Public Health Nursing Population Centered Health Care in the Community 9th Edition by Marcia Stanhope – Test Bank

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Public Health Nursing Population Centered Health Care in the Community 9th Edition by Marcia Stanhope – Test Bank

Chapter 02: History of Public Health and Public and Community Health Nursing

Stanhope: Public Health Nursing: Population-Centered Health Care in the Community, 9th Edition

 

MULTIPLE CHOICE

 

  1. In the past, population-centered nurses have been called:
a. district nurses.
b. almshouse nurses.
c. soldier nurses.
d. sisters.

 

 

ANS:   A

In the past, population-centered nurses have been called public health nurses (PHNs), district nurses, visiting nurses, school nurses, occupational health nurses, and home health nurses. Many women who performed nursing functions in almshouses and early hospitals in Great Britain were poorly educated, untrained, and often undependable. The original soldier nurses worked with Florence Nightingale at Scutari. Various groups of “sisters” have been used throughout history to care for the poor.

 

DIF:    Cognitive level: Remembering           REF:    p. 23

TOP:    Nursing process: Assessment

MSC:   NCLEX: Safe and Effective Care Environment: Management of Care

 

  1. A nurse is working in a public health nursing setting. Which of the following best describes why this specialty is appealing to nurses?
a. Interactions with wealthy contributors to secure funding
b. Autonomy and independence of practice
c. Ability to locate the source of diseases and cure patients
d. Opportunities to meet a variety of people

 

 

ANS:   B

Community health nurses have a long history of autonomous practice, problem solving, and decision making. Community health care nurses engage in the other activities as well, but overall, they have been best known for autonomy of practice.

 

DIF:    Cognitive level: Applying                  REF:    p. 23

TOP:    Nursing process: Assessment

MSC:   NCLEX: Safe and Effective Care Environment: Management of Care

 

  1. Current threats to health in the United States that community health nurses are faced include:
a. diphtheria, cholera, and hepatitis.
b. HIV, H1N1 influenza, and bioterrorism.
c. avian flu, tuberculosis (TB), and radiation.
d. polluted water and air.

 

 

ANS:   B

The newest threats to health that PHNs are involved in are HIV, H1N1 influenza, and bioterrorism. Hepatitis is also a current threat, but diphtheria and cholera are not concerns in the United States. Avian flu may be a threat, but radiation and TB are ongoing. Environmental pollution has been reduced; however, there are pollution issues that do raise concerns.

 

DIF:    Cognitive level: Understanding         REF:    p. 23

TOP:    Nursing process: Assessment

MSC:   NCLEX: Safe and Effective Care Environment: Management of Care

 

  1. A nurse is working to reform a program that was based on the Elizabethan Poor Law of 1601. Which of the following programs is the nurse most likely working on?
a. Welfare
b. Food Stamps
c. Medicaid
d. Medicare

 

 

ANS:   C

The Poor Law guaranteed medical care for poor, blind, and “lame” individuals, making it most similar to Medicaid since this program provides medical insurance to these types of individuals. Welfare provides more than health care. Food stamps do not provide medical care. The Medicare program provides medical care to the elderly population.

 

DIF:    Cognitive level: Analyzing                 REF:    p. 24

TOP:    Nursing process: Implementation

MSC:   NCLEX: Safe and Effective Care Environment: Management of Care

 

  1. In early colonial North America, a colonist worked in the public health sector. Which of the following would have most likely been the focus?
a. Establishing schools of nursing
b. Developing vaccines to administer to large numbers of people
c. Collecting vital statistics and improving sanitation
d. Developing public housing and almshouses

 

 

ANS:   C

The early colonial public health efforts included the collection of vital statistics, improvements to sanitation systems, and control of communicable disease introduced through seaports. Establishing schools of nursing, developing vaccines, and developing public housing are all events that happened after the colonial period.

 

DIF:    Cognitive level: Applying                  REF:    p. 24

TOP:    Nursing process: Assessment

MSC:   NCLEX: Health Promotion and Maintenance

 

  1. A nurse was employed by the Marine Hospital Service. Which of the following tasks would have most likely been the responsibility of the nurse?
a. Setting policy on quarantine legislation for immigrants
b. Establishing hospital-based programs to care for the sick at home
c. Identifying and improving environmental conditions
d. Providing health care for merchant seamen

 

 

ANS:   D

Providing health care to seamen was an early effort by the federal government to improve public health. The purpose of the Marine Hospital Service was to secure its maritime trade and seacoast cities. Marine Hospital Service nurses did not establish policies or hospital programs. They also did not identify and improve environmental conditions as Florence Nightingale did. Their sole purpose was to provide care for this population.

 

DIF:    Cognitive level: Analyzing                 REF:    p. 26

TOP:    Nursing process: Assessment

MSC:   NCLEX: Health Promotion and Maintenance

 

  1. Florence Nightingale’s contributions to public health included:
a. caring for the sick, poor, and neglected in institutions and at home.
b. using a population-based approach that led to improved environmental conditions.
c. writing the Elizabethan Poor Law to guarantee medical care for all.
d. founding of the district nursing association to provide health care to needy people.

 

 

ANS:   B

During the Crimean War, Nightingale progressively improved the soldiers’ health by adopting a population-based approach that used simple epidemiological measures and greatly decreased mortality. The focus of her care was on wounded soldiers, not those who were sick, poor, and neglected at homes and institutions. She did not write the Elizabethan Poor Law. William Rathbone founded the district nursing association.

 

DIF:    Cognitive level: Remembering           REF:    p. 27

TOP:    Nursing process: Assessment

MSC:   NCLEX: Health Promotion and Maintenance

 

  1. Lillian Wald’s major contribution to public health nursing was:
a. founding the American Nurses Association.
b. developing the New York Training Hospital for Nurses.
c. creating the Public Health Service.
d. establishing the Henry Street Settlement.

 

 

ANS:   D

Lillian Wald established the Henry Street Settlement. Isabel Hampton Robb founded the American Nurses Association. Lillian Wald was a graduate of the New York Training Hospital for Nurses. The Public Health Service was established by the federal government.

 

DIF:    Cognitive level: Remembering           REF:    p. 28

TOP:    Nursing process: Implementation

MSC:   NCLEX: Health Promotion and Maintenance

 

  1. A nurse is providing public health education based on the teachings of Lillian Wald. Which of the following topics will the nurse most likely discuss?
a. Taking and recording blood pressures accurately
b. Safe and sanitary baby and child care
c. Environmental pollutants and their effects on lung disease
d. Time management: balancing factory work and the home

 

 

ANS:   B

Lillian Wald provided health care that included educating the community on health care matters. The focus of the majority of her work was on health services and health promotion for families and children. Because of her focus on health promotion for families and children, her primary role would not have been taking and recording blood pressures, discussing environmental pollutants (as her focus was not occupational health), or time management (as at this point in time very few women were working outside of the home).

 

DIF:    Cognitive level: Applying                  REF:    pp. 28-29

TOP:    Nursing process: Implementation

MSC:   NCLEX: Health Promotion and Maintenance

 

  1. Nurses who provided care to people in their homes and provided that care to several people at a time were called _____ nurses.
a. private duty
b. visiting
c. public health
d. community health

 

 

ANS:   B

The visiting nurse cared for several families in a day and helped make care of the sick poor at home economical, whereas a private duty nurse may live with a family of clients receiving care and was to be available 24 hours a day. PHNs focused on care of populations. Community health nurses would be considered to be anyone who worked outside of a hospital setting.

 

DIF:    Cognitive level: Remembering           REF:    p. 28

TOP:    Nursing process: Implementation

MSC:   NCLEX: Safe and Effective Care Environment: Management of Care

 

  1. Neighborhood centers that provided health care, education, and social welfare programs were called:
a. settlement houses.
b. nursing care centers.
c. nurse-managed clinics.
d. public health services (PHSs).

 

 

ANS:   A

Settlement houses were neighborhood centers that provided health care, education, and social welfare programs. Nursing centers, nurse-managed clinics, and PHSs are not necessarily in neighborhoods.

 

DIF:    Cognitive level: Remembering           REF:    p. 28

TOP:    Nursing process: Implementation

MSC:   NCLEX: Safe and Effective Care Environment: Management of Care

 

  1. A nurse worked in a school setting during the early twentieth century. Which of the following would have been the focus of this nurse’s practice?
a. Investigating causes of absenteeism
b. Teaching school as well as being a nurse
c. Promoting nursing as an autonomous practice
d. Providing medical treatment to enable children to return to school

 

 

ANS:   A

Early school nursing focused on investigating causes of absenteeism, not providing medical treatment. That was the responsibility of physicians. Early school nurses did not teach in the schools. Early school nurses did not promote nursing as an autonomous practice.

 

DIF:    Cognitive level: Applying                  REF:    p. 30

TOP:    Nursing process: Implementation

MSC:   NCLEX: Health Promotion and Maintenance

 

  1. A nurse is comparing the historical practices of industrial and occupational health nurses. Which of the following would the nurse most likely note when comparing these two occupations?
a. Industrial nurses invented new machines to streamline production of medical goods, whereas occupational health nurses provide care to employees.
b. Industrial nurses investigated industrial injuries to improve work conditions, whereas occupational health nurses demonstrated proper body mechanics.
c. Industrial nurses treated work related-injuries, whereas occupational health nurses care for families in their homes.
d. Industrial nurses provided care for workers in their homes, whereas occupational health nurses care for work-related injuries.

 

 

ANS:   D

Early occupational health nursing did not provide care for work-related injuries, but instead focused on the care of employees and their families in the home. Contemporary occupational health nurses provide care for work-related injuries. The focus of both of these professions has been on employee care and the work environment.

 

DIF:    Cognitive level: Analyzing                 REF:    p. 29

TOP:    Nursing process: Assessment

MSC:   NCLEX: Safe and Effective Care Environment: Management of Care

 

  1. The document Visiting Nursing in the United States highlighted the fact that:
a. nurses were trained by Boards of Education.
b. trained nurses adequately covered less-densely populated areas.
c. visiting nurse services were concentrated in the northeastern United States.
d. nurses were curing diseases such as TB and typhoid fever.

 

 

ANS:   C

This report emphasized the fact that visiting nurse services were concentrated in the northeast, which underscored the need for rural health. The document did not address how the nurses were educated or the diseases that nurses were curing. This report showed that there was not adequate coverage for nurses in less populated areas.

 

DIF:    Cognitive level: Remembering           REF:    p. 29

TOP:    Nursing process: Assessment

MSC:   NCLEX: Safe and Effective Care Environment: Management of Care

 

  1. During the time when the Rural Nursing Service was operating through the American Red Cross, a nurse needed to demonstrate resourcefulness. Which of the following tasks would the nurse most likely have done?
a. Using hot bricks, salt, or sandbags to substitute for hot water bottles
b. Testing well water for pollutants
c. Teaching school and developing curricula for rural nursing programs
d. Providing post-surgical care

 

 

ANS:   A

In providing medical care, rural nurses were resourceful in finding alternatives when they did not have medical products that were available in urban areas. They were not involved in testing well water, providing post-surgical care, or teaching in rural nursing programs.

 

DIF:    Cognitive level: Applying                  REF:    p. 29

TOP:    Nursing process: Implementation

MSC:   NCLEX: Health Promotion and Maintenance

 

  1. Local health departments were formed in urban areas in the late 1800s to:
a. target environmental hazards associated with crowded living conditions.
b. facilitate interdisciplinary efforts and promote “practical nursing.”
c. provide immunizations and health care services to all citizens.
d. offer public health education to nurses who had finished basic training.

 

 

ANS:   A

Local health departments were formed to handle environmental issues in cities, including problems associated with crowded living conditions and dirty streets, and to regulate public baths, slaughterhouses, and pigsties. Because sanitation was such an issue, there was not a focus on interdisciplinary care, provision of immunizations, or public health education for nurses.

 

DIF:    Cognitive level: Understanding         REF:    p. 23

TOP:    Nursing process: Implementation

MSC:   NCLEX: Safe and Effective Care Environment: Management of Care

 

  1. A nurse was involved in the original work of the National Organization for Public Health Nursing. Which of the following best describes the influence this has had on nursing practice today?
a. Requiring that PHNs have a baccalaureate degree in nursing
b. Standardizing public health nursing education
c. Developing nursing cooperatives
d. Opening the Henry Street Settlement

 

 

ANS:   B

The National Organization for Public Health Nursing sought to standardize public health nursing. The Henry Street Settlement was already in existence. The baccalaureate degree in nursing was not developed yet. Cooperative agreements were made between life insurance companies and visiting nurses associations that expanded availability of public health nursing services.

