of care at the secondary prevention level for families who may need to
respond in a case of crisis in the future?
A) Teaching social problem-solving skills
B) Helping women develop assertiveness skills
C) Providing parenting classes
D) Helping to reestablish as sense of safety
Ans: D
Feedback:
Helping to reestablish a sense of safety would be appropriate at the secondary level of
prevention. Teaching social problem-solving skills, helping women develop assertiveness skills,
and providing parenting classes are appropriate primary prevention level
activities.
20. When assessing a family in crisis, which of the following would the community health
nurse need to do first?

A) Assess the nature of the crisis

B) Determine client's perception
C) Define available supports
D) Assess coping abilities
Ans: A
Feedback:
Initially, the nurse must assess the nature of the crisis and the client's response to it. Next,
the nurse focuses on the clients' perceptions of the event. Then the nurse determines who is
available for support to the individual or family. Finally the nurse assesses the clients'
coping abilities.
21. A community health nurse is developing a plan of care for families in crisis. Which of the
following would be most appropriate for
the nurse to include?
A) Encourage clients to suppress feelings to
minimize pain
B) Avoid correcting distorted facts to reduce
stress
C) Allow clients to blame others for the crisis
D) Help clients confront crisis
Ans: D
Feedback:
In a crisis, the community health nurse encourages clients to accept help by
acknowledging the problem. The nurse should encourage clients to express their feelings openly,
assist them in finding facts (distortions create additional tension that may lead to maladaptive
responses), and avoid blaming others to promote responsibility for
problem solving.
Chapter 19 Maternal-Child Health
1. Critical population health indicators that affect childbearing women, infant, toddler, and
preschool populations globally and in the United States include which of the following?
A) Maternal mortality rate
B) Infant mortality rate
C) HIV/AIDS
D) Crude mortality rate
E) Fetal alcohol syndrome

Ans: A, B, C, E
Feedback:

Critical population health indicators that affect childbearing women, infant, toddler, and
preschool populations globally and in the United States include maternal mortality rate, infant
mortality rate, HIV/AIDS, and fetal alcohol syndrome. Crude mortality rate does not apply
specifically to childbearing women,
infant, toddler, and preschool populations.
2. Which one of the following statements about low-birth-weight and very-low-birth-weight

babies is most accurate?
A) Low-birth-weight is more common in Whites
and Hispanics than African Americans.
B) Birth weight is one of the most important
predictors of infant mortality.
C) The incidence of low-birth-weight in the United States is decreasing in relation to the

increase in multiple births.
D) Recent trends in very-low-birth-weight babies

show that they continue to have morbidity with significant increases in survival.
Ans: B
Feedback:
Birth weight is one of the most important predictors of infant mortality. Low birth weight
is more common in African Americans than in Whites and Hispanics. The overall incidence of
low-birth-weight is increasing slightly, which can be explained by increased multiple births.
Recent trends in very-low- birth-weight babies show that they continue to have morbidity with
no significant increases
in survival.
3. A community health nurse is developing a program that would encourage mothers to use
breast-feeding exclusively for their babies' nutrition for the first 6 months. The nurse bases this
program on the understanding
about which of the following?
A) Exclusive breast-feeding promotes better
growth and development.
B) Its lower cost provides more money for other
needed items.
C) Infant mortality would significantly decrease.
D) It would aid in decreasing maternal mortality
rates.
Ans: C
Feedback:

Approximately 1.3 million infants would survive annually if mothers were able to
exclusively breast-feed their infants for 6 months. The lack of breast-feeding is related to
decreased survival and increased morbidity from infections, lower intelligence test scores,
increased cardiac risk factors, and inadequate nutrition. The superiority of breast milk and lower
costs would not be factors for developing a community health program for breast-feeding.
Exclusive breast-feeding is not associated with decreasing maternal mortality
rates.
4. A community health nurse is integrating the Healthy People 2010 goals into suggested
programs for a local community. Which of the following goals would the nurse identify as
having been met?
A) Reduction in low-birth-weight infants
B) Reduction in total preterm births
C) Increase in the number of infants put to sleep
on their backs
D) Increased proportion of mothers breast-
feeding at 6 months
Ans: C
Feedback:
After years of working toward improving maternal–child health, the United States has
made limited progress. One objective, however, has been met: 70% of infants are now being put
to sleep on their backs (up from 35% baseline), largely due to public health educational efforts
and reminders.
Objectives for LBW, VLBW, and preterm births all moved away from their Healthy People 2010
targets. Breast-feeding is beneficial to both mother and infant, and in 2005, almost 73% of
infants were breast-fed for some period of time. However, the goal
has not been met.
5. Which Healthy People 2020 goal that has

been established has been met?
A) The number of infants being put to sleep on their backs and the rate for sudden infant
death syndrome
B) Improving the proportion of infants who are
breast-fed
C) Reduce the rate of fetal and infant deaths
D) Reduce the occurrence of fetal alcohol
syndrome
Ans: A

Feedback:
After years of working toward improving maternal–child health, the United States has
made limited progress. One objective, however, has been met; 70% of infants are now being put
to sleep on their backs, up from a 35% baseline. The rate for sudden infant death syndrome
(SIDS) had dropped by over 50% since 1994. The proportion of infants who are breast-fed and
reducing the rate of fetal and infant deaths and occurrence
of fetal alcohol syndrome have not been met.
6. A community health nurse is providing a class for pregnant women about the dangers of
alcohol consumption during pregnancy.
Which of the following would the nurse include as an effect on the newborn? Select
all that apply.
A) Intellectual impairment
B) Low-birth-weight
C) Leukemia
D) Respiratory distress
E) Altered growth and development
F) Childhood cancers
Ans: A, B, E
Feedback:
The health of infants can be dramatically affected by maternal consumption of alcohol.
The pregnancy itself can be threatened.
However, the most devastating consequence of alcohol consumption during pregnancy is fetal
alcohol spectrum disorders (FASD) and fetal alcohol syndrome (FAS), both of which
compromise the intellectual functioning, birth weight, and altered growth and development of the
infant or child. Respiratory distress, leukemia, and other childhood cancers are not associated
with maternal alcohol
consumption.
7. A community health nurse is working with a group of pregnant women in the community
to reduce lifestyle risk factors associated with low-birth-weight newborns and infant mortality.
Which of the following would the
nurse address?
A) Multiparity
B) College level education
C) Environmental toxins
D) Single gestation pregnancy
Ans: C
Feedback:

Environmental toxins are lifestyle risk factors associated with low-birth-weight newborns
and infant mortality. Other risk factors include primiparity, low educational level, and
multiple gestation among others.
8. A community health nurse visits a local women's health center to provide teaching about
the effects of smoking during pregnancy. After teaching the class, the nurse determines that the
women have understood the teaching when they identify which of the following as a possible
maternal or infant
effect?
A) Low-birth-weight newborns
B) Newborn feeding problems
C) Genetic malformations
D) Developmental delays
Ans: A
Feedback:
One of the strongest predictors of both LBW and preterm birth is maternal smoking.
Other studies have shown that there is a greater incidence of stillbirths, spontaneous abortions,
and perinatal mortality in pregnancies in which women smoke.
Smoking during pregnancy is not associated with genetic malformations, developmental
delays, or feeding problems.
9. A local community health center is providing classes to childbearing families about the
effects of alcohol use during pregnancy.
During one of the classes, a community health nurse describes fetal alcohol spectrum disorder
(FASD). Which of the following would the nurse include as a common finding
in the newborn?
A) Large for gestational age
B) Facial abnormalities
C) Hypoactive behavior
D) Enhanced intellectual development
Ans: B
Feedback:
A newborn with FASD typically exhibits facial abnormalities, is small for gestational
age, demonstrates hyperactivity and
intellectual impairment.

10. While providing preconception counseling to a group of women, the community health
nurse emphasizes the need for adequate weight gain during pregnancy based on the
understanding of which of the following?
A) Maternal nutritional habits do not affect later
life.
B) Inadequate weight gain increases the woman's
risk for cesarean birth.
C) Prolonged labor can occur with too little or
too much weight gain.
D) Adequate weight gain is positively correlated
with normal birth weight.
Ans: D
Feedback:
Research has demonstrated a positive correlation between weight gain during pregnancy
and normal birth weight in babies. Inadequate weight gain is related to LBW, premature births,
and perinatal mortality.
Gaining large amounts of weight can also cause problems at birth, including increased numbers
of cesarean deliveries, large-for- gestational-age babies, along with the mother's retention of
excessive weight.
Maternal nutritional habits set gene switches
that affect later life.
11. After teaching a group of pregnant women about the need for proper oral health during
pregnancy, which of the following statements by the group indicates the need for additional
teaching?
A) “We should continue seeing the dentist like
we always do.”
B) “Chewing sugar-free gum is okay even with

the pregnancy.”
C) “If we need dental work, we can postpone it
until after the birth.”
D) “Flossing and brushing are just as important
now as before.”
Ans: C
Feedback:

Postponing dental work is inappropriate. Dental health procedures have generally been
found to be effective and safe for pregnant women, especially during the second trimester.
Statements about the importance of regular dental health checkups and proper dental hygiene,
along with referrals for dental treatment when needed, indicate effective teaching. Sugar-free
gums that contain xylitol and chlorhexidine may be helpful in reducing the maternal–child
transmission of caries-
causing bacteria.
12. What are the roles that public and community health nurses need to enact in order to
maximize the outcome for pregnant
adolescents? Select all that apply.
A) Clinician
B) Educator
C) Counselor
D) Provider of referrals
E) Friend
Ans: A, B, C, D
Feedback:
Roles that public and community health nurses need to enact in order to maximize the
outcome for pregnant adolescents include clinician, educator, counselor, and provider of
referrals. It is not appropriate for the nurse to enact the role of friend with pregnant
adolescent clients or any other client.
13. follow up. Which of the following would be

appropriate to include when teaching the woman about controlling her blood pressure at this
time?
A) Ensuring rest periods with legs elevated
B) Limiting her daily intake of fluid
C) Restricting intake of fresh fruits
D) Encouraging additional weight gain
Ans: A
Feedback:
Various methods are employed to attempt to prevent and control hypertension during
pregnancy, namely, a diet rich in fresh fruits and vegetables, adequate fluid intake, weight gain
limitations, rest, and regular exercise.
These remain the most common preventive suggestions that community health nurses, in
collaboration with the clients' primary health care providers, can give to their pregnant clients. A
calm environment, along with periods of rest with the pregnant woman either elevating her feet
or reclining in a left
side-lying position, is also recommended.

14. During a home postpartum visit, a community health nurse suspects that the woman is
experiencing depression. Which of the following responses would be most
appropriate?
A) “You should try drinking more caffeine to
help you be less tired.”
B) “Don't worry. Good mothers don't hurt their
babies.”
C) “Try napping when the baby is napping.”
D) “You should be able to achieve perfection with housekeeping tasks while you are still on
maternity leave.”
Ans: C
Feedback:
Getting adequate sleep is important, because sleep deprivation exacerbates psychiatric

symptoms. Napping when the baby naps, resting when possible throughout the day, and going to
bed early (albeit with the knowledge that sleep may be interrupted two or more times to feed the
infant) will provide more hours of rest and sleep. Caffeine can lead to sleep disturbance, and
alcohol is a depressant that has been implicated in depression. The elimination of both is a
simple yet helpful suggestion. The statement about telling the woman not worry discounts her
feelings. In addition, it also may increase her anxiety because she may be worried about hurting
the baby. The statement about ability to achieve perfection with housekeeping tasks while on
maternity leave is counterproductive as it has been recently identified perfectionism increases the
risk for postpartum depression.
15. After teaching a group of students about various community nutritional programs, the
instructor determines that the teaching has been successful when the students identify which of
the following as a result of the WIC
program?
A) Increased expenditures for health care
B) Decreased rates of large for gestational age
babies
C) Reduced rates of infant iron deficiency
anemia
D) Drop in breast-feeding rates
Ans: C
Feedback:
In addition to supporting women and young children with nutritious foods and achieving
the initial goals of decreasing the rates of preterm and LBW babies, increasing the length of

pregnancy, and reducing the incidence of infant and child iron deficiency anemia, WIC also
increases breast-feeding rates and improves pregnant women's
nutritional status.
16. A group of nursing students are studying for a test on child health statistics. The students
demonstrate that they are prepared for the test when they identify which of the following as a
major cause of death in the 1- to 4-year-old
population.
A) Pneumonia
B) Poverty
C) Unintentional injuries and homicide
D) Heart disease
Ans: C
Feedback:
Unintentional injuries and homicide cause most of the deaths for the 1- to 4-year-old
population: motor vehicle crashes, falls, drowning, fires, and burns. Pneumonia is not a major
cause of death among children.
Poverty contributes to morbidity and mortality but is not a cause of death in and of itself. Heart
disease is the fourth leading
cause of death among young children.
17. A community health nurse is developing a plan to address the nutritional needs of infants,
toddlers, and preschoolers. Which of the following would the nurse need to incorporate as a
major issue associated with
nutritional problems?
A) Life in the culture of poverty
B) Overfeeding of an infant
C) Cultural food preferences
D) Rapid growth spurts
Ans: B
Feedback:
Overfeeding an infant can lead to childhood obesity and becomes a risk factor for heart
disease, hypertension, and diabetes. Many parents overfeed infants and toddlers and allow
preschool-aged children to make inappropriate food choices, which can lead to a lifetime of
nutritional problems. Poverty may limit food choices and selection of inappropriate foods;
however, poverty itself does not cause nutritional problems. Although there are major differences
in food preferences and eating practices among different cultural groups, they do not account for

nutritional problems. Growth spurts in young children often are marked by changes in appetite,
but it is the quality of the food that can cause the nutritional problems rather than
the changes in quantity.
18. A community health nurse implements a teaching program for new parents about ways to
reduce infant mortality. Which suggestion
would the nurse include as most important?
A) “Never leave the infant alone on a dressing
table or couch.”
B) “Check the temperature of the bath water
before bathing.”
C) “Stay within an arm's length when the baby is
in the tub.”
D) “Put the infant to sleep on his or her back.”
Ans: D
Feedback:
Suffocation is the leading cause of death in infants. Therefore, the suggestion to put the
baby to sleep on the back is a major preventive measure and the most important. Never leaving
the infant alone would reduce the risk for falls, a leading case of nonfatal injuries for infants.
Checking bath water temperature is appropriate to prevent burns. Staying within an arm's length
while bathing
is a suggestion to prevent drowning.
19. A community health nurse is involved in a screening program for lead exposure. The
nurse would target this program primarily to
which age group?
A) Birth to -year-olds
B) - to 3-year-olds
C) 3- to 5-year-olds
D) 5- to 7-year-olds
Ans: B
Feedback:
The critical age of lead exposure (or peak level) is thought to be between 18 and 36
months. Levels generally begin to decline
after age 3.

20. Which of the following issues motivated the increased doses of certain vaccines and
reformulated vaccines at the start of the 21st
century? Select all that apply.
A) Increased virulence of the vaccine-
preventable disease causative organisms
B) Pertussis immunity was found to wane with age so the vaccine was reformulated to
cocoon infants by immunizing the adults
around them to prevent exposure of infants.
C) Varicella vaccine given in two doses has been
found to increase immunity.
D) Measles outbreaks were identified in populations where parents had refused MMR
vaccination for their children and received
personal belief exemptions.
Ans: B, C, D
Feedback:
The following issues motivated the increased doses of certain vaccines and reformulated
vaccines at the start of the 21st century.
Pertussis immunity was found to wane with age so the vaccine was reformulated to cocoon
infants by immunizing the adults around them to prevent exposure of infants; varicella vaccine
given in two doses has been found to increase immunity and measles outbreaks were identified
in populations where parents had refused MMR vaccination for their children and received
personal belief exemptions. There is no evidence that the vaccine preventable disease causative
organisms have increased virulence.
21. A community health nurse is making a family home visit. The family consists of the
mother, father, 1-year-old, and 4-year-old. The mother states that the 4-year-old who is in
preschool had a cold last week and now the 1-year-old has it. She asks the nurse if she can use
the over-the-counter cold medication that she gave to the 4-year-old for the 1-year-old.
Which response would be most appropriate?
A) “It shouldn't be a problem if you use that
same medication for the 1-year-old.”
B) “I don't know if the medicine will work, but
you can try it and see.”
C) “That type of medicine should not be used in
children under age 2.”
D) “You should use a smaller dose but watch if it
makes him irritable.”

Ans: C
Feedback:
Community health nurses need to emphasize that over-the-counter cough and cold
medications should not be used for children under age 2. The Food and Drug Administration
(FDA) deemed them unsafe and ineffective and most manufacturers took them off the market in
fall of 2007 in response to emergency room visits and deaths linked to their toxic effects.
Therefore, the nurse would tell the mother not to use the
medicine since the child is only a 1-year-old.
22. A community health nurse is working with a group of parents who have infants and
toddlers. Which of the following would the nurse include in a teaching plan for this group
about reducing dental caries?
A) Serving sugary foods at mealtimes and not
snacks
B) Providing juice in a sippy cup between meals
C) Allowing the older infant to fall asleep with a
bottle
D) Permitting snacking throughout the day
Ans: A
Feedback:
It is recommended that sugary foods be eaten at mealtimes and not as snacks, and that
regular snack times be established. Between- meal drinks should consist of water or milk. Juice
should be given only with meals.
Allowing infants to fall asleep with a bottle can lead to baby bottle tooth decay or nursing
caries.
23. Which of the following would be appropriate as secondary prevention level activities
focusing on child abuse and neglect?
A) Prenatal parent preparation classes
B) Public service announcements for positive
parenting
C) Education to improve family functioning
skills
D) Respite care for families with special needs

children
Ans: D
Feedback:

Providing respite care for families with special needs children is an example of a
secondary prevention action. Prenatal parent preparation classes, public service announcements,
and education to improve family functioning skills are examples of
primary prevention level activities.
24. As one aspect of ensuring adequate brain development in a child, a community health
nurse would encourage the intake of which
during the first 2 years of life?
A) Vitamins
B) Fats
C) Protein
D) Carbohydrates
Ans: B
Feedback:
During the first 2 years, when rapid myelination is taking place, 50% of total calories
should come from fat, but after age 2, the choice of 1% or 2% milk—should be the norm. A
well-balanced diet including an adequate intake of vitamins, protein, and carbohydrates is needed
for overall growth
and development.
Chapter 20 School-Age Children and Adolescents
1. When providing safety education for parents of school-age children, the community
health nurse would focus interventions on which of
the following as the priority?
A) Motor vehicle safety
B) Water safety
C) Fire safety
D) Poisoning prevention
Ans: A
Feedback:
For the 1- to 9-year-old age group, motor vehicle/traffic injury, drowning, and fire/burn
injuries were the top three causes of injury death. For the 10- to 19-year-old age group, motor
vehicle/traffic injuries, drowning, and poisoning are the three leading causes of injury death.
Thus the priority would be to focus interventions on motor vehicle safety. Although water and
fire safety and poisoning prevention would be important, motor vehicle
safety would be most important.

2. A community health nurse is presenting a program to a local elementary parent–teacher

association on the topic of pediculosis. The nurse determines that the group needs additional
teaching when they identify which of the following as a likely mode of
transmission?
A) Coming into contact with an animal
B) Combing hair with another's comb
C) Using a towel of an infected child
D) Sleeping in a friend's bed who had lice
Ans: A
Feedback:
Head lice are most often transmitted by direct contact (head-to-head) or may be passed
from infected to uninfected children through shared items such as combs and brushes, hats,
scarves, sheets, and towels (called fomites).
Contrary to some popular myths, lice do not fly or jump, and they cannot be contracted
from animals—they live only on humans.
3. A community health nurse who is participating in a nutritional screening program with

school-age children measures their body mass index (BMI). The majority of children fall within
the 45th to 65th percentile for their age. The nurse would classify these
children as which of the following?
A) Underweight
B) Healthy weight
C) At risk for overweight
D) Overweight
Ans: B
Feedback:
A BMI between the 5th and 95th percentile for age is considered healthy weight.
Underweight refers to a BMI below the 5th percentile. At risk for overweight refers to children
with a BMI between the 85th and 94th percentile. Overweight refers to children with a BMI
equal to or greater than the 95th
percentile.
4. Which of the following measures would be most appropriate for a community health
nurse to include when developing programs to
address childhood obesity?
A) Encouraging television watching for about 3
hours per day
B) Suggesting that families eat less meals
together at home

C) Urging participation in physical activity for

30 minutes per day
D) Limiting the intake of unsaturated oils in
cooking
Ans: C
Feedback:
Research has demonstrated an association between poor eating habits and physical
inactivity. Low levels of physical activity and more than 2 hours of watching television per day
were found to be predictors of overweight status in a large longitudinal study of children.
Therefore, interventions should focus on increasing levels of physical activity and encouraging
limited television for school- age children, encouraging families to eat more meals together at
home, advocating for increased physical education in the school setting, and for more safe
recreational opportunities in all neighborhoods. In addition, healthy eating habits such as using
unsaturated oils in cooking need to be stressed.
5. Which of the following programs would be least effective to institute for a community of
school-age children who are experiencing
dental caries?
A) Ensuring that the drinking water is fluoridated
B) Having the school to institute a fluoride rinse
program
C) Encouraging the parents to get their children's
teeth sealed
D) Advising parents to encourage the children to
brush once daily
Ans: D
Feedback:
Regular brushing and flossing is important for dental hygiene. However, once daily is not
enough. Fluoridated drinking water, school- based fluoride rinse or gel, and dental sealant
programs are cost-effective, proven methods of reducing dental caries in school-age
children.
6. Which of the following would a community health nurse expect to assess in the
adolescent
population with an eating disorder?
A) High levels of peer support

B) Clear sense of self
C) Feelings of being in control

D) Distorted body image

Ans: D
Feedback:
Adolescents with eating disorders typically have a disturbed body image, low levels of
peer support, distorted self-concept and low self-esteem. In addition, they have issues with
control, such that they used eating as a means
for control.
7. A community health nurse is teaching a group of parents about attention deficit

hyperactivity disorder. Which statement by the parents would indicate the need for additional
teaching?
A) “We probably will need to give him
medication to help him in school.”
B) “We need to keep him away from foods that
have additives in them.”
C) “This condition is most likely due to problems
with genes and nerve receptors.”
D) “We'll be alert to the possibility of more
injuries and accidents.”
Ans: B
Feedback:
While a number of parents feel that sugar and food coloring or additives may worsen
ADHD symptoms in their children, research shows no behavioral or learning differences in
double- blind studies with sugar and sugar substitutes. Medications are commonly used, with the
primary goal of improving academics. New research is focusing on inherited tendencies for
problems with dopamine receptors and transporter genes, supporting a neurologic basis for the
condition. Children with ADHD
are more prone to accidents and injuries.
8. local community agencies to provide services

for children and adolescents with disabilities. Based on the nurse's knowledge of the most
common disabilities affecting this group, the nurse would advocate for which of the
following to address the largest group?
A) Special education services
B) Speech therapy services
C) Mental health services
D) Mental retardation services
Ans: A
Feedback:
In descending order, the most common disabilities found in school-age children and
adolescents are learning disorders; speech or language impairment; mental retardation; serious

emotional disturbances and other disabilities, such as autism; deaf-blindness; orthopedic

problems; traumatic brain injury; and other health impairments, such as asthma, diabetes, and
epilepsy. Thus advocating for special education services would address the most common
disability, learning disorders.

children's health status and academic achievement are most accurate?
A) All health problems that can affect learning and achievement in school-age children are
preventable.
B) Physical and emotional health can affect academic achievement in children and
adolescents.
C) Only behavioral health problems can affect learning and achievement in school-age
children.
D) Poverty is one health problem that does not

affect learning and achievement in school-age children.
Ans: B
Feedback:
Physical and emotional health can affect academic achievement in children and
adolescents. Not all health problems that can affect learning and achievement in school-age
children are preventable. Behavioral health problems can affect learning and achievement in
school-age children, but other types of health problems can also affect learning and achievement
in school-age children. Poverty is a health problem that also affects learning
and achievement in school-age children.
10. A community health nurse is providing immunizations to school-age children at a local

health department. At which age would the nurse expect to administer the first dose of
human papilloma virus (HPV) vaccine?
A) 9
B) 11
C) 13
D) 15
Ans: B
Feedback:
The current recommendation is to administer the first dose of HPV vaccine at age 11.

