Community Final Full Test Bank

Chapter 01: Community-Oriented Nursing and Community-Based Nursing
Test Bank
MULTIPLE CHOICE
1. Which of the following best describes community-based nursing?
a. A philosophy that guides family-centered illness care
b. Providing care with a focus on the groups needs
c. Giving care with a focus on the aggregate’s needs
d. A value system in which all clients receive optimal care
ANS: A
By definition, community-based nursing is nursing that focuses on family-centered
illness care to individuals and families in the community.
DIF: Cognitive Level: Understand (Comprehension) REF: p. 2-3
2. Which of the following best describes community-oriented nursing?
a. Focusing on the provision of care to individuals and families
b. Providing care to manage acute or chronic conditions
c. Giving direct care to ill individuals within their family setting
d. Having the goal of health promotion and disease prevention
ANS: D
By definition, community-oriented nursing has the goal of preserving, protecting, or
maintaining health to promote the quality of life. All nurses may focus on individuals
and families, give direct care to ill persons within their family setting, and help
manage acute or chronic conditions.
DIF: Cognitive Level: Understand (Comprehension) REF: pp. 2, 10
3. Which of the following is the primary focus of public health nursing?
a. Families and groups
b. Illness-oriented care
c. Individuals within the family unit
d. Promotion of quality of life
ANS: D
The key difference between community-based and community-oriented nursing is that
community-based nurses deal primarily with illness-oriented care, whereas
community-oriented nurses or public health nurses provide health care to promote
quality of life.
DIF: Cognitive Level: Understand (Comprehension) REF: p. 2
4. Which of the following is responsible for the dramatic increase in life expectancy
during the twentieth century?
a. Technology increases in the field of medical laboratory research
b. Advances in surgical techniques and procedures
c. Sanitation and other public health activities
d. Use of antibiotics to fight infections
ANS: C
Improvement in control of infectious diseases through immunizations, sanitation, and
other public health activities led to the increase in life expectancy from less than 50
years in 1900 to more than 77 years in 2002.
DIF: Cognitive Level: Remember (Knowledge) REF: p. 2
5. A nurse is developing a plan to decrease the number of premature deaths in the
community. Which of the following interventions would most likely be implemented
by the nurse?
a. Increase the community’s knowledge about hospice care.
b. Promote healthy lifestyle behavior choices among the community members.
c. Encourage employers to have wellness centers at each industrial site.
d. Ensure timely and effective medical intervention and treatment for community members
ANS: B
Public health approaches could help prevent about 70% of early deaths by influencing
the way people eat, drink, drive, engage in exercise, and treat the environment.
DIF: Cognitive Level: Apply (Application) REF: p. 2
6. Which of the following is a basic assumption of public health efforts?
a. Health disparities among any groups are morally and legally wrong.
b. Health care is the most important priority in government planning and funding.
c. The health of individuals cannot be separated from the health of the community.
d. The government is responsible for lengthening the life span of Americans.
ANS: C
Public health can be described as what society collectively does to ensure that
conditions exist in which people can be healthy.
7. Which of the following actions would most likely be performed by a public health
nurse?
a. Asking community leaders what interventions should be chosen
b. Assessing the community and deciding on appropriate interventions
c. Using data from the main health care institutions in the community to determine needed
d. Working with community groups to create policies to improve the environment
ANS: D
Although the public health nurse might engage in any of the tasks listed, he or she
works primarily with members of the community to carry out core public health
functions, including assessment of the population as a whole and engaging in
promoting health and improving the environment.
8. Which of the following public health nurses most clearly fulfills the responsibilities
of this role?
a. The nurse who met with several groups to discuss community recreation issues
b. The nurse who spent the day attending meetings of various health agencies
c. The nurse who talked to several people about their particular health concerns
d. The nurse who watched the city council meeting on local cable television
ANS: B
Any of these descriptions might represent a nurse communicating, cooperating, or
collaborating with community residents or groups about health concerns. However,
the nurse who spent the day attending meetings of various health agencies is the most
representative, because in public health, concerns are broader than recreation,
individual concerns are not as important as aggregate priorities, and watching
television (a one-way form of communication) is less effective than interacting with
others.
DIF: Cognitive Level: Analyze (Analysis) REF: pp. 6-7
9. Which of the following best defines aggregate?
a. A large group of persons
b. A collection of individuals and families
c. A group of persons who share one or more characteristics
d. Another name for demographic group
ANS: C
An aggregate is defined as a collection of people who share one or more personal or
environmental characteristics, such as geography or special interest.
10. A registered nurse was just employed as a public health nurse. Which question
would be the most relevant for the nurse to ask?
a. Which groups are at the greatest risk for problems?
b. Which patients should I see first as I begin my day?
c. With which physicians will I be most closely collaborating?
d. With which nursing assistants will I partner the most?
ANS: A
Asking which groups are at greatest risk reflects a community-oriented perspective.
The other possible responses reflect a focus on individuals.
11. Making sure that essential community-oriented health services are available
defines which of the core public health functions?
a. Policy development
b. Assessment
c. Assurance
d. Scientific knowledge-based care
ANS: C
Public health is based on scientific knowledge but is not a core function. The
definition does not fit the terms assessment or policy development.
12. When talking to a womens group at the senior citizens center, the nurse reminded
them that the only way the center would be able to afford to provide transportation
services for them would be for them to continue to write letters to their local city
council representatives requesting funding for such a service. What was the nurse
trying to accomplish through this action?
a. Ensure that the women did not expect the nurse to solve their problem
b. Demonstrate that the nurse understood the womens concerns and needs
c. Express empathy, support, and concern
d. Help the women engage in political action
ANS: D
Public health nurses engage themselves and others in policy development and
encourage and assist persons to communicate their needs to those with the power to
take action.
13. The public health nurse has a clear vision of what needs to be done and where to
begin to improve the health of the community. Why would the nurse spend time
meeting with community groups to discuss the most important task to be addressed
first?
a. To increase the groups self-esteem
b. To maintain communication links with the groups
c. To make the groups feel good about their contribution
d. To work with the groups, not for the groups
ANS: D
Historically, health care providers have been accused of providing
care for or to people without actually involving the recipients in the decisions. Public
health nursing is a with the peoplenot a to the people or for the peopleapproach to
planning.
14. The nurse often has to make resource allocation decisions. Which of the following
best describes the criterion the nurse should use in such cases?
a. The specific moral or ethical principle related to the situation
b. The cheapest, most economical approach
c. The most rational probable outcome
d. The needs of the aggregate rather than a few individuals
ANS: D
Although all of the choices represent components of a decision that the nurse might
consider, the dominant needs of the population outweigh the expressed needs of one
or a few people.
15. Which of the following actions best represents public health nursing?
a. Assessing the effectiveness of the large high school health clinic
b. Caring for clients in their home following their outpatient surgeries
c. Providing care to children and their families at the school clinic
d. Administering follow-up care for pediatric clients at an outpatient clinic
ANS: A
A public health or population-focused approach would look at the entire group of
children being served to determine whether available services are effective in
achieving the goal of improving the health of the school population.
16. Two nurses plan to walk under a huge downtown bridge where various homeless
persons live. Why would the nurses go to such an unsafe area?
a. To assess the needs of the homeless who live there
b. To demonstrate their courage and commitment
c. To distribute some of their own surplus clothes to those who can use them
d. To share with various churches and other charities what is needed
ANS: A
In most nursing practices, the client seeks out and requests assistance. In public health
nursing, the nurse often reaches out to those who might benefit from a service or
intervention, beginning with assessment of needs.
MULTIPLE RESPONSE
1. Which of the following variables have led to a stronger commitment to population-
focused services? (Select all that apply.)
a. Economic turmoil and demand for high-technology care
b. Emergence of new or drug-resistant infectious diseases
c. Emphasis on overall health care needs rather than only on acute care treatment
d. Threat of bioterrorism
ANS: B, C, D
As overall health needs become the focus of care in the United States, a stronger
commitment to population-focused services is emerging. Threats of bioterrorism,
anthrax scares, and the emergence of modern-day epidemics have drawn attention to
population-focused safety and services.
2. Which of the following actions demonstrate(s) effective public health nursing
practice in the community? (Select all that apply.)
a. Epidemiologic investigations examine the environment for health hazards.
b. New services are organized where particular vulnerable populations live.
c. Partnerships are established with community coalitions.
d. Staff members at the public health agency continue to increase in number.
ANS: A, B, C
Evidence that public health nurses are practicing effectively in the community would
include these: organizing services where people live, work, play, and learn; working
in partnerships and with coalitions; and participating in epidemiologic studies.
3. Why are nurses increasingly providing care in clients homes rather than in
hospitals? (Select all that apply.)
a. Home care is less expensive.
b. It is much more efficient to give care in the home.
c. Nurses prefer to give home care with individual attention.
d. People prefer to receive care in their homes rather than in hospitals.
ANS: A, D
An increasing number of clients are receiving care in the home because it is less
expensive, and clients prefer to receive care in familiar and comfortable settings. It is
not more efficient nor more convenient, since travel time has to be considered. Nurses
differ as to their preferred employment setting.
Chapter 04: Ethics in Community Health Nursing Practice

Test Bank
MULTIPLE CHOICE
1. When and by whom was nursings first code of ethics written?
a. 1893, by Lystra Gretter
b. 1950, by the ANA House of Delegates
c. 1953, by the International Council of Nurses (ICN)
d. 2001, by the ANA House of Delegates
ANS: A
The Nightingale Pledge, considered nursings first code of ethics, was written by
Lystra Gretter in 1893.
2. A nurse didnt know what to do when faced with a particular ethical dilemma
because an option that would have a good outcome didnt seem possible. The nurse
decided to talk to the agency supervisor and decide what action to take. Which of the
following best describes the nurses actions?
a. Appropriate, because the supervisor is responsible for the nurses choices
Intelligent, because the supervisor has access to resource persons (clergy, physicians,
b. administrators) who might know of options the nurse hadnt considered
Justified, because this provides an opportunity to discuss the issue but the nurse maintains
c. responsibility for the decision
Wise, because the supervisor would be more knowledgeable concerning agency priorities
d. traditional practices
ANS: C
Ethically, each nurse is responsible for his or her own decisions and cannot avoid
ethical accountability by relying on obedience to a supervisor or any external rule or
policy.
3. Which of the following is the first and most crucial step in the ethical decision-
making process?
a. Assess the context or environment in which the decision must be made.
b. Consider the various ethical principles or theories.
c. Identify the ethical concerns.
d. Make a decision and act on it.
ANS: C
The first step in the ethical decision-making framework is to carefully identify the
ethical issue or dilemma.
4. A nurse is asked to meet with a family who recently emigrated from Botswana
(Africa). After the clinical doctor tells the husband the wifes diagnosis of breast
cancer, the family thanks the physician and starts to leave. Ethically, which of the
following is the nurses most important action?
a. Emphasizing that the family must set up a surgical appointment for the wife immediately
b. Assessing the familys current living situation, including insurance and other assets
c. Educating the family concerning the usual treatment and the prognosis of breast cancer
d. Interviewing the family concerning their perspective of the threat to the familys well-bein
ANS: D
Any of the actions might be taken. However, the United States is a multicultural
nation with diverse ethnic groups and diverse values. Before any intervention can be
made, the health care professionals must understand the familys cultural,
psychological, social, communal, and environmental contexts, because these contexts
affect the way issues are formulated and decisions are made. Consequently, it is
crucial to interview the family to determine their understanding of the situation before
deciding what, if any, intervention must be made. In many cultures the family, rather
than the individual, is the unit of primary concern.
DIF: Cognitive Level: Analyze (Analysis) REF: p. 54
5. The nurse learns that a family has decided not to accept medical intervention for a
health care problem because paying for the care would drastically reduce the familys
resources and ability to meet the needs of other family members. Ethically, which of
the following actions should be taken by the nurse?
Appreciate that the family has made the decision that it feels is best and take no further ac
a. if it is clear the family has made an informed choice.
Stress that each individual in society has a right to health care and the family will have to
b. create some way to raise funds for the needed treatment.
c. Talk to the media to see whether a campaign to raise funds for the family can be created.
Try to convince the agency to give the care for free, even if it means economic stress for t
d. agency, because the medical need is obvious.
ANS: A
As Callahan described, although the nurse may attempt moral persuasion to change
the familys values, in the absence of immediate and grievous harm, no ethical
requirement exists to interfere with the familys values.
6. Some nurses are debating about the appropriate action to take in relation to a
particular family. The father is ill, and the other family members have chosen to
continue working rather than take time off to care for the ill family member. One
nurse states, It is a wifes responsibility to care for an ill husband. Which of the
following ethical approaches is being used by this nurse?
a. Consequentialism
b. Communitarianism
c. Deontological ethics
d. Principlism
ANS: C
The nurse is focusing on duty, which is a deontological approach based on the moral
obligation to engage in certain actions.
particular family. One member of the family is ill, and the other family members have
chosen to continue working rather than take time off to care for the ill family member.
One nurse states, The whole family is being affected and will fall apart if they dont
focus on their familys needs first before anything else. Which of the following ethical
approaches is being used by this nurse?
a. Communitarianism
b. Deontological ethics
c. Principlism
d. Utilitarianism
ANS: D
By focusing on the whole family, not individual members, and the consequences or
outcomes for the whole family during this time of stress, the nurse is taking a
utilitarian approach.
One nurse states, But it doesnt have to be an either/or situation. Perhaps each family
member could take a turn calling in sick just 2 or 3 days. That way they could all take
a turn at helping and yet not upset their employers. Wouldnt that be fair? Which of the
following ethical approaches is being used by this nurse?
a. Communitarianism
c. Principlism
d. Utilitarianism
ANS: C
The nurse is focusing on ethical principlesin this case, beneficence (do good for the ill
family member), nonmaleficence (do no harm, even to the employer), and justice
(everyone takes a turn and shares equally).
One nurse states, Its not up to us; its the familys decision. They know what is best for
them. Which of the following ethical approaches is being used by this nurse?
a. Communitarianism
c. Principlism
d. Utilitarianism
ANS: C
The nurse is using an ethical principle, namely autonomy, in which each person or
group can choose those actions that fulfill its values and goals. Therefore, the nurse is
using principlismthat is, basic principles are the basis of the nurses actions.
10. Which of the following is the dominant issue in ethical debate around an issue
such as continuing or withdrawing treatment in acute health care?
a. Doing what is best for the community
b. Doing what is best for the family
c. Obeying legal mandates
d. Upholding ethical principles
ANS: D
In acute care settings with a single localized issue, the primary ethical principles are
usually applied, with patient autonomy being the dominant or most crucial principle.
DIF: Cognitive Level: Understand (Comprehension) REF: pp. 56-57
11. The staff cannot reach an agreement on what is the right thing to do in relation to a
specific patient. Which of the following approaches should the nurse use in personally
deciding what is right?
a. Do whatever will not get the nurse in trouble with employer
b. Do whatever is supported by an ethical expert, such as the hospital chaplain
c. Do whatever the nurse would recommend to anyone in a similar situation
d. Do whatever the nurse supervisor would feel comfortable reporting to administration
ANS: C
One of the rules in deontological decision making is to determine whether the
proposed actions can be generalized so that all persons in similar situations are treated
similarly. In the same way, principlism suggests the nurse examine the context and
make the decision that can be morally justified within that context.
12. A man entered the emergency department bleeding profusely and screaming, Ive
got to see a doctor right now! Ive got a right to see a doctor! Im hurt. You have to take
care of me! Which of the following premises would ethically justify such a demand
for immediate attention?
All hospitals receive federal money and all capable employed adults pay taxes, so all adul
a. have a right to what their tax money has purchased.
b. Saving an individuals life improves society and upholds tradition.
Our society believes that all persons should be treated equally and that basic needs, such a
c. dying if death can be avoided, should be met.
The man has a property right to his own body, and the government is responsible to ensur
d. property rights are protected.
ANS: C
The ethical theory of egalitarianism suggests that everyone is entitled to equal rights,
equal treatment, and an equal share of the goods of societyand that the governments
role is to ensure this happens, at least on a basic level. Therefore, the man has a right
to emergency care.
13. From an ethical standpoint, what is the problem with the belief that everyone
should receive his or her fair share, that life should always be fair, and that everyone
should make his or her own decisions?
a. With this belief, the needs of society as a whole are ignored.
b. Insufficient resources exist to give everyone a fair share.
c. This belief leads to a propensity for some people to like to be taken care of.
d. Some people think they deserve more than their fair share.
ANS: A
All principles of justice focus on the individual, which ignores the needs of society as
a whole. Indeed, the rights of an individual may conflict with the rights of the
community as a whole.
14. A physician refuses to order pain medication for a drug addict who has been
severely injured in a car accident. When reminded by nurses that pain medication has
not been ordered, the physician merely replies that the patients suffering from the pain
of his injuries will build character and that the addicted patient needs to get off drugs.
Which of the following ethical theories is the physician using (or misusing)?
a. Consequentialism
b. Communitarianism
c. Deontological ethics
d. Virtue ethics
ANS: D
Virtue ethics emphasizes practical reasoning applied to character development.
Although such action by a care provider is paternalistic and unethical on many
grounds, the physician may truly be concerned with enabling the injured addict to
learn from his experience and possibly develop into a drug-free person.
15. Which of the following is considered the most important goal in nursing today?
a. Adapting to technological advances such as electronic medical records
b. Demonstrating caring as the basis of nursing practice
c. Distinguishing nursing care from medical care
d. Seeking evidence-based outcomes to demonstrate nursings contribution to care
ANS: B
Since the mid-1980s, nurses have written about caring as the essence of nursing and
as the ethical and moral ideal of nursing practice.
16. With which of the following ethical approaches are Gilligan and Noddings
associated?
a. Distributive justice approach
b. Feminine ethic
c. Principled approach
d. Virtue ethics
ANS: B
Gilligan and Noddings are associated with the approach known as the feminine ethic,
which focuses on the morality of responsibility in relationships that emphasize
connection and caring as a moral imperative.
DIF: Cognitive Level: Remember (Knowledge) REF: pp. 58-59
17. How are ethics and public policies similar?
a. Both are abstract principles that often differ in actual practice.
b. Both are best achieved by persons in high political office who can effect change.
c. Both strive for the public good.
d. Both use general principles in making decisions.
ANS: C
An important goal of both policy and ethics is to achieve the public good, and both are
involved in good citizenship.
18. A new nurse states to a nursing colleague, But why do I have to be involved in
politics? I just want to be the very best clinical nurse I can. Which of the following
would be the best response from the nursing colleague?
As long as you pay your membership fee to the American Nurses Association, you have
a. participated in the professions political endeavors.
b. Political action is the way you try to fulfill your ethical responsibilities to clients.
c. Youre absolutely right; if you are good clinically, you have fulfilled your obligation.
When youve completed your clinical orientation, then youll have time to be involved in
d. politics.
ANS: B
To be a good clinical nurse, the nurse needs resources and supportive policies that can
be obtained only through political action to ensure those very resources and policies.
Many clients are members of vulnerable groups who have often previously lacked
access to quality care at an affordable cost. The American Nurses Association Code of
Ethics for Nurses emphasizes political action as the mechanism to effect social justice
and reform regarding homelessness, violence, and stigmatization.
19. Which of the following would confirm that the nurses advocacy has been truly
successful or effective?
a. Audiences agree with the nurse who is serving as advocate.
b. Legislators discuss appropriate legislation to better allocate resources.
c. People verbalize that the disenfranchised should be better treated.
d. Systematic social changes are made to improve quality of life.
ANS: D
Advocacy is the application of information and resources to effect systematic changes
that shape the way people in a community live to reduce death and disability and
improve quality of life in the community. Although all of these options could be seen
as beneficial, only when systematic social changes are made to improve quality of life
can advocacy be considered truly effective.
20. How can nurses know whether they have been effective in assessing the
community and planning and implementing appropriate interventions?
a. Ask community leaders for their opinion of the interventions.
b. Examine the morbidity and mortality rate of the community.
c. Reassess the community to determine whether obvious needs have been met.
d. Systematically survey community residents regarding their perception.
ANS: B
Although all these options might be useful, the end products of appropriate advocacy
are decreased morbidity and mortality. In other words, if advocacy has been effective,
public health problems will be decreased.