 

DIF:    Cognitive level: Applying                  REF:    p. 30

TOP:    Nursing process: Implementation

MSC:   NCLEX: Safe and Effective Care Environment: Management of Care

 

  1. A nurse is considering joining the American Public Health Association (APHA). Which of the following information about this organization should be considered when making this decision?
a. APHA focuses on the public health concerns of the medical profession.
b. APHA represents concerns of nursing specialty practices.
c. APHA provides a forum for nurses to discuss their public health concerns.
d. APHA focuses on providing health promotion education to the public.

 

 

ANS:   C

APHA was formed to facilitate interprofessional efforts and promote the “practical application of public hygiene.” The Public Health Section within APHA provides nurses with a forum to discuss their concerns and strategies. It also serves as a focus of leadership and policy development for community/public health nursing.

 

DIF:    Cognitive level: Applying                  REF:    p. 30

TOP:    Nursing process: Assessment

MSC:   NCLEX: Safe and Effective Care Environment: Management of Care

 

  1. Which statement is true about African American nurses in public health?
a. Certificate and graduate education were more difficult to obtain.
b. Cities were the major areas where they practiced.
c. They often belonged to the Frontier Nursing Service (FNS).
d. They were recruited heavily as military nurses.

 

 

ANS:   A

Due to segregation, certification and graduate education were more difficult to obtain. They were faced with many challenges because of discrimination and had a limited presence in public health nursing practice. They were not part of the FNS or recruited as military nurses.

 

DIF:    Cognitive level: Understanding         REF:    p. 31

TOP:    Nursing process: Assessment

MSC:   NCLEX: Safe and Effective Care Environment: Management of Care

 

  1. A nurse had the opportunity to work with Mary Breckinridge. Which of the following would the nurse most likely have assisted with?
a. Establishing the Henry Street Settlement
b. Developing health programs geared toward improving the health care of the rural populations
c. Blazing a nursing trail through the Rockies, providing nursing care to miners and their families
d. Teaching birth control measures to large numbers of women in the South

 

 

ANS:   B

Mary Breckinridge developed health programs geared toward improving the health care of the rural and often inaccessible populations in the Appalachian regions of southern Kentucky. Lillian Wald established the Henry Street Settlement.

 

DIF:    Cognitive level: Applying                  REF:    p. 31

TOP:    Nursing process: Implementation

MSC:   NCLEX: Health Promotion and Maintenance

 

  1. A nurse is providing care to clients through the FNS. Which of the following clients would the nurse most likely have seen?
a. An injured soldier
b. A homebound, elderly male
c. A woman in labor
d. A child with measles

 

 

ANS:   C

The FNS nurses were trained in nursing public health and midwifery and provided care to rural and inaccessible areas, which led to reduced mortality. They would not have seen injured soldiers, males, or a child with measles.

 

DIF:    Cognitive level: Applying                  REF:    p. 31

TOP:    Nursing process: Implementation

MSC:   NCLEX: Safe and Effective Care Environment: Management of Care

 

  1. A major provision of the Social Security Act of 1935 was the establishment of:
a. the FNS to provide nursing service to rural communities.
b. state and local community health services and training of personnel.
c. district nursing to provide home health care to sick people.
d. community-based settlement houses.

 

 

ANS:   B

Title VI of the Social Security Act provided funding for expanded opportunities for health protection and promotion through education and employment of PHNs. Nurses completed educational programs in public health and funds were provided to assist states, counties, and medical districts in the establishment and maintenance of adequate health services.

 

DIF:    Cognitive level: Remembering           REF:    p. 33

TOP:    Nursing process: Assessment

MSC:   NCLEX: Safe and Effective Care Environment: Management of Care

 

  1. A student is enrolled in a nursing education program during World War II. Which of the following groups would the student most likely have joined?
a. The Public Health Service of New York City
b. The Marine Nurse Corps
c. The FNS
d. The Cadet Nurse Corps

 

 

ANS:   D

The Bolton Act of 1943 established the Cadet Nurse Corps during World War II, which increased enrollment in schools of nursing at undergraduate and graduate levels. In 1925, Mary Breckinridge established the FNS based on systems of care used in the Highlands and islands of Scotland (before World War II). The first Marine Hospital opened in Norfolk, Virginia, in 1800. The Public Health Service of New York City was not a group during this time frame.

 

DIF:    Cognitive level: Analyzing                 REF:    p. 33

TOP:    Nursing process: Implementation

MSC:   NCLEX: Safe and Effective Care Environment: Management of Care

 

  1. Which of the following best describes one of the health trends that occurred in the United States between 1900 and 1955?
a. There was a rise in chronic diseases such as heart disease and cancer.
b. There was a rise in communicable disease.
c. The crude mortality rate increased dramatically.
d. The life span after diagnosis remained the same.

 

 

ANS:   A

Leading causes of death in 1955 were heart disease, cancer, and cerebrovascular disease, whereas in 1900 they were pneumonia, TB, and diarrhea/enteritis. The mortality rate decreased by 47%. There was a decrease in communicable disease, and the life span after diagnosis increased.

 

DIF:    Cognitive level: Understanding         REF:    p. 34

TOP:    Nursing process: Assessment

MSC:   NCLEX: Safe and Effective Care Environment: Management of Care

 

  1. A PHN is compiling information about how to promote early detection of breast cancer in women. Which document would most likely provide useful information about this topic?
a. The Future of Public Health
b. Healthy People 2020
c. Patient Protection and Affordable Care Act
d. Scope and Standards of Public Health Nursing Practice

 

 

ANS:   B

The Healthy People documents propose national strategies to improve significantly the health of Americans by preventing or delaying the onset of major chronic illnesses, injuries, and infectious diseases. The other documents do not address health promotion topics.

 

DIF:    Cognitive level: Analyzing                 REF:    pp. 37-38

TOP:    Nursing process: Assessment

MSC:   NCLEX: Health Promotion and Maintenance

 

  1. A neighborhood health center is researching its origins. Which of the following legislative acts most likely provided funds for its development?
a. Emergency Maternity and Infant Care Act of 1943
b. Medicaid legislation
c. Social Security Act of 1935
d. Economic Opportunity Act

 

 

ANS:   D

Funding for neighborhood health centers, Head Start, and other community action programs began in 1964 with the Economic Opportunity Act. The Social Security Act of 1935 expanded opportunities for health protection and promotion through education and employment of PHNs. Medicaid legislation focused on medical care insurance for the poor. The Emergency Maternity and Infant Care Act of 1943 provided funding for medical, hospital, and nursing care for the wives and babies of servicemen.

 

DIF:    Cognitive level: Analyzing                 REF:    p. 36

TOP:    Nursing process: Assessment

MSC:   NCLEX: Safe and Effective Care Environment: Management of Care

 

  1. A 66-year-old woman is retired and no longer has health insurance through her place of employment. Which of the following programs would be appropriate for her health insurance needs?
a. Medicare
b. Medicaid
c. Social Security
d. Economic Opportunity Act

 

 

ANS:   A

The Social Security Act was amended to include health insurance benefits for the elderly, which is addressed through Medicare. Medicaid focuses on care for the poor. Social Security does not provide health insurance. The Economic Opportunity Act provided funding for neighborhood health centers, Head Start, and other community action programs.

 

DIF:    Cognitive level: Analyzing                 REF:    p. 36

TOP:    Nursing process: Planning

MSC:   NCLEX: Safe and Effective Care Environment: Management of Care

 

  1. A PHN became involved in health care reform. Which of the following best describes the purpose of this action?
a. Promote the nursing profession
b. Increase funding for public health nursing
c. Address the concerns of nurses
d. Improve health care access and reduce health care costs

 

 

ANS:   D

PHNs have been involved in health care reform for several years. An emphasis of reform is that health promotion and disease prevention appear to yield reduction in costs and illness/injury incidence while increasing years of healthy life. The focus of health care reform is not on nursing, but rather the population as a whole.

 

DIF:    Cognitive level: Applying                  REF:    p. 38

TOP:    Nursing process: Implementation

MSC:   NCLEX: Safe and Effective Care Environment: Management of Care

 

MULTIPLE RESPONSE

 

  1. The impact of World War I on public health nursing included which of the following? (Select all that apply.)
a. Many communicable diseases were eradicated.
b. The ranks of PHNs depleted because many went off to war.
c. The feeling that the greatest patriotic duty was to stay at home.
d. Expanding nursing services in the community was limited by lack of funding.
e. More women entered the public health nursing workforce.

 

 

ANS:   B, C, D

Both World Wars I and II depleted the PHN population as nurses went off to war. The feeling of patriotism extended to the idea that patriotic duty could also be served on the home front. There was not an eradication of communicable diseases; rather, there was a worldwide influenza pandemic that swept through the United States, killing many people. Inadequate funding was the major obstacle to extending nursing services in the community.

 

DIF:    Cognitive level: Understanding         REF:    p. 31

TOP:    Nursing process: Assessment

MSC:   NCLEX: Safe and Effective Care Environment: Management of Care

 

Chapter 12: Epidemiology

Stanhope: Public Health Nursing: Population-Centered Health Care in the Community, 9th Edition

 

MULTIPLE CHOICE

 

  1. To understand the causes of health and disease, epidemiology studies:
a. individuals.
b. families.
c. groups.
d. populations.

 

 

ANS:   D

Epidemiology monitors health of populations, understands determinants of health and disease in communities, and investigates and evaluates interventions to prevent disease and maintain health. Epidemiology does not focus on individuals, families, and groups.

 

DIF:    Cognitive level: Understanding         REF:    p. 258

TOP:    Nursing process: Assessment

MSC:   NCLEX: Safe and Effective Care Environment: Management of Care

 

  1. The factors, exposures, characteristics, and behaviors that determine patterns of disease are described using:
a. descriptive epidemiology.
b. analytic epidemiology.
c. distribution.
d. determinants.

 

 

ANS:   D

Determinants are the factors, exposures, characteristics, and behaviors that determine patterns of disease, which may be individual, relational, social, communal, or environmental. Descriptive epidemiology seeks to describe the occurrence of a disease in terms of person, place, and time. Analytic epidemiology focuses on the investigation of causes and associations. Distribution describes who has the disease and where and when the disease occurs.

 

DIF:    Cognitive level: Remembering           REF:    p. 258

TOP:    Nursing process: Assessment

MSC:   NCLEX: Safe and Effective Care Environment: Management of Care

 

  1. An epidemiologist wants to know what caused severe diarrhea and vomiting in several people at a local banquet. Which of the following principles is being applied in this situation?
a. Descriptive epidemiology
b. Analytic epidemiology
c. Distribution
d. Determinants

 

 

ANS:   B

Analytic epidemiology is directed toward understanding the etiology of the disease. Descriptive epidemiology seeks to describe the occurrence of a disease in terms of person, place, and time. Distribution describes who has the disease and where and when the disease occurs. Determinants are the factors, exposures, characteristics, and behaviors that determine patterns of disease, which may be individual, relational, social, communal, or environmental.

 

DIF:    Cognitive level: Applying                  REF:    pp. 258-259

TOP:    Nursing process: Assessment

MSC:   NCLEX: Safe and Effective Care Environment: Safety and Infection Control

 

  1. A nurse states that she has been reading about an epidemic that has been occurring in the world. Which of the following is she most likely referring to?
a. “Bird” flu in China
b. Adult obesity in the United States
c. An isolated case of smallpox in Africa
d. The nursing shortage in the United States

 

 

ANS:   B

It is estimated that 30% of the adults in the United States are obese. According to the Centers for Disease Control and Prevention, this is an epidemic. The other examples are not epidemics.

 

DIF:    Cognitive level: Applying                  REF:    p. 259

TOP:    Nursing process: Assessment

MSC:   NCLEX: Safe and Effective Care Environment: Management of Care

 

  1. John Snow is called the “father of epidemiology” because of his work with:
a. cholera.
b. malaria.
c. polio.
d. germ theory.