However, the earliest age that the vaccine can be given is age 9. The HPV vaccine is
administered to females at age 13 to 18 if they
have not been previously vaccinated.
11. A community health nurse is speaking to a group of parents of incoming college

freshmen students who will be living in the dormitories. The focus of the program is on the
college health program, health issues, and immunizations. Which immunization would the nurse
most strongly encourage the students to receive if they have not received it
previously?
A) Varicella virus vaccine
B) Human papilloma virus vaccine
C) Meningococcal vaccine
D) Influenza vaccine
Ans: C
Feedback:
The meningococcal vaccine is a catch-up vaccine that is recommended for all previously
unvaccinated college freshmen living in dormitories. Adolescents who have not had chickenpox
and have not received prior vaccination should receive the varicella vaccines. The HPV vaccine
is given to females only. The influenza vaccine should be given only those who are considered
high
risk.
12. When preparing a program to address violence among school-age children and
adolescents, the community health nurse integrates knowledge of which of the
following?
A) Teen females commit homicide more
frequently than teen males.
B) Homicide is the second highest cause of death
for all adolescents.
C) Adolescents account for less than one half of
all firearm injuries treated.
D) Serious youth violence is unrelated to drugs
and guns.
Ans: B
Feedback:

Homicide is the second leading cause of death for adolescents (ages 10 to 24) and is more
common in males than females. Adolescents between the ages of 15 and 19 years account for
almost 85% of all firearm injuries treated in emergency departments or hospitals.
Serious youth violence is part of a constellation of risk-taking behaviors that also
includes precocious sex, drugs, and guns.
13. When working with community groups to develop appropriate programs for adolescent
health promotion, the nurse integrates knowledge of the Healthy People 2020 objectives, keeping
in mind that many of the
objectives address which of the following?
A) Self-esteem improvement
B) Risk-taking behaviors
C) Control of disease
D) Behavioral issues
Ans: B
Feedback:
Healthy People 2020 objectives are geared to improve the health of all Americans.
Twenty- one specific objectives have been ranked as critical for this population. The objectives
focus on issues involving mortality and morbidity in this age group that stems primarily from
risk-taking behaviors. Many of the objectives relate to reduction in alcohol- related unintentional
injuries, declines in violent behaviors, suicide and mental health issues, as well as more
responsible
reproductive health behaviors.
14. When working with school districts, which of the following would the community health
nurse encourage as the most effective school- based approach to solve the problem of
teenage suicide?
A) Suicide prevention programs with direct
interventions
B) Teachers assessing suicide risk among
students
C) Promotion of stronger parental control of
teens
D) Punitive treatment of teens by the school
administration
Ans: A
Feedback:

Programs and interventions by counselors and school nurses that are focused on
determining adolescent suicide intentions are the most effective approaches. Teachers do not feel
comfortable or prepared to assess suicide risk, and this alone will not prevent teen suicide.
Peer pressure is strong, and parent concerns are not as important to the teen. Teens are seeking
independence, and stronger parental control is not an effective method of reducing teen suicide.
This approach is inappropriate
for any school-age child or teen behavior.
15. A community health nurse is working with local schools to help address teen pregnancy.
The nurse would focus interventions on which
of the following?
A) Better use of contraceptives
B) Decreased sexual activity
C) Improved parenting skills
D) Proper nutritional habits
Ans: B
Feedback:
Although contraceptives, parenting skills, and nutrition may be areas of focus for teen
pregnancy, research has shown that the downward trend for teen pregnancy rates has been
attributed largely to better contraceptive use rather than less sexual activity. Therefore,
interventions should focus on the area of
decreasing sexual activity.
16. Which of the following would the community health nurse most commonly need to
address when planning programs for children with
chronic illness?
A) Asthma control
B) Autism education
C) Diabetes regimens
D) Seizure control
Ans: A
Feedback:
Although autism education, diabetic regimens, and seizure control are common issues
related to chronic disease in children, asthma is the most common chronic disease.
Thus asthma control would be a priority.

17. A community health nurse is working with a group of school nurses to develop
interventions for a 10-year-old girl exhibiting signs and symptoms of school refusal. Which
of the following would be most appropriate?
A) Limiting parent involvement in the school
B) Exposing the child rapidly to the classroom
C) Keeping the child at home for a while
D) Providing relaxation training
Ans: D
Feedback:
The most effective interventions for school refusal include early return to school with
parental involvement in school, systematic desensitization (gradual exposure to the classroom),
relaxation training, and
counseling.
18. A community health nurse is working with the local health department on screening for
sexually transmitted infections. Which of the following would the nurse identify as the
most common?
A) Syphilis
B) Gonorrhea
C) Chlamydia
D) Herpes simplex virus
Ans: C
Feedback:
Chlamydia is the most common STI in adolescents and should be a major focus of the
screening. Syphilis, gonorrhea, and herpes simplex virus also are common among
adolescents but less than Chlamydia.
19. When preparing a program about substance

abuse prevention for adolescents, the community health nurse would focus on which substance
as the most frequently used?
A) Marijuana
B) Alcohol
C) Ecstasy
D) Ketamine
Ans: B
Feedback:
Alcohol is the most frequently used substance for adolescents in the United States.
Marijuana is the most commonly used drug among 14- to 17-year-olds. Ecstasy and ketamine are
other drugs used by adolescents
and young adults.

20. A community health nurse is engaged in a community-wide program for promoting

nutrition in adolescents. Which of the following would lead the nurse to target the
program to adolescent girls?
A) Girls eat larger quantities of food than boys.
B) They are more physically active than boys.
C) They have a tendency to diet inappropriately.
D) They are more conscious about food nutrients.
Ans: C
Feedback:
Girls are more at risk for problems with nutrition for several reasons: They tend to diet
inappropriately, to have more finicky eating habits, and to be less physically active than teenage
boys. Boys typically eat large quantities of food, which increases the likelihood of obtaining
adequate nutrients, and they also tend to be more physically
active than girls.
21. A community health nurse is implementing a family planning program near a local inner
city's schools. The nurse is engaging which
type of health service?
A) Preventive program
B) Health protection
C) Health promotion
D) Injury prevention
Ans: A
Feedback:
A family planning program is an example of a preventive program that provides birth
control information and counseling. Health protection programs focus on safety including injury
prevention. Health promotion programs focus on areas such as nutrition and weight control,
and drug abuse education.
Chapter 21 Adult Health
1. A community health nurse is working with other professionals to develop preventive

programs to address the leading cause of death in men and women. Which of the
following would be appropriate?
A) Risk reduction for heart disease
B) Cancer screening
C) Safety education
D) Flu vaccine immunization

Ans: A
Feedback:
The leading cause of death for men and women is heart disease. Therefore, risk reduction
for heart disease would be most appropriate. Cancer screening, safety education, and flu vaccine
immunization would be appropriate for cancer, the second leading cause of death; unintentional
injuries, the third leading cause of death in men; and influenza and pneumonia, the eighth
leading cause of death in men and women
respectively.
2. of the following would the community health

nurse identify as a key aspect for this community's ability to follow through with the teaching?
A) Life expectancy
B) Health disparity
C) Health literacy
D) Financial ability
Ans: C
Feedback:
Health literacy is a critical aspect of managing health problems and a key to being able to
read and understand health information so that individuals can follow through and make
appropriate health decisions. Low health literacy also contributes to health disparities, a
difference in health status due to sex, race, or ethnicity. Life expectancy is the average number of
years an individual member is projected to live. It is a standard measurement unrelated to the
ability to follow through with teaching. Financial ability may impact a person's ability to obtain
needed services, but it is not a key aspect.
3. When assessing a population for health disparities, which of the following would the
nurse least likely evaluate?
A) Race
B) Education
C) Age
D) Sexual orientation
Ans: C
Feedback:
A health disparity is defined as a difference in health status that occurs by sex, race or
ethnicity, education or income, disability, geographic location, or sexual orientation.
Age would not be used to assess health
disparity.

life expectancy is most accurate?
A) The life expectancy for White women is 4
years greater than for Black women.
B) The life expectancy for Black men is 6 years
greater than for White men.
C) In the United States, life expectancy continues
to decline.

D) There is a gap in life expectancy between

women and men of more than 6 years.
Ans: A
Feedback:
The life expectancy for White women is 4 years greater than for Black women. The life
expectancy for White men is 6 years greater than for Black men. In the United States, life
expectancy continues to increase consistently over time. The gap in life expectancy between
women and men was 5.0 years in 2007.
5. A community health nurse is working with a grant funded project to address stroke
prevention nationwide. After reviewing statistics related to stroke, which would the nurse
identify as having the greatest need for
this type of program?
A) North central
B) Southeast
C) Southwest
D) Pacific northwest
Ans: B
Feedback:
The nurse would identify the southeast as the area of greatest need because here. Known
as the stroke belt, stroke death rates for both Blacks and Whites are higher than in any
other part of the country.
6. The nurse educator is aware that the nursing student has a grasp of the major health
problems of adults when the nursing student
makes which one of the following statements?
A) “Morbidity and mortality among adults does

not vary much by age, gender, and race/ ethnicity.”
B) “The six leading causes of death in adults include suicide, Alzheimer's disease, and
homicide.”
C) “Diseases of the heart and cerebrovascular diseases are the first and third causes of death
in adults.”
D) “Malignant neoplasms, chronic lower respiratory diseases, unintentional injuries, and

diabetes mellitus are not among the six
leading causes of death in adults.”
Ans: C
Feedback:

The following statement is true: “Diseases of the heart and cerebrovascular diseases are
the first and third causes of death in adults.” Morbidity and mortality among adults varies
substantially by age, gender, and race/ ethnicity. Malignant neoplasms, chronic lower respiratory
diseases, unintentional injuries, and diabetes mellitus are among the six leading causes of death
in adults. Causes of death in adults that are not among the six leading causes of death include
suicide,
Alzheimer's disease, and homicide.
7. The following is a list of the top five causes of unintentional injuries accounting for the
majority of adults deaths due to injury. Order these in their proper sequence from first to fifth.
A) Fire arms
B) Suffocation
C) Motor vehicle crashes
D) Poisoning
E) Falls
Ans: C, A, D, E, B
Feedback:
The top five causes of unintentional injuries include motor vehicle crashes, fire arms,
poisoning, falls, and suffocation. Together, these causes account for approximately 80%
of all injury deaths.
8. A community health nurse is preparing a presentation about drug use and abuse for a
group of adults. Which of the following would the nurse include as the one of the
fastest growing forms of drug abuse?
A) Cocaine
B) Alcohol
C) Prescription drugs
D) Heroin
Ans: C
Feedback:
Illegal use of prescription drugs is one of the fastest growing forms of drug abuse, and it
is becoming a major public health concern. The primary illicit drugs used in the United States,
such as cocaine and heroin, have and continue to be a public health problem. Alcohol abuse also
is a public health problem and is considered the third leading lifestyle-related cause of death for
people living in the United

States.
9. After teaching a group of students about the major types of cancer affecting men and
women, the instructor determines that the teaching was successful when the students identify
which of the following as the number
one cause of cancer deaths among adults?
A) Colon
B) Pancreatic
C) Esophageal
D) Lung
Ans: D
Feedback:
Lung and bronchus cancers are the number one cause of cancer deaths among adults.
Colon and rectal cancers are the third most common cancers in adults. Pancreatic and esophageal
cancers are less common causes
of cancer death.
10. A patient comes to the community health clinic with complaints of changes in urination.
Which of the following would lead the community health nurse to suspect that the patient has
benign prostatic hypertrophy
(BPH)?
A) Nighttime frequency
B) Dysuria
C) Hematuria
D) Flank pain
Ans: A
Feedback:
The symptoms of BPH vary, but the most common ones involve changes or problems
with urination, such as hesitant, interrupted, or weak urinary stream; urgency or leaking of urine;
and more frequent urination, especially at night. Dysuria may indicate a urinary tract infection.
Hematuria could suggest a variety of problems, such as infection calculi, or cancer. Flank pain
may indicate conditions
such as pyelonephritis or renal calculi.

11. When developing community health programs target to adult men, which of the
following would the nurse need to integrate
into the plan?
A) Improved quality of education programs
available for men
B) Increased access of health services by men as
compared to women
C) Limited male-gender specific research
D) Increased awareness of men's health issues
Ans: C
Feedback:
The current state of men's health involves a lack of quality health education programs for
men, health care services that are only accessed half as much by men when compared to women,
and a lack of male gender-specific research. In addition, awareness of men's health issues is
lacking. Currently, there is no Office on Men's Health in the U.S. Department of Health and
Human Services; legislation to establish such an office has been introduced; however, the bill did
not progress out of the congressional subcommittee on health and has not been
reintroduced.
12. A community health nurse is reviewing research related to women's health. Which of the
following would the nurse use to obtain information about postmenopausal women's
health?
A) The Women's Health Study
B) The Women's Health Initiative
C) The Nurses' Health Study I
D) The Nurses' Health Study II
Ans: B
Feedback:
The nurse would use The Women's Health Initiative. This study was a major 15-year
research program addressing the most common causes of death, disability, and poor quality of
life in postmenopausal women— CVD, cancer, and osteoporosis. The Women's Health Study
evaluated the effects of vitamin E and low-dose aspirin therapy in primary prevention of CVD
and cancer in apparently healthy women. The Nurses' Health Study I investigated the potential
long-term consequences of the use of oral contraceptives. The Nurses' Health Study II studied
oral contraceptives, diet, and lifestyle
risk factors in a population younger than the original Nurses' Health Study cohort.

13. While working in a community health clinic, a community health nurse interviews a 24-
year-old client. Which of the following would lead the nurse to suspect that the client is
binge eating?
A) Significant weight loss from dieting last year
B) Participation in excessive exercise
C) Exaggerated concern about body shape
D) Severe emaciation
Ans: A
Feedback:
Binge eating is an eating disorder that is characterized by repeated episodes of
uncontrolled eating. It usually starts following significant weight loss from dieting.
Typically, individuals with this disorder eat quickly, eat until they are uncomfortably full, eat
when they are not hungry, eat large amounts of food alone, have difficulty expressing their
feelings, have difficulty controlling impulses and stress, and feel depressed about overeating.
Participation in excessive exercise and an exaggerated concern about body shape is usually
associated with bulimia. Severe emaciation is
associated with anorexia.
14. Which of the following statements by a women's group indicates that they have
understood the teaching about heart disease
and women?
A) “More women die of breast cancer than heart
disease.”
B) “Women experience similar symptoms as
men.”
C) “Hormone replacement therapy protects the
heart.”
D) “Heart disease is the number one killer of
women.”
Ans: D
Feedback:
Heart disease is the number one killer of women. One in 2.6 female deaths is from
cardiovascular disease, compared to 1 in 30 from breast cancer. Women have atypical symptoms
or less acute chest pain than men, often leading them to delay care. Hormone
therapy does not reduce coronary events.

coronary heart disease and stroke are most accurate?
A) Cardiovascular disease kills more women

than men.
B) Stroke kills more men than women.
C) White persons are more likely to have their
first stroke earlier than Black persons.
D) Risk factors for cardiovascular disease are not
known.
Ans: A
Feedback:
Cardiovascular disease kills more women than men. Stroke kills more women than men.
Black persons are more likely to have their first stroke earlier than White persons. Risk factors
for cardiovascular disease are known. Some are controllable such as lifestyle, and
some are uncontrollable such as heredity.
16. A community health nurse working in a local women's health clinic is planning a
teaching session for a group of women about menopause. Which of the following would the
nurse include in the session?
A) Menopause involves very noticeable and
characteristic symptoms.
B) The symptoms are usually temporary lasting
for a month or two.
C) It can occur as early as age 30 but more
commonly ages 45 to 55 years.
D) Going 6 months without a period signals
menopause.
Ans: C
Feedback:
Menopause is a time that marks the permanent cessation of menstrual activity. It usually
occurs between the ages of 45 and 55 years. However, it can occur as early as age
30. Symptoms of menopause vary among women and last from months to years. They range
from hardly noticeable in some women to very severe in others. Natural menopause is when a
woman has not had a period in 12
months (no other apparent causes).
17. During a home visit to a family, a community health nurse encourages the mother, aged
42, and grandmother, aged 67, to have a clinical
breast exam at which frequency?
A) Monthly
B) Yearly

C) Every 2 years
D) Every 3 years
Ans: B
Feedback:
Clinical breast exams, performed by a health care provider should be done every year for
each of these women. They should also perform breast self-exam every month. The mother at her
current age should have a physical examination every 2 years. Both the mother and grandmother
should have a pelvic exam and Pap smear done every 3 years after
three consecutive negative Pap smears.
18. As part of a health screening program, a community health nurse determines that a client
is infected with the human papilloma virus (HPV). The community health nurse encourages the
client to do which of the
following?
A) Get a mammogram immediately
B) Have her blood glucose level checked
C) Undergo testing for a breast cancer gene
D) Have a pelvic examination and Pap smear
Ans: D
Feedback:
Infection with certain types of human papilloma virus is associated with an increase risk
for developing cervical cancer. Pap smears have improved early detection and prevention of
cervical cancer dramatically.
HPV infection is not associated with breast cancer, so there is no need for a mammography or
testing for a breast cancer gene. HPV is not associated with diabetes so
blood glucose testing is not indicated.
19. A nurse is instructing the adult male members of a family on how to perform testicular
self examination. Which of the following would
the nurse include?
A) Performing the examination every 3 months
B) Completing the exam right after a hot shower
C) Examining both testicles at the same time
D) Reporting a slight difference in size of one
testicle
Ans: B
Feedback:

A testicular self-examination should be performed monthly right after a hot shower or

bath. One testicle is examined at a time. One testicle, usually the right one, is normally
slightly larger than the other.
20. Which one of the following statements best describes the role of the community health
nurse in promoting the health of adult men 35
to 65 years of age?
A) Anticipatory guidance to men approaching each stage and help them with ways to
manage life more effectively.
B) Men of this age do not need to enhance their
self-care skills.
C) A positive attitude toward aging is not helpful
to men at this time in their lives.
D) Men of this age should exercise sporadically.
Ans: C
Feedback:
The community health nurse can provide anticipatory guidance to men approaching this
stage and help them with ways to manage life more successfully. Successful navigating this stage
of life can be fulfilling but may require a man to enhance his self-care skills. This includes
having a positive attitude toward aging, one that examines the benefits of maturity, finds a
balance between work and home, and maintains a healthy lifestyle by eating balanced meals and
obtaining regular
exercise.
21. When developing a plan of care for a group of male patients experiencing erectile
dysfunction, which of the following would the
nurse expect to institute first?
A) Lifestyle changes
B) Adjustments to current medications
C) Psychotherapy
D) Behavior modification
Ans: A
Feedback:
Treatment for ED usually proceeds from least to most invasive. For some men, making a
few healthy lifestyle changes may solve the problem. Smoking cessation, weight loss, and
increased physical activity may help some men regain sexual function. Cutting back on any
drugs with harmful side effects is considered next. For example, drugs for high blood pressure

work in different ways. If a particular drug is causing problems with erection, a different class of
blood pressure medicine might work just as well.
Medications, psychotherapy and behavior
modifications would follow.

health nurse recommend adult men and women over the age of 50 receive yearly?
A) Electrocardiogram
B) Tetanus booster
C) Flexible endoscopy
D) Hemoccult stool testing
Ans: D
Feedback:
Men and women over the age of 50 should receive yearly physical exams and hemoccult
stool testing, electrocardiograms every 3 years, tetanus booster every 10 years, and
flexible endoscopy every 3 to 4 years.
23. A community health nurse, who is working with a program to foster early detection of
prostate cancer, recommends prostate-specific antigen testing and a digital rectal exam for
men with average risk starting at which age?
A) 40 years
B) 45 years
C) 50 years
D) 55 years
Ans: C
Feedback:
The American Cancer Society recommends that screening of men who are at average risk
should begin at age 50 years and should include a blood test to assess PSA levels and a
digital rectal examination.
Chapter 22 Older Adults

1. When describing the changes occurring in the
older adult population globally, which of the following would be most accurate?
A) The over-80 years age group is the fastest
growing segment of the group.
B) Males have a longer projected life expectancy
when compared with females.
C) Most countries have adequate numbers of

social programs for older adults.

D) Adults over age 65 are expected to account

for about 25% of the population by 2050.
Ans: A
Feedback:
In most of the world, the population of those over 80 years of age is growing faster than
any other population age group. A higher life expectancy at birth for females compared with
males is almost universal. Many countries have few or no social programs available for older
adults. By the year 2050, one tenth of the population is expected to be
over the age of 65 years.
2. A community health nurse is working with an older adult population ranging in age from
75 to 85 years. The nurse correctly classifies this
group as which of the following?
A) Young-old
B) Old-old
C) Oldest-old
D) Elite-old
Ans: B
Feedback:
Those between the ages of 65 and 75 are classified as “young-old,” while those between
75 and 85 are labeled “old-old.” The number of people living into “older” old age (75 years and
older) is increasing. Forty percent of elderly people in the United States are among the “oldest-
old” (85 to 100 years), while more than 200,000 are among the elite-
old, or centenarians.
3. While working with another group of community health nurses, a nurse overhears one of
the nurses saying, “That older man should just retire. He's 70 years old. How productive can he
be?” The nurse interprets this statement as reflecting which of the
following?
A) Prejudice
B) Bias
C) Ageism
D) Insight
Ans: C
Feedback:
The one nurse's statement reflects stereotyping and a negative image of an older adult.
This is called ageism. It may be due to negative personal experiences, myths, or a general lack of
information. It is not reflective of prejudice or bias. Insight would reflect an understanding of the
older adult, which this
statement does not do.
4. Which of the following statements are common misconceptions about older adults?