21. What is the relationship between ethics and a community health nursing practice?
a. Ethics and actual nursing practice are not related.
b. Knowing ethics allows nurse to recognize the source of most problems.
c. Ethics is constantly involved in nurses clinical decisions.
d. Although ethics is important, political and legal responsibilities are more important in pra
ANS: C
Ethical problems in public health nursing include inequities in power, unacceptable
practices, inequitable resource allocation, conflict between ethics and law, and
inadequate systems support for nursing. Therefore, ethics permeates every aspect of
public health nursing as nurses attempt to meet the needs of the community.
MULTIPLE RESPONSE
1. Three nurses disagree over the appropriate treatment for a woman who is an
excellent candidate for hospice care. The first nurse believes that deciding on care
rather than cure is the womans decision and no one else can decide for her. The
second nurse says that it is the responsibility of the health care team to do good for the
woman, and if the physician thinks there is still a possibility of cure, then the nurses
should do everything they can to implement the treatment plan. The third nurse states
that it isnt fair for the family members to expend all their resources on the woman,
who is probably going to die anyway. Which of the following conclusions can be
drawn from this dispute? (Select all that apply.)
a. Ethical principles can conflict with one another.
b. The nurses are each using different ethical approaches.
c. The first nurse is correct because autonomy demands that the woman decide for herself.
d. There is no single accepted approach for resolving such disagreements.
ANS: A, D
One of the criticisms of using ethical principles is that they can conflict with one
another in any given situation. No rule exists for helping resolve such conflicts.
Chapter 05: Cultural Influences in Nursing in Community Health

Test Bank
MULTIPLE CHOICE
1. Which of the following best describes most Americans attitude toward immigrants?
a. Ambivalence because there are no clear solutions about how to address their needs
b. Strongly negative because immigrants take jobs that native-born Americans could have in
Strongly positive because immigrants bring useful job skills and often join previous famil
c. members already in the United States
Strong opposition to further immigration because of the increasing population in the Unite
d. States
ANS: A
Most Americans are ambivalent about immigration, recognizing both the positive and
negative aspects involved and realizing that it is a complex issue that has no clear
solutions.
2. A nurse is about to despair. Earlier in the week, she carefully taught a patient from a
different culture exactly how much medication to take and emphasized the importance
of taking the correct amount. However, the patient is back in the hospital today with
symptoms of an overdose, although the patient denies taking more than the label
indicated. Which of the following is the most likely explanation?
a. The patient was taking more mediation in the hope of getting well faster.
The patient was also taking folk medicines that had many of the same effects and perhaps
b. of the same ingredients as the prescribed medication.
c. The patient truly did not understand and thought the dose being taken was correct.
d. The patient had a unique response to the medication and should have a smaller dose order
ANS: B
For fear of disapproval, a person may not tell the nurse that he or she is using folk
medicine as well as Western medication. The two medicines may have cumulative
effects that could be dangerous to the client. Nurses who lack cultural knowledge may
develop feelings of inadequacy and helplessness because they are often unable to
effectively help their clients.
3. A nurse wishes to develop cultural competence. Which of the following actions
should the nurse take first?
a. Complete a survey of all the various ethnicities represented in the nurses community.
b. Consider how the nurses own personal beliefs and decisions are reflective of his or her cu
c. Invite a family from another culture to join the nurse for an event.
d. Study the beliefs and traditions of persons living in other cultures.
ANS: B
Cultural awareness requires self-examination and an in-depth exploration of ones own
beliefs and values as they influence behavior.
4. A nurse is caring for a client of another culture. Which of the following actions
would be most appropriate for the nurse to take?
a. Alter personal nonverbal behaviors to reflect the cultural norms of the client.
b. Keep all behaviors culturally neutral to avoid misinterpretation.
c. Rely on friendly gestures to communicate caring for the client.
d. Avoid any pretense of prejudice by treating the client in the same way as any other client.
ANS: A
Cultural competence in nursing includes adoption of culturally congruent behaviors.
Culturally skillful nurses use appropriate touch during conversation, modify the
physical distance between themselves and others, and use strategies to avoid cultural
misunderstandings while meeting mutually agreed-upon goals. Nurses who strive to
be culturally competent respect people from other cultures and value diversity, which
helps them to provide more responsive care.
5. A male nurse had a habit of sitting with the lower part of one leg resting over the
knee of his opposite leg when collecting a clients history. He stopped doing this
around Muslim clients after being told that Muslims were offended when he exposed
the sole of his foot (shoe) to their face. Which of the following was exhibited by the
nurse when he changed his behavior?
a. Cultural accommodation
b. Cultural imposition
c. Cultural repatterning
d. Cultural skill
ANS: D
Cultural skill is the effective integration of cultural knowledge and awareness to meet
client needsin this case, the clients need to not be offended by having the bottom of
the nurses foot or shoe in view of the clients face. The nurse using cultural skill makes
sure nonverbal communication techniques take into consideration the clients use of
body language and space. Cultural accommodation involves negotiation with clients
to include aspects of their folk practices with the traditional health care system to
implement essential treatment plans. Cultural imposition is the process of imposing
ones values on others. Cultural repatterning is working with clients to make changes
in their health practices if cultural behaviors are harmful or decrease their well-being.
6. The nurse practitioner (NP) discovered that an immigrant client is not taking the
penicillin prescribed because his illness is hot and he believes that penicillin, a hot
medicine, will not provide balance. Which of the following terms best describes the
action taken by the NP when the clients prescription is changed to a different yet
equally effective antibiotic?
a. Cultural awareness
b. Cultural brokering
c. Cultural knowledge
d. Cultural skill
ANS: D
Cultural skill involves the provision of care that is beneficial, safe, and satisfying to
the client. The medication change allows the client to retain his cultural beliefs and
also satisfies the nurse practitioners need to prescribe an effective antibiotic.
7. Mexican immigrants who take metamizole (Mexican aspirin) for pain may
experience life-threatening agranulocytosis. Which of the following actions would be
taken by a nurse who employs cultural repatterning?
Complete a cultural assessment to identify any other dangerous medications that the clien
a. be taking.
Put this into perspective by considering that many drugs used in the United States cause
b. agranulocytosis.
c. Explain the harmful effects of metamizole and recommend an alternative medication for p
Recognize that taking metamizole is common among persons living in Mexico and accept
d. as a cultural tradition.
ANS: C
Cultural repatterning means that the nurse works with clients to help them reorder,
change, or modify their cultural practices when the practice is harmful to them.
DIF: Cognitive Level: Apply (Application) REF: pp. 78-79
8. A health care worker tells a nurse, It does no good to try to teach those Medicaid
clients about nutrition because they will just eat what they want to no matter how
much we teach them. Which of the following is being demonstrated by this statement?
a. Cultural imposition
b. Ethnocentrism
c. Racism
d. Stereotyping
ANS: D
Stereotyping occurs when someone attributes certain beliefs and behaviors about a
group to an individual without giving adequate attention to individual differences. In
this instance, the health care worker makes the assumption that clients with low
incomes are not educable. The health care worker is guilty of making another
assumption as well: noncompliance among other Medicaid clients the worker has
known may have been related to an inability to afford nutritious food.
9. A nurse says, Im not going to change the way I practice nursing based on where the
client is from, because research shows that Western health care technology and
research is best. Which of the following is being demonstrated by the nurses
statement?
a. Ethnocentrism
b. Prejudice
c. Racism
d. Stereotyping
ANS: A
Ethnocentrism, a type of cultural prejudice at the cultural population level, is the
belief that ones own group determines the standards for behavior by which all other
groups are to be judged. For example, some American nurses and providers may
think, The way we do it is the only right way to provide this care.
10. A nurse states, The best way to treat a client from another country is to care for
them the same way we would want to be cared for. After all, we are all humans with
the same wants and needs. What does this statement reflect in relation to culture?
a. Awareness
b. Blindness
c. Knowledge
d. Preservation
ANS: B
Cultural blindness is the tendency to ignore differences between cultures and to act as
if they do not exist. People from different cultures may have different expectations,
wants, and needs.
11. A family from Mexico comes to the public health department. No one in the
family speaks English, and nobody at the health department speaks Spanish. Which of
the following actions should be taken by the nurse?
a. Attempt communication using an English-Spanish phrase book.
b. Call the local hospital and arrange a referral.
c. Emphatically state, No hablo Espaol (I dont speak Spanish).
d. Obtain an interpreter to translate.
ANS: D
Communication with the client or family is required for a careful assessment. When
nurses do not speak or understand the clients language, they should obtain an
interpreter. The nurse must use strategies that will allow effective communication
with the client. The client has the right to receive effective care, to judge whether the
care was appropriate, and to follow up with appropriate action if the expected care
was not received.
12. A nurse who is explaining to a client why it is important to take medication states,
The medication takes a couple of weeks to be effective, but then you should feel
better. When the client is next seen, no medication has been purchased. Which of the
following is the most likely explanation?
The nurse emphasized that eventually the client would feel better, but the client needed to
a. better immediately so didnt bother with the drug.
The medication required a trip to the pharmacy, and the client just hadnt had time to obtai
b. drug yet.
c. The medication was too expensive for the clients family.
d. The client really hadnt understood why the medication was important.
ANS: A
Although any of the answers given is possible, if we look closely at what the nurse
stated, there may have been a cultural disconnect based on time orientation. Many
nurses are future oriented, whereas many families may place greater value on quality
of life and view present time as being more important. When nurses discuss health
promotion and disease prevention strategies with persons from a present orientation,
they should focus on the immediate benefits these clients would gain rather than
emphasizing future outcomes.
13. A client is crying softly and saying, What did I do to deserve this punishment,
Lord? Which of the following responses by the nurse would be the most appropriate?
a. God doesnt punish people. Youre sick just because of bad luck.
b. I can call the hospital chaplain to help you talk about these feelings
c. What can I do to be helpful to you right now?
d. Would you like to confess your sins and repent so this illness will go away?
ANS: C
Some clients may view their illness as punishment for misdeeds and may have
difficulty accepting care from nurses who do not share their beliefs. Because the nurse
may not be a member of the clients religious faith group, an open-ended response
showing caring is the most appropriate statement.
14. A Buddhist patient enters the hospital for diagnostic testing just before lunch time.
The nurse tells the aide to give a meal tray to the new patient, because no tests will be
done until later that evening. The aide gives the patient a meal of Salisbury steak,
bread, green beans, and potatoes with brown gravy. The patient eats nothing but a
slice of bread and the green beans. Which of the following considerations was omitted
by the nurse?
a. The patient should not be served any food until a physicians order is obtained.
b. The patients Buddhist faith probably requires a vegetarian diet.
c. The patient may be too frightened about the tests to want to eat very much.
d. The patient may have diabetes or be allergic to some foods.
ANS: B
Although it is always wise to check with a patient before sending in food, the meal
given to this patient was offensive. Most Buddhists are vegetarians and dont eat meat.
15. At a local hospital, postpartum care policy requires that nurses observe the mother
during infant care to assess the mothers ability to care for the new baby and to
promote bonding. A new mother expresses concern that in her country, all infant care
is provided by other family members so that the mother can rest and recover. Which
of the following actions would be taken by a culturally competent nurse?
Allow family members to provide the newborns care and assess the mothers knowledge o
a. child care through discussion.
Reinforce the importance of bonding and that all good mothers gladly assume these
b. responsibilities.
Explain that the process of postpartum recovery does not require this much rest and requir
c. she provide infant care.
State that she must abide by hospital policy because documentation of the mothers ability
d. give the infant care is required for discharge.
ANS: A
Culturally competent nursing care focuses on the specific patient, reflects the patients
individual beliefs and values, and is provided with sensitivity.
16. For a bedridden Muslim patient, the nurse rearranges the room and moves the bed
so that it faces toward Mecca for the patients daily prayers. Which of the following is
the nurse demonstrating through these actions?
a. Accommodation
b. Awareness
c. Brokering
d. Imposition
ANS: A
Cultural accommodation involves including aspects of the patients religious beliefs
and/or folk practices in the traditional health care system to implement essential
treatment plans. For this patient, daily prayer in the tradition of Islam is
importantfrom the patients perspective, possibly more important than medical
treatment.
17. A nurse gives detailed information on how to apply for Medicaid to a new mother
who moved to the United States from Russia about 10 years ago. The nurses next
client is an African-American mother of newborn twins who worked until the children
were born. The nurse knows the woman is eligible to maintain her insurance after her
employment was lost and does not discuss insurance options at all. Which of the
following errors is being made by the nurse?
a. Covert intentional prejudice
b. Covert unintentional prejudice
c. Overt intentional prejudice
d. Overt unintentional prejudice
ANS: C
The nurse may have assumed that the African-American mother knew the available
resources and could negotiate for assistance on her own and that the immigrant
Russian woman had no experience negotiating government programs and thus needed
the nurse to advocate for her and inform her of the programs available to her. The
nurse, not knowing the health-seeking behaviors of either client, stereotyped both
women and intentionally used her informational power to help one client while
denying assistance to the other client.
18. A 40-year-old Bosnian, Muslim woman who does not speak English presents to a
community health center in obvious pain. She requests a female health care provider.
Through physical gestures, the woman indicates that the pain is originating in either
the pelvic or genital region. Which of the following interpreters would be the most
appropriate in this situation?
a. A Bosnian male who is certified as a medical interpreter
b. A female from the clients community
c. A female who does not know the client
d. The clients 20-year-old daughter
ANS: C
Although having experience in medical interpretation is important, in many cultures it
is inappropriate to have a male interpreter for females. This client has specifically
requested a female provider; therefore, one might anticipate that the client will not be
as forthcoming with a male interpreter. Regardless of certification and ability, the
interpreter cannot interpret information the client may withhold because she feels it
inappropriate to discuss private matters in front of a male. This client may also feel it
inappropriate to have private matters interpreted by her daughter (especially if they
are of a sexual nature or if they involve infidelity). Additionally, to avoid a breach of
confidentiality, the nurse should avoid using an interpreter from the same community
as the client.
19. When teaching a nutrition class to a student group with a large Hispanic
population, the school nurse incorporates foods such as salsa and other healthy dishes
familiar to Hispanic students into the presentation. Which of the following best
describes the action taken by the nurse?
a. Primary prevention
b. Secondary prevention
c. Tertiary prevention
d. Both primary and secondary prevention
ANS: A
Primary prevention involves activities such as health teaching to prevent a problem
from occurring.
MULTIPLE RESPONSE
1. An undocumented immigrant comes to a physicians office to receive care. Which of
the following services can the client receive? (Select all that apply.)
a. Treatment for tuberculosis
b. Treatment for Type 2 diabetes
c. Immunization for polio
d. Physical examination
ANS: A, C
Undocumented immigrants or illegal aliens are individuals who have crossed a border
into the United States illegally or whose legal permission to stay in the United States
has expired. They are eligible only for emergency medical services, immunizations,
treatment for the symptoms of communicable diseases, and access to school lunches.
2. A nurse recognizes that although a patient speaks English, the patient is from a
culture with which the nurse is unfamiliar. Therefore, a cultural assessment should be
attempted. Which of the following questions should the nurse ask? (Select all that
apply.)
a. Can you tell me where your family is from?
b. Do you practice a particular religious faith?
c. Have you ever been in an American hospital before?
d. Is there anything special we need to know about your food preferences?
ANS: A, B
In a brief cultural assessment, nurses ask clients about their ethnic background,
religious preference, family patterns, cultural values, language, education, politics and
health practices. Nurses want to also ask about the client’s perception of the health
issue and what caused it and how it should be treated as well as the results they expect
from the care they get. Such basic data help nurses understand the client from the
client’s point of view and recognize what is unique about the person, thus avoiding
stereotyping.
Chapter 06: Environmental Health

Test Bank
MULTIPLE CHOICE
1. A nurse wants to have a better understanding of the physiological effects of selected
chemicals. Which of the following individuals would provide the most useful
information to the nurse?
a. Chemist
b. Epidemiologist
c. Pharmacologist
d. Toxicologist
ANS: D
Toxicology is the basic science that studies the health effects associated with chemical
exposures. The other specialists would probably be able to provide some information,
but the toxicologist would most likely provide information related to physiological
processes.
2. A nurse wants to find information about environmental threats that are present in
the community. Which of the following would be the best source of data for the
nurse?
a. CINAHL
b. National Library of Medicine
c. State health department
d. Closest local library
ANS: B
Technology helps us understand environmental threats. The National Library of
Medicine (NLM) databases are user-friendly and accessible on the Internet. The NLM
website provides access to medical databases such as PubMed and GratefulMed,
which can be searched for possible environmental linkages to illnesses using key
terms.
3. A nurse is assessing potential environmental health risks in the community. Which
of the following would be the first step that the nurse should take?
a. Conduct health risk assessments of randomly selected individuals
b. Perform a windshield survey
c. Review facility permits and consumer confidence reports
d. Survey community members
ANS: B
Conducting a windshield survey is a useful first step to understanding potential
environmental health risks. This provides first-hand information about the community
and areas of concern that must be investigated.
4. A community citizen reports to the public health nurse that the city water in one
neighborhood has had an unusual taste for the past few months. Which of the
following actions should the nurse take first?
a. Check the most recent consumer confidence report.
b. Consult the Centers for Disease Control and Prevention.
c. Notify the Environmental Protection Agency (EPA).
d. Place a call to the poison control center.
ANS: A
The consumer confidence report (also known as the right-to-know report) reports the
condition of drinking water. Because this is only one citizen, whose sense of taste may
be affected by many conditions, it would not be appropriate to overreact by calling in
governmental agencies first. Even so, in case one needed to contact an authority, it
would be appropriate to start with local governmental agencies such as the city water
department rather than federal agencies.
5. A nurse who works at the local hospital asks a public health nurse what might be
causing her hands to become very sore and sensitive. Which of the following
statements would be the most appropriate response by the public health nurse?
a. Ask the staff in employee health if there have been any other complaints.
b. Call the local health department about any recent problems at the hospital.
c. Check the material safety data sheet on any chemicals you have used recently.
d. See the nurses health care provider for a complete work-up.
ANS: C
Employees have the right to know about hazardous chemicals with which they work.
Employers must maintain a list of all hazardous chemicals used on the premises, along
with a material safety data sheet that addresses health risks related to these chemicals,
as well as information about safe use and handling.
6. Which of the following statements about children and environmental hazards is
correct?
a. The prevalence of autism is directly related to the increase in environmental toxins.
b. Children are more susceptible to environmental toxins because of their smaller size.
c. The prevalence of asthma among children has been decreasing.
d. Children are more susceptible to cancer if they have a family history of the disease.
ANS: B
Because of the smaller size of children, they are exposed to higher doses of pesticide
residues in the foods they eat and drink. Autism has increased 1000% since the mid-
1980s. However, there is not a direct link to environmental toxins discussed in the
text. The prevalence of asthma is at an all time high. Only about 5% of all cancers are
strongly associated with heredity.
7. Which of the following actions represents the use of secondary prevention to reduce
environmental health risks?
a. Collecting blood specimens from preschool children to check for lead levels
b. Meeting with local government officials to request that the city clean up a hazardous vac
c. Referring a child with toxic lead levels to a neurologist
d. Teaching parents of a 2-year-old about the dangers of lead-based paint in older homes
ANS: A
Secondary prevention refers to actions such as surveillance and screening, which are
undertaken so that problems may be detected at early stages.
8. An occupational health nurse at a local factory is using primary prevention
strategies to reduce the environmental health risks among the employees. Which of
the following activities would the nurse most likely implement?
a. Checking radiation detectors to monitor for unsafe levels of radiation exposure
b. Irrigating the eyes of an employee who has had a chemical splash to the face
c. Teaching new employees who will work outdoors about the signs and symptoms of heat-
Using spirometry to rule out obstructive or restrictive lung disease for workers who will
d. respirators
ANS: C
Education is a primary preventive strategy. When examining the sources of
environmental health risks in communities and planning intervention strategies, it is
important to apply the basic principles of disease prevention.
9. A nurse wants to help keep the community environment safe. Which of the
following is the most appropriate action for the nurse to take?
a. Conserve water by bathing less often.
b. Downsize to a smaller living space.
c. Reduce, reuse, and recycle.
d. Replace all his appliances with new energy-efficient ones.