 

 

ANS:   A

John Snow investigated the spread of cholera in the mid-nineteenth century. John Snow did not investigate the other examples.

 

DIF:    Cognitive level: Remembering           REF:    p. 259

TOP:    Nursing process: Assessment

MSC:   NCLEX: Safe and Effective Care Environment: Management of Care

 

  1. A nurse who is studying chronic disease considers the multifactorial etiology of illness. What does this imply?
a. Genetics and molecular structure of disease is paramount.
b. Single organisms that cause a disease, such as cholera, must be studied in more detail
c. Focus should be on the factors or combinations and levels of factors contributing to disease.
d. The recent rise in infectious disease is the main focus.

 

 

ANS:   C

Multifactorial etiology implies a focus on combinations and levels of factors. There are many factors to consider other than only genetics or single organisms with multifactorial etiologies. The focus of studying multifactorial etiology is on chronic disease.

 

DIF:    Cognitive level: Applying                  REF:    p. 260

TOP:    Nursing process: Evaluation

MSC:   NCLEX: Safe and Effective Care Environment: Safety and Infection Control

 

  1. A nurse is investigating a serious epidemic of influenza. Which of the following best describes the amount of cases that are being examined?
a. 50 cases
b. 100 cases
c. 500 cases
d. Unable to determine

 

 

ANS:   D

One cannot tell the degree of seriousness without a denominator, which represents the total population.

 

DIF:    Cognitive level: Applying                  REF:    p. 262

TOP:    Nursing process: Assessment

MSC:   NCLEX: Safe and Effective Care Environment: Safety and Infection Control

 

  1. The probability an event will occur within a specified period of time is called:
a. rate.
b. risk.
c. epidemiology.
d. epidemic.

 

 

ANS:   B

Risk is the probability an event will occur within a specified period of time. Rate is a measure of the frequency of a health event in a defined population, usually in a specified period of time. Epidemiology is the study of the occurrence and distribution of health-related states or events in specified populations, including the study of the determinants influencing such states, and the application of this knowledge to control the health problems. Epidemic occurs when the rate of disease, injury, or other condition exceeds the usual level of that condition.

 

DIF:    Cognitive level: Remembering           REF:    p. 262

TOP:    Nursing process: Assessment

MSC:   NCLEX: Safe and Effective Care Environment: Safety and Infection Control

 

  1. A screening for diabetes revealed 20 previously diagnosed diabetics and 10 probable new cases, which were later confirmed, for a total of 30 cases. Which of the following best describes what is being measured?
a. Prevalence
b. Incidence
c. Attack rate
d. Morbidity rate

 

 

ANS:   A

Prevalence is the measure of existing disease in a population at a particular time. Incidence quantifies the rate of development of new cases in a population at risk, whereas an incidence proportion indicates the proportion of the population at risk who experience the event over some period of time. Attack rate is defined as the proportion of persons who are exposed to an agent and develop the disease. Morbidity rate is the incidence of disease.

 

DIF:    Cognitive level: Applying                  REF:    p. 263

TOP:    Nursing process: Assessment

MSC:   NCLEX: Safe and Effective Care Environment: Safety and Infection Control

 

  1. Which statement is true about mortality rates? Mortality rates:
a. are informative only for fatal diseases.
b. provide information about existing disease in the population.
c. are calculated using a population estimate at year-end.
d. reveal the risk of getting a particular disease.

 

 

ANS:   A

Mortality rates are informative only for fatal diseases and do not provide direct information about the level of existing disease or the risk of getting a particular disease. Because the population changes during the course of a year, typically an estimate of the population at midyear is taken as the denominator for annual rates, because the midyear population approximates the amount of person-time contributed by the population during a given year.

 

DIF:    Cognitive level: Understanding         REF:    p. 265

TOP:    Nursing process: Evaluation

MSC:   NCLEX: Safe and Effective Care Environment: Management of Care

 

  1. A public health nurse (PHN) reports an attack rate. Which of the following has most likely been reported?
a. Number of cases of cancer recorded at a medical center
b. Number of people who died of Ebola in a given year
c. Number of beef cattle inoculated against mad-cow disease on a farm
d. Proportion of people becoming ill after eating at a fast-food restaurant

 

 

ANS:   D

Attack rates are often specific to exposures, such as food-specific attack rates. The number of cases of cancer, exposure to Ebola, and beef cattle are not significant without knowing the total number of people so that a proportion can be calculated.

 

DIF:    Cognitive level: Analyzing                 REF:    p. 265

TOP:    Nursing process: Implementation

MSC:   NCLEX: Safe and Effective Care Environment: Safety and Infection Control

 

  1. The interaction between an agent, a host, and the environment is called:
a. natural history of disease.
b. risk.
c. web of causality.
d. the epidemiologic triangle.

 

 

ANS:   D

The epidemiologic triangle consists of the interaction between an agent, a host, and the environment. The natural history of disease is the course of the disease process from onset to resolution. Risk is the probability an event will occur within a specified period of time. The web of causality reflects the more complex interrelationship among the numerous factors interacting, sometimes in subtle ways, to increase (or decrease) risk of disease.

 

DIF:    Cognitive level: Remembering           REF:    p. 266

TOP:    Nursing process: Assessment

MSC:   NCLEX: Safe and Effective Care Environment: Safety and Infection Control

 

  1. Public health professionals refer to three levels of prevention as tied to specific stages in the:
a. epidemiologic triangle.
b. web of causation.
c. natural history of disease.
d. surveillance process.

 

 

ANS:   C

The natural history of disease is the course of the disease process from onset to resolution. The three levels of prevention provide a framework commonly used in public health practice to depict this process. The epidemiologic triangle consists of the interaction between an agent, a host, and the environment. The web of causality reflects the more complex interrelationship among the numerous factors interacting, sometimes in subtle ways, to increase (or decrease) risk of disease. The surveillance process involves the systematic collection, analysis, and interpretation of data related to the occurrence of disease and the health status of a given population.

 

DIF:    Cognitive level: Understanding         REF:    p. 268

TOP:    Nursing process: Assessment

MSC:   NCLEX: Safe and Effective Care Environment: Management of Care

 

  1. A nurse is studying the characteristics of an agent as part of the epidemiologic triangle. Which of the following is the nurse most likely studying?
a. Human population distribution
b. Salmonella
c. Genetic susceptibility
d. Climate

 

 

ANS:   B

An agent includes infectious organisms, such as Salmonella, chemical agents, and physical agents. Genetic susceptibility is considered to be a characteristic of a host. Human population distribution and climate are considered to be characteristics of the environment.

 

DIF:    Cognitive level: Applying                  REF:    p. 266 (Box 12-1)

TOP:    Nursing process: Assessment

MSC:   NCLEX: Safe and Effective Care Environment: Safety and Infection Control

 

  1. A PHN implements a primary prevention intervention in the community. Which of the following is most likely being implemented?
a. Pap smear
b. Blood pressure screening
c. Diet and exercise
d. Physical therapy

 

 

ANS:   C

Primary prevention refers to those interventions aimed at preventing the occurrence of disease, injury, or disability. Blood pressure screening and pap smears are secondary prevention interventions. Physical therapy is a tertiary prevention intervention.

 

DIF:    Cognitive level: Analyzing                 REF:    pp. 268-269

TOP:    Nursing process: Implementation

MSC:   NCLEX: Health Promotion and Maintenance

 

  1. A PHN conducts an immunization clinic for measles. Which of the following is being implemented?
a. Primary prevention
b. Secondary prevention
c. Tertiary prevention
d. Health promotion

 

 

ANS:   A

Primary prevention refers to those interventions aimed at preventing the occurrence of disease, injury, or disability. Immunizations are an example of primary prevention. Secondary prevention interventions are designed to increase the probability that a person with a disease will have that condition diagnosed at a stage when treatment is likely to result in cure. Tertiary prevention includes interventions aimed at disability limitation and rehabilitation from disease, injury, or disability. Health promotion is a specific primary prevention strategy.

 

DIF:    Cognitive level: Applying                  REF:    pp. 268-269

TOP:    Nursing process: Implementation

MSC:   NCLEX: Health Promotion and Maintenance

 

  1. As a result of an outbreak of influenza in a community, a nurse encourages members of the community to receive the influenza vaccine. Which of the following levels of prevention is being used?
a. Primary prevention
b. Secondary prevention
c. Tertiary prevention
d. Multifactorial prevention

 

 

ANS:   A

Nurses are involved in epidemiologic surveillance by monitoring the potential for disease outbreaks. Primary prevention refers to interventions aimed at preventing the occurrence of disease, injury, or disability. Immunizations are an example of primary prevention. Secondary prevention interventions are designed to increase the probability that a person with a disease will have that condition diagnosed at a stage when treatment is likely to result in cure. Tertiary prevention includes interventions aimed at disability limitation and rehabilitation from disease, injury, or disability. Multifactorial prevention is not possible with a disease like influenza, which has one cause.

 

DIF:    Cognitive level: Applying                  REF:    pp. 268-269

TOP:    Nursing process: Implementation

MSC:   NCLEX: Health Promotion and Maintenance

 

  1. A nurse offers a screening for hearing defects at a local community center. Which of the following best describes the action of the nurse?
a. Primary prevention
b. Secondary prevention
c. Tertiary prevention
d. Health promotion

 

 

ANS:   B

Secondary prevention focuses on early detection and prompt treatment of disease, injury, or disability. Screenings are part of secondary prevention interventions. Primary prevention refers to interventions aimed at preventing the occurrence of disease, injury, or disability. Tertiary prevention includes interventions aimed at disability limitation and rehabilitation from disease, injury, or disability. Health promotion is a specific primary prevention strategy.

 

DIF:    Cognitive level: Applying                  REF:    p. 269

TOP:    Nursing process: Implementation

MSC:   NCLEX: Health Promotion and Maintenance

 

  1. A nurse refers a client with a neuromuscular disease to a vocational rehabilitation program. Which of the following best describes the action of the nurse?
a. Primary prevention
b. Secondary prevention
c. Tertiary prevention
d. Health promotion

 

 

ANS:   C

Tertiary prevention includes those interventions aimed at disability limitation and rehabilitation from disease, injury, or disability. Referral of a client with a disease is an example of tertiary prevention. Primary prevention refers to interventions aimed at preventing the occurrence of disease, injury, or disability. Secondary prevention focuses on early detection and prompt treatment of disease, injury, or disability. Health promotion is a specific primary prevention strategy.

 

DIF:    Cognitive level: Applying                  REF:    p. 269

TOP:    Nursing process: Implementation

MSC:   NCLEX: Health Promotion and Maintenance

 

  1. A nurse implements a program that focuses on secondary prevention. Which of the following is most likely the topic of this program?
a. Rehabilitation
b. Avoidance of high-risk behaviors
c. Immunization
d. Mammogram

 

 

ANS:   D

Secondary prevention focuses on early detection and prompt treatment of disease, injury, or disability. Mammograms are a screening test. Avoidance of high-risk behaviors and immunizations are examples of primary prevention. Rehabilitation is an example of tertiary prevention.

 

DIF:    Cognitive level: Applying                  REF:    p. 269

TOP:    Nursing process: Implementation

MSC:   NCLEX: Health Promotion and Maintenance

 

  1. An intervention that focuses on the tertiary level of prevention is implemented by the nurse? Which of the following did the nurse most likely complete?
a. Rehabilitative job training
b. Parenting education
c. Testicular self-examination
d. Family counseling

 

 

ANS:   A

Tertiary prevention includes those interventions aimed at disability limitation and rehabilitation from disease, injury, or disability. Rehabilitative job training would be an example of tertiary prevention. Parenting education is an example of primary prevention. Testicular self-examination and family counseling are examples of secondary prevention.

 

DIF:    Cognitive level: Applying                  REF:    p. 269

TOP:    Nursing process: Implementation

MSC:   NCLEX: Health Promotion and Maintenance

 

  1. A nurse is told that a screening test has high specificity. Which of the following is the best interpretation of this information?
a. The test provides precise and consistent readings.
b. The test accurately identifies those with the condition or trait.
c. The test accurately identifies those without the trait.
d. The test has a high level of false positives.

 

 

ANS:   C

Specificity refers to the test accurately identifying those without the trait. High specificity is needed when rescreening is impractical and when reduction of false positives is important. The test would have a low level of false positives.