A) It is normal for older adults to become more confused and childlike, forgetful, and lose
contact with reality as they age. They become
“senile.”
B) As older adults age, they become more
different and less alike other older adults.
C) Older people are very capable of learning new
things.
D) As age increases, older adults withdraw,
become inactive, and cease being productive.
Ans: A, D
Feedback:
The misconceptions or myths about older adults include the following: It is normal for
older adults to become more confused and childlike, forgetful, and lose contact with reality as
they age. They become “senile”; As age increases, older adults withdraw, become inactive, and
cease being productive; As older adults age, they lose their individual differences and become
progressively more alike; older adults are forgetful, unable to learn new things, and set in their
old ways of
doing things.
5. Which of the following are characteristics of

healthy older adults?
A) They are able to perform functional activities
of daily living.
B) They are able to adapt, to continue to handle
stress, and to be active in life and living.
C) They maintain the maximum degree of
physical, mental, and social vigor.
D) They are likely to be dependent on others.
E) They reside in institutions.
Ans: A
Feedback:
Healthy older adults' ability to function is a key indicator of health and wellness and is an
important factor in understanding healthy aging. They are able to adapt, to continue to handle
stress, and to be active in life and living. They maintain the maximum degree of physical,
mental, and social vigor. The vast majority of older adults, even those with chronic diseases or
other disabilities, are living outside institutions and are relatively
independent.

6. The nurse educator is aware that the nursing student has a grasp of the primary
prevention needs of older adults when the nursing student
makes which of the following comments?
A) It is unnecessary for older adults to receive

immunizations.
B) All older adults must restrict their sodium
intake.
C) Older adults don't need to drink as much fluid
as they are often less thirsty.
D) The oral health of older adults is often neglected and so it is important that they see a
dentist regularly.
Ans: D
Feedback:
The oral health of older adults is often neglected, and so it is important that they see a
dentist regularly. It is necessary for older adults to receive immunizations. Neither of these
statements is true: All older adults must restrict their sodium intake and older adults don't need to
drink as much fluid as they are
often less thirsty.
7. When visiting a local senior center, a community health nurse engages several of the
older adults in a discussion about immunizations. Which statement best reflects
the importance of older adult immunization?
A) “We're at greater risk of dying from the flu or
pneumonia.”
B) “You don't get the flu from the flu shot.”
C) “The doctor told us that we should get it.”
D) “Many of us get the shot here at the center for
free.”
Ans: C
Feedback:
Older adults are at risk of not only contracting influenza or pneumonia but of dying from
them, underscoring the importance of obtaining the immunizations. The statement about not
getting the flu from the shot addresses one of the common reasons for not getting it, the belief
that the flu shot will give them the flu. The statement about the doctor telling them to get it
indirectly reflects another reason for not getting it, lack of knowledge about the need. The
statement about getting the shot for free suggests that
finances may be a barrier to obtaining the shot but not why it is important.

8. A community health nurse is teaching a group of older adults at a senior center about
strategies for successful aging. Which of the
following would the nurse include?
A) “Limit drinking alcohol to once or twice a
month”
B) “Avoid eating too many fruits and vegetables”
C) “Keep in touch with friends and family”
D) “Get up early in the morning”
Ans: C
Feedback:
Strategies for successful aging include maintaining contacts with family and friends and
staying active through work, recreation, and the community. Moderation in drinking is key. The
older adult should eat a healthy diet of fruits, whole grains, vegetables, and lean meat. They also
should get as much sleep and rest as needed. Getting up early in the
morning may or may not be appropriate.
9. An older adult interested in nutrition asks the community health nurse about the number
of calories that he or she should eat every day. Which of the following would be most
appropriate?
A) 800 to 1,200 calories
B) 1,200 to 1,600 calories

C) 1,600 to 2,000 calories
D) 2,000 to 2,400 calories
Ans: B
Feedback:
It is generally believed that older people need to maintain their optimal weight by eating
a diet that is low in fats, moderate in carbohydrates, and high in proteins with a
daily calorie count of 1,200 to 1,600.
10. An older adult comes to the community health center for a checkup. During the visit, he
or she mentions that he or she is somewhat constipated. Which of the following
suggestions would be most appropriate?
A) Use a laxative about once or twice a week
B) Increase your intake of fresh fruits and
vegetables

C) Drink about four 8-oz. glasses of fluid each

day
D) Walk around the block once a week
Ans: B
Feedback:
Older adults should add more fiber and bulk to their diet with fresh fruits and vegetables
instead of relying on the habitual use of laxatives. Also inadequate fluid intake can contribute to
bowel and bladder problems. Consuming a diet that includes eight or more 8-oz. glasses of fluid
(water, juices, tea) each day assists the gastrointestinal and genitourinary system in their
functions.
Increased physical activity and exercise, such as a daily walk, help keep an older adult's
bowel patterns regular.
11. A community health nurse meets with a group of adults at the local senior center. They
range in age from 65 to 70 years. The nurse would recommend vision screening at which
frequency?
A) Every year
B) Every 2 years
C) Every 5 years
D) Every 10 years
Ans: B
Feedback:
Currently, vision screening is recommended every 2 years for adults aged 65 years and
older. Blood pressure screening should occur yearly, and total cholesterol evaluation should
occur every 5 years. Tetanus and diphtheria immunizations should be administered every
10 years.
12. A community health nurse is assessing an older adult's ability to perform activities such
as shopping, doing the laundry, using the telephone, and handling finances. Which assessment
tool would be most appropriate
for the nurse to use?
A) Barthel Index
B) Instrumental Activities of Daily Living Scale
C) Katz Index of Activities of Daily Living
D) Modified Rankin Scale
Ans: B
Feedback:

The Instrumental Activities of Daily Living Scale looks at an older adult's ability to
perform such activities as using the telephone, shopping, doing laundry, and handling finances.
The Barthel Index assesses functional independence and is often used to determine levels of
disability or dependence of stroke victims in respect to ADLs. The Modified Rankin Scale
(MRS) is another common tool used for this purpose. The Katz Index of Activities of Daily
Living is based on an evaluation of the functional independence or dependence of clients with
respect to bathing, dressing, toileting, and related tasks.
13. A community health nurse is preparing a

teaching program that addresses chronic diseases common among older adults. Which of the
following would be most appropriate to include?
A) Forty percent of older adults are diagnosed
with diabetes.
B) Weight-bearing exercises are related to
increased cases of osteoporosis.
C) Postural hypotension can be related to falls in
elders.
D) Older White men have the highest rates of
hypertension.
Ans: C
Feedback:
Older adults need to have sufficient cerebral circulation to avoid dizziness. Dizziness can
lead to falling. A normal to high-normal blood pressure for the elder should be maintained.
Based on the most current statistics, 15.1% of men and 13.0% of women report having diabetes.
Weight-bearing exercises are a way to prevent osteoporosis. Older African American men have
the highest rates of
hypertension.
14. After teaching a group of older adult women about preventing osteoporosis, which of the
following if stated by the group indicates the
need for additional teaching?
A) “We should eat foods that are high in calcium
and vitamin D.”
B) “We need to get bone density screenings
regularly.”
C) “We should avoid activities that involve
weight bearing.”
D) “We need to make sure that maintain a
healthy weight.”
Ans: C
Feedback:

Weight-bearing activities are encouraged to promote strong bones. In addition,

individuals should be encouraged to eat diets that are rich in vitamin D and calcium, and include
calcium supplements as needed. Not smoking, maintaining a healthy weight, and receiving
ongoing bone density screenings are positive health behaviors that can contribute to strong
bones throughout life.
15. After teaching a group of students about the most common health problems affecting
older adults in the community, which of the following if identified by the students would alert
the instructor to the need for additional
teaching?
A) Arthritis
B) Hypertension
C) Emphysema
D) Peripheral vascular disease
Ans: C
Feedback:
Emphysema is not considered a common health problem of older adults. The most
common health problems of older people in the community are arthritis, reduced vision, hearing
loss, heart disease, peripheral vascular
disease, and hypertension.
16. When describing elder abuse to the families of older adults who are attending a local
community presentation, which of the following would the community health nurse
identify most commonly as the perpetrator?
A) Elder's adult child
B) Elder's partner
C) Elder's neighbor
D) Elder's grandchild
Ans: B
Feedback:
The most common perpetrators of elder abuse are spouses or partners of elders. The next
most frequent abuser is the adult child of the elder. Although it may be possible that the
perpetrator is the elder's neighbor or
grandchild, this situation would be quite rare.


elder abuse is most accurate?
A) Elder abuse is a problem that is under
recognized and underreported.
B) It is more common for elderly men to be
abused rather than elderly women.
C) If there is long-term domestic violence in an elderly couple, it is not considered elder

abuse for the perpetrator to continue to abuse the
victim.
D) Self-neglect is not considered to be a form of
mistreatment.
Ans: A
Feedback:
Elder abuse is a problem that is under recognized and underreported. It is more common
for elderly women to be abused rather than elderly men. The most common perpetrators of elder
abuse are spouses or partners of elders, often in a relationship with long-term domestic violence.
In some states, self-neglect is also considered a form of
mistreatment.
18. Which of the following comprise the primary criteria for effective programs for older
adults?
A) Coordination
B) Accessibility
C) Comprehensive
D) Complex
E) Quality
Ans: A, B, C, E
Feedback:
The primary criteria for effective programs for older adults include coordination,
accessibility, comprehensive, and quality.
19. Which of the following are included in a

comprehensive set of services? Select all that apply.
A) Adequate financial support
B) Health education
C) Encouragement to spend much time alone
D) Adult day care programs
E) Access to high quality health care services

F) In-home services
Ans: A, B, D, E, F
Feedback:
A comprehensive set of services for senior citizens should include the following:
adequate financial support, adult day care programs, access to high quality health care services,
health education, in-home services, recreation and activity programs that promote socialization
(not encouragement to spend much time alone), and specialized
transportation services.
20. A community health nurse is making a home visit to a family who is providing care to an
older adult member with Alzheimer's disease for the past 6 months. During the visit, which of
the following would be most important for
the nurse to assess?
A) Cognitive status
B) Medication regimen
C) Personality changes
D) Caregiver's status
Ans: D
Feedback:
Although assessment of the various aspects of the patient's status is important, that of the
caregiver is even more important. Often, the person with AD is cared for at home until very late
in the disease course. The intense care given to these clients can be a constant drain on the
emotional and physical reserves of their families. The stress of providing care
puts the caregiver's health at risk, as well.
21. A group of community health nurses who work in continuing care retirement centers are
asked to talk to a group of seniors about what they do. Which of the following would the
nurses identify as unique for this setting?
A) Accept clients who primarily need skilled
nursing services
B) Are similar to board and care homes
C) Are respite centers for family members of
older adults
D) Provide a variety of housing and care options
that elders need as they age
Ans: D
Feedback:

Continuing care retirement centers are comprehensive centers and have become the last
place an older adult needs to live, meeting independent to dependent needs, including skilled
nursing and Alzheimer's disease services. They can age in place without moving to another
location as their needs increase. They accept residents at all stages of need, from totally
independent living to assisted living to skilled nursing care. In some settings, residents cannot
enter the residence at the skilled nursing level. These beds are filled by residents with increasing
needs as they move from independent living, to assisted living, to skilled nursing care. Skilled
nursing facilities provide skilled nursing care along with personal care that is considered
nonskilled. Board and care or personal care homes offer 24 hours basic custodial care but
provide no skilled nursing services. Respite care centers provide time off for caregivers. It can
take place in an adult day center, home, or residential setting.
22. Which of the following care options would be most appropriate for an older adult who
experiences confusion, requires daily insulin injections and blood glucose monitoring, and needs
assistance with bathing, dressing, and
feeding?
A) Personal care home
B) Respite care
C) Intermediate care facility
D) Skilled nursing facility
Ans: D
Feedback:
Based on the situation, a skilled nursing facility would be most appropriate. A skilled
nursing facility provides skilled nursing care, such as injections and blood glucose monitoring,
along with personal care that is considered nonskilled such as bathing, dressing, and feeding. A
personal care home offers 24 hours basic custodial care but no skilled services. Respite care
provides time off for caregivers and can take place in a variety of settings. An intermediate care
facility provides health care, but the amount and type of skilled care is less than that
provided in skilled nursing facilities.
23. Which one of the following statements is most accurate when differentiating hospice
from palliative care?
A) Both palliative care and hospice focus on cure; however, hospice focuses on terminal
illnesses, and palliative care focuses on
diseases that are more chronic in nature.

B) Palliative care consists of comfort and symptom management and is often a part of
hospice care.
C) Hospice is more of a specific place than a

concept of care, whereas palliative care is more of a concept of care.
D) Hospice is intended for people who have a projected life expectancy of 6 months or more,
and palliative care is intended for
people who are actively dying.
Ans: B
Feedback:
Palliative care consists of comfort and symptom management and is often part of hospice
care. Neither palliative care nor hospice focuses on cure. Hospice does focus on care of people
who are known to be at end of life, and palliative care can be provided to people who have
chronic ongoing health conditions even when death is not imminent. Hospice is more of a
concept of care than a specific place. Palliative care should be a major focus of care throughout
the aging process, regardless of whether death is
imminent within 6 months.
24. When working with the older adult population in the community, which of the following
would be most important for the community
health nurse to do?
A) Develop case management programs to
channel clients to appropriate services
B) Place the older adult in skilled nursing
facilities for the best care available
C) Raise funds to support the needs of the older
adults in the community
D) Emphasize tertiary prevention at this stage in
the lives of the older adult
Ans: A
Feedback:
Services for the older adult should be proactive. Nurses should design interventions that
maximize nursing resources and provide the greatest benefit to elderly clients. Skilled nursing
facilities are for people with skilled needs, not for older adults managing chronic diseases
independently. One's own home is most often the best place for elders and where they want to
be. This is not something that is always needed or possible for a community health nurse to
become involved in. Nurses can identify the needs for additional funding, advocate for more
funding, and facilitate a community group's efforts to raise funds. This is how a nurse can best
serve the elderly and support their needs rather than by actually raising the funds. Prevention
should be

proactive and focus on primary prevention regardless of the client's age.
Chapter 23 Working with Vulnerable Populations
1. Which of the following would a community health nurse use to define vulnerable
populations?
A) Those persons with higher mortality rates
B) Individuals with lower life expectancy
C) Those with increased risk for adverse health
outcomes
D) Individuals with chronic illness
Ans: C
Feedback:
Vulnerable populations are groups who have a heightened risk for adverse health
outcomes. They may include various populations such as those with higher mortality rates, lower
life expectancies, or chronic illnesses. However, presence of just one of these does not
necessarily indicate that the population is
vulnerable.
2. When assessing vulnerable populations, a community health nurse uses a popular model
that contains three related concepts. Which of the following would the nurse include? Select
all that apply.
A) Resource availability
B) Relative risk
C) Health status
D) Housing
E) Education
Ans: A, B, C
Feedback:
A popular conceptual framework of vulnerability contains three related concepts:
resource availability, relative risk, and health status. Housing and education are not one of the
three related concepts in this popular
model.
3. A community health nurse is applying the Behavioral Model for Vulnerable Populations
when evaluating a local community. Which of the following would the nurse include as an
enabling factor?
A) Insurance
B) Acculturation
C) Knowledge of disease
D) Marital status

Ans: A
Feedback:
Enabling factors include personal and family resources, as well as community resources
(e.g., income, insurance, social support, region, health services resources, public benefits,
transportation, telephone, crime rates, social services resources).
Acculturation, knowledge of disease, and marital status are examples of predisposing
factors.
4. population for socioeconomic resources.

Which of the following would the nurse address?
A) Quality of care provided
B) Access to health care services
C) Educational opportunities
D) Adequacy of health care providers
Ans: C
Feedback:
Socioeconomic resources include such things as human capital (e.g., jobs, income,
housing, education), social connectedness or integration (e.g., social networks or ties, social
support or the lack of it characterized by marginalization), and social status (e.g., position,
power, role). Environmental resources deal mostly with access to health care and the quality of
that care, including the
adequacy of health care providers.
5. When assessing a population's vulnerability, which of the following would the

community
health nurse identify as a predisposing factor?
A) Social support networks
B) Crime rates
C) Transportation
D) Living conditions
Ans: D
Feedback:
Predisposing factors include demographic variables (e.g., gender, age, marital status),
social variables (e.g., education, employment, ethnicity, social networks), and health beliefs
(e.g., values and attitudes toward health and health care services, knowledge of disease). Social
structures (e.g., acculturation and immigration), sexual orientation, and childhood characteristics
(e.g., mobility, living conditions, history of substance abuse, criminal behavior, victimization, or
mental illness) are also considered as predisposing factors. Enabling factors include personal and
family resources, as well as community resources (e.g., income, insurance, social support,
region, health services resources, public benefits, transportation, telephone,
crime rates, social services resources).

6. When assessing a vulnerable population's relative risk, which of the following would the
community health nurse identify most
likely as contributing to this risk?
A) Well-balanced diet
B) Up-to-date immunizations
C) Enabling factors
D) Exposure to abuse
Ans: D
Feedback:
Relative risk refers to exposure to risk factors identified by a substantial body of research
as lifestyle, behaviors, and choices (e.g., diet, exercise, use of tobacco, alcohol and other drugs,
sexual behaviors), use of health screening services (e.g., immunizations, health promotion, use of
seat belts), and stressful events (e.g., crime, violence, abuse, firearm use). A well-balanced diet,
up-to-date immunizations, and use of seat belts would reduce one's risk whereas exposure to
abuse may increase the risk. Enabling factors relate to the Behavioral Model for Vulnerable
Populations and not to the relative risk.
7. When describing the causes of vulnerability to a group of students, which of the

following
would the instructor include?
A) Vulnerable populations are fairly similar
across the nation and globally.
B) Statistics about vulnerable populations are
highly accurate.
C) The most important causative factor is race or
ethnicity.
D) Many of the factors and conditions suggest
vulnerability overlap.
Ans: D
Feedback:
Many of the factors and conditions contribute to vulnerability overlap, making it difficult
to obtain accurate data and statistics for each group or category. Although there are some
similarities and consistencies in terms of vulnerable populations, the factors vary. They also are
interactive, making it difficult to determine which factor or cause is considered
most important.

relative risk is most accurate?
A) Lifestyle, behaviors, and choices do not relate

to relative risk.
B) Relative risk refers to exposure to risk factors
identified from a substantial body of research.
C) Relative risk means that if a risk exists, the
illness or adverse event will occur.
D) Any factor that is likely to cause increased
risk is considered relative risk.
Ans: B
Feedback:
Relative risk refers to exposure to risk factors identified from a substantial body of
research. Lifestyle, behaviors, and choices are risk factors. Relative risk is not an absolute cause
and effect that if a risk exists, the illness or adverse event will occur. Only factors that are
identified by a substantial body of research
are considered relative risk.
9. A community health nurse is describing social capital and its impact on populations to a
group of local community leaders. Which of the following would the nurse suggest as a way to
improve the social capital of the
community?
A) Better job training
B) Improved educational programs
C) Expanded employment opportunities
D) More community organizations
Ans: D
Feedback:
Social capital consists of marital status, family structure, social ties and networks, and
membership in voluntary organizations, such as a church or clubs. Thus suggesting more
community organizations would address social capital. Better job training, improved education,
and expanded employment opportunities are examples of human capital, investments in
individuals' capabilities and skills (e.g., education, job training) that comprise jobs, income,
housing, and
education.
10. Which one of the following statements is true

regarding social capital?
A) Social capital includes investments in
individuals' capabilities and skills.
B) Social capital includes marital status and
family structure.

C) Social capital includes jobs, income, housing,

and education.
D) Examples of social capital are education and

job training.
Ans: B
Feedback:
Social capital consists of marital status, family structure, social ties and networks, and
memberships in voluntary organizations.
Human capital is linked to investments in individuals' capabilities in skills (e.g., education, job
training) and comprises jobs,
income, housing, and education.

health nurse include when describing the differential vulnerability hypothesis?
A) Exposure to risk factors affects the
population's social and human capital.
B) Everyone is at risk because of stressful events
occurring in life.
C) A risk for a negative outcome increases with
lower education and income levels.
D) Certain groups are impacted by stressful
events more than others.
Ans: D
Feedback:
The differential vulnerability hypothesis states that everyone is subjected to stressful
events, but that these events hurt some people more than others, thus they are vulnerable
populations. Although everyone experiences stresses, not everyone is vulnerable. Deficits or
problems in social and human capital can increase the population's risk. Lower education and
income are associated with a higher relative risk, but these alone do not
describe the hypothesis.
12. After teaching a group of students about factors associated with vulnerable populations,
the instructor determines the need for additional teaching when the
students identify which as a factor?
A) Homelessness
B) Acute illness
C) Income

D) Immigrant status
Ans: B
Feedback:
Factors associated with vulnerable populations include income and education, age and
gender, race and ethnicity, homelessness, chronic illness and disability, and immigration among
others. Chronic, not
acute, illness is considered as a factor.
13. A community health nurse is part of a group working with local and state legislators to
expand health insurance coverage for those with inadequate or no insurance. Which outcome
would the nurse hope to achieve if
the group is successful?
A) Increase use of early screenings
B) Increase emergency room visits
C) Increase episodic care
D) Increase disparities in care
Ans: A
Feedback:
Having inadequate or no health insurance leads to poor health outcomes due to lack of
early screening and preventive measures, including regular physical exams and immunizations,
delays in getting treatment, and use of emergency rooms for worsening conditions with no
continuity of care, all as efforts to save money. Expanding health insurance hopefully would
promote increased use of early screenings, decreased emergency room visits, more continuity of
care, and better health outcomes all around with less
disparities.
14. Which of the following would be most important for a community health nurse to do first
when working with vulnerable
populations?
A) Helping them to make choices
B) Guiding them to think things through
C) Getting them to interact with the nurse
D) Providing honest feedback
Ans: C
Feedback:
When working with vulnerable populations, the first step is to open the door and interact
with the clients, engaging them, and developing rapport. Once this is accomplished, the
community health nurse can then help them in making choices, guide them to think through all
the issues and
consequences, and provide honest feedback.