ANS: C
All citizens can engage in minimizing their impact on the environment by reducing,
reusing, and recycling. Although it would be nice to replace all appliances for energy-
efficient newer models, most people cant afford thatfurthermore, it is an
environmental issue to discard the used models. Similarly, downsizing to a smaller
living space could help the environment, because the nurse would use less energy, but
again, not everyone can afford all the expenses involved in moving. On the other
hand, all persons can reduce, reuse, and recycle the individual products they currently
consume.
10. Which of the following best describes the purpose of local health departments
making unannounced inspections of local restaurants?
a. To enforce local laws and regulations
b. To ensure compliance
c. To provide exposure to oversight
d. To monitor employee safety
ANS: B
Ensuring compliance refers to the process of making certain that permitting
requirements are met. Although this activity may be seen as a type of monitoring, the
question asks for the purpose, which is to ensure compliance. Enforcement involves
penalties such as fines or facility closure.
11. A city has announced its plans to build a city dump near a community of poor and
predominantly African-American citizens. Which of the following principles would
the nurse be using when vocalizing opposition for this plan?
a. Environmental justice
b. Equal rights
c. Primary prevention
d. Risk protection
ANS: A
Environmental justice is the goal of campaigns seeking to improve the unequal burden
of environmental risks borne by impoverished and minority communities. The
Environmental Justice Act would be used in support of the nurses position.
12. A nurse is completing a basic health assessment. Which of the following questions
should be asked by an environmentally aware nurse?
a. Is anyone else in your family having these symptoms?
b. Can you tell me about your house or apartment?
c. What jobs have you held longest?
d. Where do you live?
ANS: C
An exposure history should identify current and past exposures, have a preliminary
goal of reducing or eliminating current exposures, and have a long-term goal of
reducing adverse health effects. The I PREPARE mnemonic consigns the important
questions to categories that can be easily remembered. Asking about previous
employment helps to answer the P of past work.
13. A high school student considering a job in the restaurant industry after graduation
asks a nurse about workplace safety issues. Which of the following acts would the
nurse most likely discuss with the student?
a. Chemical Safety Information, Site Security, and Fuels Regulatory Act
b. Comprehensive Environmental Response, Compensation, and Liability Act
c. Food Quality Protection Act
d. Occupational Safety and Health Act
ANS: D
The Occupational Safety and Health Act (OSHA) was passed to ensure worker and
workplace safety in all employment settings, including restaurants. Others may
contribute to safety but do not have the full oversight of OSHA.
14. The nurse is examining blood lead levels in school-age children 1 year after a
community-wide education intervention. Which of the following phases of the nursing
process is being implemented?
a. Assessment
b. Diagnosis
c. Intervention
d. Evaluation
ANS: D
In this instance, the nurse is evaluating the results of the intervention to determine
whether goals were reached. If you chose assessment, understand that this would have
been done earlier in the process because assessment was needed to determine that a
problem existed and that interventions were needed.
15. A nurse practitioner has established a mobile clinic to vaccinate
noninstitutionalized adults against influenza. Which of the following phases of the
nursing process is being implemented?
a. Assessment
b. Planning
c. Intervention
d. Evaluation
ANS: C
Giving immunizations is an intervention that will increase the number of people who
will be vaccinated. Intervention includes coordinating medical, nursing, and public
health actions to meet the clients needs.
MULTIPLE RESPONSE
1. A public health nurse is assisting the community in dealing with the effects of lead
paint poisoning. Which of the following activities would the nurse most likely
complete? (Select all that apply.)
a. Administering medications to those with signs of lead poisoning
b. Assessing community members for any health problems
c. Setting up a blood screening program with the local health department
d. Encouraging local landlords to improve the condition of their housing
ANS: C, D
The nurses role is to understand the roles of each respective agency and organization,
know the public health laws, and work with the community to coordinate services to
address the communitys needs. Other needed interventions include organizing a
blood-lead screening program through the local health department, educating local
health providers to encourage them to systematically test children for lead poisoning,
and working with local landlords to improve the condition of their housing stock.
2. Which of the following are the major sources of air pollution in the United States?
(Select all that apply.)
a. Burning of fossil fuels
b. Waste incineration
c. Industrial plants
d. Motor vehicles
ANS: A, B, D
Motor vehicles are the greatest single source of air pollution in the United States. The
burning of fossil fuels (diesel, industrial boilers, and power plants) and waste
incineration are two other major contributors.
3. A nurse wants to use the principles of risk and outrage to improve an environmental
hazard in the community. To accomplish this, which of the following actions would
be taken by the nurse? (Select all that apply.)
a. Advertise in the media throughout the entire surrounding area.
b. Communicate the correct information in a timely fashion.
c. Share all the data found on the community assessment.
d. Talk to those affected or those worried about the situation.
ANS: B, D
Sharing all the data would be overwhelming, and much of the data might not be
relevant. Using epidemiological statistics would not be meaningful to those without
the education or experience to be able to draw an appropriate conclusion. Instead, the
correct information must be given in a language the audiencenamely, those at risk or
worried about the riskcan understand. Use the communication channels the
neighborhood residents use and meet at a common meeting place for the community.
It is wasteful of resources to advertise in media throughout a wider region or to meet
at a central regional facility when only community residents will be interested or
involved.
4. Which of the following strategies would a nurse expect to be implemented by a
typical state environmental agency? (Select all that apply.)
a. Acting, through unannounced inspections, to ensure compliance
b. Writing permits that help limit toxic hazards
c. Monitoring hazardous substances to uphold established standards
d. Obtaining and analyzing samples to confirm compliance
ANS: A, C, D
The organization and approach to environmental protection vary somewhat among
states, but the common essential strategies of prevention and control via the
permitting process, establishment of environmental standards, and monitoring, as well
as compliance and enforcement, are found in every state.
5. Which of the following actions would a nurse take when serving as an advocate for
the community? (Select all that apply.)
a. Asking questions related to health implications at policy meetings
b. Calling the local health department to report problems at the hospital
c. Serving as a source of information at public meetings
d. Volunteering to serve on health-related committees
ANS: A, C, D
Advocacy roles of the community-oriented nurse include attending policy meetings to
obtain health-related information, holding public meetings (or serving on panels at
meetings) to provide health-related information, serving on health-related committees,
and informing local media about environmental hazards in the community.
Chapter 08: Economic Influences My Nursing Test Banks

Chapter 08: Economic Influences
Test Bank
MULTIPLE CHOICE
1. A nurse is discussing how health care rationing occurs in the United States. Which
of the following would most likely be discussed as the criterion that is used to ration
health care?
a. Clinic operating hours
b. Ability to pay for services
c. Availability of local provider services
d. Transportation availability
ANS: B
Because there are not enough health care services available to provide desired services
to everyone, the focus has been on reducing costs by controlling the use of services.
All of the factors listed affect health care access and therefore affect health care
rationing (either directly or indirectly). The primary determinant, however, is the
ability to pay for services. Without this ability, services are denied; therefore, those
without insurance that is accepted by a provider or institution or who do not have the
money to pay out of pocket are unable to obtain services.
2. Which of the following must a nurse be knowledgeable about to make decisions
regarding the most cost-effective way to allocate health care resources?
a. Insurance resources
b. Health care rationing
c. Health economics
d. Medical technology
ANS: C
Economics is the science concerned with the use of resources; health economics is
concerned with how scarce resources affect the health care industry. The other options
are important components of health economics but by themselves do not provide the
broad understanding called for in this question.
3. Which of the following individuals would most likely experience a barrier when
accessing health care?
a. A 40-year-old female who speaks English
b. A 25-year-old female with health insurance
c. A 50-year-old male with hypertension
d. A 30-year-old male who is unemployed
ANS: D
Barriers to accessing care include the inability to afford health care, lack of
transportation, physical barriers, communication problems, child care needs, lack of
time or information, or refusal of services by providers. The unemployed male is most
likely to experience a barrier because of not having a job, which may reduce his
access to health insurance and limit his income.
4. Which person is most likely to be uninsured?
a. An 82-year-old woman with chronic medical problems
b. A 2-year-old whose mother is on welfare
c. A 50-year-old business man who works for a large corporation
d. A 32-year-old man who works part-time at a small business
ANS: D
The typical uninsured person is one who works at a low-paying job, part-time or
temporary, or at a small business. The elderly person would be eligible for Medicare,
and the 2-year-old is probably eligible for Medicaid. The man who works at the large
corporation probably has health insurance, because most large businesses provide it.
5. Which of the following is most closely correlated with poor health?
a. Age and gender (i.e., older males)
b. Low socioeconomic status
c. Minority race status
d. High-risk lifestyle behaviors
ANS: B
Poverty is more closely related to health status even when controlling for age, gender,
race, education, and lifestyle behaviors.
6. A pregnant teenager has approached a nurse asking about ways to improve the
health outcomes for her and her unborn child. Which of the following statements
would be most appropriate for the nurse to make?
a. Dont drop out of school.
b. Sign up for childbirth classes.
c. Sign up for the WIC program.
d. Take your prenatal vitamins daily.
ANS: A
The question specifies the health of both the mother and the child. Socioeconomic
conditions improve with education. Because socioeconomic status is inversely related
to mortality and morbidity, by becoming better educated, the mother-to-be will be less
likely to live a life of poverty and, as a consequence, will enjoy a greater chance of
better health for herself and for her child.
7. A nurse is providing care to a child whose parents do not receive health insurance
as an employee benefit and who do not have the financial resources to pay for health
care out of pocket. Which of the following resources should the nurse recommend to
the family?
a. A managed care organization
b. An emergency department
c. Medicaid
d. Medicare
ANS: C
Medicaid provides coverage for adults with low income and their children.
8. Which of the following best explains how the government inadvertently encourages
low-income persons to use emergency departments as their primary care provider?
a. A huge amount of paperwork is required when Medicaid clients go to a physicians office.
Government regulations require Medicaid clients to use emergency departments when the
b. primary health care provider is unavailable.
c. Legally, emergency departments must see clients even if clients cant pay.
d. Physicians limited office hours make them unavailable during evenings and weekends.
ANS: C
People on Medicaid frequently have no primary care provider and may not be able to
pay for their care. Although physicians can choose clients based on their ability to
pay, emergency departments are required by law to evaluate every client regardless of
ability to pay. Emergency department copayments are modest and are frequently
waived if the client is unable to pay. Thus, low out-of-pocket costs provide incentives
for Medicaid clients and the uninsured to use emergency departments for primary care
services.
9. Of the four main factors that affect health, which is the least important?
a. Environment
b. Human biology
c. Lifestyle choices
d. Health care system
ANS: D
Of the four major factors that affect healthpersonal behavior (or lifestyle),
environmental factors (including physical, social, and economic environments),
human biology, and the health care systemmedical services are said to have the least
effect. Behavior (lifestyle) has been shown to have the greatest effect, but
environment and biology account for 70% of all illnesses.
10. A nurse is trying to maximize the quality of life of her clients while reducing
health care costs. Which of the following actions would most likely be completed by
the nurse?
a. Assisting in cast application for a client who was injured in a skateboard incident
b. Irrigating the eyes of a client splashed with chemicals
Restoring a normal cardiac rhythm following cardiopulmonary resuscitation of a client wi
c. heart condition
Teaching a high school boy about sexually transmitted infections and proper condom
d. application
ANS: D
Education is primary health care prevention. A proactive investment in disease
prevention and health promotion targeted at improving health behaviors and lifestyle
has the potential to improve health status and reduce health care costs.
11. Which of the following caused health care providers to begin to focus on
individual infections and trauma in the 1900s in the United States?
a. Education of health care providers moved into universities.
b. People finally had enough money to pay for medical care.
c. The improved outcomes of hospital care were recognized.
d. Advances were made in safe water, sewage disposal, and pasteurization of milk.
ANS: D
Environmental conditions influencing health began to improve with major advances in
water purity, sanitary sewage disposal, milk quality, and urban housing quality. The
health problems of this era were no longer mass epidemics but individual acute
infections or traumatic episodes.
12. Which of the following accurately describes a challenge that will be faced by
health care providers in the twenty-first century?
a. Lack of available space to provide care for clients in hospitals
b. Emergence of new and old communicable and infectious diseases
c. New guidelines for chronic disease management
d. Increased use of technology leading to a decreased need for health care workers
ANS: B
In the twenty-first century the emergence of new and the reemergence of old
communicable and infectious diseases are occurring as well as larger foodborne
disease outbreaks and acts of terrorism. Care for clients continues to move out of the
hospital setting and into the community. Chronic disease management will be a
challenge for health care providers; however, new guidelines should ease the care
provided for these diseases and wouldnt be seen as a challenge. The use of technology
will continue to increase, but the need for health care workers will not be decreasing.
New health care careers will emerge because of the changes in technology.
13. Which of the following demographic factors is expected to have the greatest
influence on national health care spending?
a. The aging population
b. Use of diagnosis-related groups to determine reimbursement
c. Insurance reform
d. An increasing number of people without health insurance
ANS: A
The aging population is expected to affect health services more than any other
demographic factor. The majority of older adults rely on publicly funded programs.
As the baby boom generation ages and retires, federal expenses for Social Security
and health care will increase.
14. Which of the following groups pays the largest amount for health care in the
United States today?
a. Consumers
b. Federal and state government
c. Insurance companies and other third-party payers
d. Hospitals and health care providers
ANS: B
Health care financing has evolved from a time when the most money was expended
by consumers, then to a system financed by third-party payers such as insurance
companies, and finally, to today, when state and federal government payments
(primarily through Medicare and Medicaid) pay more than private insurance
companies or consumers.
15. Which of the following services would be covered under Medicare Part A?
a. Blood draw to assess PT/INR
b. Physical therapy visit
c. Stay in skilled nursing facility
d. Transportation by an ambulance
ANS: C
Medicare Part A covers hospital care, home care, and skilled nursing care.
16. A Medicare recipient has elected to pay a monthly premium for Medicare that will
cover expenses such as laboratory services and equipment. Which of the following
best describes this part of Medicare?
a. Part A
b. Part B
c. Part C
d. Part D
ANS: B
Medicare Part B is a supplemental (voluntary) program; it provides coverage for
services that are not covered by Part A, such as laboratory services, ambulance
transportation, prostheses, equipment, and some supplies.
17. Which of the following criterion is now used for deciding the amount of the
reimbursement before care is provided?
a. A proportion of actual cost arbitrarily decided by the Medicare panel
b. The federal budget constraints for the current fiscal year
c. Hospital and health care provider feedback and political persuasion
d. Prospective payment scale based on the medical diagnosis
ANS: D
As a result of rising health costs, Congress passed a law in 1983 that mandated an end
to cost-plus reimbursement and instituted a prospective payment system (PPS) for
inpatient hospital services to shift the cost incentives away from the providing of more
care and toward more efficient services. The basis for prospective reimbursement is
the 468 diagnosis-related groups (DRGs).
18. Which of the following payment systems tries to keep clients healthy through
education and health promotion, with the goal of reducing the need for professional
health care intervention and therefore also lowering cost?
a. Managed care plan
b. Fee-for-service payment
c. Prospective reimbursement
d. Retrospective reimbursement
ANS: A
Fee-for-service payment encourages more services to be given. Reimbursement,
whether prospective or retrospective, is based on the same criteria, but managed care
integrates the financing and the delivery of health care. The concept of managed care
is that costly care could be reduced if consumers had access to education and health
promotion.
19. Which of the following terms describes when a nurse practitioner receives a set
monthly payment to take care of a group of clients regardless of the services needed
and provided?
a. Capitation
b. Fee for service
c. Rationing
d. Retrospective reimbursement
ANS: A
In payment by capitation, practitioners are paid a set amount to provide care to a given
client or group of clients for a set period of time.
20. A client expresses concern that health care coverage based on capitation may have
negative side effects. Which of the following would most likely be a consequence of
capitation?
a. Coercing clients to attend health promotion education classes
b. Encouraging clients to seek care elsewhere
c. Increasing the number of interventions to maximize payment
d. Neglecting to order certain tests or treatment to minimize cost to the provider
ANS: D
In capitated arrangements, physicians and other practitioners are paid a set amount to
provide care to a given client for a set period of time and amount of money. Thus,
neglecting to order certain tests or treatment would be a way for the provider to
maximize the amount of money received to provide care to members of this group.
21. A public health nurse is counseling a client who is trying to determine if a health
maintenance organization (HMO) or preferred provider organization (PPO) will
provide the better health care coverage. Which of the following best describes one
main difference between these two types of coverage?
a. HMOs provide comprehensive care to members for a fixed fee.
b. PPOs designate providers that members can choose.
c. PPOs provide one model of care delivery.
d. HMOs provide financial incentives to encourage members to select HMO providers.
ANS: A
The HMO is a provider arrangement whereby comprehensive care is provided to
members for a fixed, per member per month, fee. A PPO uses predetermined rates for
services to be delivered to members. HMOs do not have one model of care delivery.
PPOs provide financial incentives to encourage members to select PPO providers.
22. A nurse is implementing a primary prevention strategy focusing on economics
within the community. Which of the following interventions is the nurse most likely
completing?
Applying for a grant to establish a day care center to serve dependent older adult clients li
a. with working families
b. Persuading legislators to pass a bill offering health care financial aid to families at risk
c. Screening cocaine addicts for financial assistance eligibility for drug treatment
d. Referring clients with renal failure to apply for Medicare
ANS: B
Primary prevention occurs before an illness or condition develops. Of the options
provided, only persuading legislators to pass a bill offering health care financial aid to
families at risk addresses initiating interventions beforean illness occurs.
MULTIPLE RESPONSE
1. In which of the following situations would the federal government provide money
through tax relief for private enterprise? (Select all that apply.)
a. A business pays for part of health insurance premiums for its employees
b. A business purchases gifts for its employees to award them for their service
c. An employer provides health screenings and immunizations
d. An employer requests reimbursement for employee transportation costs
ANS: A, C
Businesses can pay for disease prevention and health promotion services for
employees (and sometimes their families) in the form of immunizations, health
screenings, and counseling. The business can then deduct these costs as a business
expense, which reduces the amount the business owes the government in taxes on
their profits. Similarly, when businesses subsidize health insurance for their
employeesand familiesthis is also a business expense, which decreases the amount the
business would otherwise pay in taxes. Thus, the government indirectly provides the
money, but the business, a part of the private sector, decides how it is used.
2. Which of the following best explains why clients who have Medicaid have poor
health outcomes? (Select all that apply.)
a. Clients may have preexisting conditions not covered by insurance.
b. Many physicians wont accept Medicaid clients.
c. Medicaid wont pay for certain medical interventions.
d. Medicaid recipients are noncompliant with their health care providers recommendations.
ANS: A, B, C
The primary reasons for delay, difficulty, or failure to access care include inability to
afford health care and a variety of insurance-related reasons, including the insurer not
approving, covering, or paying for care; the client having preexisting conditions; and
physicians refusing to accept the insurance plan. Practical problems such as lack of
childcare, transportation, long waiting periods, and communication issues also
interfere.
3. A nurse would like to help members of the community focus on receiving primary
preventive health care services. Which of the following interventions should be
implemented by the nurse? (Select all that apply.)
a. Publicize data on success of health promotion efforts, including cost savings.
b. Lobby for decreased reimbursement for secondary and tertiary care services.
c. Establish standards for appropriate screenings at specific intervals.
d. Encourage members of the military service to engage in appropriate healthy lifestyle beha
ANS: A, C
Reasons given for the lack of emphasis on prevention in clinical practice and lack of
financial investment in prevention include provider uncertainty about which clients
should receive services and at what intervals, lack of information about preventive
services, negative attitudes about the importance of preventive care, lack of time for
delivery of preventive services, delayed or absent feedback regarding success of
preventive measures, less reimbursement for these services than for curative services,
lack of organization to deliver preventive services, and lack of use of services by the
poor and elderly. Although all of the above suggestions may have some merit, some
would be illegal, such as requiring people to change their lifestyle.
4. Which of the following are some major differences in health care today, as
compared with the first half of the twentieth century? (Select all that apply.)
a. Consumers are influenced by advertising for specific health care agents or procedures.