 

DIF:    Cognitive level: Applying                  REF:    p. 271

TOP:    Nursing process: Evaluation

MSC:   NCLEX: Safe and Effective Care Environment: Management of Care

 

  1. The proportion of persons with positive test results who actually have a disease, interpreted as the probability that an individual with a positive test result has the disease, is the:
a. sensitivity.
b. specificity.
c. positive predictive value.
d. negative predictive value.

 

 

ANS:   C

Positive predictive value refers to the proportion of persons with positive test results who actually have the disease, interpreted as the probability that an individual with a positive test result has the disease. Sensitivity quantifies how accurately the test identifies those with the condition or trait. Specificity indicates how accurately the test identifies those without the condition or trait. Negative predictive value is the proportion of persons with a negative test who are actually disease free.

 

DIF:    Cognitive level: Understanding         REF:    p. 271

TOP:    Nursing process: Assessment

MSC:   NCLEX: Safe and Effective Care Environment: Management of Care

 

  1. A nurse examines birth and death certificates during an epidemiologic investigation. Which of the following data categories is being used?
a. Routinely collected data
b. Data collected for other purposes but useful for epidemiologic research
c. Original data collected for specific epidemiologic studies
d. Surveillance data

 

 

ANS:   A

Birth and death certificates are considered to be vital records and are examples of data collected routinely. Data collected for other purposes would be hospital, physician, health department, laboratory, and insurance records. Original data is that which is collected by the National Center for Health Statistics for specific health surveys. Surveillance data is used to assess and prioritize the health needs of populations, design public health and clinical services to address those needs, and evaluate the effectiveness of public health programs.

 

DIF:    Cognitive level: Applying                  REF:    p. 272

TOP:    Nursing process: Implementation

MSC:   NCLEX: Safe and Effective Care Environment: Management of Care

 

  1. The most important predictor of overall mortality is:
a. race.
b. age.
c. gender.
d. income.

 

 

ANS:   B

The mortality curve by age drops sharply during and after the first year of life to a low point in childhood, then begins to increase through adolescence and young adulthood and then increases sharply through middle and older ages. Race, gender, and income are not the most important predictor for overall mortality.

 

DIF:    Cognitive level: Understanding         REF:    p. 274

TOP:    Nursing process: Assessment

MSC:   NCLEX: Safe and Effective Care Environment: Management of Care

 

  1. A nurse is investigating an outbreak of a gastrointestinal illness from a food-borne pathogen. Which of the following terms is being applied?
a. Attack rate
b. Point epidemic
c. Secular trend
d. Event-related cluster

 

 

ANS:   B

One temporal and spatial pattern of disease distribution is the point epidemic. A point epidemic is most clearly seen when the frequency of cases is plotted against time. The sharp peak characteristic of such graphs indicates a concentration of cases in some short interval of time. Attack rate is defined as the proportion of persons who are exposed to an agent and develop the disease. Secular trends are long-term patterns of morbidity or mortality rates. Event-related clusters are patterns in which time is not measured from fixed dates on the calendar but from the point of some exposure or event, presumably experienced in common by affected persons, although not occurring at the same time.

 

DIF:    Cognitive level: Applying                  REF:    p. 275

TOP:    Nursing process: Assessment

MSC:   NCLEX: Safe and Effective Care Environment: Safety and Infection Control

 

  1. The type of epidemiologic study that is used to describe a group of persons enrolled in a study who share some characteristic of interest and who are followed over a period of time to observe some health outcome is a(n):
a. case-control study.
b. cross-sectional study.
c. cohort study.
d. experimental study.

 

 

ANS:   C

A cohort study is the type of epidemiologic study that is used to describe a group of persons enrolled in a study who share some characteristic of interest and who are followed over a period of time to observe some health outcome. A case-control study uses a sample from the cohort rather than following the entire cohort over time. A cross-sectional study provides a snapshot of a population or group at one point in time. An experimental study is one in which the investigator initiates some treatment or intervention that may influence the risk or course of the disease.

 

DIF:    Cognitive level: Remembering           REF:    pp. 276-277

TOP:    Nursing process: Assessment

MSC:   NCLEX: Safe and Effective Care Environment: Management of Care

 

  1. A study that uses information on current health status, personal characteristics, and potential risk factors or exposures all at once is called:
a. cross-sectional.
b. ecological.
c. case-control.
d. cohort.

 

 

ANS:   A

A cross-sectional study collects information on current health status, personal characteristics, and potential risk factors or exposures all at once. A cohort study is the type of epidemiologic study that is used to describe a group of persons enrolled in a study who share some characteristic of interest and who are followed over a period of time to observe some health outcome. An ecological model considers the multiple factors that contribute to disease development.

 

DIF:    Cognitive level: Remembering           REF:    p. 278

TOP:    Nursing process: Assessment

MSC:   NCLEX: Safe and Effective Care Environment: Management of Care

 

  1. Voters have recently decided to have fluoride added to the city water system. Epidemiologists now want to study the effect of fluoride on dental caries in this population. Which of the following would be conducted by the epidemiologists?
a. Ecological study
b. Double-blind study
c. Community trial
d. Screening

 

 

ANS:   C

A community trial is similar to a clinical trial, but the issue is often health promotion and disease prevention rather than treatment of existing disease. An ecological model considers the multiple factors that contribute to disease development. A double-blind study is one in which neither the subject nor the investigator knows who is receiving the treatment. A screening involves the testing of groups of individuals who are at risk for a certain condition but are not yet symptomatic.

 

DIF:    Cognitive level: Applying                  REF:    p. 280

TOP:    Nursing process: Evaluation

MSC:   NCLEX: Safe and Effective Care Environment: Management of Care

 

  1. A nurse is considering the potential for selection bias. Which of the following best describes the situation that is the nurse has encountered?
a. Determining the population to be studied
b. Considering how the participants will enter the study
c. Studying cause and effect relationships
d. Documenting results of the study

 

 

ANS:   B

Selection bias is attributable to the way subjects enter a study. It has to do with selection procedures and the population from which subjects are drawn. Determining the population to be studied relates to the design of the study. Studying cause and effect relationship has to do with ecological studies. Documenting the results of the study is completed at the end of the study after the participants have been selected.

 

DIF:    Cognitive level: Applying                  REF:    pp. 280-281

TOP:    Nursing process: Implementation

MSC:   NCLEX: Safe and Effective Care Environment: Management of Care

 

MULTIPLE RESPONSE

 

  1. During the twentieth century, a nurse participated in research that examined the epidemiology of various diseases. Which of the following best describes the factors that influenced these studies? (Select all that apply.)
a. Increasing rate of poverty
b. Declining child mortality rates
c. Overcrowding in major cities
d. Development of new vaccinations
e. Advancements in medical equipment

 

 

ANS:   B, D

Factors contributing to the development and application of epidemiologic methods in the twentieth century were: improved nutrition, new vaccines, better sanitation, the advent of antibiotics and chemotherapies, and declining infant and child mortality and birth rates. A rise in the standard of living occurred for many following the Great Depression and World War II. The advancements in medical technology have not influenced the examination of the epidemiology of various diseases.

 

DIF:    Cognitive level: Applying                  REF:    p. 260

TOP:    Nursing process: Evaluation

MSC:   NCLEX: Safe and Effective Care Environment: Management of Care

 

  1. A nurse states that he has incorporated epidemiology into his practice and functions in epidemiologic roles. Which of the following best describes the actions taken by the nurse? (Select all that apply.)
a. Policy making
b. Collection, reporting, analysis, and interpretation of data
c. Environmental risk communication
d. Documentation on patient charts and records
e. Law enforcement

 

 

ANS:   B, C, D

Collection, reporting, analysis, and interpretation of data, environmental risk communication, and documentation on patient charts and records are examples of the use of epidemiology in practice. Policy making and law enforcement do not apply to epidemiology.

 

DIF:    Cognitive level: Applying                  REF:    pp. 281-282

TOP:    Nursing process: Implementation

MSC:   NCLEX: Safe and Effective Care Environment: Management of Care

 

Chapter 24: Public Health Surveillance and Outbreak Investigation

Stanhope: Public Health Nursing: Population-Centered Health Care in the Community, 9th Edition

 

MULTIPLE CHOICE

 

  1. What occurs during biological terrorism?
a. The intentional release of hazardous chemicals into the environment
b. Environmental and occupational exposure to biological toxins
c. Immunity to toxins related to repeated exposures
d. An intentional release of viruses, bacteria, or other toxins

 

 

ANS:   D

An intentional release of viruses, bacteria, or other toxins would be described as biological terrorism. Chemical terrorism is the intentional release of hazardous chemicals into the environment for the purpose of harming or killing. Surveillance is used to monitor environmental and occupational exposures. Immunity to toxins after repeated exposures does not occur during biological terrorism.

 

DIF:    Cognitive level: Understanding         REF:    p. 531

TOP:    Nursing process: Assessment

MSC:   NCLEX: Safe and Effective Care Environment: Management of Care

 

  1. Which problem does a health department usually have the legal authority to investigate?
a. Pandemics
b. Unusual clusters of illness
c. World trends of disease
d. Cases of the common cold and pneumonia

 

 

ANS:   B

Powers of local government include surveillance of unusual clusters of illness. A health department does not have legal authority to investigate pandemics, world trends of disease, and cases of the common cold and pneumonia.

 

DIF:    Cognitive level: Understanding         REF:    p. 530

TOP:    Nursing process: Assessment

MSC:   NCLEX: Safe and Effective Care Environment: Management of Care

 

  1. Which is a feature of public health surveillance?
a. Sharing of the results with others
b. Defining public health policy
c. Evaluating interventions
d. Planning national programs

 

 

ANS:   A

One of the features of public health surveillance is sharing of the results with others. Defining public health policy, evaluating interventions, and planning national programs are all purposes of surveillance, not features.

 

DIF:    Cognitive level: Understanding         REF:    p. 531

TOP:    Nursing process: Assessment

MSC:   NCLEX: Safe and Effective Care Environment: Management of Care

 

  1. A nurse is conducting disease surveillance. Which of the following describes the rationale for this action?
a. To eradicate a disease before it starts
b. To establish a baseline rate of disease occurrence and patterns of spread
c. To target populations for triage
d. To reduce the incidence of heart disease in a community

 

 

ANS:   B

Disease surveillance helps establish baseline rates of disease occurrence and patterns of spread to make it possible to initiate a rapid response to an outbreak. Disease surveillance is unable to eradicate a disease before it starts, to target populations for triage, or to reduce the incidence of heart disease in a community. However, disease surveillance does make it possible to initiate a rapid response to an outbreak of a disease or an event that can cause a health problem.

 

DIF:    Cognitive level: Analyzing                 REF:    p. 531

TOP:    Nursing process: Evaluation

MSC:   NCLEX: Safe and Effective Care Environment: Management of Care

 

  1. A hospital is using surveillance. Which of the following describes the rationale for this action?
a. To protect the public against isolated patients
b. To eliminate pathogens from the environment
c. To improve quality of care and outcomes
d. To decrease the incidence of ventilator-acquired pneumonia

 

 

ANS:   C

Hospital surveillance is used to improve quality of care and outcomes. An example is an infection that occurs in patients who had procedures at that facility. Reduction of the incidence of ventilator-acquired pneumonia is one reason why a hospital uses surveillance, but it does not address the entire issue. Hospital surveillance is unable to eliminate pathogens from the environment and cannot protect the public against isolated patients.

 

DIF:    Cognitive level: Analyzing                 REF:    p. 532

TOP:    Nursing process: Evaluation

MSC:   NCLEX: Safe and Effective Care Environment: Management of Care

 

  1. A community coalition monitors the increasing obesity rate of children in their schools. Based on this data, they consider a variety of programming options which may possibly help decrease this trend. What was the purpose of conducting this surveillance?
a. Protect the children from diseases that affect obese children
b. Teach parents that obesity will not be tolerated in this community
c. Educate children on surveillance techniques
d. Demonstrate that new clinical and effective protocols need to be developed

 

 

ANS:   D

Ongoing surveillance in a community can lead to new clinical and effective protocols to address an issue. Ongoing surveillance makes it possible to have ongoing monitoring in place to ensure that disease and event patterns improve rather than deteriorate. This surveillance cannot protect children from diseases, teach parents that obesity will not be tolerated, or educate children on surveillance techniques.