15. A community health nurse is working to empower clients of a vulnerable population.

Which of the following client behaviors
indicates that the nurse is achieving this goal?
A) Collaboration with their health care providers
B) Demonstration of a reactive focus
C) Hesitancy in the use of resources
D) Viewing of situations as nonchangeable
Ans: A
Feedback:
Empowerment would be manifested by the clients engaging in collaboration with their
health care providers, becoming more proactive than reactive, being better able to seek and use
services, and being realistic about barriers with a view for ways to change
things for the better.
16. Which of the following would be least helpful to a novice community health nurse
working with vulnerable populations who is feeling overwhelmed and somewhat guilty about his
or her personal situation as compared to his or
her clients?
A) Setting up an community agency clothing
drive collection
B) Working for changes in community attitudes
C) Sending a personal donation to an agency in
the area
D) Remaining grounded
Ans: C
Feedback:
Working with disadvantaged populations can be challenging and exhausting. Often a
novice community health nurse may feel overwhelmed and suffer compassion fatigue and guilt
about ones one life. To be effective, it is often helpful to donate money or items on a group level
such as an agency clothing drive rather than an individual level and to work for substantial
changes in community attitudes. In addition, the nurse needs to remain grounded in order to
continue to have the necessary
energy and compassion.
17. A community health nurse working with a group of vulnerable clients is focusing on
empowering them. Which of the following
would be most effective?
A) Keeping the clients to a firm schedule of

visits
B) Viewing the clients as active partners in the
process
C) Having the clients cut through bureaucratic
red tape
D) Focusing on the clients' limitations
Ans: B
Feedback:
Activities that are most effective in promoting empowerment include viewing the clients
as active partners (shows mutual respect and helps build a trusting relationship), being flexible in
dealing with the clients (demonstrates a client-centered approach), cutting through the
bureaucratic red tape (demonstrates advocacy), and focusing on the clients' strengths rather than
limitations (helps
to build client capacity).
18. A community health nurse is preparing a presentation for a group of local community
nurses about measures to help decrease health disparities. Which of the following would be
the least effective suggestion?
A) Avoiding political involvement in issues
B) Working with schools to reduce the dropout
rate
C) Organizing task forces to raise community
awareness
D) Holding community meetings to identify
needs
Ans: A
Feedback:
To help decrease health disparities, political advocacy is necessary to influence health
policy. In addition, working with schools to reduce the dropout rate helps to address the
connection between education and outcomes. Organizing task forces, raising community
awareness, and community input for need identification are all effective methods to address
vulnerable populations and health
disparities.
19. After teaching a group of students about the socioeconomic gradient in health, the
instructor determines that the students understand the concept when they state that the
relationship between social class and

health is which of the following?
A) Direct
B) Inverse
C) Positive
D) Unequal
Ans: B
Feedback:
The socioeconomic gradient refers to the inverse relationship between social class or
income and health, such that the lower the social class or income, the higher the rates of
disease.
20. Which one of the following statements is true

regarding the socioeconomic gradient of health?
A) The behavior of smoking is lowest among those who have low income and low
educational levels.
B) The socioeconomic gradient of health has
been found in populations around the world.
C) All persons who have a low socioeconomic
status will develop particular health problems.
D) The socioeconomic gradient of health is
universal.
Ans: B
Feedback:
The socioeconomic gradient of health has been found in populations around the world,
although not always unfailingly. The behavior of smoking is highest among those who have low
income and low educational levels. Not all persons who have low socioeconomic
status will develop particular health problems.
21. Which of the following are types of health disparities that are due to inequities that can
be corrected? Select all that apply.
A) Patients feel that they are unable to trust the

information given to them and may not follow it as explained.
B) Limited access to appropriate level of care
C) Poor access to quality care
D) Overt discrimination

E) Health-damaging behaviors that are chosen by an individual despite health education and
counseling efforts
Ans: A, B, C, D
Feedback:
Health disparities may be unavoidable, such as health-damaging behaviors that are
chosen by an individual despite health education and counseling efforts, but most are thought to
be due to inequities than can be corrected.
Reported disparities exist in the areas of quality of health care, access to care, levels and types of
care, and care settings; they exist within subpopulations (e.g., elderly, women, children, rural
residents, disabled) and across clinical conditions. Patients can also react to providers in a way
that promotes disparities; they may not trust the information given to them and may not follow it
as explained,
leading to inadequate care.
22. Which of the following vulnerable populations have been subjected to perceived poor
quality of care and access to care? Select
all that apply.
A) HIV-infected persons
B) Persons who use illicit drugs
C) People of non-White race/ethnicity
D) People of White race/ethnicity
E) Homeless persons
Ans: A, B, C, E
Feedback:
Higher perceived discrimination was associated with HIV infection, homelessness, drug
use, and race/ethnicity, emphasizing the perceived poor quality of care and difficulties
with access to care.
Chapter 24 Clients with Disabilities
1. develop effective plans to meet the needs of people with disabilities, the community
health nurse reviews the statistics involving individuals with disabilities. Which of the following
would the nurse identify as accurately reflecting the number of persons
with ongoing disability?
A) 10 million people—less than 5% of the US
population
B) 27 million people—about 10% of the US
population
C) 36 million people—about 12% of the US
population
D) 150 million people—almost 50% of the US
population
Ans: C

Feedback:
An estimated 36 million people or 12% of the population is living with some ongoing
level of disability. The other statistics of 10 million,
27 million, and 150 million are inaccurate.
2. When explaining the concept of disability to a local community group, which of the
following descriptions would be most
appropriate for the nurse to include?
A) A disability is a condition someone has, not
something one is.
B) The plan of care for two persons with the
same disability would be the same.
C) A disability refers to a person's inability to do
something.
D) Handicap and disability are two terms that go
hand in hand.
Ans: A
Feedback:
Long-held negative views of disabilities are being replaced with new and more positive
approaches that view individuals and their challenges from a more holistic standpoint. Thus, a
disability is something that a person has, not something one is. Even persons with the same
disability but their plan of care can be quite different. Earlier terminology equated disability with
an inability or incapacity or handicap that presents a more
negative view of the condition.
3. In Healthy People 2020, what is the emphasis of the categories of objectives that relate to
the goal of “Disability and Health to promote the health and well-being of people with
disabilities?”
A) A growing emphasis on a holistic approach that recognizes life satisfaction is just as

important to health and well-being as
preventative services
B) A growing realization that healthy-life years for persons with disabilities do not equate to
decreased health costs at local, state, and national levels, unlike they do for persons
without disabilities
C) Focus on personal responsibility for healthy
lifestyle by persons with disabilities

D) Concept that persons with disabilities are

always dependent on others
Ans: A
Feedback:
In Healthy People 2020, the emphasis of the categories of objectives that relate to the
goal of “Disability and Health to promote the health and well-being of people with disabilities”
is a growing emphasis on a holistic approach that recognizes life satisfaction is just as important
to health and well-being as preventative services. It also indicates a growing realization that
healthy life years for persons with disabilities equate to decreased costs at local, state, and
national levels, just as they do for persons without disabilities. There is not a focus on personal
responsibility for healthy lifestyle by persons
with disabilities or a concept that persons with disabilities are always dependent on others.
4. Which of the following are the three areas has Healthy People identified for public health
action for the year 2020 using the International Classification of Functioning,
Disability, and Health? Select all that apply.
A) Improve the conditions of life for persons
with disabilities
B) Address the inequitable distribution of resources among people with disabilities and
those without disabilities
C) Expand the knowledge base and raise

awareness about determinants of health for people with disabilities
D) Ensure the health of people with disabilities

by influencing many social and physical factors
E) Public health activities need to focus only on
preventing disability
Ans: A, B, C
Feedback:
The three areas that Healthy People has identified for public health action for the year
2020 using the International Classification of Functioning, Disability, and Health include
improve the conditions of life for persons with disabilities; address the inequitable distribution of
resources among people with disabilities and those without disabilities; and expand the
knowledge base and raise awareness about determinants of health for people with disabilities.
The plan to ensure the health of people with disabilities by influencing many social and physical
factors is too broad. Public health activities need to focus only on preventing disability is a
misconception.

5. The community health nurse is invited to speak to a group of students about clients with
disabilities. As part of the class, the nurse intends to describe The International Classification of
Functioning, Disabilities, and Health (ICF) and its attempts at standardized language. Which of
the following would the nurse include as terminology that was standardized? Select all
that apply.
A) Disability impairment issues
B) Body functions
C) Handicapping conditions
D) Activities
E) Environmental factors
F) Personal Factors
Ans: B, D, E, F
Feedback:
The ICF included definitions for body functions and structures, activities, and
environmental and personal factors. Terms such as disability, impairment, and handicap have
been removed from the definition and replaced with functioning, which is more
holistic and positive.
6. After teaching a group of students about leading health risks, the instructor determines
that the teaching was successful when the students identify which of the following as the
#1 leading health risk?
A) Unsafe sex
B) High blood pressure
C) Underweight
D) Tobacco consumption
Ans: C
Feedback:
The ten leading health risks are (1) underweight; (2) unsafe sex; (3) high blood pressure;
(4) tobacco consumption; (5) alcohol consumption; (6) unsafe water, sanitation, and hygiene; (7)
iron deficiency;
(8) indoor smoke from solid fuels; (9) high
cholesterol; and (10) obesity.

7. A community health nurse is preparing for a presentation on disabilities and is planning

to include information about Healthy People 2020 goals. When addressing these goals, the nurse
identifies differences from the goals addressed by Healthy People 2000. Which of the following
would the nurse identify as
different? Select all that apply.
A) Rather than individuals with disabilities and/ or chronic illnesses being defined by their
limiting conditions, they are viewed as having the potential to meet and exceed health promotion
and disease prevention goals set
for the nation's population as a whole.
B) The approach to disability now emphasizes the principles of health promotion and disease
prevention for those currently experiencing
disabilities and/or chronic illness.
C) The goals for Healthy People 2000 have an entire section on disability and secondary
conditions.
D) A growing realization that healthy life-years for persons with disabilities equate to
decreased health costs at local, state, and national levels, just as they do for persons
without disabilities.
Ans: A, B, D
Feedback:
A comparison among Healthy People plans over the last decades underscores the
emergence of new approaches to identifying priority areas and planning to improve the health of
individuals with disabilities and chronic illness. In Healthy People 2000, only one priority was
devoted to disability and chronic illness. Over the past two decades, interest in disability has
accelerated. Areas that are focused on with Healthy People 2020 include rather than individuals
with disabilities and/or chronic illnesses being defined by their limiting conditions, they are
viewed as having the potential to meet and exceed health promotion and disease prevention goals
set for the nation's population as a whole; the approach to disability now emphasizes the
principles of health promotion and disease prevention for those currently experiencing
disabilities and/ or chronic illness; and a growing realization that healthy life-years for persons
with disabilities equate to decreased health costs at local, state, and national levels, just as they
do for persons without disabilities.
8. A community health nurse is compiling a list of organizations that serve the needs of
persons with disabilities. Which of the following would the nurse categorize as a

federal agency?
A) National Organization on Disability
B) National Council on Disability
C) National Association of the Deaf
D) American Foundation for the Blind
Ans: B
Feedback:
The National Council on Disability is an independent federal agency. The National
Organization on Disability, National Association of the Deaf, and American Foundation for the
Blind are private
organizations.
9. Which of the following is a major difference between Healthy People 2010 and Healthy
People 2020 with respect to people with
disabilities?
A) Healthy People 2010 emphasized the

disparities that persons with disabilities experience.
B) The emphasis on “secondary conditions” in Healthy People 2010 has been replaced in
Healthy People 2020 with a concern for
health disparities for people with disabilities.
C) People with disabilities do not experience health disparities any more than people in the
general population.
D) Healthy People 2020 continues to emphasize
secondary conditions.
Ans: B
Feedback:
The emphasis on “secondary conditions” in Healthy People 2010 has been replaced in
Healthy People 2020 with a concern for health disparities for people with disabilities. Key to
addressing the barriers is for people with disabilities to “(1) be included in public health
activities; (2) receive well-timed interventions and services; (3) interact with their environment
without barriers; and (4) participate in everyday life activities. Without these opportunities,
people with disabilities will continue to experience health disparities,
compared to the general population.”
10. An instructor is reviewing the principles that resulted from the 2011 reassessment of
global progress on addressing disability with a class. Which of the following would the nurse
include?

A) The government must focus solely on seeking improvement in the lives of individuals
and
families living with disability.
B) Government must play the only role in
addressing disability.
C) It is unimportant for service providers, academic institutions, the private sector,

communities, and people with disabilities and
their families to address disability.
D) The importance of all persons, including those with disabilities to participate in their
country's development.
Ans: D
Feedback:
In 2011, the World Health Organization and the World Bank reassessed global progress
on addressing disability in light of the 2006 Convention on the Rights of Persons with
Disabilities. It was determined that not only must governments seek improvements in the lives of
individuals and families living with disability, but every citizen needs to participate in their
country's development.
Government at every level may play a most significant role, but there are important roles for
service providers, academic institutions, the private sector, communities, and especially people
with disabilities and their
families.
11. When describing the importance of the World Health Report to a group of students, the
instructor would emphasize which of the
following?
A) It challenged the world community to focus more attention on unhealthy behaviors that
lead ultimately to chronic disease, disability,
and early mortality.
B) Lifestyle choices are not one of the key

contributors to morbidity and mortality levels in either affluent or poor countries.
C) Infectious disease is the major threat.
D) Malnutrition is the only threat.
Ans: A
Feedback:
The World Health Report challenged the world community to focus more attention on
unhealthy behaviors that lead ultimately to chronic disease, disability, and early mortality. It
recognized that although infectious disease and malnutrition require ongoing vigilance because

they continue to plague many parts of the world, they are not the only threat. Lifestyle choices
are also one of the key contributors to morbidity and mortality levels in both affluent and poor
countries.
12. After teaching a class about the International Classification of Functioning, Disability,
and Health (ICF), the instructor determines that the teaching was successful when the students
identify which of the following as a personal
factor?
A) Problems with ambulation
B) Working
C) Coping styles
D) Amputation
Ans: C
Feedback:
Personal factors are the features of an individual's background, life, and living that are
not part of a health condition or health status, such as gender, race, age, other health conditions,
fitness, lifestyle habits, upbringing, coping styles, social background, education, profession, past
and current experience, overall behavior pattern and character style, individual psychological
assets, and other characteristics. Problems with ambulation would be considered an activity
limitation. Working would be an
activity. Amputation would be an impairment.
13. A community health nurse is planning to apply the International Classification of

Functioning, Disability, and Health to clinical care in the community. The nurse could use this
document as a basis for which of the
following?
A) Curriculum design
B) Needs assessment
C) Quality of life measures
D) Policy design
Ans: B
Feedback:
In clinical care, the ICF document would be helpful with a needs assessment. Using the
ICF document for curriculum design would reflect education; using it for quality of life measures
would reflect research; using it for
policy design would reflect social policy.

14. A community health nurse is working with a group of visually impaired individuals and
is developing a program to promote self- confidence and self-respect. Which of the following
organizations would be a valuable
resource for the nurse?
A) American Foundation for the Blind
B) American Council of the Blind
C) Guide Dogs for the Blind
D) National Federation of the Blind

Ans: D
Feedback:
The nurse would contact the National Federation of the Blind whose focus is on helping
blind individuals achieve self- confidence and self-respect. The American Foundation for the
Blind advocates for the visually impaired through increased state and federal funding. The
American Council of the Blind provides services such as information and referral, scholarship
assistance, public education, and industry consultation, governmental monitoring, consultation,
and advocacy. The Guide Dogs for the Blind
makes guide dogs available for the visually impaired.
15. A community health nurse is making a home visit to a family. The family has a son with
a disability who requires a motorized wheelchair. The family asks for the nurse's assistance.
Which response by the nurse
A) “His disability should automatically cover the
cost of the chair.”
B) “We'll need to check with the insurance
company about coverage.”
C) “You'll probably be able to get it if you pay
for half the cost.”
D) “You might be able to get a regular wheelchair, but a motorized one is

impossible.”
Ans: B
Feedback:
One major obstacle for families with a disabled or chronically ill member may be
obtaining needed assistive devices and technology. Just because the technology exists does not
mean that it can be obtained. Often the insurance carrier, whether private or governmental, sets

limits on which products can be obtained or which brands are acceptable. Thus the nurse
working with the family would need to check with the insurance company first and determine
what if anything is covered and then determine how
to go about obtaining what the son needs.
16. A community health nurse is developing a plan of care for a family who is providing
round-the-clock care in their home for a daughter who is chronically ill. Which of the following
would be most important for the
nurse to integrate into the plan?
A) Insurance limitations
B) Skill teaching
C) Flexible visiting
D) Respite care
Ans: D
Feedback:
Respite care is another area of great importance for families of the disabled and the
chronically ill. It can be emotionally draining to meet the daily needs of a member who cannot
perform self-care. This often leads to caregiver fatigue and increased stress. It is also important
to recognize the effect of the situation on noncaregivers in the family, particularly nondisabled
siblings of a disabled child. Respite care offers some needed relief to the family and allows for
uninterrupted attention to the nondisabled children.
Whatever the source, some type of respite care is often vital to the family's health and should be
a priority in the overall treatment plan of the family. Although insurance considerations,
teaching, and flexible visiting would be issues to be addressed, respite care
is a priority.
17. When developing programs to assist individuals with disability and chronic illness, which
of the following would be most
important?
A) Narrow focus
B) Holistic practice
C) Orientation to the present
D) Episodic care
Ans: B
Feedback:
The role of the community health nurse with respect to disabilities and chronic illness
requires a holistic practice and broad focus. Strong and sustained efforts are needed to achieve
results. The community health nurse addresses current needs and plans for the

future.
18. A community health nurse is providing information handouts that describe the need for
annual gynecologic exams to local health clinics that provide care for individuals with
disabilities. The nurse is fulfilling which role?
A) Advocate
B) Coordinator
C) Researcher
D) Educator
Ans: D
Feedback:
Providing information handouts is a method for teaching. Therefore, the nurse is
assuming the role of an educator at the community level. In the advocate role, the nurse would
assist in arranging for the population to receive the appropriate screening, ensuring that any
special modifications or adaptations would be available. In the coordinator role, the nurse might
arrange for screening to be performed during a routine visit made by a client to a facility or make
arrangements for transporting the clients to a facility for the screening. In the researcher role, the
nurse might contact other community health nurses about their experience in ensuring screening
for this population to discover if they have
similar needs or problems.
19. A community health nurse is reviewing the effects of the Americans with Disabilities Act
of 1990. Which of the following would the nurse identify as a major result of this
legislation?
A) Employers with five or more employees must
abide by the American with Disabilities Act.
B) Architectural barriers must be removed from

pathways so that they are accessible by wheelchair.
C) The disabled are eligible to receive telephone
services in their home at no cost to them.
D) Individuals with disabilities who wish to vote

must be provided transportation to polling places to vote.
Ans: B
Feedback:
A major accomplishment of this law was the removal of architectural barriers; curbs,
stairs, handicap toilets, etc. so that the disabled in wheelchairs can freely move about.

Employers with 15 or more employees must follow this law. Adapted telephone services are
provided for those who are hearing or physically impaired, but the telephone service is not free.
Polling places must be accessible to the disabled and absentee ballots and voter
registration can be done from home.
20. When reviewing the concept of universal design with a group of community developers,
the community health nurse recognizes that the emphasis is on which of
the following as the underlying theme?
A) Disability needs
B) Adaptation
C) Access
D) Safety
Ans: C
Feedback:
The underlying theme of universal design is ensuring access. Universal design is the
design of products and environments to be usable by all people, including those with disability
needs as well as chronic illness. The concept incorporated issues of adaptive design and safety
measures such as reinforcement in bathroom walls to allow for installation of grab bars, but the
key issue is
accessibility.

the benefits of universal design for all persons is the most accurate?
A) It is the right thing to do to allow access to the built environment for all persons including
persons with disabilities.
B) A healthier population may be achieved with attention to the environmental barriers that
impede healthy lifestyles for all persons, including those with chronic or disabling
conditions.
C) The built environment refers to the naturally
occurring features of the planet.
D) Access implies universal design.
Ans: B
Feedback:
A healthier population may be achieved with attention to the environmental barriers that
impede healthy lifestyles for all persons, including those with chronic or disabling conditions.

Universal design is the right thing to do for persons with disabilities but is not the most accurate
or best reason to ensure universal design. The built environment refers to the physical parts of
where we live and work (e.g., homes, buildings, streets, open spaces, and infrastructure).
Universal design incorporates access, but access does not
necessarily imply universal design.
Chapter 25 Behavioral Health in the Community
1. A community health nurse is meeting with a group of individuals who have been
diagnosed with a serious mental illness. The nurse interprets this to mean which of the
following?
A) The clients have impaired level of functioning
and quality of life.
B) The clients' disorder is chronic and persistent.
C) The clients have issues of impaired control
and dependency.
D) The clients have a significant behavior
syndrome with present distress.
Ans: A
Feedback:
Serious mental illness (SMI) is mental illness that has compromised both the client's level
of function and his or her quality of life.
Serious and persistent mental illness (SPMI) is the preferred term for serious mental illness of a
chronic nature. Impaired control and dependency are components of addiction. A significant
behavior syndrome with present
distress characterizes a mental illness.
2. When developing appropriate programs for adult mental health promotion, the nurse
incorporates knowledge about the most prevalent mental disorders. Which of the following
would the nurse identify as the
most prevalent?
A) Major depression
B) Bipolar disorder
C) Anxiety disorders
D) Schizophrenia
Ans: C
Feedback:
For American adults, the most prevalent mental disorders are anxiety disorders, followed
by mood disorders, especially major depression and bipolar disorders.
Schizophrenia, which affects approximately the same number of adults as bipolar disorder, is
problematic because it is so persistently

disabling.
3. After teaching a group of women in the community about common mental health
disorders affecting them, the community health nurse determines that the teaching has been
effective when the group identifies
which one of the following?
A) Anxiety disorders and mood disorders occur
twice as frequently in men as in women.
B) Women of color, women on welfare, poor women, and uneducated women are more
likely to experience depression than women
in the general population.
C) The three main types of eating disorders
affect more men than women.
D) The three main types of eating disorders include undereating due to food
unavailability.
Ans: B
Feedback:
Women of color, women on welfare, poor women, and uneducated women are more
likely to experience depression than women in the general population. Anxiety disorders and
mood disorders occur twice as frequently in women as in men. The three main types of eating
disorders affect more women than men. The three main types of eating disorders (anorexia,
bulimia nervosa, and binge eating)
also affect more women than men.
4. A community health nurse is part of community discussion group on alcohol. The nurse
recommends that adult males should
have less than
A) 6 standard drinks weekly.
B) 8 standard drinks weekly.
C) 10 standard drinks weekly.
D) 14 standard drinks weekly.
Ans: D
Feedback:
For the general male adult population, the recommended drinking limits are fewer than
five standard drinks daily or 14 weekly. For the general female adult population, the
recommended drinking limits are fewer than four standard drinks daily or eight weekly, and for

people age 65 and older, recommended drinking limits are no more that one standard drink daily
or seven
standard drinks weekly.
5. When determining a target population for education about alcohol use, which age group
would the community health nurse most
likely plan to address?
A) 18- to 25-year-olds
B) 30- to 40-year-olds
C) 45- to 55-year-olds
D) 65 years of age and older
Ans: A
Feedback:
Trends in alcohol use in the United States differ across subsets of the population. Young
adults (age 18 to 25) have the highest incidence of problem drinking. Thus the community health
nurse would most likely
address this age group.
6. After teaching a class about commonly used illicit substances, the instructor determines
that the teaching was successful when the class identifies which of the following as the
most frequently reported illicit drug?
A) Heroin
B) Methamphetamine
C) Marijuana
D) Cocaine
Ans: C
Feedback:
Although heroin, methamphetamine, and cocaine are frequently used illicit drugs,
marijuana is the most frequently reported
illicit drug.
7. A community health nurse is discussing alcohol use disorders and is explaining what is
meant by a standard drink. Which of the following would the nurse include as an
example? Select all that apply.
A) Two 12-oz. cans of beer
B) 5-oz. glass of wine

C) 1.5 oz. of an 80-proof spirit

D) 3 oz. of a cordial
E) Two bottles of wine cooler
Ans: B, C, D
Feedback:
A standard drink contains about 14 g of alcohol (0.6 fluid ounces or 1.2 tablespoons),
which is equivalent to one 12-oz. bottle of beer or wine cooler; 8 to 9 oz. of malt liquor; one 5-
oz. glass of table wine; 3 to 4 oz. of fortified wine, 2 to 3 oz. of cordial, liqueur, or aperitif; 1.5
oz. of brandy; or 1.5 oz. of 80-
proof distilled spirits.
8. When assessing a group of individuals for factors related to an increased risk for alcohol
use disorders, which of the following would
the nurse expect to find? Select all that apply.
A) Academic engagement/achievement
B) Antisocial peer affiliations
C) Decreased impulsivity
D) Positive mother–child/father–child
relationships
E) Stressful life events
Ans: A, B, E
Feedback:
Individual factors associated with the development of AUDs include problems with
academic engagement/achievement, antisocial peer affiliations, problems in the mother–
child/father–child relationship, and other
stressful life events.
9. Which one of the following statements

regarding the etiology of substance use disorders is most accurate?
A) It is believed that nurture has substantially

more influence on the development of substance use disorders than nature.
B) With the mapping of the human genome, hope has decreased that the genes related to
substance use disorders could be identified.
C) Alcohol dependence is thought to be a multigenomic disorder influenced by the

environment (gene–environment interaction).