The emphasis is on the continued expansion of health care facilities, especially acute care
b. hospitals.
c. Education and specialization of personnel have increased.
d. The need to create new ways to pay for health care is a central focus.
ANS: A, C
Since the 1980s, the United States has been in a period of limited resources, with an
emphasis on containing costs, restricting growth in the health care industry, and
reorganizing care delivery. Results have included shorter hospital stays and
substitution of one set of personnel (such as nurse practitioners) for another set
(physicians). Such trends are made more challenging by increased direct marketing to
consumers. Also with increased knowledge has come increased education and
specialization.
Chapter 09: Epidemiological Applications My Nursing Test

Banks
Chapter 09: Epidemiological Applications
Test Bank
MULTIPLE CHOICE
1. A nurse is using analytic epidemiology when conducting a research project. Which
of the following projects is the nurse most likely completing?
a. Reviewing communicable disease statistics
b. Determining factors contributing to childhood obesity
c. Analyzing locations where family violence is increasing
d. Documenting population characteristics for healthy older citizens
ANS: B
Epidemiology refers not only to infectious epidemics but also to other health-related
events. Analytic epidemiology looks at the etiology (origins or causes) of disease.
2. A nurse is employed as a nurse epidemiologist. Which of the following activities
would most likely be completed by the nurse?
a. Eliciting the health history of a client presenting with an illness
b. Evaluating the number of clients presenting with similar diseases
c. Performing a physical examination of an ill client
d. Providing treatment and health education to a client with a disease
ANS: B
Epidemiology differs from clinical medicine, which focuses on the diagnosis and
treatment of disease in individuals. Epidemiology monitors the health of the
population.
3. Which of the following actions by Florence Nightingale demonstrates her role as an
epidemiologist?
a. She convinced other women to join her in giving nursing care to all the soldiers.
b. She demonstrated that a safer environment resulted in decreased mortality rate.
c. She obtained safe water and better food supplies and fought the lice and rats.
d. She met with each soldier each evening to say goodnight, thereby giving psychological s
ANS: B
Nightingale examined the relationship between the environment and the recovery of
the soldiers. Using simple epidemiological measures, she was able to show that
improving environmental conditions and adding nursing care decreased the mortality
rates of the soldiers. Nightingale used statistics to document decreased mortality rates
when the environmental factors were improved.
4. Which of the following statements describes how nursing in the community is more
challenging than nursing in an acute care setting?
a. There is limited access to information useful to the nurse in giving care in the community
b. More paperwork and forms are required when giving care in the home.
c. It is more challenging to control the environment in the community.
d. Specialization isnt possible in the community setting.
ANS: C
In the community, nurses often use epidemiology, since the factors that affect the
individual, family, and population group cannot be as easily controlled as in acute
care settings. It is essentially impossible to control the environment in the community.
5. Several small communities have applied for grant funding from the state department
of health to help decrease their teenage pregnancy rate. Which of the following
communities should the nurse suggest receive funding first?
a. Community Awith 23 single teenage pregnancies in a city of 500
b. Community Bwith 45 single teenage pregnancies in a city of 1000
c. Community Cwith 90 single teenage pregnancies in a city of 2000
d. Community Dwith 90 single teenage pregnancies in a city of 1500
ANS: D
Without doing any actual math, it should be fairly obvious that 23:500, 45:1000, and
90:2000 are all about the same proportion but that 90:1500 is a larger proportion.
Doing the math, the pregnancy rates of A, B, and C are 45-46:1000, whereas the rate
in Community D is 60:1000.
6. Between 2000 and 2005, 1000 of 10,000 young women ages 17 to 20 years at a
university tested positive for a sexually transmitted infection (STI). Of the 1000
diagnosed STIs, 300 were gonorrhea and 500 were chlamydia. Which of the following
statements best summarizes these findings?
a. The proportion of cases of gonorrhea to all STIs was 300:1300.
b. The proportion of cases of gonorrhea to chlamydia was 300:500.
c. The proportion of cases of gonorrhea to all STIs was 50%.
d. The proportion of STIs to the total population was 100:1000.
ANS: D
A proportion is a ratio in which the denominator includes the numerator.
If the proportion is small, we can express the number per 1000. The answer of
300:1300 adds the total of the numerator to the denominator, which is unnecessary
because the gonorrhea cases were already included in the denominator. In the answer
of 300:500, the ratio comparing gonorrhea to chlamydia does not meet the
epidemiological definition of proportion (i.e., the denominator must contain the
numerator). Although proportions may be expressed as percentages, in the answer of
50% the percentage reflects the number of gonorrhea cases to all STIs, which doesnt
summarize the total STI problem. The answer of 100:1000 correctly summarizes that
1000 of 10,000 (or 100:1000) young women had the problem.
7. The nursing staff has attempted to screen the entire African-American population in
the community for diabetes. Which of the following would provide immediate
verification of the success of the nursing staffs efforts?
a. An epidemic of diabetes will be recognized.
b. The incidence of diabetes will increase in the community.
c. The prevalence of diabetes will decrease in the community.
d. The risk for diabetes in the community will increase.
ANS: B
If the screening has been successful, more diabetes will be diagnosed and, hopefully,
treated. Thus, the incidence of new cases will increase. Overall, prevalence will also
increase, but that is not one of the answer options.
8. In a particular community, several high school students were diagnosed with
diabetes mellitus Type 2 during the annual high school health fair. Over the next few
years, the nursing staff developed and implemented educational programs about the
risk factors for diabetes mellitus Type 2 and proper nutrition. Which of the following
would be most useful for the nurses to use to determine if they are having any impact?
a. The epidemic of diabetes in the high school is gradually ending.
b. The incidence of diabetes is slowly decreasing during screening events.
c. The prevalence of diabetes is slowly decreasing during screening events.
d. The risk for diabetes is slowly increasing over time.
ANS: B
Incidence rates and incidence proportions are the measure of choice to study etiology
because incidence is affected only by factors related to the risk of developing disease
and not to survival or cure. Prevalence is a fairly stable number over time, but
incidence reacts more quickly to changes in risk factors or intervention programs. If
the educational programs are having the desired impact, the incidence of diabetes
being diagnosed will decrease in future screenings.
9. This year 600 of 8000 young women ages 17 to 20 years at a university health
center tested positive for a sexually transmitted infection (STI). Which of the
following terms best describes this data?
a. An epidemic
b. Incidence
c. Prevalence
d. Risk
ANS: C
Because we do not have baseline data, we have no way to conclude that this is an
epidemic with higher-than-normal results from the screening. Incidence refers to new
cases, whereas prevalence means all cases. We dont know whether the finding
represents the first time a woman was told she had an STI or whether she had
previously been diagnosed with the problem. Therefore, we cant say whether these are
new cases (incidence), but the results do represent all cases (prevalence). Risk is the
probability of developing an STI, but no risk factors are discussed.
10. A nursing staff has successfully screened for diabetes in the community. Which of
the following might best persuade the health board to increase funding for diabetic
clinics in this community?
a. An epidemic of diabetes is now recognized and must be addressed.
b. The incidence of diabetes is now higher than previously recognized in the community.
c. The prevalence of diabetes is now higher than previously recognized in the community.
d. The risk for diabetes in the community could decrease if funding is received.
ANS: C
If more people are now being diagnosed with diabetes and need support, more
ongoing services will be needed for this population. Incidence may go up and down,
but prevalence is a fairly stable number.
11. A public health nurse found that out of the 70 people who ate the potato salad at a
school picnic, 63 developed symptoms of food poisoning. Which of the following best
describes the attack rate?
a. 63%
b. 70%
c. 90%
d. 100%
ANS: C
The attack rate is the proportion of persons exposed to an agent who develop the
disease. Because 63 of the 70 persons became ill, the attack rate is 63:70, or 90%.
12. A man is diagnosed with prostate cancer. Which of the following data should the
nurse know to answer the man when he asks, What are the chances Ill survive this
thing?
a. Attack rate
b. Case fatality rate
c. Cause-specific morbidity rate
d. Crude mortality rate
ANS: B
The case fatality rate (CFR) is the proportion of persons diagnosed with a particular
disorder (i.e., cases) who die within a specified period. The CFR is considered an
estimate of the risk for death within that period for a person newly diagnosed with the
disease. Persons diagnosed with a particular disease often want to know the
probability of surviving. The CFR provides that information.
13. Which of the following statistics is used by countries to compare the success of
their health care systems?
a. Attack rate
b. Infant mortality rate
c. Cause-specific morbidity rate
d. Cause-specific mortality rate
ANS: B
Infant mortality is used around the world as an indicator of overall health and
availability of health care services.
14. A nurse is examining all of the various factors which can lead to disease. Which of
the following models would the nurse most likely use?
a. Epidemiologic triangle
b. Health promotion
c. Levels of prevention
d. Natural history of disease
ANS: A
The epidemiologic triangle categorizes factors as agent, host, or environment. The
model encourages the health care provider to examine all the influences that lead to
increased risk. Levels of prevention are actions taken to improve health outcomes.
Health promotion addresses health improvement, not the risk for disease.
15. A nurse is examining the various factors that lead to disease and suggests several
areas where nurses could intervene to reduce future incidence of disease. Which of the
following models would the nurse most likely use?
a. Epidemiologic triangle
b. Health promotion
c. Levels of prevention
d. Web of causality
ANS: D
The web of causality model recognizes the complex interrelationships of many factors
interacting to increase or decrease the risk for disease. Causal relationships (one thing
or event causing another) are often more complex than the epidemiologic triangle
conveys. With all the various antecedents identified, the nurse can then decide in
which areas interventions are possible.
16. Which of the following actions would a nurse take to reduce the high incidence of
coronary artery disease (CAD) in a community?
Introduction of a heart-healthy curriculum beginning in the first grade, presentations on d
a. for the community at large, and special education sessions for high-risk populations
Provision of online activities related to prevention of cardiac disease, smoking reduction
b. blood pressure screenings
c. Distribution of handouts, including age-appropriate games, self-assessments, and educati
healthy lifestyles; availability of community screenings for hyperlipidemia in persons ag
and walking programs for those affected with CAD
Enrollment of clients with CAD into cardiac rehabilitation programs, routine evaluation
CAD treatment regimens, and participation in clinical trials that evaluate interventions fo
d. with CAD
ANS: C
Education in schools, the community, and high-risk populations focuses only on
primary prevention activities. Online activities focus only on primary and secondary
prevention. Efforts focused only on those who already have CAD are not primary
prevention. Distributing handouts includes all three levels of prevention to target all
members of the population. Targeting all members of the population and
implementing all levels of prevention increase the likelihood of positive outcomes for
the community as a whole.
17. A school nurse wants to decrease the incidence of obesity in elementary school
children. Which of the following describes a secondary prevention intervention that
the nurse could implement?
a. Giving a presentation on the importance of exercise and physical fitness
b. Designing a game in which students select healthy food choices
c. Weighing students to identify those who are overweight
d. Putting students on a diet if they weigh greater than 20% of their ideal weight
ANS: C
Secondary prevention refers to interventions that increase the probability that a person
with a condition will have the condition diagnosed early. Health screenings are the
mainstay of secondary prevention. Weighing students and assessing whether the
weight is higher than recommended will allow for early intervention so that obesity
may be avoided.
18. A nurse advises a client with osteoporosis to have three servings of milk or dairy
products daily. Which of the following levels of prevention is being used by the
nurse?
d. Treatment, but not prevention
ANS: C
Interventions that prevent worsening of a condition are tertiary prevention activities.
In this instance, the client already has a health problem (osteoporosis). By advising
adequate dairy intake, the nurse aims to ensure that enough calcium is available to
limit worsening of the osteoporosis.
19. A nurse has only a regular blood pressure cuff when conducting a health screening
for all of the residents of a community. Which of the following may be lacking when
obtaining blood pressure readings?
a. Reliability
b. Sensitivity
c. Specificity
d. Validity
ANS: D
Validity is the accuracy of a test or measurement, or how closely it measures what it
claims to measure. With only one regular BP cuff, the nurse cannot obtain accurate
measurements on those who are extremely obese or extremely thin. A thigh cuff and a
pediatric cuff would allow the nurse to obtain accuratethat is, validmeasurements.
20. A nurse is administering a tuberculosis skin test to a client who has AIDS. Which
of the following results should the nurse anticipate when using this screening test?
a. Decreased positive predictive value
b. Decreased reliability
c. Decreased sensitivity
d. Decreased specificity
ANS: C
Persons with immune deficiencies may have a negative tuberculosis skin test even
though they are infected. Sensitivity is the extent to which a test identifies those
individuals who have the condition being examined. AIDS is an acquired immune
deficiency; thus, clients with AIDS may have a false-negative response to TB skin
tests; that is, they have the disease but the test is not sensitive enough to detect
infection in these individuals. Therefore, there is decreased sensitivity with those
clients.
21. Persons in an auditorium may have been exposed to a disease. If they are infected,
it is crucial that they receive immediate treatment and not take the disease home to
their families. Which of the following characteristics would be most important to
consider when selecting the screening test to be used?
a. The negative predictive value
b. The positive predictive value
c. The sensitivity of the test
d. The specificity of the test
ANS: C
Because it is most important to identify every case, the sensitivity of the test is crucial.
High sensitivity is needed when early treatment is important and when identification
of every case is important.
22. A woman is sitting in a corner of the clinical waiting room, crying audibly. The
nurse asks, Whats wrong? Can I help? The woman responds, They just told me I have
a positive mammogram and I need to see my doctor for follow-up tests. I know Im
going to die of cancer. How can I tell my family? Which of the following information
does the nurse need to know in order to help the woman cope with this finding?
a. The negative predictive value of mammography
b. The positive predictive value of mammography
c. The reliability of mammography
d. The validity of mammography
ANS: B
The positive predictive value is the proportion of persons with a positive test who
actually have the disease, interpreted as the probability that an individual with a
positive test has the disease.
23. The administration at a local medical center examines the trends in health
problems when developing long-range plans for staffing and space allocation. Which
of the following sources of information would be most helpful?
a. Local data drawn from a professional survey in the city
b. The National Health Interview Survey
c. The National Hospital Discharge Survey
d. The states vital statistics
ANS: A
The National Health Interview Survey and the National Hospital Discharge Survey
both provide information on the health status and behaviors of the national population.
For many studies, however, the only way to obtain the needed information is to collect
the required data in a study specifically designed to investigate a particular question.
24. Statistics clearly demonstrate that there are significantly more cases of a disease in
one particular neighborhood than in all the rest of the city. Assuming all else is the
same, which of the following is the most likely explanation for a single neighborhood
having such a different pattern of illness?
a. A cultural or ethnic concentration in the neighborhood
b. The geographical location of the neighborhood within the city
c. A statistical fluke without meaning
d. The time of year the different statistics were collected throughout the city
ANS: A
Although any explanation is possible, the most probable reason is that there is a
cultural or ethnic concentration in that particular neighborhood that has a different
lifestyle pattern, resulting in different health outcomes.
25. Two women seem to agree on almost everything from favorite music to favorite
media stars to the best way to prepare a meal. Which of the following best explains
this similarity in the two women?
a. They are both members of the same birth cohort.
b. They are close friends.
c. They attended the same school.
d. They both go the same church.
ANS: A
Being close friends is probably the result of the similarity rather than the cause.
However, being born at about the same time would mean both women have lived
through similar social events and media occurrences and therefore would have much
in common. Going to the same school or the same church, depending on the size of
the institutions, might not result in any personal interaction whatsoever.
26. A nurse reports that in comparison to all the children in a particular school, the
children who are members of the Cub Scouts have 0.3 risk for obesity before entering
the sixth grade. Which of the following recommendations would the nurse make to the
new parents of two boys who had just moved into this schools neighborhood?
a. Discourage the parents from enrolling their sons in Cub Scouts because of the risk.
b. Dont say anything about Cub Scouts, because it isnt relevant to nursing care.
c. Encourage the parents to enroll their sons in Cub Scouts.
d. Share the finding and let the parents draw whatever conclusions they feel appropriate.
ANS: C
Relative risk is an estimation of the risk of acquiring a problem for those who are
exposed compared with those who are unexposed. As the risk for obesity is less for
those that are members of Cub Scouts, joining the group is protective and reduces the
incidence among members.
27. A principal comments to the school nurse that it seems there are a lot more
problems with asthma among the students than there were before the school was
remodeled a couple of years ago. The nurse investigates the principals observation by
reviewing all the school records to determine visits to the health office because of
asthma by week and month for the past 5 years. Which of the following best describes
the type of study the nurse is conducting?
a. Descriptive epidemiological study
b. Ecological study
c. Prospective cohort study
d. Retrospective cohort study
ANS: D
Retrospective cohort studies rely on existing records to define a cohort that is
classified as having been exposed or unexposed at some time in the past. In this case,
the issue is whether there is some health risk in the new building addition that is
increasing frequency of visits to the school nurse because of asthma.
28. Which of the following types of study should the nurse researcher choose if the
goal is to identify the long-term benefits and risks of a particular nursing intervention
for senior citizens living in the community?
a. Cross-sectional study
b. Ecologic study
c. Clinical trial
d. Retrospective analysis
ANS: C
The goal of a clinical trial is to evaluate the effectiveness of an intervention. Clinical
trials are generally the best way to show causality.
29. A teacher recommends that surveys to obtain data on drug use be given to high
school students when they meet for various school organizations. Which of the
following best describes why the nurse would reject this suggestion?
a. This method of data collection would result in classification bias.
b. This method of data collection would result in confounding bias.
c. This method of data collection would result in personal bias.
d. This method of data collection would result in selection bias.
ANS: D
Any study is subject to bias resulting from selective choice. There may be a difference
between students who choose to belong to an organization and students who choose
not to join an organization. Selection bias occurs when selection procedures are not
representative of the population as a whole. In this instance, the goal is to determine
drug use of all students at the school. If only students who join school organizations
are selected, those who do not join organizations will not be represented.
30. A nurse is investigating a bacterial illness that has caused a health problem in the
community. Only some of the people exposed to the bacteria have become ill. Which
of the following factors best explains why this would have happened?
a. Chemical agent factors
b. Environmental factors
c. Host factors
d. Physical agent factors
ANS: C
The epidemiologic triangle includes the agent, host, and environment. The bacteria
were the agent so chemical and physical agents are not relevant. The environment was
apparently the same for everyone, since all were exposed to the bacteria. Therefore,
only differences in host factors can explain why some became ill and some were able
to fight off the bacterial infestation.
MULTIPLE RESPONSE
1. Which of the following explains why contagious infections are becoming a central
focus of public health? (Select all that apply.)
a. Americans are fearful of terrorists using biological agents.
b. Awareness of human susceptibility to animal diseases has been publicized.
c. Drug-resistant strains of old diseases have evolved.
d. Media coverage exaggerates the dangers of exposure to crowds.
ANS: A, C
New infectious diseases and new forms of old diseases, such as drug-resistant strains
of TB, have emphasized the dangers of infectious diseases. Potential threats from
terrorist use of infectious agents have also emphasized infectious diseases.
2. A nurse is concerned about the high incidence of STDs in the community college
population and sets up a special STD screening. Which of the following groups of
students would be encouraged to attend? (Select all that apply.)
a. Sexually active students currently receiving treatment for an STD
b. Sexually active students who had been screened the previous year
c. Students who claimed to not be sexually active and do not plan to become sexually activ
d. Students who are sexually active but never go all the way
ANS: B, C, D
Those already diagnosed with the problem are not at risk, because they already have
the condition and are no longer at risk for developing it.
3. A nurse is planning to host a health screening at a large urban mall. Which of the
following variables will help the nurse determine which screenings should be
included? (Select all that apply.)
a. Adequate space for persons to lie down after testing until side effects are reduced
b. Health problems for which the specific population is at risk
c. Whether adequate privacy can be obtained for the invasive or embarrassing procedures
d. Whether health care providers are available to follow up on any positive screening result
ANS: B, D
The screening tests should be reliable, valid, fast, and inexpensive. They should have
few side effects, be minimally invasive, and be capable of detecting enough new cases
to warrant the effort and expense. Results should be known immediately. No tests
should be used that have negative side effects, are invasive, or cause embarrassment.
Ethically, nurses should not screen for any problem unless they can refer those with
positive results to a source for follow-up testing and treatment.