 

DIF:    Cognitive level: Analyzing                 REF:    p. 532

TOP:    Nursing process: Evaluation

MSC:   NCLEX: Safe and Effective Care Environment: Management of Care

 

  1. A nurse is using surveillance to collect outcome data. What information would most likely be collected?
a. Number of clinic services which use evidence-based protocols
b. Proportion of the population vaccinated against influenza
c. Incidence of breast cancer in the population
d. Probability of a bioterrorism attack occurring in the community

 

 

ANS:   C

Outcome data focus on change in health status; incidence rates are one example of this type of information. Process data focus on what is done, such as services provided or protocols for health care delivery. An example of process data is collection of data about the proportion of the eligible population vaccinated against influenza in any 1 year.

 

DIF:    Cognitive level: Analyzing                 REF:    p. 531

TOP:    Nursing process: Assessment

MSC:   NCLEX: Safe and Effective Care Environment: Management of Care

 

  1. A nurse practitioner reports a case of gonorrhea to the local health department. Which type of surveillance system is being used?
a. Active
b. Passive
c. Sentinel
d. Special

 

 

ANS:   B

In the passive system, case reports are sent to local health departments by health care providers. In the active system, the public health nurse may begin a search for cases through contacts with local health providers and health care agencies. In the sentinel system, trends in commonly occurring diseases or key health indicators are monitored. Special systems are developed for collecting particular types of data and may be a combination of active, passive, and/or sentinel systems.

 

DIF:    Cognitive level: Applying                  REF:    p. 536

TOP:    Nursing process: Assessment

MSC:   NCLEX: Safe and Effective Care Environment: Management of Care

 

  1. A public health nurse (PHN) is investigating an outbreak of salmonellosis in a community. Which type of surveillance system is being used?
a. Active
b. Passive
c. Sentinel
d. Special

 

 

ANS:   A

In the active system, a PHN begins to search for cases through contacts in the community. The nurse names the disease and gathers data about existing cases to try to determine the magnitude of the problem. In the passive system, case reports are sent to local health departments by health care providers. In the sentinel system, trends in commonly occurring diseases or key health indicators are monitored. Special systems are developed for collecting particular types of data and may be a combination of active, passive, and/or sentinel systems.

 

DIF:    Cognitive level: Applying                  REF:    p. 537

TOP:    Nursing process: Assessment

MSC:   NCLEX: Safe and Effective Care Environment: Management of Care

 

  1. What information is shared among agencies when they collaborate to implement a quality surveillance system?
a. How to use algorithms to identify which events should be investigated
b. Who is to blame for a disease outbreak
c. What shelters will be used and by whom
d. How political action will be necessary to ensure public health

 

 

ANS:   A

Collaboration promotes the development of plans and a directory of emergency responses. How to use algorithms is a key type of information that is shared. Blaming others is not part of collaboration. Determining what shelters will be used and by whom is not the priority for collaboration. How political action will be necessary to ensure public health is not a priority for collaboration.

 

DIF:    Cognitive level: Understanding         REF:    p. 532

TOP:    Nursing process: Implementation

MSC:   NCLEX: Safe and Effective Care Environment: Management of Care

 

  1. What does each state do with the information that it receives about notifiable diseases?
a. Uses the information for surveillance purposes
b. Reports the information to the local branch of the World Health Organization (WHO)
c. Transmits the data electronically, weekly, to the Centers for Disease Control and Prevention (CDC)
d. Does nothing with the information

 

 

ANS:   C

Data is transmitted weekly to the CDC through the National Electronic Telecommunications System for Surveillance. States need to transmit the information to the CDC rather than only keeping its own records. The reports are sent to the CDC, not to the WHO.

 

DIF:    Cognitive level: Understanding         REF:    p. 535

TOP:    Nursing process: Evaluation

MSC:   NCLEX: Safe and Effective Care Environment: Management of Care

 

  1. A nurse is applying the Minnesota Model of Public Health Interventions: Applications for Public Health Nursing Practice steps of surveillance. Which of the following describes the initial action that the nurse would take?
a. Analyze data
b. Consider whether surveillance is appropriate to the situation
c. Evaluate the impact of the surveillance
d. Collect data

 

 

ANS:   B

The first step in this model considers whether the surveillance was appropriate. Analyzing data is the fifth step in this model. Evaluation of the impact of the surveillance is the last step of the model. Collecting data is the fourth step in this model.

 

DIF:    Cognitive level: Applying                  REF:    p. 533

TOP:    Nursing process: Implementation

MSC:   NCLEX: Safe and Effective Care Environment: Management of Care

 

  1. A large amount of data related to hypertension rates is collected in a community. The data is analyzed. Which of the following describes the next step in the surveillance process?
a. Collecting data from multiple valid sources
b. Evaluating the impact on the surveillance system
c. Interpreting the data and disseminating it to decision makers
d. Asking political officials to finance a hypertension clinic

 

 

ANS:   C

After data is collected and analyzed, the findings must be disseminated. Collection of data is the step described in this scenario and the question asks what must be done next. Evaluating the impact on the surveillance system occurs after dissemination. Dissemination may occur to a broader audience than only political officials.

 

DIF:    Cognitive level: Applying                  REF:    p. 533

TOP:    Nursing process: Implementation

MSC:   NCLEX: Safe and Effective Care Environment: Management of Care

 

  1. What information is included in a case definition?
a. The precise point of contact
b. Laboratory confirmation
c. Source of contamination
d. Clinical symptoms

 

 

ANS:   D

Each case has a unique set of criteria based on what is known about the particular disease. It may include clinical symptoms, laboratory values, and epidemiologic criteria. The precise point of contact, laboratory confirmation, and source of contamination are not part of a case definition.

 

DIF:    Cognitive level: Understanding         REF:    p. 536

TOP:    Nursing process: Assessment

MSC:   NCLEX: Safe and Effective Care Environment: Management of Care

 

  1. What was the purpose of the CDC creating the first list of standard case definitions for notifiable diseases?
a. Some diseases were underreported and others were overreported.
b. There was no central office to collect data.
c. Some people refused to notify officials when diseases were seen.
d. No one knew where to report the information that was collected.

 

 

ANS:   A

The initial work was done by the CDC because diseases were overreported or underreported. Before this time, state and local health departments used many different criteria for identifying cases of reportable diseases. There was a central office to collect the data and providers knew that this information needed to be reported, but what was being reported by departments was different.

 

DIF:    Cognitive level: Understanding         REF:    p. 534

TOP:    Nursing process: Evaluation

MSC:   NCLEX: Safe and Effective Care Environment: Management of Care

 

  1. A nurse is completing a disease investigation. Based on the clinical symptoms presented, it is assumed that the individual has measles. However, there has been no laboratory evidence documenting that this individual has the disease. Which of the following types of cases is the nurse investigating?
a. A suspected case
b. A confirmed case
c. A prolonged case
d. An identified case

 

 

ANS:   A

A suspected case is a clinically compatible case of illness without isolation. A confirmed case is a clinically compatible case that is laboratory confirmed by isolation. A prolonged case and identified case are not types of cases discussed in the text.

 

DIF:    Cognitive level: Applying                  REF:    p. 536

TOP:    Nursing process: Implementation

MSC:   NCLEX: Safe and Effective Care Environment: Management of Care

 

  1. The SARS (severe acute respiratory syndrome) outbreak was an epidemic that spread over several countries. Which of the following terms describes what happened?
a. Hyperendemic
b. Pandemic
c. Mixed outbreak
d. Holoendemic

 

 

ANS:   B

A pandemic refers to the epidemic spread of the problem over several countries or continents. If a problem is considered hyperendemic, there is a persistently (usually) high number of cases. A mixed outbreak is a common source followed by secondary exposures related to person-to-person contact. Holoendemic implies a highly prevalent problem found in a population commonly acquired early in life.

 

DIF:    Cognitive level: Applying                  REF:    p. 538

TOP:    Nursing process: Evaluation

MSC:   NCLEX: Safe and Effective Care Environment: Management of Care

 

  1. A person has returned from overseas and it is determined that he has Q fever. Which of the following must occur?
a. This is not a disease that is on the notifiable list; nothing need be reported.
b. The case must be reported to the state and local health departments.
c. The patient must be isolated immediately.
d. The patient will probably die, so it is not reportable.

 

 

ANS:   B

Q fever is on the notifiable list and must be reported to the state and local health departments. Thus, it needs to be reported, but does not imply immediate isolation or probable death.

 

DIF:    Cognitive level: Analyzing                 REF:    p. 535 (Box 24-1)

TOP:    Nursing process: Assessment

MSC:   NCLEX: Safe and Effective Care Environment: Management of Care

 

  1. A nurse is collecting morbidity data. Which of the following would be the source that the nurse would use?
a. Vital statistics reports
b. Birth records
c. Death certificates
d. Specialized disease registries

 

 

ANS:   D

There are many sources of morbidity data (rate of disease incidence), including specialized disease registries. Vital statistics reports, birth records, and death certificates are part of mortality data.

 

DIF:    Cognitive level: Applying                  REF:    p. 533

TOP:    Nursing process: Assessment

MSC:   NCLEX: Safe and Effective Care Environment: Management of Care

 

  1. A college student goes to the Student Health Center with an extremely swollen neck. The advanced practice nurse determines that he has mumps. His roommate also is experiencing malaise and a sore throat. Which of the following defines these two students?
a. Mixed outbreak
b. Common source
c. Point source
d. Propagated outbreak

 

 

ANS:   C

A point source outbreak involves all persons exposed becoming ill at the same time, during one incubation period. A mixed outbreak is a common source followed by secondary exposures related to person-to-person contact. A common source outbreak refers to a group exposed to a common noxious influence such as the release of noxious gases. A propagated outbreak does not have a common source and spreads gradually from person to person over more than one incubation period.

 

DIF:    Cognitive level: Applying                  REF:    p. 538

TOP:    Nursing process: Assessment

MSC:   NCLEX: Safe and Effective Care Environment: Management of Care

 

  1. A nurse is investigating a potential bioterrorism attack. Which of the following evidence would a nurse find if a bioterrorism attack occurred?
a. A large number of cases of influenza
b. A case of cholera in a local politician following a trip to India
c. Dengue fever in a group of students who just returned from a mission trip
d. An unusual illness in a population

 

 

ANS:   D

Unusual illness in a population should trigger an investigation that may signal a covert bioterrorism attack. Cases of influenza, cholera, and dengue fever in a group would not be considered unexpected illnesses.

 

DIF:    Cognitive level: Applying                  REF:    p. 539 (How to Box)

TOP:    Nursing process: Evaluation

MSC:   NCLEX: Safe and Effective Care Environment: Management of Care

 

MULTIPLE RESPONSE

 

  1. A nurse is using public surveillance. Which of the following describes the actions involved? (Select all that apply.)
a. Estimating the magnitude of an influenza outbreak
b. Determining the geographical distribution of gonorrhea cases
c. Detecting an epidemic of whooping cough
d. Reducing the prevalence of obesity
e. Determining the incidence of cardiovascular disease

 

 

ANS:   A, B, C

Estimating the magnitude of the problem, determining geographic distribution of an illness, and detecting epidemics are all uses of public surveillance. Reduction of the prevalence of obesity and determining the incidence of cardiovascular disease are not how public health surveillance is used.

 

DIF:    Cognitive level: Analyzing                 REF:    p. 531

TOP:    Nursing process: Implementation

MSC:   NCLEX: Safe and Effective Care Environment: Management of Care

 

  1. A staff nurse has demonstrated the ability to be competent as a participant in surveillance and investigation activities. Which of the following skills would you expect that nurse to possess? (Select all that apply.)
a. The ability to identify appropriate data sources
b. The ability to communicate effectively using written reports
c. The ability to collaborate with community agencies
d. The ability to create a budget
e. The ability to interpret laboratory findings

 

 

ANS:   A, B, C, D

The staff nurse must have analytic assessment skills, communication skills, and community dimensions of practice to be a participant in surveillance and investigation. The ability to interpret laboratory findings is not a core competency.