D) Only genetic heritability is involved in the

etiology and course of substance use disorders.
Ans: C
Feedback:
Alcohol dependence is thought to be a multigenomic disorder influenced by the
environment (gene–environment interaction). It is believed that genetics is a risk factor in the
range of 50% to 50%. With the mapping of the human genome, hope has increased that the genes
related to substance use disorders could be identified. In addition to genetic heritability, both
personal and environmental factors are involved comparably in the etiology and course of
substance use
disorders.
10. The community health nurse is using effect theory to design a prevention program for
behavioral health. Which of the following would be the most likely place for the nurse to
start?
A) Identifying antecedent factors leading to the
problem
B) Identifying the specific health problem
C) Determining the desired health problem
impact
D) Specifying the health problem outcome
Ans: B
Feedback:
When using effect theory to design a prevention program for behavioral health, a good
place to start is to identify the specific health problem and then the desired health problem
impact and health problem outcome. As the program is developed, the community health nurse
starts by identifying the antecedent factors that lead to behavioral health problems. This provides
a clear rationale for why the intervention should
provide the desired impact.
11. A community health nurse is providing an in- service program to the agency staff about
effect theory, which will be used to develop behavioral intervention programs. The nurse
determines that the staff needs additional teaching when they identify which of the
following as a component of the theory?
A) Determinant theory

B) Intervention theory
C) Impact theory
D) Process theory
Ans: D
Feedback:
Process theory is a theoretical framework used in community/public health science. It is
not a component of effect theory. Effect theory has four components: determinant theory,
intervention theory, impact theory, and
outcome theory.
12. A community health nurse is applying the Institute of Medicine model based on Gordon's
Classification of Disease Prevention model to address prevention of alcohol use during
pregnancy and prevention of fetal alcohol syndrome. Which of the following populations would
the nurse target indicated
prevention strategies?
A) Local women in the community of
childbearing age
B) Women of childbearing age living in a city

C) Women of childbearing age considered at risk
D) Pregnant women who have a child with fetal
alcohol syndrome
Ans: D
Feedback:
Indicated prevention strategies would be designed to prevent the use of alcohol in
pregnant women who had screened positive for alcohol use during pregnancy or already had a
child diagnosed with FAS or FASD. Universal prevention strategies would address the entire
population of women of childbearing age (national, local community, school, neighborhood),
with messages and programs aimed at preventing the use of alcohol if pregnancy is a possibility.
Selective prevention strategies would target subsets of women of childbearing age who are
deemed to be at risk for alcohol use by virtue of their
membership in a particular population segment.
13. A community implements a plan to enforce the underage drinking law. The community
health nurse interprets this action as reflecting
which public health model?
A) Primary prevention
B) Behavioral prevention

C) Environmental prevention
D) Clinical prevention
Ans: C
Feedback:
Environmental prevention relies on a societal commitment for the implementation of the

interventions and aims to alter the environment by reducing risk (e.g., community-wide decrease
in availability of the substance; underage drinking law enforcement). Primary prevention is
conducted when no disease is present in the target population with the primary goal being
prevention of disease development.
Behavioral prevention includes a broad array of strategies aimed at changing lifestyles (e.g.,
exercise, smoking cessation, balanced nutrition). The goal of the intervention is to change
behaviors that put the person at risk for developing the disease or to prevent consequences of the
disease. Clinical prevention is based on the medical model for preventive services. It relies on
one-to-one, provider-to-patient interaction and occurs within the traditional health care delivery
system.

National Alliance on Mental Illness (NAMI) is most accurate?
A) NAMI focuses on the needs of the people
who actually have mental illness.
B) NAMI is committed to enhance the care of those with mental illness and improve the
quality of life of those who are affected.
C) The NAMI Web site contains some information that is intended to be used
exclusively by care providers.
D) All services of NAMI are provided at the
main headquarters.
Ans: B
Feedback:
NAMI is committed to enhance the care of those with mental illness and improve the
quality of life of those who are affected.
NAMI focuses on the needs of the families, peers, and consumers of Mental Health services. The
NAMI Web site contains extensive information that can be utilized by both consumer and care
providers. NAMI is a nationwide organization with chapters in each
state and county.

15. Which one of the following statements about nonprofit organizations that serve those
with
mental health issues is most accurate?
A) They are all associated with the government.
B) A for-profit organization that promotes mental

health is Mental Health America, which was established in 1909.
C) The organization National Mental Health
Association is a scam.
D) They focus on advocacy, education, service,
and funding research endeavors.
Ans: D
Feedback:
Nonprofit organizations focus on advocacy, education, service, and funding research
endeavors. They are not all associated with the government. Mental Health America was
formerly known as National Mental Health Association, which is a leading nonprofit
organization that promotes mental health.
16. Healthy People 2020 objectives focus on tobacco, alcohol, and illicit drug use education.
Which of the following are steps in the process to providing this education?
A) Identifying the impact of substance use on the
environment
B) Identifying trends of substance use to develop
a prevention program
C) Understanding the consequences of substance

use that affect a community as a whole
D) Differentiating between legal and illegal
substance use
E) There are no differences in prevention
programs for different populations
Ans: B, C, D
Feedback:
The three steps in the process for providing tobacco, alcohol, and illicit drug use
education are in order (1) identifying trends,
(2) differentiating legal versus illegal use, and
(3) consequences of use. Identifying the impact of substance use on the environment is not
one of the steps. There are differences in prevention programs—if the target population is young
adults, the prevention of binge drinking might be a top concern; if homeless adults, the focus will
be on chronic alcohol, cocaine, and heroin use; cultural and ethnic differences in alcohol and

SUDs are noted in American Indians with increased rates of fetal alcohol syndrome and
increased prevalence in
prison and jail populations.
17. A community health nurse is involved in a screening program for alcohol use with an
ethnically diverse population. Which of the following would be the best instrument to
use?
A) Alcohol Use Disorders Identification Test
(AUDIT)
B) CAGE questionnaire
C) Michigan Alcoholism Screening Test (MAST)
D) Drug Abuse Screening Test (DAST)
Ans: A
Feedback:
For alcohol use, the screening instrument recommended by the NIAAA is the AUDIT.
WHO developed this instrument for use across populations, and it has established high reliability
and validity across ethnic groups.
Other tests that can be used include the CAGE questionnaire and MAST. The DAST
would be appropriate to screen for drug use.
18. Which of the following would the community health nurse identify as a major limitation
for using biological markers for screening for
substance use?
A) Sensitivity of the test
B) Cost of the test
C) Factors influencing the test
D) Ease of obtaining a specimen
Ans: B
Feedback:
Biological screening tests are rarely used in a community-based screening program due to
the cost and the problems with obtaining biological specimens. In addition, numerous factors can
influence sensitivity and specificity of biological markers, including other metabolic disorders or
other diseases,
medication use, and reliability of the method.

19. Which of the following statements about Healthy People 2020 and reducing substance
use and addressing mental health needs is
most accurate? Select all that apply.
A) After a diagnosis is established, the nurse can decide on an intervention that can address
the specific public health issue identified in the diagnosis using the Healthy People 2020
objectives.
B) It could be considered a priority as two of the

top ten health indicators relate to substance use and mental health.
C) Target benchmarks and data derivation for

each objective can be used to guide program development.
D) Reducing substance abuse and addressing mental health needs are not priority with
Healthy People 2020.
E) The goals are to improve mental health through prevention and to reduce substance abuse
to protect the health, safety, and quality
of life for all, especially children.
Ans: A, B, C, E
Feedback:
Reducing substance abuse and addressing mental health needs is a priority with Healthy
People 2020.
20. Which of the following would a community health nurse address as a means for
enhancing
the life of the public?
A) Proper nutrition
B) Healthy sleep patterns
C) Use of community supports
D) Creative outlets
Ans: D
Feedback:
Life-enhancing activities to enhance public well-being include meaningful work, whether
through or outside of employment, creative outlets, interpersonal relationships, recreational
activities, and opportunities for spiritual and intellectual growth. Proper nutrition, healthy sleep
patterns, and use of community supports are life-sustaining
activities.

21. A community health nurse has completed a community assessment. Which of the
following would be next?
A) Decide on an intervention
B) Locate an appropriate the specific focus area
in Healthy People 2020
C) Establish a community diagnosis
D) Determine the level of prevention

Ans: C
Feedback:
After completing a community assessment, the nurse then establishes a community
diagnosis. Once this is done, the next step is to decide on an intervention that can address the
specific public health issue identified in the diagnosis. A good starting point in the development
of community/public health intervention is to begin with the Healthy People 2020 objectives,
locating the specific focus area that matches the community diagnosis. Once the nurse identifies
the focus of the intervention, the next step is to
determine the level of prevention.
22. A community health nurse is working with a political group to lobby for changes in
funding for a mental health promotion program. The nurse is functioning in which
role?
A) Educator
B) Collaborator
C) Advocate
D) Case manager
Ans: C
Feedback:
The advocacy role requires being politically involved by serving on decision-making

boards and committees, lobbying for legislative changes, and helping to influence mental health
policy development that will better serve this population. In the educator role, the community
mental health nurse teaches clients individually and in groups about their mental health
conditions, their treatment protocols, ways to function more independently in the community,
prevention and health-promoting strategies, and much more. In the collaborator role, the nurse
works with others, pooling the groups professional expertise to enhance the quality and
effectiveness of services. In the case manager role, the nurse is involved with screening,
assessment, care planning, arranging for service delivery, monitoring, reassessment, evaluation,
and discharge, often within the context of a community mental health center (CMHC). Case
management helps the person with an SMI to access services and live as independently as
possible.

23. Which one of the following are the primary roles that the community health nurse must
use to understand and serve populations with
mental illness?
A) Advocate
B) Educator
C) Case manager
D) Consumer of epidemiologic data
Ans: D
Feedback:
The access and use of epidemiologic data to
understand and serve populations with mental illness are primary.
24. Which of the following are involved in accessing and using epidemiologic data to
understand and serve populations with mental
illness? Select all that apply.
A) Identifying the incidence and prevalence of
mental disorders
B) Understanding that all data are accurate
C) Examining the causes and risk factors
associated with mental illness
D) Identifying the needs of people with mental
disorders
Ans: A, C, D
Feedback:
This means identifying the incidence and prevalence of mental disorders, examining the
causes and risk factors associated with mental illness, and identifying the needs of populations
with mental illness. However, not
all data are accurate.
Chapter 26 Homeless Populations

1. An instructor reviews the definition of homelessness according to the McKinney Vento
Homeless Assistance Act with a group of community health nursing students. The instructor
determines that the students need clarification when they include which of the
following as homeless?
A) Someone living in a public shelter
B) Someone living in a park
C) Someone who is incarcerated
D) Someone who lives in his or her car
Ans: C
Feedback:

The McKinney–Vento Homeless Assistance Act (Title 42 of the U.S. Code) defines a
person as homeless who lacks a fixed, regular, adequate night time residence including
supervised public or private shelters that provide temporary accommodations, institutional
settings providing temporary shelter, or public or private places that are not designed for or used
as a regular sleeping accommodation for human beings (i.e., cars, parks, camp grounds).
Incarcerated individuals, however, are not considered
homeless under this definition.
2. When addressing homeless children and youth, which of the following situations are also
considered homeless according to the education subtitle of the McKinney–Vento Homeless
Assistance Act? Select all that
apply.
A) Children who share housing with others due
to economic hardship or loss of housing
B) Children who are abandoned in hospitals
C) Children who are awaiting placement in foster
care
D) Children who are living in motels, trailer
parks, or camping grounds
E) Children who are living apart from one or
more of their parents
Ans: A, B, C, D
Feedback:
The education subtitle of the McKinney– Vento Homeless Assistance Act expands on the
definition of homelessness when addressing homeless children and youth. The act includes as
homeless those children who share housing with others due to economic hardship or loss of
housing, are abandoned in hospitals, are awaiting placement in foster care, or are living in
motels, trailer parks, or camping grounds. Children who are living apart from one or more of
their parents may
not be homeless.
3. Which of the following would likely provide the best estimate of the number of persons
who are homeless?
A) Counting the number of homeless people on a
particular day
B) Counting the persons who are homeless in a
given week
C) Counting the number of persons who are
homeless at a specific time on a specific date

D) The number of people who have been

homeless over the course of a year
Ans: D
Feedback:
Rather than trying to count the number of homeless people on a given day or week (point
in time counts), it may be more prudent to measure the number of people who have been
homeless over a longer timeframe such as over the course of a year (period
prevalence counts).
4. Which of the following are reasons why it is difficult to estimate the number of persons
who are homeless? Select all that apply.
A) It is difficult to estimate the number of people who are homeless, since homelessness is a
temporary condition.
B) It is difficult to locate and account for people
who are homeless.
C) Some people are unable to access shelters where they would be counted as homeless
because the shelter is already overcrowded
and there is limited capacity.
D) In rural areas, there are fewer housing options and resources for the homeless and as a
result people may be forced to live temporarily with
friends or family.
E) Homelessness is increasing due to poverty and the growing shortage of affordable rental
housing.
Ans: A, B, C, D
Feedback:
The following are reasons: It is difficult to estimate the number of people who are
homeless, since homelessness is a temporary condition. It is difficult to locate and account for
people who are homeless. Some people are unable to access shelters where they would be
counted as homeless because the shelter is already overcrowded and there is limited capacity. In
rural areas, there are fewer housing options and resources for the homeless, and as a result,
people may be forced to live temporarily with friends or family. It is true that homelessness is
increasing due to poverty and the growing shortage of affordable rental housing, but this is not a
reason why it is difficult to estimate
the number of people who are homeless.

5. After reviewing statistics on homelessness, which of the following would a community

health nurse identify as the fastest growing
segment of the homeless population?
A) Children under age 18 years
B) Families headed by a female single parent
C) Families headed by a male single parent
D) Families with children
Ans: D
Feedback:
Families with children are the fastest growing segment of the homeless population based
on statistics, accounting for approximately 34% of the homeless population. Single female
parents account for most of the homeless families. However, because many two-parent families
and families headed by single fathers are becoming homeless because of the recession, and most
homeless provider organizations serving families are geared to serving single women with
children, it can be harder for intact families and families headed
by men to access shelter.
6. Which of the following are subpopulations

that are more likely to be sheltered homeless in urban areas? Select all that apply
A) Adult males
B) African Americans
C) Veterans
D) Disabled
E) Migrant workers
Ans: A, B, C, D
Feedback:
When compared to their housed counterparts nationwide, the sheltered homeless are more
likely to be adult males, African Americans, veterans, unaccompanied, and disabled. In rural
areas, the homeless are more likely to be
White, Native American, or migrant workers.
7. Which of the following are reasons for the increase in poverty rates over recent years?
A) Declining wages
B) Decline in public assistance
C) Loss of jobs that offer security and carry
benefits
D) A decline in manufacturing jobs in favor of
lower paying service jobs
E) Globalization and outsourcing
F) Homelessness

Ans: A, B, C, D, E
Feedback:
The increase in poverty rates over recent years may be attributed to declining wages, loss
of jobs that offer security and carry benefits, and increase in temporary and part- time
employment, erosion of the true value of the minimum wage, a decline in manufacturing jobs in
favor of lower paying service jobs, globalization and outsourcing, and a decline in public service.
As wages drop, the potential to secure adequate housing wanes. This does not mean that
homelessness
is a cause of poverty. Actually, it is poverty that is known to cause homelessness.
8. Which one of the following statements

regarding mental illness and homelessness is most accurate?
A) 75% of the sheltered homeless report a severe
mental illness.
B) Deinstitutionalization or being released from institutions into the community contributes

to the number of persons who have a severe
mental illness who are homeless.
C) Mental illness only contributes to homelessness because poor mental health adversely
affects an individual's ability to make sound judgments, solve problems, and
make wise decisions.
D) Mental illness and substance abuse are not often comorbid conditions that contribute to
homelessness.
Ans: B
Feedback:
Deinstitutionalization or being released from institutions into the community contributes

to the number of severely mentally ill persons represented in the homeless population.
Twenty-five percent of the sheltered homeless report a severe mental illness. Mental illness
contributes to homelessness because poor mental health adversely affects an individual's ability
to make sound judgments, solve problems, and make wise decisions. Mental illness and
substance abuse are often comorbid conditions, which, coupled with poor physical health, make
it especially difficult to secure employment and safe,
affordable housing.

9. Which of the following would a community health nurse expect to assess in the
population
of homeless men?
A) Marital status
B) Substance abuse
C) Permanent employment
D) Frequent use of shelters
Ans: B
Feedback:
The majority of homeless men are single adults. Homeless men are more likely to be
employed than their homeless female counterparts; yet, they usually hold temporary, low wage
jobs that offer little security. They are also more likely than homeless women to have
uncontrolled substance abuse issues. This makes it more difficult for them to access shelters,
which
tend to require abstinence for admission
10. A community health nurse is preparing a program for a local community group about
homelessness. A portion of the program will address homeless men. Which of the
following would the nurse include?
A) Homeless men are not looked down upon less

than other groups.
B) Homeless men are usually eligible for social
services.
C) Homeless men are perceived as blameless for
their situation.
D) Single, low-income men only qualify for
medical assistance if disabled.
Ans: D
Feedback:
Single, low-income men only get medical assistance if they are disabled. Homeless men
are more likely to be treated with disdain than other homeless subgroups. Some people perceive
homeless men as largely to blame for their plight, believing that they are able bodied and should
be able to work. Moreover, homeless men may suffer from disabilities that are not severe enough
to warrant eligibility for health and social services. Often health and social programs give
priority to
women and children.

11. The nurse educator knows the nursing student understands the effect of homelessness on
the health of children when the nursing student
identifies which of the following?
A) “Homeless children are four times more likely
to become ill.”
B) “While approximately 87% of homeless children are enrolled in school, only about
77% attend regularly.”
C) “Fewer than 25% of homeless children
graduate from high school.”
D) “Homeless children are twice as likely as their housed counterparts to repeat a grade in
school.”
Ans: A
Feedback:
Only one of these statements that directly relates to the effect of homelessness on the
health of children is, “Homeless children are
four times more likely to become ill.”
12. For which reason are homeless youth at higher risk for HIV, hepatitis, and sexually
transmitted infections?
A) They are not likely to receive treatment for HIV, hepatitis, and sexually transmitted
infections.
B) They lack education or job training skills and may resort to prostitution or survival sex,
which increases their risk for HIV, hepatitis,
and sexually transmitted infections.
C) Homeless adolescents may have difficulty accessing emergency shelter because of shelter
policies that prohibit older youth from
the facility.
D) It is not uncommon for homeless youth to be

arrested for running away, breaking curfews, or being without supervision.
Ans: B
Feedback:
The reason that homeless youth are at higher risk for HIV, hepatitis, and sexually
transmitted infections is that they lack education or job training skills and may resort to
prostitution or survival sex. The following factors do not increase the risk for HIV, hepatitis, and
sexually transmitted infections: They are not likely to receive treatment for HIV, hepatitis, and
sexually transmitted infection; they may have difficulty accessing emergency shelter because of

shelter policies that prohibit older youth from the facility; and it is not uncommon for homeless
youth to be
13. Which one of the following statements about mental health issues and homeless young
people is most accurate?
A) 87% of homeless children has suffered

emotional disturbances due to the effects of traumatic stress and violence.
B) Homeless youth suffer disproportionately from anxiety, depression, conduct disorders,

posttraumatic stress, and low self-esteem.
C) It is not common for homeless youths to be

D) Homeless youth are persons under age 18
who lack parental, foster, or institutional care.
Ans: B
Feedback:
Homeless youth suffer disproportionately from anxiety, depression, conduct disorders,
posttraumatic stress, and low self-esteem. One in six homeless children has suffered emotional
disturbances due to the effects of traumatic stress and violence. It is not uncommon for homeless
youth to be arrested for running away, breaking curfews, or being without supervision. Homeless
youth are persons under age 18 who lack parental, foster, or institutional care, but this is not
necessarily related to mental health issues.
14. The community health nurse is explaining the reasons for health problems in the
homeless population. Which of the following would the
nurse identify as the most likely reason?
A) Issues related to storage of medications
B) Lack of transportation to keep appointments
C) Time and energy focus on survival needs
D) Limited access to health care services
Ans: C
Feedback:
Although issues related to medication storage, lack of transportation, and limited access
to health care play a role, many homeless people expend their time and energy trying to meet
basic survival needs such that health care takes a backseat to finding food, clothing, or
shelter.