4. A nurse believes a new mouth care procedure (MCP) is causing more mouth
problems than it is helping to avoid. Which of the following must be present for the
nurse to go to administration with confidence that the new mouth care procedure
(MCP) is causing problems? (Select all that apply.)
a. A plausible explanation of how the new MCP could cause harm
b. A strong feeling that the MCP is the cause
c. Consistently seeing mouth inflammation in many of the patients who have received the M
Documentation from patient records that mouth inflammation in clients did not occur un
d. procedure was implemented
ANS: A, C, D
Strength of association is suggested by the fact that patients who did not receive the
MCP and patients seen on the floor before the new MCP did not have problems,
whereas patients who received the new MCP are having problems. Seeing the
problems in many of the patients suggests a consistency. The fact that those who had
the procedure more often have worse problems suggests a dose-response relationship.
A plausible explanation of how the new procedure could cause harm enhances the
biological risk. Feelings alone are not convincing. A study should be set up to confirm
or dispute the nurses hypothesis. Although one would hope that previous testing
would have been done before the product was released to market, the product could be
safe for healthy persons but a risky process for those with compromised immunity or
those who are under stress.
Chapter 10: Evidence-Based Practice My Nursing Test

Banks
Chapter 10: Evidence-Based Practice
Test Bank
MULTIPLE CHOICE
1. A nurse executive is implementing evidence-based practice at a community nursing
center that serves a large Cuban immigrant population. Which of the following actions
would be the most helpful for the nurse?
a. Review clinical policies with cultural competency experts from the local university.
b. Conduct weekly staff meetings to discuss which methods work best when helping immig
c. Invite Cuban immigrants from the community to serve on the centers advisory board.
d. Send personnel to conferences and seminars that focus on treating Hispanic immigrants.
ANS: C
Although all of these options are good, to determine whether practice is serving the
needs of the population, the nurse will need to consult the population served. This
means that evidence should be applied with input from the community. For example,
decisions related to the services to be offered in a nurse-managed clinic should be
made with input from the clinics advisory board, which should include community
leaders and consumers of the clinics services. Cuban immigrant needs may not be the
same as those of Hispanic immigrants from other places such as Mexico or Spain.
2. A community health nurse is determining the best way to address an outbreak of a
new infectious disease using evidence-based practice. Which of the following actions
would the nurse most likely take?
a. Review policies and procedures
b. Review outcomes of clinical trials
c. Review several nursing textbooks
d. Review reputable sites on the Internet
ANS: B
Research findings, knowledge from basic science, clinical knowledge, and expert
opinion should be considered sources of evidence for EBP. The problem with nursing
textbooks is that many are not grounded in evidence-based practice, because the
concept is relatively new to the United States (as mentioned in the section of the
chapter on historical perspectives of EBP). Scanning the Internet for ideas is helpful
only if evidence-based practice sites are accessed, and most Internet sites are not EBP
sites.
DIF: Cognitive Level: Apply (Application) REF: p. 176, 181
3. A nursing administrator wants to develop a work environment conducive to the
implementation of evidence-based practice (EBP). Which of the following actions
would best achieve this goal?
a. Conducting market research to determine customer satisfaction with EBP
b. Eliciting opinions from nurses on how EBP will affect workload
c. Purchasing computers and Internet access for use by employees
d. Sending staff to conferences related to incorporation of EBP into practice
ANS: C
A lack of computers and Internet access can create a barrier to implementation of EBP
in community-based nursing agencies. If these are provided, nurses can quickly access
current evidence-based findings and recommendations.
4. A busy school health nurse concerned over the rising incidence of obesity wants to
implement evidence-based practice (EBP) but faces barriers because of time
constraints. Which of the following actions should the nurse take first?
Identify students who are obese so that they may be closely monitored for weight control
a. failure.
Evaluate best practices to determine those that have the highest success rates for weight c
b. children.
c. Schedule physician appointments for obese children.
d. Develop an obesity management program for children whose body mass index exceeds n
ANS: B
The first step of the seven-step EBP process is step zero, which involves a curiosity
about the interventions that are being applied; this is not described in any of the topic
descriptors. Step one requires asking questions in a PICOT format; this is not
described in any of the topic descriptors. Step two involves searching for the best
evidence to answer the question. This is done through evaluating best practices.
5. The nurse has been reading everything she can find on a particular clinical problem,
using both the closest medical library and the Internet. Which of the following would
be the most helpful source?
a. A journal with a whole issue devoted to research on that clinical problem
b. A randomized controlled clinical trial related to that clinical problem
c. A researcher who has built a career on studying that clinical problem
d. A systematic review related to the clinical problem
ANS: D
A systematic review is an approach to identifying, appraising, and synthesizing
research evidence to evaluate and interpret all available research that is relevant to a
particular research question. Systematic reviews can be accessed from most databases.
Systematic reviews require more rigor and contain less opinion of the author than
typical reviews of the literature.
6. A school health nurse plans to use evidence-based practice (EBP) to guide the
development of health education programs most likely to increase retention of
learning in elementary schoolchildren. Which of the following would be the best way
to use EBP in this situation?
a. Ask other school health nurses what they included in their own education programs.
b. Compare and contrast randomized clinical trials related to learning in elementary schoolc
c. Develop a series of games to accompany the programs developed to promote health.
d. Seek out and examine health education programs for elementary school children on the I
ANS: B
Randomized clinical trials are the gold standard of evidence gathering in EBP.
7. After finding several studies related to the clinical problem, a nurse knows the
studies must be evaluated. Which of the following characteristics should be present in
the literature?
a. Federally supported multiagency clinical studies
b. Multiple high-quality studies with large sample sizes and consistent findings
c. Research studies done by multidisciplinary teams in multiple settings
d. Controlled clinical trials
ANS: B
The Agency for Healthcare Research and Quality (AHRQ) reviewed 40 systems used
to evaluate the quality of studies and strength of evidence. The report identified three
domains for evaluating systems that grade the strength of evidence: quality, quantity,
and consistency. The quality of a study refers to the extent to which bias is minimized.
Quantity refers to the number of studies, the magnitude of the effect, and the sample
size. Consistency refers to studies that have similar findings, using similar and
different study designs.
8. A nurse is familiar with evidence-based practice (EBP) and wants to implement it
into the care of clients. Which of the following would present the biggest challenge?
a. Assessing ones current practice and accessing evidence-based resources
b. Convincing administration that EBP is beneficial
c. Distinguishing EBP from practice based on old standards
d. Showing clients that EBP will improve their health outcomes
ANS: A
The first step toward implementing evidence-based practice in nursing is recognizing
the current status of ones own practice and believing that care based on the best
evidence will lead to improved client outcomes. The challenge for the clinician is how
to access the evidence and integrate it into practice, thus moving beyond practice
based solely on experience, tradition, or ritual.
9. Which of the following groups is pressuring clinicians the most to use evidence-
based practice (EBP)?
a. Administrators
b. Insurance companies
c. Nurses
d. Physicians
ANS: B
Much of the pressure to use evidence-based practice comes from third-party payers
and is a response to the need to contain costs and reduce legal liability.
10. A nurse implements an education program that incorporates computer games to
reinforce learning for a group of older adults. Although the research demonstrates
evidence of improved retention of this information, the nurse experiences exactly the
opposite with this group. Which of the following is the most likely cause of such poor
outcomes?
a. Failure to consider client and setting differences
b. Inadequate incorporation of evidence into practice
c. Inferior quality of the available research evidence
d. Lack of skills when evaluating the evidence
ANS: A
EBP cannot be applied as a universal remedy without attention to client differences.
When EBP is applied at the community level, best evidence may point to a solution
that is not sensitive to cultural issues and distinctions and thus may not be acceptable
to the community. For example, computer games may be excellent for younger groups
but are often poorly suited for older Americans who may face challenges with
learning new technology.
11. A health care provider is concerned about the high number of clients with type 2
diabetes mellitus who have poor glucose control. What would be the best reference for
the provider to implement evidence-based practice (EBP) in the management of this
problem?
a. Published protocols
b. Current research findings
c. Opinions of colleagues
d. Nursing journals
ANS: B
EBP in community-oriented nursing challenges nurses to integrate outcomes of the
best evidence into their clinical practice. Current research findings will explicate
evidence of most successful interventions. (Randomized clinical trials are the gold
standard of research for EBP.) Protocols and opinions often reflect tradition rather
than the most current scientific evidence. Although many nursing journals are peer
reviewed, many are not and, even if peer reviewed, many are not research based or
focused on scientific evidence. Similarly, information from the Internet may or may
not be reliable, because the goal of many websites is to sell products rather than to
serve as an unbiased source. Determining when the website was last updated would
also be helpful in evaluating the sites usefulness.
12. Staff members have agreed to implement evidence-based practice; they have
chosen a specific problem and searched the literature. The group has selected the
interventions that seem the easiest to implement. Which of the following actions
would the staff take next?
a. Assess the quality of the evidence in the literature.
b. Decide how best to orient the staff and community to the proposed changes.
c. Eliminate all nursing interventions that are not evidence based.
d. Choose another specific problem for the next literature search.
ANS: A
After the group has chosen the topic and evaluated the literature for approaches that
seem feasible, specific interventions are chosen. The quality of the evidence must be
assessed before recommending specific changes or writing a protocol to resolve the
problem. Grading the strength of evidence or determining the quality, quantity, and
consistency of research studies must be done before making recommendations for
practice.
13. A school nurse is developing a primary prevention strategy for school-aged
children. Which of the following interventions would the nurse most likely
implement?
a. Developing individualized exercise programs for overweight children
b. Drafting policy for increases in noncompetitive physical activity programs
c. Monitoring body mass index in children to identify elevations before they become difficu
d. Notifying parents and/or guardians of their childs height-weight scale in comparison with
ANS: B
At the primary prevention level, campaigns to support regular exercise, greater
emphasis on school-based physical education programs, and environmental and policy
initiatives to create or enhance places for physical activity in communities can make
significant contributions to improving the lifestyle of sedentary children. Exercise
programs are an example of tertiary prevention. Monitoring BMI in children is an
example of secondary prevention. Notifying parents of their childrens height-weight
scale increases family awareness but does not meet the definition of a preventive
measure.
14. Which of the following is the best way to increase the number of persons who
come to their screening test appointments?
a. Reminding clients via telephone, e-mail, or mail
b. Emphasizing long life and happy family when conditions are caught early and treated suc
c. Pointing out how inexpensive and convenient screening tests are
d. Stressing the dangerousness of the condition if not caught early
ANS: A
Client reminders and recalls via mail, telephone, or e-mailor a combination of these
strategiesare effective in increasing compliance with screening activities such as those
for colorectal and breast cancer.
15. A nurse manager wants to facilitate incorporation of evidence-based practice
(EBP) in the clinical setting. Which of the following would be the best strategy to
accomplish this goal?
a. Eliminate all protocols and standards that are not evidence based
b. Encourage group reflection on the ideals and expectations of nursing care
c. Refer agency nurses to Internet sources of research findings
d. Support nurses using practice-oriented research findings in decision making
ANS: D
EBP demands changes. It requires incorporating more practice-oriented research and
more collaboration between clinicians and researchers. Emphasis should be on
decision making using the varied sources of evidence. The environment and climate
must be supportive in order to implement EBP.
MULTIPLE RESPONSE
1. A nurse has decided to increase the evidence base of current nursing practice in an
agency. Which of the following describes a barrier that could be encountered by the
nurse? (Select all that apply.)
a. Colleagues who dont know how to search the literature or critique research
b. Dedication to the history and tradition of the agency
c. Little or no research published in the clinical area of concern
d. Several meta-analyses in the literature with inconsistent results
ANS: A, C
Barriers to evidence-based practice exist when the following are limited or lacking:
time, access to journal articles, search skills, critical appraisal skills, and an
understanding of research terminology. Other barriers include miscommunication
about the process; inferior or unavailable research or other evidence; unwillingness of
organizations to fund research or make decisions based on evidence; and concern that
evidence-based practice will decrease emphasis on individual client needs or the
nurses clinical decisions.
Chapter 13: Case Management My Nursing Test Banks

Chapter 13: Case Management
Test Bank
MULTIPLE CHOICE
1. Which of the following best describes case management?
a. A tool of health maintenance organizations
b. Targeted toward a specific segment of the population
c. Implemented with individual clients
d. Used to monitor the health status, resources, and outcomes for an aggregate
ANS: C
Case management, in contrast to the definition of care management, involves
activities implemented with individual clients in the system.
2. Which of the following best describes why planning care for an individual is so
challenging in todays health care system?
a. Because todays clients have high expectations of the health care system
b. Because multiple providers, payers, and settings have to be coordinated
c. Because of the new high technology constantly being created and used for client treatme
d. Because so many different health care providers are in the acute care setting today
ANS: B
Case management practice is complex because of the coordinating activities of
multiple providers, payers, and settings throughout a clients continuum of care.
3. Which of the following best describes the primary problem that can result from
health care today being given by many different care providers?
a. Clients are not sure which provider to see first.
b. Health care providers have to make referrals to other providers.
c. Clients sometimes are not sure who their primary provider is.
d. Overuse, underuse, or gaps in care may result.
ANS: D
A particularly challenging problem is the fragmenting of services, which can result in
overuse, underuse, gaps in care, and miscommunication.
4. Which of the following public health nurse applicants is the least qualified for a
position of case manager in a rural county?
a. A 24-year-old who has a masters degree in public health
b. A 34-year-old who will be moving from a large city
c. A 44-year-old who was born and raised in the community
d. A 54-year-old who, until recently, was a member of the communitys school board
ANS: B
Case management competency requires the following knowledge and skills:
knowledge of community resources and financing methods; written and oral
communication and documentation skills; negotiation and conflict-resolution skills;
critical-thinking processes to identify and prioritize problems from the provider and
client views; and identification of best resources for the desired outcomes. Because
communities are unique, someone new to the area will lack knowledge of community
resources and financing methods. There is nothing in the descriptions of the other
public health nurses that indicates a lack of current knowledge or skills.
5. Which of the following best explains why every client doesnt receive care from a
case manager?
a. Case management time is demanding; thus it is restricted to complex cases.
b. Many health agencies do not employ case managers.
c. Most clients would not benefit from case management.
d. Most nurses do not know how to function as case managers.
ANS: A
Case management can be labor intensive, time consuming, and costly. Because of the
increasing number of clients with complex problems in nurses caseloads, the intensity
and duration of activities required to support the case management function may soon
exceed the demands that the direct caregiver can meet.
6. The nurse suggests use of telehealth to assess how a client is progressing. Which of
the following resources must be available for continuing care to be implemented?
a. A physician who is willing to use wireless prescriptions and plans of care
b. Family permission for the nurse to make home visits
c. Long-distance telephone service or a computer with Internet access
d. Willingness of the caregiver to drive the client to the nearest clinic
ANS: C
Telehealth is an organized health care delivery approach to triage and to provide
advice, counseling, and referral for a clients health problem using phones or
computers with cameras. The client is usually in the home, and the nurse is at an
office, health care facility, or phone bank location.
7. A nurse is using a case management plan to maximize patient care outcomes.
Which of the following describes an important consideration that should be made by
the nurse?
a. Case management plans should be used only by nurses to manage care.
b. Case management plans should be individualized for each client.
c. Case managements plans provide additional expense to the client and family.
d. Case management plans focus on the natural progression of the disease.
ANS: B
Adaptation of the case management care plan to each clients characteristics is a
crucial skill for standardizing the process and outcome of care. It links multiple
provider interventions to client responses and offers reasonable predictions to clients
about health outcomes. Institutions report that sharing case management plans with
clients empowers the clients to assume responsibility for monitoring and adhering to
the plan of care.
8. A client spends a great deal of his time on the Internet or reading articles related to
diabetes and its long-term effects. One day the client asks why the nurse has not
suggested a life care plan. Which of the following would be the best response by the
nurse?
a. Life care plans are only for young persons who are newly diagnosed.
b. Life care plans are primarily used to determine long-term financial needs for legal reason
You are receiving appropriate care for your diabetes without serious side effects, so a life
c. really appropriate.
d. I was waiting for you to express interest in having a life care plan.
ANS: C
Life care plans are typically used for clients experiencing catastrophic illness or
adverse events resulting from professional malpractice. Others who benefit from life
care planning are those who have sustained injury when younger and whose care
requirements have changed as a result of aging.
9. Which of the following Medicaid clients would most likely receive case
management?
a. An elderly person
b. A person receiving rehabilitation following an injury
c. A person who has a high-cost chronic disease
d. A person with acute illness
ANS: C
Some states, through their Medicaid programs, are developing disease management
programs for high-cost chronic diseases among their populations, such as asthma and
diabetes.
10. Which of the following best describes the goal or priority of the nurse advocate?
a. To gain organizational and governmental support for the promotion of nursing objectives
b. To improve community service needs identified by research findings
c. To integrate evidence-based practice guidelines in the provision of community nursing se
d. To promote the clients rights and self-determination
ANS: D
In todays practice, the nurse advocate makes the clients rights the priority. Thus, the
goal of advocacy is to promote self-determination in a constituency or client group.
11. A case manager advocates for a client by helping an insurer understand the clients
needs and desires and by helping the client understand programs and benefits offered
by the insurer. What role is the nurse?
a. Arbitrator
b. Counselor
c. Mediator
d. Negotiator
ANS: D
Negotiating is a strategic process used to move conflicting parties toward an outcome.
Parties must see the possibility of achieving an agreement and the costs of not
achieving an agreement. Mediating is the process of assisting parties to understand
each others concerns and to determine their conclusion of the issues. The mediator has
no authority to decide, whereas an arbitrator is legally allowed to suggest an
appropriate outcome.
DIF: Cognitive Level: Apply (Application) REF: pp. 236, 242
12. A nurse reviews with the client what the client can expect during the next 3 days,
as well as how the client should expect to feel each of those days. The client laughs
and says, Youve got my care all mapped out. Which of the following tools is the nurse
using to determine what will happen when?
a. Care planning
b. Critical pathway
c. Demand management
d. Use management
ANS: B
Critical paths are tools that name activities to be used in a timely sequence to achieve
desired outcomes for care with measureable outcomes. Use management attempts to
redirect care and monitors the appropriate use of provider care and treatment services.
Demand management seeks to control use by providing clients with correct
information to empower themselves to make healthy choices, to use healthy and
health-seeking behaviors to improve their health status, and to make fewer demands
on the health care system.
13. A nurse, client, family, and other care providers meet to discuss what will be the
best approach to use to continue care. Which of the following best describes why the
nurse suggests changing the goal from obtaining appropriate long-term care placement
to ensuring that the clients convalescence is beneficial and safe?
a. To consider all possible consequences of long-term care placement
b. To encourage the group to review the client outcomes in the different settings
c. To expand the goal so that different solutions can be generated and considered
d. To help the group focus on the critical aspects the clients family considered most importa
ANS: C
One problem with seeking solutions is stating the problem in such a narrow fashion
that only one possible outcome is acceptable. To avoid this, the nurse may restate the
problem. By expanding the goal, different solutions can be generated. Clients and
advocates may feel limited in their options if they generate solutions before
completely analyzing the problems, needs, desires, and consequences.
14. The case manager explains to two disagreeing parties that coming to an agreement
will save personnel costs for both of them. Which of the following terms best
describes this action?
a. Assertiveness
b. Collaboration
c. Cooperation
d. Compromising
ANS: B
In collaborating, an individual attempts to work with others toward solutions that
satisfy the needs of both parties.
15. A nurse is using the problem identification phase of the case management process.
To which of the following phases of the nursing process does this correspond?
a. Assessment phase
b. Diagnosis phase
c. Planning phase
d. Implementation phase
ANS: B
The diagnosis phase of the nursing process is analogous to identification of the
problem in the case management process. It is during this phase that the case manager
determines conclusions based on the assessment.
16. A nurse is completing a case management advocacy activity which corresponds to
the implementation phase of the nursing process. Which of the following activities
would the nurse most likely use?
a. Asking the client what is most important
b. Seeking appropriate referrals for the client
c. Assuring the client that his wishes will be supported
d. Determining the order in which actions will occur
ANS: C
Assuring the client is a component of the advocacy process that corresponds to the
implementation phase. Asking the client what is most important is a way to illuminate
values, which occurs in the assessment phase. Seeking appropriate referrals for the
client occurs in the assessment phase. Determining the order in which actions will
occur is a prioritization of action, which occurs in the planning phase.