 

DIF:    Cognitive level: Applying                  REF:    pp. 532-533

TOP:    Nursing process: Implementation

MSC:   NCLEX: Safe and Effective Care Environment: Management of Care

 

  1. Which are the objectives of a disease investigation? (Select all that apply.)
a. Enhance the knowledge of the nurse working in public health
b. Control and prevent disease or death
c. Identify factors that contribute to the disease outbreak/event occurrence
d. Implement measures to prevent occurrences
e. Participate in the core functions of public health

 

 

ANS:   B, C, D

The objectives of an investigation are to control and prevent disease or death, identify factors that contribute to the disease outbreak/event occurrence, and implement measures to prevent occurrences. Enhancing the knowledge of the nurse working in public health and participating in the core functions of public health are not objectives of an investigation.

 

DIF:    Cognitive level: Understanding         REF:    p. 538

TOP:    Nursing process: Assessment

MSC:   NCLEX: Safe and Effective Care Environment: Management of Care

 

Chapter 36: Mental Health Issues

Stanhope: Public Health Nursing: Population-Centered Health Care in the Community, 9th Edition

 

MULTIPLE CHOICE

 

  1. Who led reform efforts to correct types of inhumane practices in the care of criminals, those with mental disorders, and victims of the Civil War?
a. Dorothea Dix
b. Philippe Pinel
c. Benjamin Rush
d. Clifford Beers

 

 

ANS:   A

Dorothea Dix led reform efforts to correct types of inhumane practices in the care of criminals, those with mental disorders, and victims of the Civil War. Philippe Pinel and Benjamin Rush led a reform movement that led to hospital expansion, medical treatment, and the community mental health movements. Clifford Beers urged mental health reform and influenced the founding of the National Committee for Mental Hygiene.

 

DIF:    Cognitive level: Remembering           REF:    p. 786

TOP:    Nursing process: Evaluation

MSC:   NCLEX: Safe and Effective Care Environment: Management of Care

 

  1. The first major piece of legislation to influence mental health services in the United States was the:
a. National Mental Health Act.
b. Mental Health Study Act.
c. Social Security Act.
d. Protection and Advocacy for Mentally Ill Individuals Act.

 

 

ANS:   C

The Social Security Act was the first major piece of legislation to influence mental health services in the United States. This act was created in response to economic and social problems of the era and shifted the responsibility of care for ill people from the state to the federal government. The National Mental Health Act included the objectives of development of education and research programs for community mental health treatment approaches. The Mental Health Study Act promoted the study of national mental health needs. The Protection and Advocacy for Mentally Ill Individuals Act promoted the development of advocacy programs for mentally ill persons.

 

DIF:    Cognitive level: Understanding         REF:    p. 787

TOP:    Nursing process: Evaluation

MSC:   NCLEX: Safe and Effective Care Environment: Management of Care

 

  1. Many clients with mental disorders were institutionalized because:
a. there was a continued fear of people with mental disorders.
b. the success rate was higher with hospital treatment.
c. it was easier to stabilize clients with psychotropic medications.
d. it provided a less stressful environment for clients to recuperate.

 

 

ANS:   A

Many clients with mental disorders were institutionalized because of a continued fear of people with mental disorders. These clients were essentially separated from the community and isolated from their families. This institutionalization combined with minimal information about cause, cure, and care, resulted in overcrowded conditions and exploitation of clients.

 

DIF:    Cognitive level: Understanding         REF:    p. 786

TOP:    Nursing process: Evaluation

MSC:   NCLEX: Safe and Effective Care Environment: Management of Care

 

  1. An individual viewed physical and mental illness as interrelated, resulting from physical conditions. Which of the following best describes the era in which this individual lived?
a. Ancient times
b. Middle Ages
c. Colonial
d. Greco-Roman

 

 

ANS:   D

An individual viewed physical and mental illness as interrelated, resulting from physical conditions during the Greco-Roman era. During the ancient times, Middle Ages, and colonial times, mental illness was viewed as resulting from supernatural forces.

 

DIF:    Cognitive level: Applying                  REF:    p. 786

TOP:    Nursing process: Evaluation

MSC:   NCLEX: Safe and Effective Care Environment: Management of Care

 

  1. A nurse worked in a psychiatric institution during the hospital expansion era. Which of the following best describes the location where the nurse most likely worked?
a. Near small communities with access to families and activities
b. In rural areas removed from family and social activities
c. Near urban areas with access to families and low-paying jobs
d. In urban areas without access to families and jobs

 

 

ANS:   B

During the hospital expansion era, most psychiatric institutions were located in rural areas removed from family and social activities. Clients were essentially separated from the community and isolated from their families. Many were institutionalized for the rest of their lives.

 

DIF:    Cognitive level: Analyzing                 REF:    p. 786

TOP:    Nursing process: Assessment

MSC:   NCLEX: Safe and Effective Care Environment: Management of Care

 

  1. A nurse has specialized knowledge and skills in mental health illness and problems in order to provide effective nursing care for this population. Which of the following best describes the need for this knowledge and skills?
a. Services for people with mental disorders are inadequate.
b. The effects of mental health are universal.
c. Mental health disorders affect small sectors of the population.
d. Current health objectives can be met without the influence of nursing.

 

 

ANS:   A

There are two universal truths that require nurses to have specialized knowledge and skills in this area: services for people with mental disorders are inadequate in all countries, and mental illness has a major impact on families, communities, and nations. The effects of mental health are variable. Mental health disorders can affect all populations. Nursing plays a major role in meeting the current health objectives for mental health disorders.

 

DIF:    Cognitive level: Analyzing                 REF:    p. 783

TOP:    Nursing process: Evaluation

MSC:   NCLEX: Safe and Effective Care Environment: Management of Care

 

  1. A nurse is employed by the National Institute for Mental Health (NIMH). Which of the following best describes an activity the nurse would be involved in?
a. Expansion of psychiatric units in general hospitals
b. Development of education programs for community mental health treatment
c. Legislation and advocacy for the rights of people with mental disorders
d. Deinstitutionalization of patients

 

 

ANS:   B

After the National Mental Health Act was passed in 1946, the NIMH administered its programs. Objectives included development of education and research programs for community mental health treatment approaches. The NIMH is not involved with expansion of psychiatric units in general hospitals, legislation and advocacy for the rights of people with mental disorders, or the deinstitutionalization of patients.

 

DIF:    Cognitive level: Analyzing                 REF:    p. 787

TOP:    Nursing process: Implementation

MSC:   NCLEX: Safe and Effective Care Environment: Management of Care

 

  1. Approximately what percentage of the adult population (ages 18 and older) in the United States suffers from a mental condition that is severe enough to impair daily function?
a. 6%
b. 14%
c. 18%
d. 25%

 

 

ANS:   C

Approximately 18% of the adult population in the United States has a mental health condition severe enough to impair daily function. Nearly half of those with any mental disorder meet the criteria for two disorders.

 

DIF:    Cognitive level: Remembering           REF:    pp. 783-784

TOP:    Nursing process: Evaluation

MSC:   NCLEX: Safe and Effective Care Environment: Management of Care

 

  1. According to the NIMH, which is the leading cause of disability among adults?
a. Schizophrenia
b. Major depression
c. Obsessive-compulsive disorder
d. Anxiety

 

 

ANS:   B

Major depression is pervasive and is the leading cause of disability among adults ages 15-44. Anxiety disorders, which include obsessive-compulsive disorder, are prevalent, affecting 18% of American adults each year. Schizophrenia is considered a severe mental illness and is part of the mental health illnesses experienced by 3.9% of the population.

 

DIF:    Cognitive level: Remembering           REF:    p. 784

TOP:    Nursing process: Evaluation

MSC:   NCLEX: Safe and Effective Care Environment: Management of Care

 

  1. A client who has been diagnosed with major depression works with other mental health consumers to advocate for establishment of additional self-help services for individuals and families with mental illness in a community. Which of the following best describes the organization that the client is likely involved with?
a. Community Support Program (CSP)
b. NIMH
c. Mental Health Study
d. National Alliance for the Mentally Ill (NAMI)

 

 

ANS:   D

NAMI was the first consumer group to advocate for better services. This consumer advocacy group worked to establish education and self-help services for individuals and families with mental illness. The Mental Health Study Act promoted the study of national mental health needs. The National Mental Health Act established the NIMH, which includes the objectives of development of education and research programs for community mental health treatment approaches. The CSP provided grant monies to states to develop comprehensive services for persons discharged from psychiatric institutions and invited consumers to participate.

 

DIF:    Cognitive level: Applying                  REF:    p. 784

TOP:    Nursing process: Evaluation

MSC:   NCLEX: Safe and Effective Care Environment: Management of Care

 

  1. A nurse is working with a client who is concerned about discrimination in the workplace based on a current mental health diagnosis. Which legislation has prohibited discrimination for persons with mental disorders?
a. National Mental Health Act
b. American with Disabilities Act (ADA)
c. Developmental Disabilities Act
d. Protection and Advocacy for Mentally Ill Individuals Act

 

 

ANS:   B

The ADA prohibited discrimination and promoted opportunities for persons with mental disorders. The National Mental Health Act established the NIMH, which includes the objectives of development of education and research programs for community mental health treatment approaches. The Developmental Disabilities Act addressed the rights and treatment of people with developmental disabilities and provided a foundation for similar action for individuals with mental disorders. The Protection and Advocacy for Mentally Ill Individuals Act legislated advocacy programs for mentally ill persons.

 

DIF:    Cognitive level: Applying                  REF:    p. 788

TOP:    Nursing process: Evaluation

MSC:   NCLEX: Safe and Effective Care Environment: Management of Care

 

  1. A client who was deinstitutionalized during the 1960s experienced difficulties living in the community. Which of the following best describes why this difficulty existed?
a. Insufficient community mental health services
b. Difficulties connecting with community resources
c. Lack of affordable housing
d. Increased cost of care

 

 

ANS:   A

Insufficient community mental health services were available in the community. Families were not prepared for treatment responsibilities. There were no education and support programs for families. Staff in nursing homes lacked skills to treat people with mental disorders, and clients had little or no supervision in independent settings. There were not enough resources in the community, so the primary problem was the lack of resources not connecting with them. The lack of affordable housing or increased costs of care were not reasons this population had difficulties living in the community.

 

DIF:    Cognitive level: Analyzing                 REF:    p. 788

TOP:    Nursing process: Evaluation

MSC:   NCLEX: Safe and Effective Care Environment: Management of Care

 

  1. Which factor has influenced the advancement in the treatment of mental illness?
a. The movement of clients out of mental institutions to the community
b. A better understanding of the neurobiology of mental illness
c. More interest in helping persons with mental illness
d. A change in the culture about what constitutes mental illness

 

 

ANS:   B

Two major movements have influenced the treatment of mental illness: (1) consumer advocacy and (2) a better understanding of neurobiology. The movement of clients into the community has not advanced the treatment of mental illness, nor has there been an increased interest in helping this population or a culture change.

 

DIF:    Cognitive level: Understanding         REF:    p. 784

TOP:    Nursing process: Evaluation

MSC:   NCLEX: Safe and Effective Care Environment: Management of Care

 

  1. A nurse considers the effects of biology and environment, or nature and nurture, on the development of mental illness when providing care for clients with mental illness. Which nursing model/theory is being applied?
a. Community mental health model
b. Holistic model
c. Systems theory
d. Diathesis-stress model

 

 

ANS:   D

The diathesis-stress model integrates the effects of biology and environment on the development of mental illness. Certain genes or genetic combinations produce a predisposition to a disorder. When an environmental stressor challenges an individual with a predisposition to a disorder, the expression of a mental disorder may result. The community health model is the primary method of care for people with serious and persistent mental illness. This model includes team care, case management, outreach, and a variety of rehabilitative and recovery approaches to help prevent exacerbations of illness. The systems theory uses a holistic view, which emphasizes the relationship between the elements of a unit and the whole. An understanding of the whole occurs through the examination of interactions and relationships that exist between the parts.

 

DIF:    Cognitive level: Applying                  REF:    p. 789

TOP:    Nursing process: Planning

MSC:   NCLEX: Safe and Effective Care Environment: Management of Care

 

  1. A nurse categorizes mental illness as a biopsychosocial disorder. What is meant by this classification?
a. Mental illness is an abnormal brain vasculature that can be detected with angiography.
b. Antipsychotic drugs can be used for all types of mental illness.
c. Experience and psychosocial factors affect the etiology and treatment of mental illness.
d. Mental illness can be cured with the right drugs and therapy.