15. community-based organization to develop

programs to provide quality accessible health care to the homeless population. Which of the
following would be the most appropriate source from which to seek funding for this program?
A) Projects for Assistance in Transition from
Homelessness (PATH)
B) Health Care for the Homeless (HCH)
C) The Interagency Council on Homelessness
D) U.S. Department of Housing and Urban
Development
Ans: B
Feedback:
The HCH program (a provision of the McKinney Act) awards grants to community-
based organizations that seek to provide quality, accessible health care to the homeless and
would be the most appropriate source for funding. PATH is a grant program created under the
McKinney Act to support the delivery of services to persons with severe mental illnesses,
including those who are homeless or at risk of becoming homeless.
The Interagency Council on Homelessness coordinates the federal response to homelessness and
creates a national partnership with public and private sectors to reduce and end homelessness in
the United States. HUD provides funding for supportive housing for low-income families, as
well as low-income individuals with disabilities, and
low-income elderly.
16. After teaching a group of community health students about public and private sector
programs and initiatives aimed at combating homelessness, the instructor determines that they
need additional teaching when they identify which of the following as a private
sector organization?
A) National Coalition for the Homeless
B) National Alliance to End Homelessness
C) National Resource Center on Homelessness

and Mental Illness
D) National Low Income Housing Coalition
Ans: C
Feedback:
The National Resource Center on Homelessness and Mental Illness is a federally
sponsored public program for addressing the needs of the homeless. The National Coalition for
the Homeless, the National Alliance to End Homelessness, and the National Low Income
Housing Coalition
are private sector resources.

17. A community health nurse who will be working with a homeless population is planning
care. Which of the following would
the nurse need to do first?
A) Develop trust with the population
B) Clarify personal values and beliefs
C) Focus on the issue of homelessness
D) Visit the local shelter where the clients are
Ans: B
Feedback:
When working with the homeless population, it is crucial that the nurse clarify personal
beliefs and values about poverty, homelessness, addictions, and mental disorders to ensure
nonjudgmental care. Trust too is essential, but this would need to occur after the nurse has
clarified his or her values and beliefs. Biases or judgments on the nurse's part would undermine
the development of trust. The nurse needs to use a comprehensive, holistic approach or focus, not
just focus on the population's homelessness. Visiting the local shelter may be helpful to gather
information about what
the nurse might expect, but it isn't the first thing the nurse would do.
18. women who are victims of intimate partner

violence, the nurse develops interventions aimed at the primary level of prevention. Which of the
following would be most
appropriate for the nurse to include?
A) Assisting them to locate a safe shelter
B) Providing immunizations
C) Screening for sexually transmitted infections
D) Teaching about basic hygiene measures
Ans: A
Feedback:
For women who are victims of intimate partner violence, counseling and helping them
locate a safe shelter can assist in preventing homelessness. Providing immunizations and
teaching about basic hygiene may be appropriate, but these would not priorities at this time.
Screening for sexually transmitted disease would be a secondary level of
prevention activity.
19. A community health nurse is working with a group of homeless clients with substance
abuse problems. Which of the following would be appropriate for the nurse to do at the
tertiary level of prevention?
A) Conduct mass screening for common

B) Institute a mobile van to assist in early

diagnosis of common illnesses
C) Advocate for counseling programs to address
high risk behaviors and abuse
D) Assist in ensuring participation in substance
abuse rehabilitation programs
Ans: D
Feedback:
Tertiary prevention level activities include treatment of complications of advanced

disease, providing rehabilitative care, such as participation in a substance abuse rehabilitation
program, and offering counseling and support. Conducting mass screenings for common
communicable diseases associated with substance abuse and a mobile van program to assist in
early diagnosis are secondary prevention level activities. Advocating for counseling programs to
address risk behaviors and abuse
would be a primary prevention level activity.
Chapter 27 Rural, Migrant, and Urban Health Care

1. When describing the term “frontier area,” which of the following would the nurse
include as the most common description?
A) A population density of fewer than 1,000
people per square mile
B) Population density of 1,000 people or more
per square mile
C) Fewer than 10,000 residents in the community
D) Fewer than six people per square mile
Ans: D
Feedback:
Fewer than six people per square mile is one of the most common descriptions of a
“frontier area.” Fewer than 10,000 residents or population density of less than 1,000 people per
square mile is the definition of “rural.” A population density of 1,000 or more people per square
mile refers to an urbanized
area or urban cluster.
2. The nurse educator is aware that the nursing student needs further instruction on the
terminology related to rural, frontier, migrant, and urban issues when the nursing students
identifies which of the following?
A) A rural area has six or fewer persons per

square mile.

B) There are many factors that are considered when determining if a community is rural or
frontier other than population density.
C) Urban areas are much more densely populated
than urban areas.
D) An urban area consists of at least 2,500 people per square mile with at least 1,500 of
those who reside outside institutional group
quarters.
Ans: A
Feedback:
If a nursing student would identify that a rural area has six or fewer persons per square
mile, the student would need further instruction as it is a frontier area that has six or fewer
persons per square mile. There are many factors that are considered when determining if a
community is rural or frontier other than population density. Urban areas are much more densely
populated than rural areas.
Urban areas consist of at least 2,500 people per square mile with at least 1,500 of them
living outside institutional group quarters.
3. When attempting to describe the characteristics of a typical rural population to a group of

community health nurses, which of
A) Older, White, with a lower income and less
formal education
B) Young minorities with a lower income and
less formal education
C) Wealthier, more highly educated, older White
Americans
D) A reflection of the population as a whole
Ans: A
Feedback:
Population characteristics include older adults as the largest segment of the population,
majority as White, with lower educational attainment, and, on the average, a lower
income.
4. Which of the following reasons is most likely

to force a rural hospital to close?
A) Rural hospitals have a high risk for financial
problems and closures.
B) Rural hospitals do not have access to high
tech equipment and services.

C) Rural hospitals are able to attract many

specialty physicians.
D) Many rural residents depend heavily on
public health department services.
Ans: A
Feedback:
Rural hospitals have a high risk for financial problems and closures. Rural hospitals
usually have less high-tech health care equipment and services, but this does not directly
influence closure of the hospital.
Rural hospitals are usually not able to attract many specialty physicians, and indeed physician
and nurse and pharmacist shortages in rural areas make it difficult to operate a hospital. Many
rural residents depend heavily on public health department services, but this is more likely an
effect of lack of access to acute care services than a cause of lack of
access to acute care services.
5. Which of the following are barriers to access to health care that may be experienced by
rural clients? Select all that apply.
A) Adequate numbers and types of providers
B) Unpredictable and hazardous weather
conditions
C) Lack of transportation
D) Physical distance between the residence and
the location of health care services
E) Less high-tech health care equipment and

services available
Ans: B, C, D, E
Feedback:
The barriers to access to health care that may be experienced by rural clients include
unpredictable and hazardous weather conditions, lack of transportation, physical distance
between the residence and the location of health care services, and less high- tech health care
equipment and services available. There are often not adequate numbers and types of providers
of health care
in rural areas.

migrant workers and their families most accurately describes their lifestyle?
A) They are usually paid fairly and treated justly
by their employers.
B) Often the men are the only ones who perform

the migrant work.

C) They often work 6 days a week from sunrise
to sunset.
D) Their earning power is dependent only upon
their skill level.
Ans: C
Feedback:
Migrant workers often work 6 days a week from sunrise to sunset. They are often paid
unfairly and treated unjustly. The entire family is often involved in performing the migrant work.
Their earning power is variable depending on the variables of weather and
crop conditions.
7. When assessing a group of migrant farmworkers, the community health nurse notes that
the group leaves their home base for part of the year to travel to the same place along a route
during the agricultural season, usually returning on yearly basis. The community health nurse
identifies this as
A) Restricted circuit migration
B) Point-to-point migration
C) Nomadic migration
D) Migrant stream migration
Ans: B
Feedback:
Point-to-point migration entails leaving a home base for part of the year to travel to the
same place or series of places along a route during the agricultural season, usually returning on a
yearly basis. In a restricted circuit, many people travel throughout a season within a small
geographic area, following the crops. Nomadic migration involves traveling away from home for
several years, working from farm to farm and crop to crop, relying on word of mouth about job
opportunities. Migrant stream migration involves following the harvest seasons of agricultural
crops, moving from place to
place, usually along predetermined routes (migrant streams).
8. A community health nurse is working to improve the health children of migrant families.
Which of the following issues would be of least importance for the nurse to
address?
A) Adolescent substance abuse
B) Exposure to domestic violence
C) Mental health problems
D) Participation in chores

Ans: D
Feedback:
Many migrant children are called upon by their families to stay home from school to
work, care for younger children, or attend to other household chores, thus affecting the child's
academic performance. However, chores and helping the family are necessary to the family's
survival and as such would be something the nurse would focus on at a later time. Issues such as
adolescent substance abuse, domestic violence, and mental health problems are common and
would need to be
addressed early on.
9. Which of the following have a direct and

negative influence on the vulnerability of migrant workers? Select all that apply.
A) Many are undocumented aliens and live in
fear of deportation.
B) They are often deprived of safe working
conditions.
C) Their children are deprived of a quality
education.
D) They often lack adequate sanitation and
housing.
E) They often have poor nutrition because of
poverty.
Ans: A, B, D, E
Feedback:
Factors that have a direct and negative influence on the vulnerability of migrant workers
include many are undocumented aliens and live in fear of deportation; lack of safe working
conditions; lack of adequate sanitation and housing; and poor nutrition because of poverty. That
their children are deprived of a quality education is also significant, but it is not a direct influence
on the vulnerability to health concerns of the
migrant workers themselves.
10. A community health nurse is working to develop programs to address the health status of
migrant families. Which of the following would the nurse need to keep in mind when planning
these programs? Select all that
apply.
A) A greater mortality from injuries, TB, respiratory diseases, and cerebrovascular

diseases
B) A dramatic increase in use of immunizations
for migrant children

C) An infant mortality rate that is 25% to 30% higher than for other infants in the United
States
D) Health needs compromised by limited access
to health care and high mobility
E) A much lower life expectancy than that of the
general population
Ans: A, C, D, E
Feedback:
The life expectancy of a migrant worker is much lower than the general population, with
proportionally increased mortality from “injuries, tuberculosis, mental disorders, cerebrovascular
disease, respiratory diseases, ulcers, hypertension, and cirrhosis.” The migrant infant mortality
rate is 25% to 30% higher than the national average. Migrant children are delayed for
immunizations.
Migrant families have numerous health needs, but they often face many obstacles to accessing
health care including their frequent
movement from place to place.
11. A local community has a significant population of migrant workers. In response, a

community health nurse plans to prevent a program to the local community about this
population. As part of the program the nurse plans to include information about Cesar Chavez,
describing him as which of the
following?
A) A Mexican president who worked to keep

people from crossing the border illegally
B) A well-known actor who advocates for increasing the number of Latinos in

Hollywood
C) The senator who wrote the Children's Health
Insurance Program (CHIP) bill
D) Founder of the United Farm Workers who
spent his life fighting for social justice
Ans: D
Feedback:
Cesar Chavez founded the United Farm Workers (UFW), the first union in agricultural
labor history that successfully organized migrant farmworkers. Chavez fought for social justice
and is an example of a migrant hero. He was not a senator, well-known actor,
or Mexican president.

12. When providing care for migrant workers, which of the following would be most
appropriate for the community health nurse to
do?
A) Maintain existing services
B) Use standard methods of health care delivery
C) Employ information tracking systems
D) Use professionals for community outreach
Ans: C
Feedback:
Employing information tracking systems is necessary due to the mobility of this
population and the need for continuity of care. The nurse should improve the existing services,
use unique methods of health care delivery to reach this population, and use lay
personnel for community outreach.
13. A community health nurse works to offer increased health care services to meet the needs
of a local migrant population. Which of the following ideas will work well for this
population? Select all that apply.
A) Providing a mobile van clinic that comes to

the farms during the day
B) Offering a clinic at the migrant camp from 7
to 10 PM
C) Asking local doctors to stay open until 6 PM
during the summer
D) Offering school-based health services for the
children
E) Providing a breakfast program for the
children at school
Ans: A, B, D, E
Feedback:
The van at the work site, services for children in school including a breakfast program, a
late evening clinic at the camp would help the greatest number of migrant family members.
Migrant workers are in the fields until dark. In the summer that may be 9 PM; thus, a physician
who stays open until 6 PM will not
help.

14. When dealing with urban populations, which of the following issues would a community
health nurse most likely face? Select all that
apply.
A) Health disparities in the population
B) Lower levels of homelessness
C) Increased cases of asthma
D) High levels of poverty
E) Major transportation issues
Ans: A, C, D
Feedback:
Health disparities are very evident in the populated urban setting. There are increased
levels of asthma and higher levels of poverty. Homelessness is more evident, yet transportation
issues are not as great as in
suburban or rural areas.
15. After teaching a group of community health nursing students about urban sprawl and its
effects, the instructor determines that additional teaching is needed when the students identify
which of the following as an
effect?
A) Water pollution
B) Heat islands
C) Less exposure to pesticides
D) Decreased air quality
Ans: C
Feedback:
Encroachment of housing areas into natural habitats or farmlands can lead to wider
human exposure to pesticides, herbicides, and other things such as mosquito-borne illnesses.
Urban encroachment into agricultural areas creates problems with air and water pollution,
access to health care, and heat islands.
16. Which of the following are livability principles that have been identified by the
Partnership for Sustainability Communities?
A) Diminish economic competitiveness
B) Disassemble existing communities
C) Coordinate and leverage federal policies and
investment
D) Provide more transportation choices
E) Promote equitable, affordable housing
Ans: C, D, E
Feedback:

The six livability principles include (1) provide more transportation choices, (2) promote
equitable, affordable housing, (3) enhance economic competitiveness, (4) support existing
communities, (5) coordinate and leverage federal policies and investment, and (6) value
communities and
neighborhoods.
17. concept of social justice, which of the

following if stated by the group as a component indicates effective teaching?
A) Decreased burden borne by all
B) Increased benefits obtained for all
C) Narrow isolated view of health
D) Diversity viewed as a strength
Ans: D
Feedback:
Social justice occurs when a society provides for the health needs and health care issues
of all people by treating people fairly, regardless of where they live or who they are. It deals with
concepts of inclusion, participation, empowerment, and the recognition that diversity is a
strength. Social justice involves an equal bearing of the burdens and equal reaping of the
benefits. Community health nurses who practice social justice have broad and holistic views of
health.
18. A community health nurse working with urban populations integrates the concept of
social justice into practice by demonstrating
A) Impartiality
B) Paternalism
C) Self-interest
D) Inflexibility
Ans: A
Feedback:
Social justice requires impartiality, that is, ensuring that interventions are just and the
outcome is fair when viewed by an uninvolved outsider. Paternalism reflects an individual focus
rather than the population focus of social justice. Self-interest and inflexibility would interfere
with impartiality
and, subsequently, social justice.
19. is describing how rural community health

nursing compares with community health nursing in urban and suburban areas. Which of the
following would the nurse include about rural community health nurses?
A) Salaries comparable with the other two areas
B) More difficulty in initiating planned change
C) Nurses viewed as active, highly respected
community members
D) Less physical isolation from professional

opportunities
Ans: C
Feedback:
Rural community health nurses are active members of their community and are highly
respected professionals. Salaries typically are lower than that of urban nurses in comparable
positions. However, because the system of health care is smaller, it can be easier to understand
the system and initiate planned change. Rural community health nurses may experience the
challenge of physical isolation from personal and professional opportunities associated with
urban areas. Traveling to cities for basic and continuing education can be a barrier. In addition,
rural nurses may feel isolated in clinical practice because of the scarcity of professional
colleagues.
20. A community health nurse implements the use of promotoras to promote health in
migrant communities. Which of the following best
describes a promotora?
A) Nonprofessional community outreach worker
B) Trained childbirth assistant
C) Retired nurses knowledgeable of the area
D) Language translators
Ans: A
Feedback:
The use of promotoras—lay community outreach workers—or doulas—usually trained

childbirth assistants—have promoted health in migrant communities. Promotoras are not
retired nurses or language translators.
21. Which of the following activities best

exemplifies a community health nurse forging a relationship?
A) Dealing with sensitive subjects
B) Introducing one's self as a community health
nurse
C) Listening to more than just what is said
D) Being aware of the long term commitment to
the client
Ans: B
Feedback:
In forging a relationship, CHNs begin with creating a “perception of presence” by
identifying themselves as a public health nurse and passing out their card with the instruction to
the client to call upon them when needed. Acting as a resource involves dealing with “sensitive
subjects” and requires “honesty, asking direct questions, and ignoring rude behavior.” Detecting
and asking the next question “means listening to more than what is said.” When a client is truly

heard and all information is on the table, making an informed judgment is then possible. Sense of
time includes the awareness of the long-term commitment of the community health nurse to the
client and the belief that results can occur, despite the lack of progress or even regression on the
part of some clients.
22. After teaching a class on urban health to a group of community health nursing, the
instructor determines that the teaching was successful when the students describe it as
A) Providing care to those individuals who are

living in ghettos
B) Addressing the needs of immigrants living in
large cities
C) Considering effects of environment on the
health of large cities
D) Ensuring the appropriate planning of
attractive and equitable places
Ans: C
Feedback:
Urban health considers those characteristics of the environment as they relate to the
health of the population living within large cities.
Individuals living in ghettos and immigrants living in large cities are but two segments of the
urban population. Urban planning works to improve the welfare of individuals and communities
by creating more healthful,
efficient, attractive, and equitable places.
23. A rural community health nurse is acting in the role of a mentor. Which of the following
activities would the nurse most likely be
doing?
A) Providing childbirth classes
B) Contacting a specialist for a client
C) Collecting immunization data for program
development
D) Orienting a new rural health nurse to the
community
Ans: D
Feedback:
In the role of a mentor, the rural community health nurse would engage in guiding new
community health nurses, nursing students, and other nurses new to the rural community.

Childbirth classes would be characteristic of the educator role. Contacting a specialist for a client
reflects the nurse's role as a referral agent. Collecting immunization data for program
development reflects the nurse's role
as a change agent/researcher.
Chapter 28 Public Settings

1. As a guest speaker for a group of community health nurses who are considering
corrections nursing as a career, a corrections nurse provides an overview of the history of
corrections nursing. Which of the following would the nurse describe as the historic view
of corrections nursing?
A) Health care to inmates occurred primarily as
emergency treatment.
B) Inmates were viewed as not deserving care
paid by public dollars.
C) The emphasis was on corrections, not
punishment.
D) Prisons provided safe havens from
Ans: B
Feedback:
Although the correctional system of prisons and jails has been around for a very long
time, it historically provided minimal, if any, health care to inmates. Prison was a punishment,
and the inmates were viewed as not deserving of care that was being paid for from public dollars.
Communicable diseases were and
continue to be a major health issue.
2. A nurse is considering a career in public health nursing. The nurse determines the need to
obtain which of the following for entry-
level practice?
A) Associate's degree in nursing
B) Bachelor's degree in nursing
C) Master's degree in nursing
D) Post-master's degree certification
Ans: B
Feedback:
The American Nurses Association recommends that an entry-level PHN should have a
bachelor's degree in nursing. Some states, such as California, require nurses to take additional
classes and obtain certification beyond a bachelor's degree if the BSN program does not offer
specific content (e.g., child abuse, public health didactic and practicum). PHNs working with
specific populations, or in administration, should hold a master's degree. A PHN with a master's

degree in community/public health nursing may take a national certification examination offered
by the American Nurses Credentialing
Center.
3. When describing the differences between public health nursing and nursing in general,
which of the following would an instructor include as characteristic of public health
nursing? Select all that apply.
A) Acute care services
B) Focus on the greater good
C) Seek out of clients in need
D) Community commitment
E) Health restoration
Ans: B, C, D
Feedback:
Public health nurses focus on the greater good, seek out clients in need, and are
committed to the community. Public health nursing is grounded in social justice and focuses on
health promotion and disease prevention. Public health nursing does not usually include acute
care services or health
restoration.
4. Which of the following activities best reflects a public health nurse's role in the public
health function of assessment?
A) Prioritizing the issues of a community to
determine appropriate interventions
B) Evaluating for potential safety hazards in a

childcare center
C) Ensuring that children in a day care center are
properly immunized
D) Working with officials to develop a program
for solving a problem
Ans: A
Feedback:
The public health function of assessment is reflected when a public health nurse identifies
the problems in a community and then prioritizes which issue to address first by deciding which
issue impacts the most people and what interventions will help the population thrive. Evaluating
for potential safety hazards and ensuring proper immunizations reflect the assurance function of
public health. Working with officials to develop programs reflects the function of
policy development.

5. Which one of the following statements best illustrates the similarities and differences
between public health nursing and other types
of nursing?
A) The priorities are the same for both public
health nursing and other types of nursing.
B) In hospital nursing, nurses must address the issues that come to them. Whereas in public
health nursing, it is necessary for the nurse to actively seek out and identify potential
problems and situations.
C) Nurses whose main practice is in the hospital

are required to collaborate more effectively than public health nurses.
D) Nurses who work in public health do not use the nursing process as a foundation for their
work.
Ans: B
Feedback:
In hospital nursing, nurses must address the issues that come to them. Whereas in public
health nursing, it is necessary for the nurse to actively seek out and identify potential problems
and situations. The priorities vary for both public health nursing and other types of nursing and
certainly within different communities that a public health nurse practices. Nurses who work in
public health must collaborate as must nurses who work in the hospital. However, the types of
people and agencies that a public health nurse must collaborate with vary from the types of
people and agencies that a hospital nurse must collaborate with. Nurses who work in public
health use the nursing process as a foundation for their work, just as nurses who work in
hospitals do. In public health nursing, the community is the client but the nursing process may
also be applied to individuals and families.
6. After teaching a group of students about the federal agencies involved in public health,
the instructor determines that the teaching was successful when the students identify which
agency as the main organization that is
involved in public health?
A) Environmental Protection Agency
B) Department of Homeland Security
C) Department of Agriculture
D) Department of Health and Human Services

Ans: D
Feedback:
The main organization involved with public health is the Department of Health and
Human Services (DHHS). Other federal agencies that also impact public health include the
Environmental Protection Agency (EPA), the Department of Homeland Security, the Department
of Agriculture, the Department of Education, and the Department
of Veterans Affairs.
7. A public health nurse is employed by the Indian Health Services. This nurse is working
at which of the following levels?
A) Local
B) Community
C) State
D) Federal
Ans: D
Feedback:
The Indian Health Service is an agency headed by the Department of Health and Human
Services, a federal agency. Thus the
nurse would be working at the federal level.
8. After teaching a group of students about public health nursing and the U.S. Public Health
Service Commissioned Corps, the instructor determines that the students need additional
instruction when they state which of the following is necessary to qualify for a
position in the Corps?
A) Age over 45 years
B) Bachelor's degree in nursing
C) Valid nursing license
D) U.S. citizenship
Ans: A
Feedback:
To qualify as a nurse in the Commissioned Corps, one must be a U.S. citizen, <44 years
old, able to pass a physical examination, possess a bachelor's or higher degree from an accredited
nursing program, pass the National Council Licensure Examination (NCLEX), and hold a valid
nursing license from one of the 50 states, the District of Columbia, Puerto
Rico, Guam or the U.S. Virgin Islands.