17. A case manager implements a primary prevention activity. Which of the following
actions would the nurse most likely complete?
a. Advocating for the client whose values conflict with those of the medical service provide
b. Collaborating between nursing and occupational health personnel
c. Educating a group regarding community services that are available if ever needed
d. Resolving conflict between a primary care clinic and a tertiary health care facility
ANS: C
Primary prevention involves the use of the information exchange process to increase
the clients understanding of how to use the health care system. Primary prevention
occurs at a point before illness or problem exists. In the remaining options, the client
has a problem for which interventions have been employed.
MULTIPLE RESPONSE
1. Which of the following is the primary goal of case management? (Select all that
apply.)
a. To ensure that care coordination occurs across the continuum
b. To emphasize evidence-based clinical decision making
c. To manage resource use and control expenses
d. To stress the advantages and benefits of community-based care
ANS: A, B, C
The goals in case management are to reduce institutional care while maintaining
quality processes and satisfactory outcomes; manage resource use through protocols,
evidence-based decision making, guideline use, and disease-management programs;
and control expenses by managing care processes and outcomes.
2. A case manager is concerned about his exposure to possible lawsuits. Which of the
following are appropriate actions to take to minimize this risk? (Select all that apply.)
a. Assure clients they can appeal any decision.
b. Carefully document client involvement and reasons for decisions.
c. Share client information with the other involved providers and agencies.
d. Confirm credentials and capabilities of providers or agencies to give care.
ANS: A, B, D
Elements that reduce risk exposure include clear documentation of the extent of
participation in decision making and reasons for decisions; records demonstrating
accurate and complete information on interactions and outcomes; use of reasonable
care in selecting referral sourceswhich may include confirming credentials and
capabilities of providers and agencies; maintaining good communication with clients;
and informing clients of their rights of appeal. In compliance with HIPAA, no nurse is
allowed to share information with others without written consent of the client.
Chapter 18: Family Development and Family Nursing

Assessment My Nursing Test Banks
Chapter 18: Family Development and Family Nursing Assessment
Test Bank
MULTIPLE CHOICE
1. The following people enter the health clinic together: an unmarried man and his
year-old son, an unmarried woman with a year-old daughter, and the mans married
brother, who is separated from his wife. During the assessment it is determined that
both men work and contribute to the household, where all of them live. Which of the
following best describes the family?
The group consists of three families: the man and his son, the woman and her daughter, a
a. who is married even though he and his wife are separated.
There are two families involved: first, the unmarried man and woman and their two child
b. the brother, who is married even though he and his wife are separated.
There is no family here, only three adults sharing resources between themselves and two
c. related children.
d. The family includes whoever the adults state are family members.
ANS: D
Nurses working with families should ask an adult member to identify all those
considered to be family members and then include those members in health care
planning. A family may range from the traditional nuclear model with extended
family to such postmodern family structures as single-parent families, stepfamilies,
same-gender families, and families consisting of friends.
2. The nurse in community health needs to conduct a family assessment within a
commune but is uncertain how to proceed because family lines appear blurred. The
best way to determine the family of a mother and her child is to ask the woman which
of the following questions?
a. How many children do you have, and who is the father of each?
b. Is there a register of families who are members of this commune?
c. Tell me about your significant other.
d. Who are the members of your and your childs family?
ANS: D
The members of a family are self-defined. The family includes whoever the woman
says are family members. The nurse should include all those members in health care
planning.
3. In taking a family history, the nurse in community health finds that this is the
second marriage for the previously divorced parents and that the male partner is the
stepparent to the oldest child. For which of the following aspects of the family
assessment is data being gathered?
a. Dynamics
b. Function
c. Structure
d. System
ANS: C
Family structure refers to the characteristics and demographics (gender, age, number)
of individual members who make up the family. Structure defines the roles and the
positions of family members.
4. Which of the following statements best explains why family functions and
structures create unique challenges in family nursing?
a. Function and structure change over time.
b. Function and structure do not apply to all family units.
c. Some clients do not have families.
d. Traditional families are rare in society.
ANS: A
The functions that families serve evolve and change over time. Some become more
important and others less so. Family structures also change over time. The great speed
with which changes in family structure, values, and relationships are occurring makes
working with families at the beginning of the twenty-first century exciting and
challenging.
5. A nurse is working with a family who is confronting major challenges to their
health. Which of the following approaches would be most helpful for the nurse to use?
a. Allowing the family to be noncompliant
b. Building on the familys strengths and resilience
c. Labeling the family as resistant
d. Recognizing that the family is dysfunctional
ANS: B
The labels of dysfunctional, noncompliant, resistant, or unmotivated all denote
families who are not functioning well; however, such labels do not create an
environment conducive for positive family change and intervention and should not be
used. Families are neither all good nor all bad; families have both strengths and
difficulties and have seeds of resilience. Recognizing the familys strengths gives the
nurse assets on which to draw in planning care.
6. The nurse is told that a healthy, functional family consisting of a 25-year-old man
and a 24-year-old woman, who are expecting their first child, would appreciate a
nurse coming to their apartment for anticipatory guidance in preparing themselves and
their apartment for the baby. Based on that statement, which of the following
assumptions can the nurse safely make about the family?
a. The family is lacking a strong support system.
b. The familys basic needs are being met.
c. The couples in-laws are unavailable to share their expertise about child care.
d. The married couple is excited about their first baby.
ANS: B
In functional, healthy, or resilient families, the basic survival needs are met. Healthy
families exist based on attachment and affection. There is nothing in the example to
suggest that they are married, that their income is low, or that they lack other
resources or support systems.
7. A nurse focuses on the care of the individual while viewing the clients family as a
background resource or possible stressor. Which of the following conceptualizations
of family does this nurses view represent?
a. Client
b. Component of society
c. Context
d. System
ANS: C
Family as the context, or structure, has a traditional focus that places the individual
first and the family second. In the family as context concept, the family serves as
either a resource or a stressor to individual health and illness.
8. A nurse asks a family member, What has changed between you and your spouse
since your childs head injury? Which of the following focuses of the family is the
nurse assessing?
a. The context
b. The client
c. A system
d. A component of society
ANS: C
When the focus is on the family as a system, the family is viewed as an interactional
system in which the whole is more than the sum of its parts. The approach
simultaneously focuses on individual members and the family as a whole at the same
time. The interactions between family members are the target for nursing
interventions.
9. Which of the following theories views the family as a whole with boundaries that
are affected by the environment?
a. Family developmental theory
b. Structural-functional theory
c. Family role theory
d. Family systems theory
ANS: D
The theory that views the family as a whole with boundaries that are affected by the
environment is the family systems theory.
10. A nurse organizes care for a family by focusing on the common tasks of family life
and considering a longitudinal view of the family life cycle. Which theory is being
applied?
a. Family systems
b. Structural-functional
c. Family developmental
d. Interactionist
ANS: C
The family developmental theory focuses on common tasks of family life and
provides a longitudinal view of the family life cycle.
11. A new mother is a full-time college student who lives with her parents, because the
babys father has been imprisoned related to theft and drug abuse. The infants
grandmother, although also employed, cares for the child while the young mother
attends classes. Which of the following theoretical frameworks would be most helpful
to the nurse when assessing this familys needs?
a. Developmental
b. Interactional
c. Structure-function
d. Systems
ANS: A
Developmental theory explains and predicts the changes that occur to humans or
groups over time. Achievement of family developmental tasks helps individual
members accomplish their tasks. In this case the new mother has tasks, whereas her
parents have temporarily interrupted their progress in response to their daughters (and
grandchilds) needs.
12. A nurse considers how the environment outside of the family influences the
development of a child when planning care for a family. Which of the following
theories is being used by the nurse?
a. Bioecological systems theory
b. Family systems approach
c. Family developmental theory
d. Interactionist theory
ANS: A
The bioecological systems theory describes how environments and systems outside of
the family influence the development of a child over time.
13. A nurse is in the termination phase of the nurse-family relationship. Which of the
following strategies would the nurse most likely implement?
a. Increasing sessions with the nurse
b. Making referrals when appropriate
c. Providing a formative evaluation of the relationship
d. Refusing additional communication with the family
ANS: B
It also includes decreasing contact with the nurse, extending invitations to the family
for follow-up, and a summative evaluation meeting for formal closure.
14. A nurse is making an appointment with a family for a nursing visit. Which of the
following describes a potential barrier the nurse may encounter?
a. The assessment cannot be done unless the extended family is present.
b. It may be difficult to find a convenient time for all family members to be present.
c. Nurses have limited time to do home visits.
d. Families are often scattered over a large area, making access difficult.
ANS: B
It is important to encourage all family members to attend the meeting. However, it can
be difficult to find a convenient time for all family members to attend. Many times
late afternoon or evening appointments are necessary to accommodate the needs of the
family.
15. Which of the following factors must be considered before deciding on an
appropriate plan of action?
a. Family agrees to the nurses plan.
b. Family is capable of the required actions.
c. Family will learn better coping skills from the nurses plan.
d. Nurse has informed family how to complete the required actions.
ANS: B
Family theorists stress that any intervention plan must be developed in collaboration
with the family, using and enhancing family strengths and increasing independence of
family members. The plan cannot be the nurses choice alone. Further, the plan must
be within the information and skill level of the family, and the family must be
committed to the plan and have adequate resources available to implement the plan.
16. Which of the following terms refers to government actions that have a direct or
indirect effect on families?
a. Family funding
b. Family legislation
c. Family planning
d. Family policy
ANS: D
Government actions that have a direct or indirect effect on families are called family
policy.
17. A nurse is using the provisions of the Family Medical Leave legislation. Which of
the following actions is the nurse most likely to take?
a. Resigning from employment, but retaining health insurance
b. Sharing family information with colleagues
c. Providing Medicaid to a family who cannot afford health insurance
d. Taking a defined time off of work for family events without fear of job loss
ANS: D
The Family Medical Leave legislation allows for a family member to take a defined
amount of leave for family events, such as births and deaths, without fear of losing his
or her job.
18. A nurse is conducting a family assessment. Which of the following behaviors
would the nurse recognize as suggestive of a family with problems?
a. Before eating, the family prayed, expressing gratitude for their blessings.
b. During family play, jokes and laughter were heard.
c. Each person had a private room with a door for alone time.
d. Most of the conversation was between the father and the eldest daughter.
ANS: D
Evidence of healthy families can be seen in a variety of observations, including open
communication among all members, mutual play with humor, balanced interactions
among all members, expressions of a religious core or other value system, and each
member being allowed some privacy.
19. The hospital-based nurse has worked with a client at some length regarding
appropriate diet. Based on the family systems theory, which of the following will
most likely occur when the client returns home?
The family member who prepares food will probably suggest the newly discharged mem
a. everyone in the family enjoys.
The family member who prepares food will probably try to modify family meals without
b. for the family as a whole.
The family member who prepares food will probably prepare meals based on the diet pla
c. family.
The family member who prepares food will probably prepare special meals for the newly
d. member.
ANS: B
Family systems typically maintain stable patterns, although families do change
constantly in response to stresses. Change in one part of the family affects the total
system. It is not realistic to expect the whole family to change eating patterns
immediately based on the needs of one family member. However, if family members
are supportive, they will want to try to help the ill member. Because of the rapid
change and stress in American society, preparing different sets of meals is not very
realistic. Therefore, the member who prepares the meals will probably compromise by
trying to meet the ill members needs without making drastic changes in the overall
eating patterns of the family.
20. A nurse has just met a family and is being doing their family assessment. Which of
the following actions should the nurse take before engaging in self-disclosure?
a. Confirm the reason for the assessment.
b. Demonstrate culture awareness.
c. Take time to build trust.
d. Understand the family dynamics.
ANS: C
Assessment is interactive. As you are evaluating families, they are evaluating you.
Too much disclosure during the early contacts between the family and nurse may
scare the family away. Slow the process down, and take time to build trust.
21. A nurse is completing a tertiary prevention activity in a predominantly poor
community, where eating clay (pica) is a common practice. Which of the following
actions would the nurse most likely take?
Assist those who eat large amounts of clay to obtain food stamps after explaining that cla
a. filling, does not provide necessary nutrients.
Initiate early intervention in the school system through education programs designed to f
b. food choices.
Provide laboratory testing and physical assessments to assess for nutritional deficits resu
c. intake.
d. Survey families in the community to determine whether they eat clay and how much clay
ANS: A
Tertiary prevention is undertaken to prevent additional health problems when a
problem has occurred. Early intervention in the school system is an example of
primary prevention. Lab testing and surveying families are screening activities to
determine whether a problem is present and to catch it in the early phases; such
screening activities are representative of secondary prevention.
MULTIPLE RESPONSE
1. A nurse requests to meet a newly referred family in their home. Which of the
following best explains the rationale for this request? (Select all that apply.)
a. The nurse can assess the family environment.
b. The family will feel more comfortable.
c. Families typically welcome others into their home.
d. More family members can typically be involved.
ANS: A, B, D
Advantages to meeting in the family home include the fact that it allows the nurse to
see the everyday family environment and observe typical family interactions. Also,
more family members can be present, and families are often more comfortable in their
own environment. However, a disadvantage to meeting in the familys home is that
family members may view this as an intrusion into the only place they feel safe from
outside observation; thus, the nurse must be highly skilled in guiding the interactions
and setting limits.
2. In comparison with traditional norms, which family functions have become
increasingly important in modern American society? (Select all that apply.)
a. Conferring appropriate social status
b. Educating the younger members
c. Ensuring physical and mental health
d. Fostering interpersonal relationships and support
ANS: C, D
Historically, families have had several functions including financial survival,
reproduction, protection from hostile forces, and enculturation, including religious
faith, education, conferring social status. Today, however, the more important
functions are fostering relationships (emphasizing how people get along and their
level of satisfaction) and promoting physical and mental health.
3. Which of the following must be firmly established before beginning a family
assessment? (Select all that apply.)
a. Why the data are needed
b. How best to interview each individual in the family
c. The most convenient time for you to visit the family
d. The rationale or purpose of the visit
ANS: A, C, D
Assessment of families requires an organized plan, including the purpose of seeing the
family, which family members can be present, what you are assessing and why, and
how will you obtain the necessary data. It can be assumed that the nurse would
already know agency policies. It is more informative to interview the family as a
whole so that you can observe family interaction (rather than focusing on interviewing
each individual). Therefore, the preferred time to visit is when most family members
will be available. Similarly, it is more informative to see the family in their home
setting than to establish a different site for the visit.
Chapter 21: Vulnerability and Vulnerable Populations: An

Overview My Nursing Test Banks
Chapter 21: Vulnerability and Vulnerable Populations: An Overview
Test Bank
MULTIPLE CHOICE
1. Which of the following is the primary cause of vulnerability to health problems?
a. Breakdown of family structures
b. Poverty
c. Prejudice
d. Social isolation
ANS: B
People with lower incomes and less education tend to be at higher risk for health
problems. Poverty is a primary cause of vulnerability.
2. Which of the following terms is used to describe aggregates who are at high risk for
having poor health outcomes because of limited resources?
a. Disadvantaged families
b. Multi-problem families
c. Resilient populations
d. Vulnerable populations
ANS: D
Vulnerable populations are groups (aggregates) with an increased risk to develop
adverse health outcomes. Families are a subgroup of populations.
3. A community health nurse would like to implement an intervention to increase
lasting resilience among new immigrants. Which of the following actions should be
taken by the nurse?
a. Direct clients to English-as-second-language courses.
b. Give immigrant clients money to help them get settled.
c. Identify areas in the city where housing is less expensive.
d. Solicit donations for food, clothing, and other needs.
ANS: A
Vulnerability can be reversed by obtaining resources to increase resilience. Although
money, food, and clothing meet needs for the short term, they do not help the
immigrant develop the power and control to improve health risks over the long term
or contribute to lasting resilience. Learning the basic language of the country of
residence will give immigrants the ability to communicate and navigate through
systems and thus remove barriers that promote disenfranchisement and disadvantaged
status.
4. Which of the following factors predisposes many migrant farmworkers to
disenfranchisement?
a. Being a minority group member
b. Inability to attend religious services because of work requirements
c. Previous experiences of physical abuse
d. Short length of time in the community
ANS: D
Disenfranchisement refers to a feeling of separation from mainstream society. The
person does not seem to have an emotional connection with any group in particular or
the larger society. For migrant workers who are frequently moving, the short length of
time they stay in the community does not allow for the development of social ties.
Being a minority group member would not by itself cause disenfranchisement if the
minority group member lived in a community with persons from similar ethnic and
cultural backgrounds.
5. A large financial grant was being offered to whichever health facility wanted to
accept the responsibility for giving care to local vulnerable populations. Which of the
following actions would most likely be taken by the local medical centers?
a. Agree to collaboratively apply for the funds in a cooperative proposal.
b. Individually compete eagerly for the additional funds now available.
c. Reach out enthusiastically to this previously underserved population group.
d. Strongly consider not applying, because this population will be expensive to treat.
ANS: D
Many agencies do not wish to provide services to vulnerable populations. Vulnerable
populations are more expensive to treat because they have multiple, cumulative risks
and require special service delivery considerations (e.g., to help overcome
transportation problems or provide culturally competent care).
6. Which of the following statements best describes an outcome of the Balanced
Budget Act of 1997?
a. Additional funding was provided to the State Childrens Health Insurance Program (SCH
b. Individuals were able to keep their health insurance when moving from one place to anot
c. Patient privacy and security of health information was enhanced.
d. A prospective payment system for home health services was created.
ANS: D
The Balanced Budget Act of 1997 had some shifts in payment with the stipulations
related to home health. In an attempt to curb the rapid growth in spending on home
health and financial fraud in that industry, the Health Care Financing Administration
(now the Centers for Medicare and Medicaid Services [CMS]) instituted prospective
payment for home health services. The Health Insurance Portability and
Accountability Act of 1996 was intended to help people keep their health insurance
when moving from one place to another as well as provide privacy and security of
personal health information. The State Childrens Health Insurance Program (SCHIP)
was created by Title XXI of the Social Security Act in 1998.
7. A homeless family brought their father to the public health clinic after he reported
bleeding when he went to the bathroom. Which of the following nursing actions
would be most appropriate?
Begin tests to determine the cause of the bleeding while asking about other family conce
a. to shelter for the night.
b. Refer the man to a urologist to address the urinary bleeding.
c. Suggest that the family take him to an urgent care center immediately.
d. Treat the urinary infection and give the man medication to take to prevent the return of in
ANS: A
It is important to provide comprehensive, family-centered, one-stop services.
Providing multiple services during a single clinic visit is an example of one-stop
services. If social and economic assistance are provided and included in
interdisciplinary treatment plans, services can be more responsive to the combined
effects of social and economic stressors on the health of special population groups.
8. Nursing students have been assigned to set up a health fair for the homeless
population in a large urban setting. Without any funds to pay for space, where should
the health fair be located, assuming that all of the following sites are available at no
cost?
a. At the citys homeless shelter, which is, by policy, vacant during the day
b. At a large medical center, where the students could get permission to use an empty clinic
c. At the largest inner-city police station, where there was a large empty space available
d. At the local community college, where there are plenty of tables and chairs
ANS: A
Homeless persons would probably avoid the police station, and many may not wish to
go to the medical centeralso, there would be transportation issues. The most
convenient place for the clients would be the homeless shelter, where transportation
and lack of comfort in an unfamiliar place would not be issues. It is helpful to provide
comprehensive services in locations where people live and work, including schools,
churches, neighborhoods, and workplaces. Thus, for the homeless population the
homeless shelter would be an appropriate location.
9. Which of the following bills would the nurse lobbyist, who believes strongly in
social justice, encourage legislators to support?
a. A bill that establishes policies requiring all persons to pay the same cost for services rega
b. A bill that promotes universal health insurance coverage
c. A bill that requires all health care providers to give care to uninsured persons without cha
d. A bill that requires health care workers to report undocumented immigrants who present
ANS: B
Requiring health care professionals to give care to uninsured persons without charge
would quickly bankrupt hospitals, and health professionals could not afford to
continue in those roles. Such a law is unfeasible. Social justice refers to providing
humane care and social supports for the most disadvantaged members of society.