 

 

ANS:   C

Biochemical changes of the brain are being studied as causes of mental illness. Angiography is used to screen for abnormalities of the vascular system, such as atherosclerosis and brain tumors, that can lead to behavior changes. Antipsychotic drugs are only appropriate for treatment of certain mental illnesses. More is known about the functions of the brain than any time in history; however, treatment of mental illness continues to be challenging.

 

DIF:    Cognitive level: Applying                  REF:    pp. 784-785

TOP:    Nursing process: Evaluation

MSC:   NCLEX: Safe and Effective Care Environment: Management of Care

 

  1. A nurse implements a primary prevention intervention related to mental health care. Which of the following interventions has most likely been implemented?
a. Group psychotherapy
b. Stress reduction education
c. Case management
d. Monitoring illness symptoms

 

 

ANS:   B

Primary prevention refers to the reduction of health risks, thus stress reduction education is the correct response. Group psychotherapy and case management are secondary prevention strategies, and monitoring illness symptoms is a tertiary prevention strategy.

 

DIF:    Cognitive level: Applying                  REF:    p. 789

TOP:    Nursing process: Implementation

MSC:   NCLEX: Health Promotion and Maintenance

 

  1. A nurse implements a tertiary prevention intervention related to mental health care. Which of the following interventions has most likely been implemented?
a. Screening for anxiety
b. Depression education
c. Counseling following a natural disaster
d. Coordination transition from the hospital to the community

 

 

ANS:   D

Tertiary prevention efforts attempt to restore and enhance functioning, thus coordination of transition from the hospital to the community is tertiary prevention. Screening and counseling are secondary prevention activities, and depression education is a primary prevention activity.

 

DIF:    Cognitive level: Applying                  REF:    p. 790

TOP:    Nursing process: Implementation

MSC:   NCLEX: Health Promotion and Maintenance

 

  1. The nurse is working in the role of educator with groups of clients. Which of the following interventions would the nurse likely perform?
a. Care for clients in acute care settings
b. Coordinate activities with staff members in community settings
c. Use learning principles to increase understanding about mental illness
d. Act as an advocate for mental health support groups

 

 

ANS:   C

The educator role is foundational to health maintenance, health promotion, and community action. Using learning principles to increase understanding in the community about mental illness is a role of the educator. Caring for clients in acute care settings is the role of clinician. Coordinating activities with staff members in community settings is the role of coordinator. Acting as an advocate for mental health support groups is the role of an advocate.

 

DIF:    Cognitive level: Applying                  REF:    p. 791

TOP:    Nursing process: Implementation

MSC:   NCLEX: Safe and Effective Care Environment: Management of Care

 

  1. An undergraduate-level prepared nurse is working with a mental health population. Which of the following roles would be most appropriate for the nurse?
a. Prescribe medications and have hospital admission privileges
b. Work as a case manager for large groups of persons with mental illness
c. Assess clients in acute psychiatric hospital settings
d. Provide basic primary, secondary, and tertiary services

 

 

ANS:   D

The undergraduate level–prepared nurse is prepared to implement primary, secondary, and tertiary services. Roles of the nurse may include clinician, educator, and coordinator. Prescribing medications and having hospital admission privileges, working as a case manager for large groups of persons with mental illness, and assessing clients in acute psychiatric hospital settings would be roles of an advanced practice nurse who specialized in mental health care.

 

DIF:    Cognitive level: Analyzing                 REF:    p. 791

TOP:    Nursing process: Implementation

MSC:   NCLEX: Safe and Effective Care Environment: Management of Care

 

  1. A nurse is counseling a client following an unexpected loss. If given adequate support and adaptation, which of the following best describes what will happen with the client?
a. Recover from the crisis and become mentally ill
b. Avoid the loss and potential mental illness
c. Be able to ignore the grief
d. Resume previous lifestyle in spite of sadness

 

 

ANS:   D

When people do not have adequate resources, there is an increased risk of altered mental health. However, when given adequate support and adaptation, most persons will resume their lifestyles and will not become mentally ill, avoid the loss, or ignore the grief.

 

DIF:    Cognitive level: Applying                  REF:    p. 794

TOP:    Nursing process: Implementation

MSC:   NCLEX: Safe and Effective Care Environment: Management of Care

 

  1. A nurse is providing care to an African American population in the community. Which of the following would be the most appropriate intervention for the nurse to implement?
a. Build on the cultural traditions of the community
b. Develop a support system in a nearby community
c. Integrate mental health services into primary care settings
d. Focus on migrant health issues

 

 

ANS:   C

Nurses can promote the mental health of this population by integrating mental health services into primary care settings, providing services in community centers, collaborating with faith communities, providing education to decrease the stigma, working toward the provision of safer communities, and recruiting members of this population to work as community mental health providers. Focusing on migrant health issues would occur with the Latino population. Building on cultural traditions is important in the Native American population. Developing a support system outside of the community would not be an appropriate intervention for any population.

 

DIF:    Cognitive level: Analyzing                 REF:    p. 798

TOP:    Nursing process: Implementation

MSC:   NCLEX: Health Promotion and Maintenance

 

  1. A nurse is working with older adults and their caregivers. Which of the following would be the most appropriate intervention for the nurse to implement?
a. Work with legislators to advocate for policies that support families
b. Refer clients and families to community support groups to reduce stress
c. Involve clients and families in case management programs to coordinate care
d. Conduct depression screenings with clients and families on a regular basis

 

 

ANS:   B

Family caregivers and older adults are at risk for health disruptions. Involvement in a community support group can help reduce stress of caregiving and provide networking opportunities for the older adult. Working with legislators to advocate for policies that support families, involving clients and families in case management programs to coordinate care, and conducting depression screenings with clients and families on a regular basis would not be the most effective interventions when working with this population.

 

DIF:    Cognitive level: Analyzing                 REF:    p. 797

TOP:    Nursing process: Planning

MSC:   NCLEX: Safe and Effective Care Environment: Management of Care

 

  1. A nurse is involved with a group who advocates for improved and effective psychiatric services and consumer empowerment. Which of the following groups is the nurse most likely working with?
a. NAMI Consumer Council
b. National Mental Health Consumer’s Association (NMHCA)
c. National Association of Psychiatric Survivors (NAPS)
d. Consumer/Survivor Mental Health Research and Policy Work Group

 

 

ANS:   A

The NAMI Consumer Counsel advocates for improved and effective psychiatric services and consumer empowerment. The NMHCA is a consumer organization that advocates for improvements in the mental health system. The NAPS is a consumer organization that advocates for such things as involuntary treatment and some forms of treatment like electroconvulsive therapy. The Consumer/Survivor Mental Health Research and Policy Work Group is an endeavor sponsored by the Mental Health Statistics Improvement Program of the CMHS to initiate consumer representation in activities of the National Association of State Mental Health Program Directors (NASMHPD).

 

DIF:    Cognitive level: Applying                  REF:    p. 789 (Box 36-1)

TOP:    Nursing process: Implementation

MSC:   NCLEX: Safe and Effective Care Environment: Management of Care

 

  1. A nurse is working with persons with serious mental illness. Which of the following recognitions should be made by the nurse?
a. Persons with severe mental illness require institutionalization until they are functional.
b. Inadequate community resources have caused problems with homelessness among this population.
c. Serious mental illness originates from childhood events and therapy is ineffective.
d. Motivation influences a person’s ability to earn a living and purchase necessary medications.

 

 

ANS:   B

Many people with serious mental illness live in poverty because they lack the ability to maintain a suitable standard of living. Brief hospital stays and inadequate community resources have resulted in an increased number of persons with serious mental illness living on the streets or in jail. Persons with severe mental illness need support, not necessarily institutionalization. There are a variety of contributing factors to the development of severe mental illness, and some are unknown. Those with severe mental illness may lack motivation because of their illness.

 

DIF:    Cognitive level: Analyzing                 REF:    p. 796

TOP:    Nursing process: Implementation

MSC:   NCLEX: Safe and Effective Care Environment: Management of Care

 

  1. A nurse is implementing relapse management. Which of the following interventions would most likely be used by the nurse?
a. Use a holistic view of the system
b. Identify triggers
c. Understand the individual’s personality
d. Provide crisis intervention

 

 

ANS:   B

Recognizing triggers that may lead to illness helps the consumer manage the illness and promotes recovery. Examples of triggers are poor social skills, hopelessness, and poor symptom management. Relapse management does not include understanding the individual’s personality, providing crisis intervention, or using a holistic view of the system.

 

DIF:    Cognitive level: Analyzing                 REF:    p. 790

TOP:    Nursing process: Planning

MSC:   NCLEX: Safe and Effective Care Environment: Management of Care

 

MULTIPLE RESPONSE

 

  1. According to the Surgeon General’s report, how can people receive assistance for mental health problems? (Select all that apply.)
a. Specialty mental health systems
b. General medical or primary care sectors
c. Human service sectors
d. Voluntary support networks
e. Community agencies

 

 

ANS:   A, B, C, D

The Surgeon General’s report defined specialty mental health systems, general medical or primary care sectors, human service sectors, and voluntary support networks as ways through which people could receive assistance.

 

DIF:    Cognitive level: Understanding         REF:    pp. 785-786

TOP:    Nursing process: Evaluation

MSC:   NCLEX: Safe and Effective Care Environment: Management of Care

 

  1. A nurse is using Healthy People 2020 as a guide to develop community programming for mental health. Which of the following objectives for mental health would be found in this document? (Select all that apply.)
a. Reduce suicide rates
b. Increase employment of persons with severe mental illness
c. Increase the proportion of children treated for mental health problems
d. Decrease the number of juvenile facilities that screen new admissions for mental health problems
e. Reduce rates of violent acts against women

 

 

ANS:   A, C

Reducing suicide attempts and increasing the proportion of children with mental health problems who receive treatment are two objectives for mental health targeted by Healthy People 2020.

 

DIF:    Cognitive level: Applying                  REF:    p. 794 (Healthy People 2020 box)

TOP:    Nursing process: Implementation

MSC:   NCLEX: Safe and Effective Care Environment: Management of Care

 

  1. A nurse is referring a client with a mental illness to a community group for additional information and support. Where would the nurse most likely refer a client? (Select all that apply.)
a. Alcoholics Anonymous (AA)
b. Obsessive-Compulsive Foundation
c. Schizophrenics Anonymous
d. Anxiety Disorders Association of America
e. Salvation Army

 

 

ANS:   A, B, C, D

AA, Obsessive-Compulsive Foundation, Schizophrenics Anonymous, and Anxiety Disorders Association of America are all sources of information and help for people with mental illness.

 

DIF:    Cognitive level: Applying                  REF:    p. 797 (Box 36-4)

TOP:    Nursing process: Implementation

MSC:   NCLEX: Safe and Effective Care Environment: Management of Care

 

Chapter 46: Public Health Nursing at Local, State, and National Levels

Stanhope: Public Health Nursing: Population-Centered Health Care in the Community, 9th Edition

 

MULTIPLE CHOICE

 

  1. What is the goal of local public health departments?
a. To monitor communicable diseases
b. To improve the health status of communities
c. To offer services for the uninsured
d. To enforce environmental codes and laws

 

 

ANS:   B

The goal of local public health departments is to safeguard the public’s health and improve the health status of communities. The federal and state levels monitor communicable diseases, offer services for the uninsured, and enforce environmental codes and laws.

 

DIF:    Cognitive level: Understanding         REF:    pp. 995-996

TOP:    Nursing process: Evaluation

MSC:   NCLEX: Safe and Effective Care Environment: Management of Care

 

  1. Which agency delegates the authority of the local health department?
a. The federal government
b. The state
c. Local authorities
d. Regional governing boards

 

 

ANS:   B

The authority of the local health department is delegated by the state. The federal government, local authorities, and regional governing boards are not involved with delegating authority of the local health department.

 

DIF:    Cognitive level: Understanding         REF:    p. 995

TOP:    Nursing process: Evaluation

MSC:   NCLEX: Safe and Effective Care Environment: Management of Care

 

  1. A nurse is working in a public health department. Which of the following would most likely be the focus of the care that is provided?
a. Home visiting and hospice care
b. Care of communicable diseases
c. Health maintenance and health promotion
d. Illness prevention

 

 

ANS:   C

Public health nurses (PHNs) employed in local, state, and federal agencies work together to identify, develop, and implement interventions that will improve and maintain the nation’s health.