9. A public health nurse working with several communities to develop appropriate programs
for health surveillance. Which agency would the nurse contact to obtain information on this
topic?
A) Centers for Disease Control and Prevention
B) National Institutes of Health
C) Agency for Health Care Research and Quality
D) Food and Drug Administration
Ans: A
Feedback:
The nurse would contact the Centers for Disease Control and Prevention that is
responsible for health surveillance and the prevention of disease and bioterrorism. The National
Institutes of Health provide medical research. The Agency for Health Care Research and Quality
is responsible for research on health care quality and effectiveness. The Food and Drug
Administration works to ensure the safety of food, medication, medical procedures, and
equipment.
10. A community health nurse is advocating for the development of school-based health
centers in the community high schools as a
means to accomplish which of the following?
A) Maintain the current absentee rate
B) Provide contraceptive services
C) Increase ready access to health care services
D) Promote increased use of emergency services
Ans: C
Feedback:
School-based health centers (SBHC) provide ready access to health care for large
numbers of children and adolescents during school hours, reducing absences from school due to
health care appointments. SBHCs provide a variety of services in a user-friendly manner at a
convenient location. Many SBHCs do not provide contraceptive services on the school site due
to school district policy or state law. These centers also are a cost-effective way to
decrease visits to the emergency department.
11. Which one of the types of services that may be available in a school-based health center
may be controversial and not be supported by
all parents and community members?
A) On-site sexually transmitted infections testing
and treatment
B) On-site provision of contraceptives
C) Well-child care

D) Sick-child care
Ans: B
Feedback:
Many school-based health centers do not provide contraceptive services on the school site
because of school district policy or state
law.
12. During a class, an instructor reviews the impact of the Supreme Court decision regarding
Estelle v. Gamble. The instructor determines that the students understand the material when they
identify which of the
following about this decision?
A) It created the need for cleaner, less crowded
facilities.
B) It led to major reforms including
establishment of inmates' rights.
C) It required the use of managed care
organizations for service.
D) It mandated care to be provided in a timely
fashion.
Ans: B
Feedback:
The Supreme Court ruled that not providing medical services inflicted pain and denied
inmates of their Eighth Amendment rights. This decision led to major reforms in the corrections
health system. Medical providers were hired and inmates' rights were established. The decision
did not address facilities or use of managed care organizations. Treatment in a timely fashion
was not part of this decision. However, later
lawsuits involve this issue.
13. Which of the following health conditions would the corrections nurse expect to address
as most prevalent? Select all that apply.
A) Heart disease
B) Tuberculosis
C) Hepatitis C
D) Asthma
E) Substance abuse
Ans: B, C, E
Feedback:

Communicable diseases such as tuberculosis and Hepatitis C are of great concern in the
correctional community. In addition, drug abuse by inmates is very high. Heart disease
and asthma rates vary.
14. A school nurse functions to promote a healthy school environment. Which of the
following would be most appropriate for the nurse to
do?
A) Advocating for proper nutrition and exercise to prevent and reduce the incidence of
obesity
in school-age children
B) Providing care for children with asthma
C) Developing individualized health plans
D) Engaging in incidental teaching about
scoliosis
Ans: A
Feedback:
Promotion of healthful school living emphasizes planning a daily schedule for monitoring
healthful classroom experiences, extracurricular activities, school breakfasts and lunches,
emotional climate, discipline programs, and teaching methods. It also includes screening,
observing, and assessing to identify needs early and report illegal drug use, suspected child
abuse, and violations of environmental health standards. Health promotion involves the nurse in
supporting the physical, mental, and emotional health of school personnel by being an accessible
resource to teachers and staff regarding their own health and safety. Providing asthma care and
developing individualized health plans are examples of providing health services.
Engaging in incidental teaching reflects the function of health education.
15. A school nurse who is not a nurse practitioner works in an elementary school (K-4) with
1,200 students. Which of the following would the nurse engage in with this group? Select all
that apply.
A) Screening for scoliosis
B) Vision and hearing screening
C) Teaching basic health practices
D) Monitoring chronic illnesses
E) Ordering medications
F) Providing primary care
Ans: B, C, D
Feedback:

Vision and hearing screening, teaching basic health practices, and monitoring chronic
illnesses are appropriate school nurse activities for children in this age group.
Scoliosis screening would be more appropriate for children in their early adolescent growth spurt
years, not at this age. A school nurse would not order medications. A school nurse practitioner
would provide primary care and if allowed by the state,
prescribe medications.
16. A school nurse is describing the responsibilities associated with this specialty to a group
of students. Which of the following would the school nurse identify as a primary
responsibility?
A) Providing care to children with special health
needs
B) Preventing illness among the school
community
C) Performing health screenings
D) Assessing acute health problems
Ans: B
Feedback:
The primary responsibilities of the school nurse are to prevent illness and to promote and
maintain the health of the school community. The school nurse serves not only individuals,
families, and groups within the context of school health but also the school as an organization
and its membership (students and staff) as aggregates. Caring for children with special health
needs, performing health screenings, and assessing acute health problems are aspects associated
with the primary responsibilities of preventing illness
and promoting and maintaining the health of the school community.
17. A school nurse is reviewing the population of school age children for chronic conditions.
Which of the following would the school
nurse expect to find most often? Select all that apply
A) Rheumatoid arthritis
B) Asthma
C) Diabetes
D) HIV/AIDS
E) Tuberculosis
F) Seizures
Ans: B, C, F
Feedback:
The four chronic conditions most often seen in school-age children are asthma, diabetes,
seizures, and severe food allergies.

Rheumatoid arthritis is not as common. HIV/ AIDS and tuberculosis are more commonly
seen in correctional settings.
18. A school nurse is providing care to a group of children with severe food allergies. Which
of the following would be most important for the
nurse to include in the child's plan of care?
A) Ensuring that the child has ready available
access to EpiPen
B) Advising teachers to call the child's parents in
case of a reaction
C) Teaching other students how to administer the
EpiPen
D) Administering daily medication to control the
allergies
Ans: A
Feedback:
Severe food allergies can lead to anaphylactic shock. School nurses coordinate and work
with students and their families, along with school personnel to raise awareness and enlist
caution. They also work with families and health care providers to ensure that epinephrine via an
autoinjector EpiPen is available for the child in case of emergencies. School nurses also work
with teachers and lunch room personnel to alert them of the allergy, explain what can happen in a
case of anaphylaxis, and provide training on how to use the EpiPen or other needed medication.
Calling the child's parents in case of a reaction would be important but prompt treatment with
epinephrine is the priority. Responsible adults, not other children should know how to administer
the epinephrine.
Daily medication usually is not required for
children with food allergies, however, avoidance of the allergen is.
19. A corrections nurse is working to develop programs for inmates and reviews the
demographics of this population to determine potential issues. Which of the following
would the nurse expect to find?
A) Greater portion of inmates who are white
B) Increasing numbers of women in prisons
C) Equal distribution of socioeconomic
backgrounds
D) Incarceration primarily for commission of
minor crimes
Ans: B

Feedback:
Looking at the demographics of inmates, there are many differences from the general
population. First, inmates have all committed some type of crime, with nearly half (52%) being
violent crimes. National statistics indicate a larger portion of Black (3,042 per 100,000) and
Hispanic (1, 261 per 100,000) male inmates than White male inmates (487 per 100,000).
Although males are still the majority population (88.6%), trends show an increase in the number
of women in state or federal prisons. In addition, the inmate population is drawn
disproportionately from
lower socioeconomic backgrounds when compared with the general public.
20. A corrections nurse is proactively working with the institution to develop programs for
the facility to address problems to address the trends for the future. Which type of program
would be most appropriate for the nurse to
recommend?
A) Treatment of typical disorders found in
younger inmates
B) Dealing with older, sicker, and longer periods
of incarceration for many inmates
C) Clinics to address acute disease conditions
D) Education for release after shorter
incarcerations
Ans: B
Feedback:
Typically, inmates are older, sicker, and remain in prison longer than in previous years.
Therefore, the nurse would need to develop programs to address older inmates with more chronic
illnesses and longer
incarcerations.
21. A corrections nurse is visiting a local nursing school to describe this career. Which of the
following would the nurse include in the
discussion?
A) Lower salaries than other fields

B) Primarily assessment oriented
C) Extensive employee benefits
D) Low safety risk
Ans: C
Feedback:

Salaries depend upon the state, although they tend to be higher salaries than in other
nursing fields. Moreover, corrections nurses usually receive extensive employee benefits and
insurance packages as government employees. Corrections nurses must have good mental health
and assessment skills.
They must be able to communicate well and be strong nursing advocates and strong advocates
for their clients. They work in an intense environment where their safety could be threatened,
and they must deal with clients who may be noncompliant, combative, and manipulative.
Corrections nurses must also be very flexible and knowledgeable about a
variety of nursing specialties.
22. A school nurse is addressing the dental health issues of the local community of school
children. Which activity would be most
appropriate at the community level?
A) Educating parents about the importance of
oral health
B) Teaching children how to brush and floss
properly
C) Assisting with finding resources for those
without dental insurance
D) Advocating for the fluoridation of drinking
water
Ans: D
Feedback:
At a community level, school nurses can educate the public about the benefits of dental
fluoride treatments. They can advocate for fluoridation of drinking water, school-based fluoride
rinses or gels, and dental sealant programs. At the classroom level, school nurses can provide
dental education and provide toothbrushes, toothpaste, and floss to ensure that students are able
to practice good dental hygiene habits. At an individual level, school nurses can assist in finding
resources for those with no dental health insurance.
Finally, school nurses can successfully educate parents regarding the importance of
oral and dental health.
23. Which of the following would the school nurse who is dealing with a primarily
adolescent school population focus on? Select
all that apply.
A) Substance abuse
B) Eating disorders
C) Suicide prevention
D) Sexual activity

E) Dental sealants
Ans: A, B, C, D
Feedback:
Many of the health issues that modern adolescents face are a result of their own choices
and high-risk activity; for example, sexual activity, substance abuse, injury, and violence. Eating
disorders are most prevalent in adolescent females. Dental sealants are more appropriate for
elementary school
children.
24. Which one of the following statements about the common roles and functions of public
health nurses, school nurses, and corrections
nurses is most accurate?
A) Emphasis is placed on the treatment of
disease and disability.
B) Nurses in all of these areas serve the population as client as opposed to individuals
as clients.
C) All of these specialty nursing fields are paid very well because their setting is supported
through public funds.
D) Public health nurses can influence the health

of vulnerable populations more than any of the other specialties.
Ans: B
Feedback:
Nurses in all of these areas serve the population as client as opposed to individuals as
clients. Emphasis is placed on prevention of disease or disability. These community nurses all
work in settings that are supported by public funds but the amount of pay varies. All of these
specialties of nursing can influence the health of vulnerable
populations.
Chapter 29 Private Settings

1. After reviewing the history of nurse-managed health centers, the instructor determines
that the teaching was successful when the students identify which of the following as the
beginnings of today's model?
A) 1920s
B) 1940s
C) 1960s
D) 1980s
Ans: C

Feedback:
Today's NMHCs trace their roots to changes in national health care laws begun in the
mid-1960s. However, the nursing model of holistic care focusing on vulnerable
populations and integrating primary care and
public health dates back to the 19th century.
2. centers to a group of students, which of the following would the instructor emphasize?
A) Use as a vital safety net health care provider
B) An alternative to primary care for insured
persons
C) Focus on the individual in the community
D) Affiliation with a local acute care facility
Ans: A
Feedback:
Nurse-managed health centers have emerged as a vital safety net health provider in
America's health care delivery system. A “safety-net provider” is defined as a provider that by
mandate or mission organizes and delivers a significant level of health care and other health-
related services to the uninsured, Medicaid recipients, and other vulnerable populations. The
distinctiveness of these centers is the community orientation. The centers can be a freestanding
business or may be affiliated with universities and other service institutions.
3. After describing the various models for nurse- managed health centers, the instructor
determines that the student understand the information when they identify which organization
structure as being partnered
legally with a human services organization?
A) Academic nursing center
B) Freestanding center
C) Subsidiary center
D) Affiliated center
Ans: D
Feedback:
An affiliated center is one in which there is a legal partnership with a health care or
human services organization. An academic nursing center is located within a School of Nursing.
A freestanding center is an independent center with its own governing board. A subsidiary
center is part of a larger health care system.
4. Which of the following statements about the focus of nurse-managed health centers is
most
accurate?
A) The focus is providing clinical experiences

for nursing students.

B) They are truly community oriented.
C) They all have the same practice models.
D) They only focus on health promotion and
wellness.
Ans: B
Feedback:
Nurse-managed health centers are truly community oriented. They may provide clinical
experiences for nursing students but this is not their focus. They vary in practice models. They
provide a range of services from health promotion and wellness to
conventional primary care.
5. A nursing instructor is preparing a group of students for a clinical rotation in a nurse-

managed health center. Which of the following would the instructor include when
describing the students' role?
A) Clinical supervision
B) Passive participation
C) Use of tertiary-level activities
D) Implementation of best practices
Ans: D
Feedback:
Nurse-managed health centers implement evidence-based practice via best practices or
the application of the best available evidence to improve practice. Thus students also would
follow this approach. Students' roles are similar to their staff mentors; faculty roles would
involve clinical supervision. Students assigned to these centers are active
participants in the vital activities of the center.
6. Which of the following would be the most

likely source of funding for services provided in a comprehensive primary care center?
A) Government grants
B) Medical insurance plans
C) Another nurse-managed care center
D) Private contracts
Ans: B
Feedback:
In the comprehensive primary care centers, advanced practice nurses provide primary
care services. Such services are usually reimbursable under Medicaid and managed care medical
insurance plans. In wellness centers, public health nurses and other interdisciplinary team
members provide a range of primary and secondary prevention strategies. These services are
usually not reimbursed by insurance plans, but are often covered by grants and contracts. Often

one nurse-managed care center partners with one or more nurse-managed care centers or other
community based organizations to provide strength to the proposal for funding.
7. Which of the following criteria must a nurse- managed health center meet to ensure
designation as a Federally Qualified Health
Center?
A) Located in a densely populated area
B) For profit status
C) Consumers comprise the majority of the
board of directors.
D) Care provision to women and children
exclusively
Ans: C
Feedback:
In order to qualify, the centers must: be located in a medically underserved area or serve
a medically underserved population; have a nonprofit, tax exempt, or public status; have a board
of directors, a majority of whom must be consumers of the center's health services; provide
culturally competent, comprehensive primary care services to all age groups; and offer a sliding
scale fee and
provide services regardless of ability to pay.
8. Which of the following statements about funding sources for nurse-managed health
clinics is most accurate?
A) All nurse-managed health clinics can be

reimbursed by Medicaid and managed care medical insurance plans.
B) Grants can be used as a source of initial start up funding and/or to support ongoing
activities.
C) It is common for nurse-managed health

clinics to receive funding from one primary source.
D) Contracts are awarded based on competition and are renewable when goals and
objectives
are not met.
Ans: B
Feedback:
Grants can be used as a source of initial start up funding and/or to support ongoing
activities. In comprehensive primary care centers, advanced practice nurses provide primary care

services that are usually reimbursable under Medicaid and managed care medical insurance
plans. Most nursing centers operational and salary budgets entail a combination of funding
sources. Contracts are usually noncompetitive and renewable when
goals and objectives are met.
9. After discussing nurse-managed care centers with a group of community health nursing
students, the instructor determines that the teaching was effective when the students identify
which of the following as one of the
main challenges?
A) Ensuring adequate populations for services
B) Exerting a positive influence on community's
health
C) Continuing services after funding has stopped
D) Managing the multitude of services provided
Ans: C
Feedback:
Sustainability, or the ability to carry on services and health promotion activities when
funding is no longer available, is one of the main challenges of NMHCs. The populations served
are vast and not predicted to decrease in light of the current status of health care.
Nurse-managed health centers have much to offer toward resolving the national health care crisis
facing vulnerable populations who are uninsured or underinsured and exerting a positive
influence on the community's health. Management of the multiple services may be challenging,
but the sustainability of the
center is paramount.
10. Which party is usually required to describe detailed plans for sustainability after the
award period ceases?
A) The client
B) The funder
C) The providing organization
D) The insurer
Ans: C
Feedback:
In the past, funders were often confronted with the task to help organizations find and
secure other resources, or extend their own financial support, to ensure the continuity of services.
More recently, both public and private funders are stipulating that organizations describe detailed
plans for sustainability after the award period ceases in
their application submitted for funding.

11. Which of the following statements about faith

community nursing is most accurate?
A) Nurses are uniquely able to focus on the
spiritual influences on health.
B) Faith community nursing is one of the newest

nursing specialties, and one of the oldest means of health care delivery.
C) Faith community nursing is restricted to

Christian religious institutions in the United States.
D) For hundreds of years, deaconesses, sisters, and lay members of religious communities
have been engaged in health promotion.
Ans: B
Feedback:
Faith community nursing is one of the newest nursing specialties, and one of the oldest
means of health care delivery. Nurses have the unique ability to bridge the disciplines of
medicine and religion and assist the client in understanding the physical and spiritual influences
on health. The parish nursing movement soon spread outside of Christian religious institutions
and beyond the borders of the United States to Canada, Australia, and New Zealand. For
hundreds of years, deaconesses, sisters, and lay members of
religious communities have been involved in ministering to the sick.
12. A community health nursing instructor is developing a class plan about faith community
nursing for a group of community health nursing students. Which of the following would the
instructor expect to
include?
A) One of the oldest nursing specialties
B) One of the newest means of health care
delivery
C) Diversity in activities and interventions
D) Differences from parish nursing
Ans: C
Feedback:
Activities and interventions used by faith community nurses are as diverse as their faith
communities. Faith community nursing is one of the newest nursing specialties and one of the
older means of health care delivery.
Nurses practicing in the faith community may be referred to a faith community nurses (FCN),
parish nurses, health ministry nurses, or congregational nurses depending upon preference and
the traditions of the faith
community.

13. Which of the following agencies was instrumental in developing the first Scope and
Standards of Parish Nursing Practice?
A) International Parish Nurse Resource Center
B) Health Ministries Association
C) American Nurses Association
D) Parish Nurse Institute
Ans: B
Feedback:
The Health Ministries Association provides additional resources and support for faith
community nursing practice and was instrumental in developing the first Scope and Standards of
Parish Nursing Practice. The International Parish Nurse Resource Center, formed in the 1980s,
has provided educational programs and resources for nurses seeking to practice as a parish nurse
for over two decades. The American Nurses Association in conjunction with the Health Ministry
Association has developed the Scope and Standards of Practice for this field of nursing. The
Parish Nurse Institute is an organization dedicated to the education and support of registered
nurses who wish to practice nursing
as Parish Nurses or Faith Community Nurses.
14. Faith community nurses engage in seven diverse nursing roles. Which one of the roles is
distinctly unique to faith community
nursing?
A) Advocate
B) Integrator of faith and health
C) Coordinator of volunteers
D) Developer of support groups
Ans: B
Feedback:
To achieve the goal of faith community nursing, seven diverse nursing roles are central to
incorporate into practice: Health educator, health counselor, advocate, referral agent, developer
of support groups, coordinator of volunteers, and integrator of faith and health. A distinctly
unique role of
the FCN is as integrator of faith and health.
15. Which of the following roles would be critical to a faith community nurse to assume to
achieve the goals of this practice? Select all
that apply.
A) Advocate

B) Health educator
C) Volunteer coordinator
D) Health counselor
E) Case manager
F) Direct care provider
Ans: A, B, C, D
Feedback:
The faith community nurse assumes seven diverse nursing roles as essential for practice
including: health educator, health counselor, advocate, referral agent, developer of support
groups, coordinator of volunteers, and integrator of faith and health. Case manager and direct
care provider are not considered
roles of the faith community nurse.
16. A faith community health networks with a local transportation service to provide service
to several clients in the community needing rides to health care appointments. The nurse
is functioning in which of the following roles?
A) Developer of support groups
B) Referral agent
C) Advocate
D) Health counselor
Ans: B
Feedback:
The faith community health (FCN) nurse functions as a referral agent through networking
with community agencies to assist and guide the client through the health care system and
connect the client with needed community resources. As a developer of support groups, the faith
community nurse develops groups tailored to the faith community needs such as coping with loss
and grief, cancer, caregiver stress, chronic illness, single parenting, addiction recovery, and
more. The FCN may lead or facilitate the support groups or may train others to fulfill those
positions. As an advocate, the FCN uses knowledge of the health care system and awareness of
safe and effective care practices to facilitate appropriate, timely intervention. In the health
counseling role, the nurse seeks to understand the individual's perceptions, fears, and barriers
that prevent the person from taking action.