Nurses can be advocates for policy changes to improve social, economic, and
environmental factors that predispose vulnerable populations to poor health. Many
people do not have health insurance, particularly those who work in jobs where
insurance is not offered or costs are too high. Promoting universal health insurance for
all would be a step toward providing humane care for those who might not otherwise
be able to receive care.
10. A nurse who is providing diabetes screening at a community clinic discovers that a
new client has type 2 diabetes mellitus. The nurse provides counseling, refers the
client to an endocrinologist for initial assessment and treatment, arranges for the client
to see someone regarding financial assistance, contacts the mobile van to arrange
transportation, and sets up a follow-up appointment. Which of the following types of
service do these actions represent?
a. Case management
b. Client advocacy
c. Holistic care
d. Wrap-around services
ANS: A
Nurses often function as case managers for vulnerable clients, making referrals and
linking them with community services. Case management services are especially
important for vulnerable persons because they often do not have the ability or
resources to make their own arrangements. Linking clients with health services is
accomplished by making appropriate referrals and by following up with clients to
ensure that the desired outcomes from the referral were achieved.
11. A nurse offers homeless clients yearly tuberculosis (TB) screening and free
treatment for those who test positive for TB. Which of the following levels of
prevention is being used?
d. Secondary and tertiary prevention
ANS: B
Screening homeless adults and providing medications to those who test positive for
TB are examples of secondary prevention. The TB screening identifies infection in
early stages. Medications work to prevent infection from developing into disease.
12. A community health nurse is implementing a tertiary prevention activity related to
tuberculosis. Which of the following interventions is the nurse most likely
completing?
a. Administration of skin tests to identify persons who have been infected with tubercle bac
b. Assessing for signs and symptoms of active tuberculosis
c. Directly observing clients with active tuberculosis as they take their antitubercular medic
d. Interpretation of tuberculosis skin test findings
ANS: C
Tertiary prevention is exemplified when nurses provide directly observed medication
therapy for people with active TB.
13. A staff member is orienting a new nurse to a health clinic that serves primarily
vulnerable populations. Which of the following statements indicates a need for
additional staff education?
a. If a client who does not speak English comes in, you must obtain an interpreter right awa
We try to take care of as many problems as possible in one visit, so when you interview t
b. about additional concerns.
c. You will like working with Hispanic immigrants because they have close-knit family stru
You will need to assist the client by scheduling any referral or follow-up appointments a
d. schedules.
ANS: C
Assumptions are not helpful. Each person and family should be assessed individually.
No two people or groups are alike. Any stereotype, positive or negative, can be
problematic. Even though Hispanic groups, as a whole, do have close-knit family
structures, by assuming that all Hispanics are this way, staff members are less likely to
be open to the possibility of issues such as family violence.
14. Nurses at a homeless clinic are concerned that homeless clients rarely return to
have the nurses assess the findings of their tuberculosis (TB) skin tests. Which of the
following is the most appropriate policy for the clinic to have regarding the screening
test findings?
Call all homeless clients 48 hours after TB skin testing to remind them to return to the cl
a. interpretation.
Have homeless individuals read their TB skin test, if necessary, and mail in results on a p
b. coded to protect privacy.
c. Re-administer the TB skin test if the client returns later than scheduled for test interpreta
d. Routinely refer all homeless clients for chest x-rays.
ANS: B
Homeless people often do not have a way to receive telephone calls. Additionally,
they usually face numerous barriers to return to the clinic. These issues often require
deviation from strict policies, especially strict policies that are not working. Nurses
should develop a way for homeless individuals to read their TB skin test, if necessary,
and give them a self-addressed, stamped card they can return by mail with the results.
15. A nurse is working as a case manager with a vulnerable population. Which of the
following actions should the nurse do when providing care?
a. Be willing to enter into a long-term relationship with families.
b. Direct and control the clients care because the nurse knows what is most needed.
Encourage families to become self-sufficient and less dependent on nursing personnel fo
c. referrals.
d. Rotate assignments periodically to prevent attachment and codependency.
ANS: A
Case management is a process that enhances continuity and appropriateness of care.
When using case management with vulnerable populations, the nurse can be of
greatest benefit if he or she is willing to develop long-term relationships with the
families served. This increases trust as well as continuity of care. Care involves a
partnership between nurse and client. Nurses who direct and control the clients care
cannot establish a trusting relationship and may inadvertently foster a cycle of
dependency and lack of personal health control.
MULTIPLE RESPONSE
1. Which statements by a nurse demonstrate understanding of the unique needs of
vulnerable groups? (Select all that apply.)
a. I always address the problem that the client believes is the most important.
b. I avoid asking clients for income or financial information, because this is an invasion of
c. I try to observe the clients cultural traditions as I probe for signs of abuse.
I make sure to do a complete assessment, since we often dont know when the person will
d. clinic.
ANS: A, C
Because poverty is a primary cause of vulnerability, the nurse should include
questions about the clients financial status. Nurses should not provide financial or
legal advice; however, they should make sure to connect clients with someone who
can and will help them. Although an assessment must be done, a nurse should only
collect data that will actually be used. Focus on what data are needed to help the client
that day with the problem the client believes is most important.
Chapter 24: Alcohol, Tobacco, and Other Drug Problems in

the Community My Nursing Test Banks
Chapter 24: Alcohol, Tobacco, and Other Drug Problems in the Community
Test Bank
MULTIPLE CHOICE
1. Which of the following approaches has research suggested is the most effective way
to approach drug addiction?
a. Criminal justice system
b. Harm reduction
c. Punishment approach
d. Substance abuse education
ANS: B
The harm reduction model is a health care approach that recognizes addiction as a
health problem and focuses on pragmatic interventions, especially education, to
reduce the adverse consequences of drug use and treatment for addicts.
2. A woman has just delivered a baby and is lamenting that the babys father is not with
her. She shares with you that he became involved with drugs and is now in prison for
theft. The new mother says, Its so sad. Hes clearly no good. Which of the following
would be the best response by the nurse?
a. Im so sorry to hear that. Is your mother able to be with you?
b. Its good that you and the baby are safe from him.
Is there anyone to help you with the baby until the babys father can be released and enco
c. treatment for his addiction?
d. You must hate him for leaving you alone with a new baby!
ANS: C
The nurse must express concern and empathy and hold out hope for future
improvement. To be therapeutic, the nurse must realize that any drug can be abused,
that anyone may develop drug dependence, and that drug addiction can be
successfully treated.
3. A man who takes a prescribed narcotic for pain on a regular basis reports that he
does not like the way the medicine makes him feel. He has tried to change to an
alternate analgesic but experienced withdrawal symptoms when he stopped taking the
narcotic. Which of the following problems is the man experiencing?
a. Drug abuse
b. Drug addiction
c. Drug dependence
d. Substance abuse
ANS: C
Drug dependence is a state of neuroadaptation (a physiological change in the central
nervous system) and alterations in other systems caused by the long-term, regular
administration of a drug. People who are dependent on drugs must continue using
them to prevent withdrawal symptoms. Drug addiction is a pattern of abuse
characterized by an overwhelming preoccupation with the compulsive use of a drug
and securing its supply and a high tendency to relapse if the drug is removed.
Substance abuse does not apply in this case, because the man is taking a prescribed
medication for a legitimate purpose. The term drug abuse is no longer meaningful.
4. A school health nurse is asked by a parent group to explain risk factors for
alcoholism. Which of the following information should the nurse include?
a. Alcoholism is determined primarily by the family environment.
b. Alcoholism is determined partly by genetic factors.
c. Persons who are alcoholics are usually women.
d. Persons born with fetal alcohol syndrome are alcoholics from birth.
ANS: B
Research has shown conclusively that familial transmission of alcoholism is at least in
part genetic and not just the result of family environment.
5. A movie shows a woman and a man having a contest to see who can drink more
shots of whiskey. Who is more likely to win the drinking contest when the other
passes out and cannot continue?
a. If their drinks are the same size, theyll both pass out about the same time.
b. If they play fair, theyll probably both vomit before passing out.
c. The man will win.
d. The woman will win.
ANS: C
Women are more affected by alcohol than men, because women have less alcohol
dehydrogenase activity than men (except for males with chronic alcoholism).
6. Students at first-day orientation at the local community college are discussing
alcohol and drug abuse with their freshmen advisor. During a break, some students go
outside for soft drinks and snacks. Soon after, the advisor walks by and notices several
of these students smoking cigarettes. Based on this, which of the following topics of
the drug and alcohol orientation would be most important for the advisor to
reemphasize after the break?
a. A discussion of which drugs are commonly used on campus
b. How students can learn to just say no when offered drugs or drinks
c. How to recognize and overcome peer pressure to continue bad habits
The fact that tobacco smoking causes more deaths than any other behavior in the
d. United States
ANS: D
Although all these options are worthy of discussion, the most relevant action in this
case is making it clear to students that tobacco is a drugand that smoking cigarettes
accounts for one in five deaths in the United States. Smoking is the foremost
preventable cause of death in the United States.
7. A nurse sees the father of a newborn baby push his wife in a wheelchair out onto
the patio. The man and woman each smoke a cigarette while the baby sleeps in the
mothers arms. Which of the following information should the nurse share with the
parents?
a. Fetal nicotine syndrome may cause complications in the newborn.
The sidestream smoke that the baby is exposed to is more dangerous than the mainstream
b. parents are inhaling themselves.
c. The baby will eventually develop tolerance to tobacco smoke.
d. The parents should switch to chewing tobacco as long as the child lives in the home.
ANS: B
Sidestream smoke contains higher concentrations of toxic and carcinogenic
compounds than does mainstream smoke.
8. Which of the following addictive drugs is both legal and culturally acceptable
throughout almost all of the United States?
a. Beer
b. Caffeine
c. Cigarettes (nicotine)
d. Mixed alcoholic beverages
ANS: B
Caffeine is in commonly served beverages such as coffee, tea, and soft drinks, as well
as in some commonly used pain medications.
9. A home health client has been taking 50 mg of meperidine, a narcotic analgesic,
every 4 hours for pain. Which of the following statements made by a nurse to the
clients physician indicates a need for further education on narcotics?
You need to decrease the time interval between doses to every 3 hours so that my client w
a. relief.
b. You need to discontinue that order before my client becomes addicted.
c. You need to increase the meperidine so that my client will achieve adequate pain relief.
d. You need to give my client something in addition to the meperidine.
ANS: B
Opiates are by far the most effective drugs for pain relief. When these drugs are used
for pain control, only approximately 0.1% of those clients will develop addiction, and
therefore, fear of addiction should not be used as a reason to undertreat pain.
10. A school nurse stops a student in the hall and asks whether the student has been
having trouble with her eyes, which look rather red and dry. The female student
yawns and says that she hasnt noticed any eye problems. However, she does confess
to the school nurse that she has gained 15 pounds since she began smoking special
cigarettes. Which of the following is the student most likely smoking?
a. Tobacco
b. Crack cocaine
c. Ice methamphetamine
d. Marijuana
ANS: D
Side effects of marijuana include increased appetite, dry and reddened eyes, and
drowsiness.
11. Which of the following is an accurate concern about the use of marijuana?
a. Marijuana has painful withdrawal symptoms.
b. Marijuana may damage the respiratory tract.
c. Marijuana can often reduce pain but physicians refuse to prescribe it.
d. Marijuana quickly leads to psychological and physiological dependence.
ANS: B
Marijuana is the most widely used illicit drug in the United States. It may reduce pain
but is currently illegal with national efforts at total prohibition. It is not highly toxic
except for possible damage to the respiratory tract from smoking. It does not quickly
lead to dependence, and withdrawal symptoms are mild.
12. A teacher sends a student to the school nurse because the student does not seem to
be thinking clearly. The nurse notes that the student is having palpitations, as well as
elevated pulse, blood pressure, temperature. Which of the following would most likely
cause these symptoms?
a. Alcohol
b. Ecstasy (MDMA)
c. Heroin
d. Marijuana
ANS: B
Ecstasy raises the bodys temperature, pulse rate, and blood pressure. The other drugs
listed would have a depressant effect.
13. A home health nurse believes a client may be a drug addict. However, the client
denies the use of drugs when questioned by the nurse. Which of the following is the
most likely cause of the clients denial?
a. Confusion resulting from dementia
b. History of compulsive lying
c. Mental status changes
d. Use of addictive drugs
ANS: D
Denial is a primary symptom of drug addiction.
14. Three women were brought to the emergency department by ambulance after a
two-car accident at a busy intersection. Which of the following tests should
automatically be done under such circumstances?
a. Alcohol blood level
b. Cardiac workup
c. Pregnancy test
d. STD tests
ANS: A
Approximately 40% to 50% of people seen in trauma centers were drinking at the
time of their injuries. Hence, blood alcohol testing should be routinely done for
patients admitted to the emergency department for traumatic injuries.
15. A male IV drug abuser admits to the nurse that he has no desire to stop using
drugs, so rather than lecture him on the dangers of drug addiction, the nurse counsels
him on how to sterilize his needles. Which of the following prevention efforts is the
nurse attempting to achieve? (Select all that apply.)
a. Primary prevention by educating about safe injections
b. Primary prevention by avoidance of future legal complications
c. Secondary prevention to reduce the risk for infection or other complications
d. Tertiary prevention to reduce the transmission of blood-borne diseases
ANS: D
Tertiary prevention is for people who already have a disease or problem (in this
instance, someone already abusing IV drugs) to prevent complications (harm
reduction). In this instance, because the client does not plan to stop taking drugs, the
nurse is trying to prevent complications related to use of contaminated needles and
reduce the transmission of disease through sharing contaminated needles with others.
Abstinence is ideal, but it is unrealistic for many addicts. Using the harm reduction
model, the nurse should provide education on cleaning needles with bleach between
uses and inform the addict about needle exchange programs to decrease the spread of
the blood-borne pathogens.
16. A man is addicted to alcohol. In which of the following scenarios is a family
member enabling the man to continue drinking?
a. The wife asks the nurse to explain why her husbands continued drinking is dangerous.
b. The son threatens to leave home because he finds the fathers behavior embarrassing.
c. The teenage daughter turns to a favorite teacher for emotional support.
d. The wife tells her husbands boss that her husband is sick when he is actually inebriated.
ANS: D
Enabling is the act of shielding or preventing the addict from experiencing the
consequences of the addiction.
17. Which of the following statements accurately describes why methadone is used to
treat heroin addiction?
a. Addicts come to prefer methadone instead of heroin.
b. Methadone blocks the effects of heroin and reduces the craving.
c. Methadone prevents further dependence on drugs.
d. Methadone gives an enjoyable high, so addicts continue treatment.
ANS: B
Methadone, when administered in moderate or high daily doses, produces a cross-
tolerance to other narcotics, thereby blocking their effects and decreasing the craving
for heroin. The advantages of methadone are that it is long-acting and effective when
taken orally, it does not produce a high, it is inexpensive, and it has few known side
effects.
18. A client requests help to stop smoking. Which of the following methods would be
the best for the nurse to suggest to the client?
a. A combination of interventions, beginning with changing the environment
b. Acupuncture to reduce the nicotine cravings
c. Behavior modification through hypnosis
d. Nicotine replacement products
ANS: A
The most effective way to get people to stop smoking and prevent relapse involves
multiple interventions and continuous reinforcement, and most smokers require
several attempts at cessation before they are successful. Making changes to the
smokers environment helps by eliminating cues to smoking, such as ash trays,
lighters, and cigarette cases.
19. A nurse is reviewing with a client the importance of the diabetic diet to
maintaining control of blood glucose levels. The client states, I went to the classes and
learned how to count carbohydrates. I have even started to write down what I eat for
each meal. Which of the following would be most appropriate response from the
nurse?
a. Im so glad youre beginning to recognize the need to control your blood sugar.
b. Now you just have to make sure you dont give that habit up!
c. Sounds like youre not ready to really plan your eating yet.
d. That is great. Youve started to take action and make changes.
ANS: D
There are five stages of change: (1) precontemplationor resisting that there is a
problem, (2) contemplationor thinking about the problem, (3) preparationpreparing for
action and taking some initial steps, (4) actionor making modification in behavior and
environment, and (5) maintenanceor preventing relapse. As the client learns how to
eat and recognizes what she is eating, she is preparing for action. Therefore, the nurse
should be encouraging and recognize that the client has begun serious change.
20. At a county board meeting, a nurse reports statistics on drug use in the school. The
nurse then requests funding for an after-school recreation program that promotes age-
appropriate fun activities and sports. Which of the following objectives is the nurse
attempting to meet through this action?
a. Help prevent obesity and boredom.
b. Offer alternatives to being on the streets.
c. Prevent children from getting in trouble before their parents get home from work.
d. Promote healthy lifestyles with physical activity.
ANS: D
The nurse is engaging in primary prevention efforts against substance abuse by
helping to promote healthy lifestyles and resiliency factors.
21. A school health nurse is conducting drug screening to detect drug use by students
before problems develop. Which of the following levels of prevention does this action
represent?
d. Primary and secondary prevention
ANS: B
One means of secondary prevention is to institute early detection (screening)
programs in schools, the workplace, and other areas in which people gather to
determine the presence of substance abuse.
MULTIPLE RESPONSE
1. A mother is concerned that her daughter may be considering experimentation with
drugs and alcohol. Which of the following strategies would the nurse suggest the
mother implement? (Select all that apply.)
a. Provide opportunities for her daughter to develop her talents.
b. Provide realistic feedback to the daughter about her performance at school.
c. Encourage her daughter to become involved in extracurricular activities.
d. Encourage her daughter to develop new friendships.
ANS: A, B, C
Prevention guidelines to teach parents and teachers how to increase resiliency in
youths include the following strategies: help them develop an increased sense of
responsibility for their own success; help them identify their talents; motivate them to
dedicate their lives to helping society rather than believing that their only purpose in
life is to be consumers; provide realistic appraisals and feedback, stress multicultural
competence, and encourage and value education and skills training; and increase
cooperative solutions to problems rather than competitive or aggressive solutions.
2. A nurse is helping a clients family prepare to have an intervention that hopefully
will encourage the alcoholic father to realize the need for change. Which of the
following instructions by the nurse to the clients family members would be most
effective? (Select all that apply.)
a. Express your love and your belief that he can change.
b. Point out that his behavior is his choice and his responsibility.
Let him know that you understand how much he loves being with his drinking pals and t
c. their friendship is important.
d. Remind him that entering treatment is better than going to prison.
ANS: A, B
Using FRAMES as a guideline, the nurse would provide Feedback about problems
with using drugs, emphasize the persons own personal Responsibility for any changes
made, and give Advice on how to change behaviors, including a Menu of options from
which to choose while expressing Empathy. Finally, the nurse would provide
encouragement and belief that the person can change, hence increasing feelings
of Self-efficacy.
3. A nurse is screening a client for ATOD problems. Which of the following actions
would the nurse most likely complete? (Select all that apply.)
a. Assist with identifying help or resources.
b. Advise about the need to enter a treatment program.
c. Ask about how relationships with family members and friends have been affected.
d. Assess amount and pattern of use.
ANS: A, D
The nurse should use the 5 As when screening for ATOD problems: ask about use
(how taken, how much, how long and how often); assess amount and pattern of use;
advise about safe use as appropriate; and assist with identifying help or resources.
Chapter 26: Infectious Disease Prevention and Control My

Nursing Test Banks
Chapter 26: Infectious Disease Prevention and Control
Test Bank
MULTIPLE CHOICE
1. Which of the following is the number one cause of death worldwide?
a. Chronic diseases (heart disease, cancer, stroke)
b. Infectious diseases
c. Injuries (accidental or purposeful)
d. Terrorism
ANS: B
In countries with higher standards of living, where people live longer, chronic
diseasesheart disease, cancer, and strokeare the leading causes of death. Infectious
diseases, however, are still the number-one cause of death worldwide.