 

DIF:    Cognitive level: Applying                  REF:    pp. 994-995

TOP:    Nursing process: Implementation

MSC:   NCLEX: Safe and Effective Care Environment: Management of Care

 

  1. Which event has the potential to weaken existing public health programs?
a. The shift in funding to support bioterrorism response efforts
b. The outbreaks of H1N1 influenza
c. The number of citizens with human immunodeficiency virus (HIV)
d. The lack of PHNs

 

 

ANS:   A

The events of the twenty-first century have shifted funding to bioterrorism programs. This shift of funding has the potential to weaken existing important public health programs.

 

DIF:    Cognitive level: Understanding         REF:    p. 997

TOP:    Nursing process: Evaluation

MSC:   NCLEX: Safe and Effective Care Environment: Management of Care

 

  1. A PHN discusses with a client which services are appropriate to meet her needs. Which of the following best describes the role that the nurse is using?
a. Case manager
b. Advocate
c. Counselor
d. Role model

 

 

ANS:   B

As an advocate, the PHN collects, monitors, and analyzes data and works with the client to identify and prioritize needed services, whether the client is an individual, a family, a community, or a population. A PHN discusses with a client which services are appropriate to meet her needs. In this case, the nurse’s public health function is that of an advocate. Case managers assist clients in identifying services they need the most at the least cost. As a counselor, the nurse is a person for the client to talk with to discuss feelings and concerns. A nurse serves as a role model for the client by being a person for the client to look up to.

 

DIF:    Cognitive level: Applying                  REF:    p. 1003

TOP:    Nursing process: Evaluation

MSC:   NCLEX: Safe and Effective Care Environment: Management of Care

 

  1. A PHN assists a client in identifying the services needed the most at the least cost. Which of the following best describes the role that the nurse is using?
a. Role model
b. Advocate
c. Counselor
d. Case manager

 

 

ANS:   D

The public health function of a nurse who assists a client in identifying the services needed the most at the least cost is a case manager. As an advocate, the PHN collects, monitors, and analyzes data and works with the client to identify and prioritize needed services, whether the client is an individual, a family, a community, or a population. A PHN discusses with a client which services are appropriate to meet her needs. As a counselor, the nurse is a person for the client to talk with to discuss feelings and concerns. A nurse serves as a role model for the client by being a person for the client to look up to.

 

DIF:    Cognitive level: Applying                  REF:    p. 1001

TOP:    Nursing process: Implementation

MSC:   NCLEX: Safe and Effective Care Environment: Management of Care

 

  1. The PHN aims to change behaviors such as poor hand washing skills and unsafe sex practices. Which of the following best describes the role that the nurse is using?
a. Case manager
b. Advocate
c. Educator
d. Role model

 

 

ANS:   C

The PHN works as an educator, teaching to the level of the client so that information received is information that can be used. The PHN who aims to change behaviors, such as poor hand washing skills and unsafe sex practices, is acting in the role of educator. The public health function of a nurse who assists a client in identifying the services needed the most at the least cost is a case manager. As an advocate, the PHN collects, monitors, and analyzes data and works with the client to identify and prioritize needed services, whether the client is an individual, a family, a community, or a population. A PHN discusses with a client which services are appropriate to meet her needs. A nurse serves as a role model for the client by being a person for the client to look up to.

 

DIF:    Cognitive level: Applying                  REF:    pp. 1004-1005

TOP:    Nursing process: Implementation

MSC:   NCLEX: Safe and Effective Care Environment: Management of Care

 

  1. A nurse is providing services for uninsured women. Which of the following best describes the role that the nurse is using?
a. Role model
b. Primary caregiver
c. Outreach worker
d. Case manager

 

 

ANS:   B

A nurse providing services for uninsured women is acting in the role of primary caregiver. The public health function of a nurse who assists a client in identifying the services needed the most at the least cost is a case manager. A nurse serves as a role model for the client by being a person for the client to look up to. As an outreach worker, the nurse is able to gain acceptance with the population served.

 

DIF:    Cognitive level: Applying                  REF:    p. 1005

TOP:    Nursing process: Implementation

MSC:   NCLEX: Safe and Effective Care Environment: Management of Care

 

  1. A nurse is providing information about safe-sex practices. Which of the following levels of prevention is being implemented?
a. Primary prevention
b. Secondary prevention
c. Tertiary prevention
d. Assessment

 

 

ANS:   A

Primary prevention refers to those interventions aimed at preventing the occurrence of disease, injury, or disability—providing information about safe sex practices. Secondary prevention focuses on early detection and screening. Tertiary prevention focuses on treatment and rehabilitation. Assessment is not a level of prevention.

 

DIF:    Cognitive level: Applying

REF:    pp. 1006-1007 (Levels of Prevention box)

TOP:    Nursing process: Implementation

MSC:   NCLEX: Health Promotion and Maintenance

 

  1. A nurse is implementing secondary prevention strategies in the community. Which of the following best describes what the nurse is doing?
a. Screening children for lead poisoning
b. Working with communities on emergency preparedness plans
c. Developing social networking interventions to modify community norms
d. Educating patients with strokes at rehab centers to help optimize their functioning

 

 

ANS:   A

Screenings are secondary prevention activities. Secondary prevention focuses on early detection and screening. Tertiary prevention focuses on treatment and rehabilitation—educating patients with strokes. Primary prevention refers to those interventions aimed at preventing the occurrence of disease, injury, or disability—working with communities on emergency preparedness plans and developing social networking interventions.

 

DIF:    Cognitive level: Analyzing

REF:    pp. 1006-1007 (Levels of Prevention box)

TOP:    Nursing process: Implementation

MSC:   NCLEX: Health Promotion and Maintenance

 

  1. A nurse is implementing tertiary prevention strategies in the community. Which of the following best describes what the nurse is doing?
a. Providing immunizations
b. Conducting lead screening activities for children
c. Providing case management services for clients with chronic illness
d. Identifying and treating clients in a tuberculosis (TB) clinic

 

 

ANS:   C

Providing case management services for clients with chronic illness demonstrates tertiary prevention, as it is focused on treatment and rehabilitation. Providing immunizations is a primary prevention, and conducting lead screening activities and identifying and treating clients in a TB clinic are at the secondary level of prevention.

 

DIF:    Cognitive level: Analyzing

REF:    pp. 1006-1007 (Levels of Prevention box)

TOP:    Nursing process: Implementation

MSC:   NCLEX: Health Promotion and Maintenance

 

  1. A PHN is working with uninsured individuals. Which of the following is the most appropriate action for the nurse to take?
a. Providing direct care for this population in times of acute illness
b. Advocating for federal policy changes for this population
c. Assisting this population to access necessary health care services
d. Encouraging lifestyle changes for this population

 

 

ANS:   C

PHNs serve vulnerable populations by acting as a bridge between these populations and the resource needs for this at-risk group by approaching health care providers on behalf of individuals seeking medical/health services and keeping the needs of this population on the political agenda.

 

DIF:    Cognitive level: Analyzing                 REF:    pp. 999-1000

TOP:    Nursing process: Implementation

MSC:   NCLEX: Safe and Effective Care Environment: Management of Care

 

  1. After reviewing the objectives of Healthy People 2020, the PHN determines the focus for the programming for communicable diseases in the community. Which of the following would the nurse most likely select as the focus?
a. Encouraging community members to engage in healthy behaviors
b. Identifying high-risk sexual behaviors among community members
c. Monitoring the sexual activity of adolescents
d. Providing information about the hazards of multiple sexual partners

 

 

ANS:   D

Healthy People 2020 lists communicable disease as an area of focus, including levels of HIV, acquired immunodeficiency syndrome (AIDS), and sexually transmitted infections. One method to reduce the risk of acquiring a communicable disease is by the PHN providing information on the hazards of multiple sexual partners and street drug use. Encouraging community members to engage in healthy behaviors does not specifically address communicable diseases. Identifying behaviors and monitoring sexual activity are not appropriate focuses for programming.

 

DIF:    Cognitive level: Analyzing                 REF:    p. 1003

TOP:    Nursing process: Planning

MSC:   NCLEX: Health Promotion and Maintenance

 

  1. Which is a principle of good practice for community partnerships?
a. Partnerships are easily formed among those working in public health.
b. Partnerships use their own roles to accomplish tasks.
c. Partnerships are built on identified strengths and assets.
d. Partnerships are loose associations among people.

 

 

ANS:   C

Partnerships are built upon identified strengths and assets, including areas that need improvement. This is one of the principles of good practice. An effective partnership is formed by balanced power and understanding among the partners. Partnerships use mutual trust and respect genuineness and commitment as part of their relationship.

 

DIF:    Cognitive level: Understanding         REF:    p. 994 (Box 46-1)

TOP:    Nursing process: Evaluation

MSC:   NCLEX: Safe and Effective Care Environment: Management of Care

 

  1. A nurse considering working as a PHN refers to the American Public Health Association (APHA) Public Health Nursing Section to determine what level of educational preparation has been recommended. Which of the following best describes the educational preparation?
a. Associate degree
b. Baccalaureate degree
c. Master’s degree
d. Certification

 

 

ANS:   B

All PHNs should have a background in the social and behavioral sciences, epidemiology, environmental health, current treatment modalities, and health care delivery options in order to fully understand health policy, research, and treatment choices and to translate this knowledge into the promotion of healthy populations.

 

DIF:    Cognitive level: Applying                  REF:    pp. 1002-1003

TOP:    Nursing process: Planning

MSC:   NCLEX: Safe and Effective Care Environment: Management of Care

 

  1. A PHN is involved in disaster planning. Which of the following best describes why this is important?
a. To be most effective as a disaster responder
b. To anticipate the potential disasters that may occur
c. To educate the public about their responsibilities if a disaster occurs
d. To demonstrate the importance of community partnerships

 

 

ANS:   A

To be most effective as a disaster responder, the PHN needs to be part of the team before an emergency occurs. PHNs can be involved in educating the public, working with community partnerships, and anticipating potential disasters; however, the nurse must be part of the team before the emergency in order to accomplish these things.

 

DIF:    Cognitive level: Applying                  REF:    p. 1006

TOP:    Nursing process: Implementation

MSC:   NCLEX: Safe and Effective Care Environment: Management of Care

 

MULTIPLE RESPONSE

 

  1. Which is an example of a federal agency? (Select all that apply.)
a. The U.S. Department of Health and Human Services (USDHHS)
b. The Centers for Disease Control and Prevention (CDC)
c. The Health Resources and Services Administration (HRSA)
d. The Pentagon
e. The Congress

 

 

ANS:   A, B, C

The USDHHS, the CDC, and the HRSA are all federal agencies. The Pentagon and the Congress are not federal agencies.

 

DIF:    Cognitive level: Applying                  REF:    p. 995

TOP:    Nursing process: Evaluation

MSC:   NCLEX: Safe and Effective Care Environment: Management of Care

 

  1. Which principles are included in the Scope and Standards of Public Health Nursing Practice? (Select all that apply.)
a. The client or “unit of care” is the population.
b. Primary prevention is given priority.
c. All processes must include partnering with representatives of the people.
d. Government agencies mandate requirements for public health.
e. The focus of many interventions should be on secondary prevention.

 

 

ANS:   B, C

The eight tenets of public health nursing distinguish public health nursing from other nursing specialties. Primary prevention is given priority and all processes must include partnering with representatives of the people as part of these established principles.

 

DIF:    Cognitive level: Understanding         REF:    p. 998 (Box 46-3)

TOP:    Nursing process: Evaluation

MSC:   NCLEX: Safe and Effective Care Environment: Management of Care

 

  1. A PHN collaborates with agencies to address the problem of obesity in the community. Who would be the most appropriate people to include in this collaborative partnership? (Select all that apply.)
a. Local health department staff members
b. Restaurant owners
c. Parks and recreation department staff members
d. Church representatives
e. Appliance store managers

 

 

ANS:   A, B, C, D

PHNs practice in partnership with each other at the local, state, and federal levels and with other public health staff, other governmental agencies, and the community to safeguard the public’s health and to improve the community’s health status. All of these people would provide valuable insight into the problem of obesity in the community.

 

DIF:    Cognitive level: Applying                  REF:    p. 994

TOP:    Nursing process: Planning

MSC:   NCLEX: Safe and Effective Care Environment: Management of Care

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