17. Place in order, the steps involved in creating a faith community nursing position within a
faith community.
A) Seek support of the faith community members and staff.
B) Seek formal approval from the organization's governing body.
C) Assess the community the nurse plans to serve and identify the health needs of the faith
community and the roles of the faith community nurse that meet those needs.
D) Solicit input from the staff and spiritual
leaders of the faith community.
Ans: C, A, D, B
Feedback:
First the faith community nurse must assess the community the nurse plans to serve and
identify the health needs of the faith community and the roles of the faith community nurse that
meet those needs. Then the faith community nurse must seek support of the faith community
members and staff.
Then the faith community nurse must solicit input from the staff and spiritual leaders of the faith
community. Finally, the faith community nurse must seek formal approval
from the organization's governing body.
18. Which of the following are the main categories of occupational health nursing
practice? Select all that apply.
A) Safety
B) Compliance
C) Health promotion
D) Care
Ans: B, C, D
Feedback:
Occupational health nursing practice can be divided into three main categories:
compliance, care, and health promotion.
19. An occupational and environmental health nurse recently treated approximately 20

employees for hand injuries. The employees all work on the factory assembly line. The nurse
decides to implement a program for primary prevention. Which of the following
activities would be appropriate?
A) Institute an orientation for employees about
the equipment
B) Conduct hearing screening tests of the
employees

C) Institute whirlpool treatments for injured

extremities
D) Ensure adherence to physical therapy regimen
for injured workers
Ans: A
Feedback:
Instituting an orientation program reflects primary prevention, that is, preventing an
illness or injury from occurring. Conducting hearing screening would reflect secondary level of
prevention. Whirlpool treatments and physical therapy would reflect tertiary level
activities.
20. When describing the major functions of an occupational and environmental health nurse,
which of the following would the nurse
identify as being the most time consuming?
A) Activities involving safety education
B) Care of injured employees
C) Programs for improved working conditions
D) Teaching activities for healthy nutrition
Ans: B
Feedback:
In addition to emergency care and nursing of ill employees, the activities of many
industrial nurses involved safety education, hygiene, nutrition, and improvement of working
conditions. Yet, a significantly high number of industrial injuries and sick employees kept many
nurses too busy to do anything but care
for the ill.
21. After teaching a group of community health nursing students about the trends affecting
occupational and environmental health nursing, the instructor determines that more teaching is
needed when the students identify
which of the following as a trend?
A) Continued escalation of health care costs
B) Upturn in the global economy
C) Increase in worldwide competition
D) Increase in technologic hazards
Ans: B
Feedback:

Four critical issues affect the practice of occupational and environmental health nursing.
First, the downturn in the global economy, and in the economy of the United States specifically,
has skeletonized many worksites, shut down companies, eliminated night or evening shifts, or
moved companies to less expensive communities. Second, increasing worldwide competition
requires businesses to remain competitive by reducing or controlling operating costs at the
lowest level possible. Third, there has been an increase in technologic hazards that require a
sophisticated approach as well as knowledge of toxicology, epidemiology, ergonomics, and
public health principles. Fourth, health care costs continue to escalate at faster rates than
most company profits do.
22. Which activity would an occupational and environmental health nurse expect to perform
in the future based on current trends?
A) Supervise care for emergency illnesses
B) Counsel employees about health risks
C) Perform periodic health assessments
D) Suggest cost-effective in-house health
services
Ans: D
Feedback:
Future occupational health nurse activities will involve recommending more efficient and
cost-effective in-house health services. Supervising care for emergency illnesses, counseling
employees about health risks, and performing periodic health assessments are current
occupational and environmental
health nursing activities.
23. Which of the following would an occupational and environmental health nurse need to
keep in mind when selecting the field
of nursing?
A) The workplace is very similar to a health care

institution.
B) The nurse focuses on health not workforce
productivity.
C) Production or service is a primary goal.
D) The nurse functions in a supervisory position.
Ans: C
Feedback:
Unlike hospitals or ambulatory care centers, the workplace is a non-health care institution
in which production or service (not health care) is the primary goal. The occupational and
environmental health nurse participates in the organization's goals through activities that

contribute to the productivity of the workforce. An occupational and environmental health nurse
in the organization is in a staff position, taking on the role of a consultant, educator, or role
model in the workplace, but has no
supervisory responsibilities or power to hire or fire workers.
24. A community health nursing student is interviewing several occupational and

environmental health nurses about their experiences. Each of the nurses works in a small
organization and is the only nurse for the company. Which of the following would the student
most likely note as being similar
among the nurses?
A) Use of critical thinking skills
B) Collegial relationships
C) Decrease in workload
D) Role certainty
Ans: A
Feedback:
The occupational and environmental health nurse, especially in smaller organizations,

may be the only nurse in the company. As a result, she or he has none of the on-site consultation
and direction that are needed for comfortable, competent, and independent decision making.
Nurses who use critical thinking skills to develop a framework for independent problem-solving
enhance their efficiency. In addition, the nurse may feel isolated because of being the only health
professional. The corporate culture and leadership may foster work overload, be nonsupportive,
and have limited career opportunities for the nurse. The nurse may experience role ambiguity
due to a lack of professional preparation or inadequate
orientation and continuing education.
25. Which of the following about the educational preparation for occupational and
environmental health nursing is most
accurate?
A) Any licensed nurse can provide the services
necessary.
B) Because it is a specialty of nursing, a
Bachelor's degree in nursing is required.
C) Ideally, a nurse would be prepared for these
specialties at the graduate level.
D) This career option is restricted to advanced
practice nurses.

Ans: C
Feedback:
Ideally, a nurse would be prepared for these specialties at the graduate level. It is a
minimum requirement that the nurse be licensed but there is a special knowledge set and skill set
required for this position. A Bachelor's degree in nursing is not required for this job but would be
a good start. This career option is not restricted to advanced
practice nurses.
26. Which of the following are adverse working conditions that may impact the health status
of nurses. Select all that apply.
A) Physical hazards
B) Radiation hazards
C) Biological hazards
D) Chemical hazards
E) Low pay
Ans: A, B, C, D
Feedback:
Nurses may be exposed to physical, radiation, biological, and chemical hazards. Nursing
is
not considered to be a low-paying job.
27. After discussing the effects of shift work on workers' health, the nurse educator knows
that the nursing students understand this concept when the nursing students make which of the
following comments?
A) “It is beneficial for workers to have their
circadian rhythms disturbed.”
B) “Rotating shifts negatively impacts sleep and
rest cycles.”
C) “Shift work interferes with a person's social
life.”
D) “Insufficient sleep is associated with
respiratory problems and weight loss.”
Ans: B
Feedback:
Rotating shifts negatively impacts sleep and rest cycles. It is not beneficial for workers to
have their circadian rhythms disturbed. Shift work may interfere with a person's social life but
that is not a primary effect on health.
Insufficient sleep is associated with obesity
and diabetes.


nurse entrepreneurship in community/public health practice is most accurate?
A) It allows for innovation in meeting needs of

the community.
B) Nurse entrepreneurs are most commonly
associated with institutions.
C) It is very easy for a nurse to become an
entrepreneur.
D) It is most likely to fail.
Ans: A
Feedback:
Nurse entrepreneurship allows for innovation in meeting the needs of the community.
Nurse entrepreneurs are not most commonly associated with institutions. It is very difficult for a
nurse to become an entrepreneur. There may be failure in nurse entrepreneurship but without the
risk of failure, it is not possible to
advance.
Chapter 30 Home Health and Hospice Care
1. The nurse educator knows that the nursing student understands the contributions that
Lillian Wald made to home care when the nursing student makes which one of the
following statements?
A) “Lillian Wald made the earliest known effort
to care for the sick poor at home.”
B) “Lillian Wald trained nurses so that wealthy
women would hire them as visiting nurses.”
C) “Lillian Wald began home visiting in New York City and is famed for professionalizing
visiting nurses.”
D) “Lillian Wald approached congress with the
idea of Medicare Home Health Benefit.”
Ans: C
Feedback:
Lillian Wald began home visiting in New York City and is famed for professionalizing
visiting nurses. It was the Ladies Benevolent Society in Charleston, South Caroline who made
the earliest known efforts to care for the sick at home. It was Florence Nightingale who trained
nurses so that wealthy women would hire them as visiting nurses. Lillian Wald did establish
insurance coverage for home care with the Metropolitan Life Insurance Company but this was in
the early 1900s and the Medicare Home Health Benefit
did not exist until 1965.

2. After reviewing the various events associated with the history of home health care, the
students demonstrate understanding of the events when they state which of the following as the
most significant influence on the
growth of home care agencies?
A) Creation of the visiting nurse associations
B) Era of the Medicare Home Health Benefit
C) Enactment of the Balanced Budget Act
D) Discharge of nonacute clients
Ans: C
Feedback:
The number of Medicare-certified home care agencies grew rapidly until enactment of
the Balanced Budget Act of 1997 that sought explicitly to reduce federal payments for home
health care by changing the payment from reimbursement for each visit to the Medicare
Prospective Payment System that determined Medicare payment rates based on client
characteristics and need for services.
Visiting nurse associations, discharging of nonacute clients, and the Era of the Medicare Home
Health Benefit had no effect on the
growth of agencies.
3. Which one of the following statements best

describes the family caregiver burdens of providing home care?
A) Family members are expected to contribute financially to cover all of the costs of home
care.
B) Individuals recovering from severe illness or

living with debilitating chronic illness rely on family members for unpaid assistance.
C) Informal caregivers assume a considerable physical, psychological, and economic burden

in the care of their loved one at home.
D) Caregivers often describe themselves as
emotionally and physically drained.
Ans: D
Feedback:
The best description of family caregiver burdens is that caregivers have other
responsibilities but that their caregiver tasks compete for time, energy, and attention leaving
them emotionally and physically drained. Informal caregivers assume a considerable physical,
psychological, and economic burden in the care of their loved one at home. Individuals
recovering from severe illness or living with debilitating chronic illness rely on family members
for unpaid assistance. The other two statements describe the burden in part but the best
description is where caregivers often describe themselves as emotionally and physically

drained.
4. When evaluating a client's eligibility for Medicare-reimbursed home care, which of the
following is crucial?
A) The client needs visits by a homemaker.
B) The client is homebound.
C) The client is a veteran.
D) The client is terminally ill.
Ans: B
Feedback:
Homebound status is a requirement and means the person can only leave the home with
difficulty and only for medical appointments or adult day care. Medicare requires that the
recipient of reimbursable services need skilled services. The services of a homemaker are not
considered a skilled service and are not a requirement for receiving services. There are no
requirements that the client be associated with the military, either now or in the past. A client
must be considered terminally ill to receive hospice services reimbursed by Medicare but not
home health care—the person would just require skilled services.
5. An instructor is describing the various types of home health care agencies and uses the
visiting nurse association as an example of
which of the following types?
A) Voluntary nonprofit
B) Hospital-based
C) For-profit proprietary
D) Noncertified
Ans: A
Feedback:
Visiting nurse associations are examples of voluntary nonprofit agencies. Hospital-based
agencies are those involving a hospital operating a separate department as a home health agency.
It may be nonprofit or generate revenue for the hospital. For-profit proprietary agencies can be
governed by individual owners, but many are part of large, regional, or national chains that are
administered through corporate headquarters. Many agencies providing services in the home
remain outside the federal Medicare system that reimburses skilled nursing. These noncertified
agencies are usually private and derive their funding from direct payment by
the client or from private insurers.

6. Assessment of a client in the home reveals that his or her services will be paid by a
government source. Which of the following
would be a possible source of payment?
A) Insurance company
B) Health maintenance organization
C) Medicare
D) Preferred provider organization
Ans: C
Feedback:
Government payers include Medicare, Medicaid, the military health system (TRICARE),
and the Veterans Administration system. Corporate payers include insurance companies, health
maintenance organizations (HMOs), preferred provider organizations
(PPOs), and case-management programs.
7. A home health care nurse performs an initial visit to a client and determines that the
client meets the criteria for services with Medicare reimbursement. The nurse understands that
this service will be reimbursed for which
period?
A) 30 days
B) 60 days
C) 90 days
D) 120 days
Ans: B
Feedback:
The Medicare prospective payment system (PPS) pays an agency for a 60-day “episode
of care.” All services and many medical supplies must be provided under the payment amount
adjusted to geographic location and determined by the client's clinical and functional status at the
start of care, as well as the projected need for services over the
anticipated 60-day period.
8. home health care agency. Which of the

following would the agency want to achieve higher percentage rates?
A) Hospital admissions
B) Urgent unplanned medical care
C) Deteriorating wound status
D) Decreased pain with movement
Ans: D
Feedback:
A home health care agency would want to achieve higher percentages of the measure
involving decreased pain with movement. A higher percentage indicates that the clients are
improving with care. The agency would want to achieve decreased or lower percentages for
hospital admissions, urgent unplanned

medical care, and deteriorating wound status.
9. A home health care nurse is working with

informal caregivers. Which of the following is most important?
A) Include the client's spouse or significant other
in the plan
B) Visit frequently to manage and maintain
equipment
C) Focus on caretaker abilities, not their
limitations
D) Use nurse's intuition to determine what to
teach first
Ans: C
Feedback:
Keeping a positive attitude that is focused on abilities, not limitations, of the caregivers is
most important. The home health care nurse includes all family members and caregivers in the
plan, teaches family members and caregivers how to manage and maintain equipment, and
chooses an area to teach first that the client or caretaker is motivated to
learn.
10. When providing home health care, which individual is responsible for coordinating the
care?
A) Registered nurse
B) Social worker
C) Physician
D) Dietician
Ans: A
Feedback:
The registered nurse is considered the coordinator of care. The social worker is another
clinical staff member but is not the coordinator of care. The physician directs the skilled care to
clients by agreeing (signing the nurse-generated paperwork) with the plan of care established by
the registered nurse who coordinates the care. The dietician is another clinical staff member but
is not the
coordinator of care.
11. When visiting a client in the home for the first

time, which of the following is absolutely critical to remember?
A) There may be dangers lurking around every
corner.
B) Clients are glad to have the nurse in their

home.
C) The nurse is a guest in the client's home.
D) The nurse knows what is best for the client.
Ans: C
Feedback:
Once the nurse arrives at the client's home, there is the challenge of getting through the
closed door and making the connection. The nurse must always remember that he or she is a
guest in the home. Although there may be dangers, the nurse must focus on the client while
maintaining a watchful eye. Clients may be apprehensive or suspicious about a nurse coming to
visit, wondering why or what they did. Not all clients are welcoming. The nurse needs to start
where the client and
family are, not what the nurse thinks is best.
12. A home health care nurse reviews the most common conditions managed at home. Which
of the following are the most common conditions managed at home? Select all that
apply.
A) Chronic skin ulcer
B) COPD
C) Heart failure
D) Terminal cancer
E) Diabetes
Ans: A, C, E
Feedback:
The most common diagnoses managed at home are diabetes, chronic skin ulcer, essential
hypertension, heart failure, and
osteoarthritis
13. When developing the plan of care for a client receiving home health care services, which
of the following would be the most important
goal?
A) Promotion of client independence
B) Complete resolution of the problem
C) Detecting family conflicts
D) Ensuring access to resources
Ans: A
Feedback:
The most important goal of home health care is to promote independence and self-
management. Every effort is made to develop the capacity for self-care so that the home team
can safely withdraw. Complete resolution of the problem in many cases is unrealistic. Detecting

family conflicts and ensuring access to resources are areas that the nurse addresses and
intervenes if necessary to
promote the ultimate goal of self-care.
14. When providing palliative care to a client receiving hospice care, which of the following
would be important? Select all that apply.
A) Assume nothing about what is wrong
B) Use the most complex interventions first
C) Believe what the client is reporting
D) Be persistent in trying different strategies
E) Wait until the symptoms recur to relieve them
Ans: A, C, D
Feedback:
When providing palliative care, the nurse should make no assumptions about what is
wrong; believe the client's report of symptoms; anticipate the symptoms and relieve them before
they recur; choose the least complex and most manageable interventions that clients and families
can manage themselves at home; and never give up, but persist in trying different palliative
strategies.
15. The family of a hospice client is holding a vigil at the client's bedside. During a visit, a
hospice nurse participates in this vigil and encourages each of the family members to say their
good-byes. The nurse is demonstrating
A) Palliative care
B) Guided letting go
C) Connecting
D) Responsive use of self
Ans: B
Feedback:
Guiding letting go is a truly unique nursing practice that involves helping the client to let
go of former activities and hopes, including life itself. This involves listening to intense emotions
and helping the person and family find resolution. Sometimes it involves participating in a vigil
at the bedside of the dying person and encouraging loved ones to say their final words of
farewell. Palliative care involves the relief of suffering without curing the underlying disease.
Connecting refers to the centrality of relationships in providing hospice care as the nurse seeks to
understand the emotional and spiritual distress common to the end of life. Responsive use of self
is the process expert nurses use to understand the lives of vulnerable clients in the community
resulting in stereotypes and assumptions being overturned.

16. As part of a group exercise, students are to compare and contrast home care and hospice
care. The instructor determines that the activity was successful when the students identify which
of the following as reflective
of home health care?
A) Emphasis on rehabilitation
B) Focus on health of the whole family
C) Expert use of opioids for suffering
D) Management of symptoms
Ans: A
Feedback:
Home health care emphasizes rehabilitation and stabilization of the client whereas
hospice emphasizes the quality of life and comfort.
Focusing on the whole family, expert use of opioids for suffering and management of symptoms
are features associated with hospice care. In contrast, home health care focuses on the health of
the client; opioids are used hesitantly to reduce suffering; and symptom management may
require
hospitalization if unmanageable.
17. A home health care nurse is assigned to visit a client's home. The nurse identifies the area
as a problem neighborhood. Which of the following would be most appropriate for the
nurse to do?
A) Perform the visit via telephone
B) Have another nurse buddy along
C) Reschedule the visit for another time
D) Leave the cell phone at home
Ans: B
Feedback:
If there is a question of safety, the nurse should have another nurse accompany him or her
on the visit. It would be inappropriate to perform the visit over the telephone. The nurse needs to
physically see the client to perform the assessment. The agency typically has policies about how
soon after a referral the client must be seen. So, rescheduling the visit may not be an option. In
addition, rescheduling the visit does nothing to address the safety issues. The nurse should carry
his or her cell phone but leave any valuables, such as cash, wallet, or purse locked in the
care.

18. A home health care nurse is invited as a guest speaker to talk to a group of students about
challenges of working in the home. As part of the discussion, the nurse describes medication
safety. Which of the following would the nurse include as a measure to address this
issue?
A) Asking the client what he or she takes the
drug for
B) Throwing out any medications over 1 month
old
C) Reconciling drugs in the home with those on
the discharge sheet
D) Setting up medication boxes to organize the
medications
Ans: C
Feedback:
It is important for the home health care nurse to reconcile the medications in the client's
home with those on the discharge sheet. If there are any discrepancies, then the nurse should
contact the client's primary care physician to clarify any differences and confirm the orders.
Asking the client what he takes the drug for provides limited information. The nurse needs to
know if he or she is taking it currently, and if so, the frequency and dosage. Throwing out any
medications that are over 1 month old is inappropriate. A medication may have been ordered
previously but was inadvertently missed on the discharge sheet. The nurse must always double
check the order and with the physician about any medication. Setting up medication boxes are
helpful to organize the medications, but the nurse still needs to verify that the client should be
taking the medication.
19. When describing the philosophy of hospice care to a group of students, which of the
following would the instructor include?
A) The right to die and euthanasia
B) Working with people in their last year of life
C) Holistic and family-centered care to
terminally ill clients
D) Weaving hospice concepts around curative
treatment
Ans: C
Feedback:
The philosophy of hospice care includes holistic and family-centered care to terminally ill
clients. Hospice care is delivered to terminally ill people with the recognition that death is a
human experience. Euthanasia is not part of the care. Hospice care can be initiated after a
physician has declared that a person has 6 months or less to live. Hospice care is initiated in the
final phase of a person's illness when he or she is not receiving

curative treatment.
20. After teaching a group of students about hospice and its view of end-of-life care, which
statement by the students indicates a
need for additional teaching?
A) Care should attend to the body, mind, and
spirit.
B) Death is not considered a taboo topic.
C) Medical technology should be used widely.
D) Clients have a right to truthful discussion.
Ans: C
Feedback:
The hospice movement has emphasized four major changes in end-of-life care: (1) care
should attend to body, mind, and spirit; (2) death must not be a taboo topic; (3) medical
technology should be used with discretion; and (4) clients have a right to truthful discussion and
involvement in treatment
decisions.
21. A client will receive hospice care under the Medicare Hospice Benefit. The nurse
understands that which of the following is
true?
A) The client denies terminal prognosis.
B) The client has a prognosis of at least 6 months
of life.
C) The client chooses life-extending care.
D) The hospice acts as clinical and financial case
manager.
Ans: D
Feedback:
The Medicare Hospice Benefit requires that a client, who has a prognosis of 6 months or
less, must sign up for the comfort-focused hospice benefit and waive the regular hospice benefit.
This mandates that the client acknowledge a terminal prognosis and choose comforting care
instead of life-extending care. When this choice is made, the hospice coordinates care in all
settings, functioning
both as clinical and financial case manager.

22. When describing the role of hospice nurses to

a group of students, a hospice nurse identifies which of the following as most important?
A) Speaking the truth
B) Sustaining oneself
C) Encouraging choice
D) Strengthening the family
Ans: B
Feedback:
Although speaking the truth, encouraging choice and strengthening the family are key
interventions of a hospice nurse, sustaining oneself is the priority. Effective hospice nurses
understand that to care for others, they must care for themselves because without a
healthy nurse, the client cannot thrive.
23. Which of the following Medicare definitions prevent people who could benefit from
home care services from receiving those services, even when it would be most cost effective for
the client to receive home care rather than more expensive emergent and inpatient
interventions? Select all that apply.
A) Home-bound status
B) Medical necessity
C) Prospective payment
D) Skilled nursing
Ans: A, B, D
Feedback:
The entire model for service provision in the home must change to a health care delivery
system that continuously serves those living with disabling and terminal illness to maximize
well-being at home, anticipate and prevent crises, and minimize emergent and inpatient
interventions. The Medicare definitions of homebound, medical necessity
and skilled nursing must become extinct.
24. Which one of the following Medicare policies prevent people who could benefit from
hospice services from receiving those services, even when it would be most cost- effective for
the client to receive hospice
rather than inpatient interventions?
A) Controlled cost at the expense of assuring
quality of life and comfort
B) That a person must discontinue treatment in

order to receive hospice service.

C) Education and support for clients and family
caregivers
D) Refusing to pay for homemaking and personal

care that might keep a person at home as long as possible
Ans: B
Feedback:
The Medicare requirement that patients receiving hospice benefits must have
discontinued treatment in order to receive hospice service. It is not appropriate for there to be
controlled cost at the expense of assuring quality of life and comfort.
Education and support for clients and family caregivers is important, and homemaking and
personal care might keep a person at home as long as possible that would reflect a cost
savings in the long run.

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TEST BANK For COMMUNITY AND

PUBLIC HEALTH NURSING 10TH

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COMMUNITY AND PUBLIC HEALTH NURSING 10TH

A) “Community health nursing is defined as

B) “Public health nursing is defined as nursing care that is provided in an institutional

2. Which of the following statements would best

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In this textbook, community health practice refers to a focus on specific, designated

3. Which of the following is most accurate about

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5. Which of the following would a community health nurse identify as a community of

B) Small rural town in a northern state

C) The term health is limited to reflect an

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A) Wellness is a relative concept, not an absolute, and illness is a state of being

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10. Which of the following statements about

B) Disease prevention differs from health promotion in that disease prevention is

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B) The construction of affordable organized

Chapter 2 Public Health Nursing in the Community

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A) Gathering and analyzing information that will

D) Accessing relevant data that enable identification of strengths, weaknesses, and

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4. A community health nurse is collaborating with local community leaders to prepare a

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7. A community health nurse is interviewing for employment. The interviewer describes

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11. Which of the following statements about the

B) People are unable to recognize the value of

12. Which of the following statements about the

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B) Successful community health practice depends on multidisciplinary collegiality and

Community health nurses seldom practice in isolation. As collaborators, nurses work

C) The researcher role for community health

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A) Occupational health nurses are increasing

The community at large is not confined to a specific philosophy, location, or building. It

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19. Which of the following is included in the

The management process incorporates a series of problem-solving activities or function:

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D) Ordering pamphlets over the Internet to be

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As a manager, a community health nurse would be involved in orienting new nurses in

25. Which of the following are core values of

Chapter 3 History and Evolution of Public Health Nursing

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contributed most to this change?

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4. Which factor was the most significant feature

5. In their early stages, district nursing was

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A) Demonstrating the effectiveness of placing school nurses in public schools to reduce