2. Which of the following places best describes where the incidence of Vancomycin-
resistant Staphylococcus aureus (VRSA) and methicillin-resistant S. aureus (MRSA)
is currently rising?
a. Areas where people share dressing or bathing facilities
b. Daycare centers and schools
c. Long-term care facilities
d. Senior citizen centers
ANS: A
Vancomycin-resistant Staphylococcus aureus (VRSA) and methicillin-resistant S.
aureus (MRSA) remain problems for people who acquire the bacteria in the hospital,
but there is a growing incidence of community-acquired MRSA in places where
people closely share facilities such as locker rooms, prisons, and other close bathing
areas.
3. During an outbreak of hepatitis A, nurses are giving injections of hepatitis A
immunoglobulin to selected susceptible persons. Which of the following best
describes the type of immunity that will follow the administration of these injections?
a. Active immunity
b. Long-lasting immunity
c. Natural immunity
d. Passive immunity
ANS: D
Passive immunity refers to immunization through the transfer of a specific antibody
from an immunized individual to a nonimmunized individual, such as the transfer of
antibody by administration of an antibody-containing preparation (immune globulin
or antiserum). Passive immunity from immune globulin is almost immediate but
short-lived. It often is induced as a stopgap measure until active immunity has had
time to develop after vaccination.
4. A man loudly protests his increased property tax bill right after the public health
department has made a plea for more funds. Why, he asks, should my tax dollars be
used to pay for their children to be immunized? Which of the following would be the
best response by the nurse?
a. Immunizations are required by law, and if their parents cant afford it, you and I will have
b. Its just the right thing to do.
c. Only by making sure most kids are immunized can we stop epidemics that might hurt all
d. Were a religious God-fearing community, and we take care of each other.
ANS: C
Herd immunity is the resistance of a group of people to invasion and spread of an
infectious agent because a high proportion of individual members of a group are
resistant to the infection. Higher immunization coverage will lead to greater herd
immunity, which in turn will block the further spread of the disease.
5. Which of the following components of the epidemiologic triangle contributes most
to a female client developing a vaginal infection caused by fungi after successful
treatment of her strep throat with antibiotics?
a. Agent
b. Environment
c. Host
d. Agent and host
ANS: B
The antibiotic therapy eliminates a specific pathological agent, but it also may alter
the balance of normally occurring organisms in the womans body, which causes a
change in the vaginal environment and allows normally present fungi to proliferate,
resulting in a yeast infection.
6. Which of the following best represents an example of infectious disease spreading
via a vector?
a. Being bitten by an infected mosquito
b. Disease spreading from infected mother to infant via the placenta
c. A group of partygoers hugging and shaking hands
d. Two persons, one of whom is infected, sharing a glass of soda
ANS: A
Vertical transmission is the passing of infection from parent to offspring via placenta.
Horizontal transmission is the person-to-person spread of infection through (among
other ways) contact. Common vehicle refers to transportation of the infectious agent
from an infected host to a susceptible host via food, water, milk, or other substance.
Vectors include mosquitoes, which can transmit the infectious agent by biting the
host.
7. A nurses Mantoux test is positive for exposure to tuberculosis. Which of the
following conclusions should be drawn by the nurse?
a. The nurse has been exposed to tuberculosis.
b. The nurse has tuberculosis.
c. The positive test result probably is due to a problem in the testing process.
d. The test is inaccurate and needs to be repeated.
ANS: A
An individual who tests positive has been exposed and may be infected, but if that
person shows no clinical signs, the person is not diseased. Infection refers to the entry,
development, and multiplication of the infectious agent in the susceptible host.
Disease is one of the possible outcomes of infection. People with latent TB have no
symptoms, are not infectious, and can continue on with life. They may develop active
TB. A nurse who interacts with clients may receive INH for a year as a precaution.
8. A student engages in unprotected sex under the influence of alcohol. The student
decides to have an HIV test completed the next day. Which of the following results
will most likely occur?
a. The results will probably be negative for HIV.
b. The results will probably be positive for HIV.
c. The probability of disease is so low there is no reason to be tested.
d. The test results wont be reliable so soon after exposure.
ANS: D
It may take up to 6 months after exposure to the HIV virus before an HIV antibody
test can test positive, although most infected people will test positive within 3 months.
A negative test, therefore, is not a reliable indicator of infection status if exposure is
very recent. The incubation period or the time interval between invasion by an
infectious agent and the first appearance of signs and symptoms of the disease may be
between 10 and 15 years for AIDS.
9. Which of the following data would most likely be collected in a syndromic
surveillance system?
a. Incidence of bioterrorism attacks
b. Number of air travelers
c. Incidence of school absenteeism
d. Number of influenza vaccines administered
ANS: C
Syndromic surveillance systems use existing health data in real time to provide
immediate analysis and feedback to those charged with investigation and follow-up of
potential outbreaks. These systems incorporate factors such as the previously
mentioned temporal and geographic clustering and unusual age distributions with
groups of disease symptoms or syndromes (e.g., flaccid paralysis, respiratory signs,
skin rashes, gastrointestinal symptoms) with the goal of detecting early signs of
diseases that could result from a bioterrorism-related attack. Syndromic surveillance
systems may include tracking emergency department visits sorted by syndrome
symptoms as well as other indicators of illness including school absenteeism and sales
of selected over-the-counter medications. In recent years, the tracking of cold
medicines used to make crystal methamphetamine has received considerable attention.
10. A community is experiencing an epidemic of the measles. The nurse is trying to
determine if this problem is happening in other communities as well. Which of the
following resources should the nurse use to answer this question?
a. Centers for Disease Control and Prevention Weekly Report
b. Communicable Diseases Weekly Report
c. Morbidity and Mortality Weekly Report
d. Weekly National Report of Communicable Diseases
ANS: C
Requirements for disease reporting in the United States are mandated by state rather
than federal law. The list of reportable diseases varies by state. State health
departments, on a voluntary basis, report cases of selected diseases to the Centers for
Disease Control and Prevention (CDC) in Atlanta, Georgia. The National Notifiable
Diseases Surveillance System (NNDSS) data are collated and published weekly in the
Morbidity and Mortality Weekly Report (MMWR).
11. There is great concern in the nurses community over three local cases of West Nile
virus. Which of the following actions should the nurse take to get the community
involved in addressing this problem?
a. Ask the state department of health for assistance
b. Demand that everyone over age 65 become immunized immediately
c. Encourage immunization of all children under 12
d. Have an educational campaign to remove any containers of standing water
ANS: D
Periodic outbreaks of West Nile virus appear to result from a complex interaction of
multiple factors, including weatherespecially hot, dry summers followed by rain,
which influences mosquito breeding sites and population growth. Removing standing
water will remove mosquito breeding sites.
12. Which of the following is the most probable cause of the increase in new emerging
infectious diseases?
a. Activities or behavior of humans, including changes in the environment
b. Increasing urbanization and growth in new housing materials
c. New infectious agents are evolving throughout the world
d. Overpopulation in many areas, creating a need to reduce global population
ANS: A
Most of the emergence factors are consequences of activities and behavior of the
human hosts and of environmental changes such as deforestation, urbanization, and
industrialization. For example, the rise in households with two working parents has
increased the number of children in daycare, and with this shift has come an increase
in diarrheal diseases such as shigellosis. Urbanization is not a problem, but increasing
development into formerly unaffected areas such as rainforests is.
13. Which of the following best describes the current goal in relation to communicable
diseases?
a. To control political borders so diseases cannot spread further
b. To exterminate specific infectious agents one by one
c. To expand health care facilities to improve infectious disease treatment
d. To achieve worldwide immunization to control new cases
ANS: B
The goal of prevention and control programs is to reduce the prevalence of a disease
to a level at which it no longer poses a major public health problem. In some cases,
diseases may even be eliminated or eradicated. The goal of elimination is to remove a
disease from a large geographical area (e.g., a country or region of the world), such as
has been done with polio in the Americas. Eradication is the irreversible termination
of all transmission of infection by extermination of the infectious agents worldwide,
as has been done with smallpox.
14. Which of the following biological warfare agents poses the greatest bioterrorism
threat to a community?
a. Anthrax
b. Botulism
c. Smallpox
d. Tularemia
ANS: A
Because of factors such as the ability to become an aerosol, the resistance to
environmental degradation, and a high fatality rate, inhalational anthrax is considered
to have an extremely high potential for being the single greatest biological warfare
threat.
15. Which of the following public health actions has been particularly instrumental in
reducing childhood infectious diseases in the United States?
a. Answering parents questions about the safety and importance of vaccines today
Educational campaigns to all health care providers about the importance of immunization
b. child is seen
c. No shots, no school legislation, which legally requires children be immunized before sch
d. Offering all immunizations to all children free of any charge
ANS: C
Vaccines are one of the most effective methods of preventing and controlling
communicable diseases. Hopefully, all nurses answer questions, remind colleagues to
think about immunizations whenever a child is seen, and encourage continuing free or
low-cost immunization clinics. One of the most effective programs has been the no
shots, no school legislation, which has resulted in the immunization of most children
by the time they enter school.
16. A student comes to the college health clinic with typical cold symptoms of fever,
sneezing, and coughing, but the nurse also notes small white spots on the inside of the
students cheeks. Which of the following actions should be taken by the college health
nurse?
a. Inform all students, staff, and faculty of a possible rubella epidemic
b. Inform all students, staff, and faculty of a possible measles epidemic
c. Reassure the student that it is just a bad cold and will soon pass
d. Tell the student to take two acetaminophen and drink lots of fluids
ANS: B
Measles is an acute, highly contagious disease that, although considered a childhood
illness, is often seen in the United States in adolescents and young adults. Symptoms
include fever, sneezing, coughing, conjunctivitis, small white spots on the inside of
the cheek (Koplik spots), and a red, blotchy rash beginning several days after the
respiratory signs. Measles is serious. Around 10% of measles cases require hospital
admission. It can lead to pneumonia and encephalitis, and it can kill. Persons who
may have been exposed should be informed that anyone under 18 who has not
received both immunization doses should receive measles vaccine.
17. An instructor is reviewing Salmonella infections with her class. Which of the
following comments indicates that the student needs further review on
how Salmonella is spread?
a. Certain pets and farm animals may be Salmonella carriers.
b. It is possible to transmit Salmonella by person-to-person contact.
c. Salmonella may be spread by spores that form once contaminated blood is exposed to the
d. Salmonella outbreaks are usually due to contaminated meat, poultry, and eggs.
ANS: C
Meat, poultry, and eggs are the foods most often associated with salmonellosis
outbreaks. Animals are the common reservoir for the various Salmonella serotypes,
although infected humans may also fill this role. Animals are more likely to be
chronic carriers. Reptiles such as iguanas have been implicated as Salmonella carriers,
along with pet turtles, poultry, cattle, swine, rodents, dogs, and cats. Person-to-person
transmission is an important consideration in daycare and institutional settings.
Anthrax (not Salmonella) forms spores when infected blood is exposed to air.
18. Which of the following is the most common vector-borne disease in the United
States?
a. Babesiosis
b. Ehrlichiosis
c. Lyme disease
d. Rocky Mountain spotted fever
ANS: C
All four are diseases borne by ticks as the vectors. Lyme disease became a nationally
notifiable disease in 1991 and is now the most common vector-borne disease in the
United States.
19. A student complains to the college health nurse that her academic work has been
going downhill because of lack of sleep. My 3-year-old probably misses her babysitter
since she has started going to the big daycare center. She hasnt been sleeping well and
keeps scratching her bottom. Hopefully, shell adapt to daycare soon. Which of the
following information should the nurse provide to the student?
a. Dry skin in winter weather can cause itchiness; try to put on lotion before bedtime.
b. Your daughter may have pinworms; let me teach you how to check for this.
c. Perhaps your child is not developmentally ready for group play.
d. Try to arrange more one-on-one time with your 3-year-old.
ANS: B
Enterobiasis (pinworm infection) is the most common helminthic infection in the
United States with about 42 million cases a year. This infection is seen most often
among children in institutional settings. Pinworms cause itching, especially around the
anus, which can result in a lack of sleep for both child and caregiver.
20. Which of the following is the most common vector-borne disease worldwide?
a. Dengue
b. Malaria
c. Onchocerciasis (river blindness)
d. Yellow fever
ANS: B
Globally, malaria is the most prevalent vector-borne disease, with over 2.4 billion
people at risk and more than 275 million cases reported each year. More than 1
million children die of malaria each year. Dengue is the second most common vector-
borne disease.
21. At a town meeting with public health officials to discuss a communicable disease
outbreak, a nurse is asked to explain what is meant by the phrase a virulent organism.
The nurse explains that this means the organism causing the disease is able to do
which of the following?
a. Bypass normal immunological response mechanisms
b. Invade major organ systems
c. Produce toxins and poisons that weaken the body
d. Produce very severe physical reactions
ANS: D
Virulence is the ability to produce a severe pathological reaction.
22. A client is using a primary prevention strategy to prevent infectious disease.
Which of the following actions is the client most likely taking?
a. A client receives a tetanus booster every 10 years.
b. A client receives a tetanus booster after stepping on a nail.
c. A client receives tetanus immunoglobulin after stepping on a nail.
d. A client with tetanus is given antibiotics and is placed on seizure precautions.
ANS: A
Tetanus boosters given before exposure are a measure of primary prevention because
exposure has not yet occurred. If given after exposure (i.e., the client may be infected
but disease has not developed), they are considered secondary prevention (similar to
the textbook examples of immunoglobulin and rabies immunizations given after
exposure). Immunoglobulin would be given if the client had not been previously
immunized; however, this again is after exposure, so it is secondary prevention.
Because the client has the condition, treatment is aimed at prevention of further
injury.
23. Which of the following infectious disease interventions best represents the use of
secondary prevention?
a. Clients with HIV infection are encouraged to use condoms to protect sexual partners.
b. Clients with HIV infection are given medications to improve immunological response.
c. Health care workers are encouraged to receive annual vaccinations for influenza.
d. Health care workers are required to have a tuberculosis skin test or chest x-ray.
ANS: D
Tuberculosis screening for health care workers is an example of secondary prevention.
TB skin tests and chest x-rays are methods of tuberculosis screening. Encouraging
clients with HIV to use condoms is an example of primary prevention, because the
goal is to prevent exposure to the partner. Encouraging annual influenza vaccinations
is also an example of primary prevention. Giving clients with HIV medications is an
example of tertiary prevention, because the goal is to reduce complications in those
already having the infection.
MULTIPLE RESPONSE
1. Six students order meals at a local restaurant. Which of the following students are at
highest risk for illness? (Select all that apply.)
a. The first student asks for a salad with chicken strips and dressing on the side.
b. The second student asks for a hamburger, very rare.
c. The third student orders a tuna salad sandwich with extra mayonnaise.
d. The fourth student orders a breakfast meal with two very soft-poached eggs and toast.
ANS: B, D
Escherichia coli O157:H7 can produce a strong cytotoxin that can cause a potentially
fatal hemorrhagic colitis. Hamburger is often involved in outbreaks, since the grinding
process exposes pathogens on the surface of the whole meat to the interior of the
ground meat, effectively mixing the once-exterior bacteria thoroughly throughout the
hamburger so that searing the surface no longer suffices to kill all bacteria. Also,
hamburger is often made of meat ground from several sources. The best protection
against foodborne pathogens is to thoroughly cook food before eating it. Salmonella is
also transmitted by undercooked foods such as eggs, poultry, dairy products, and
seafood. Consequently, students eating very rare hamburger and undercooked eggs are
at high risk.
2. Which of the following symptoms suggests smallpox as opposed to the more
common and much less dangerous chickenpox? (Select all that apply.)
a. Child appears only mildly ill until late stages in smallpox.
b. Lesions appear in various stages in the same area of the body rather than all at once.
c. Rash lesions are most abundant on the face and extremities, not on the trunk.
d. Rash occurs 2 to 4 days after sudden onset of fever rather than with the fever.
ANS: C, D
Symptoms of smallpox include rash lesions on face and extremities, rash that occurs 2
to 4 days after onset of fever, and vesicles that are deep seated.
3. The advanced practice nurse explains that the client has an upper respiratory
infection (URI) and suggests several measures that might make the client more
comfortable. Which of the following best describes why the nurse doesnt just
prescribe antibiotics as the client repeatedly requests? (Select all that apply.)
a. Antibiotics are expensive, whereas the support measures would be almost free of cost.
b. Viral diseases are not affected by antibiotics.
c. Clinics cannot afford to continually give antibiotics to anyone who asks for them.
d. The more antibiotics are prescribed, the more infectious agents develop resistance to suc
ANS: B, D
Antibiotics are not effective against viral diseases, a fact found unacceptable to many
clients looking for relief from the misery of a cold or flu. The inappropriate
prescribing of antibiotics contributes to the growing problem of infectious agents that
have developed resistance to once-powerful antibiotics.
Chapter 28: Nursing Practice at the Local, State, and
National Levels in Public Health My Nursing Test Banks
Chapter 28: Nursing Practice at the Local, State, and National Levels in Public
Health
Test Bank
MULTIPLE CHOICE
1. Which of the following is the underlying science or area of study on which public
health is based?
a. Biostatistics
b. Epidemiology
c. Medicine
d. Social sciences
ANS: B
Public health uses biostatistics in its practice. It is not a branch of medicine; it is an
organized community approach designed to prevent disease, promote health, and
protect populations. It works across many disciplines and is based on the scientific
core of epidemiology.
2. A nurse is employed at the state department of public health. Which of the
following is a fundamental principle guiding his practice?
Decisions are made at the federal level, disseminated at the state level, and carried out at
a. level.
b. Health of populations is only as good as the health of individuals that live and work in th
c. Oversight of community health departments is the most important function.
d. The interaction of the local-state-federal partnership is critical to success.
ANS: D
In the United States, the local-state-federal partnership includes federal agencies, the
state and territorial public health agencies, and the local public health agencies. Their
effective interaction is critical to the effective use of both financial and personnel
resources to address the health of populations. Nurses working in all of these agencies
work together to identify, develop, and implement interventions that will improve and
maintain the nations health.
3. The public health administrator is in the process of hiring a new public health nurse.
Which of the following statements made by an applicant would most likely result in
the applicant not being hired?
I like to be the only person working on a project because individuals in teams have their
a. plans and the resulting debate slows progress.
I prefer to work in teams because no single person has too much responsibility because th
b. shared.
c. Teamwork is better than work done by individuals because teamwork incorporates differ
Whether teamwork is better than work done by individuals depends on the nature of the w
d. performed.
ANS: A
Working in collaborative partnerships is an essential role of public health nursing.
Partnerships and collaboration among groups are much more powerful in making
change than the individual client and nurse working alone. Part of the reason is that
multiple perspectives are examined in the process of coming to the best solution.
4. Which of the following federal agencies is most influential in public health
activities?
a. The Agency for Healthcare, Research, and Quality
b. Centers for Disease Control and Prevention
c. Department of Health and Human Services
d. Food and Drug Administration
ANS: C
The U.S. Department of Health and Human Services (USDHHS) and the
Environmental Protection Agency (EPA) are the federal agencies that most influence
public health activities at the state and local levels. The Agency for Healthcare,
Research, and Quality, the Centers for Disease Control and Prevention, and the Food
and Drug Administration are all pieces of the broader USDHHS.
5. Which of the following agencies are responsible for implementing and enforcing
local, state, and federal public health codes and ordinances and providing essential
public health programs to a community?
a. Community health clinics
b. Federal health agencies
c. Local health agencies
d. State health agencies
ANS: C
Local public health agencies are the agencies responsible for implementing and
enforcing local, state, and federal public health codes and ordinances and providing
essential public health programs to a community.
6. A nurse at a migrant clinic assists clients with completing the application process to
receive supplemental food assistance. Which of the following roles of the nurse is
being used?
a. Advocate
b. Case manager
c. Outreach worker
d. Primary caregiver
ANS: A
As an advocate, the nurse collects, monitors, and analyzes data and discusses with the
client which services are needed and whether the client is an individual, a family, or a
group.
7. Which of the following best describes the primary reason life spans have notably
lengthened over the past 100 years?
a. Advances in hospital care and procedures
b. Advances in medicine and medical research
c. Advances in nursing practice
d. Advances in public health
ANS: D
A person born today can expect to live 30 years longer than someone born in 1900.
Medical care accounts for 5 years of that increase, but public health is responsible for
the additional 25 years, through prevention efforts brought about by changes in social
policies, community actions, and individual and group behavior changes.
8. Which of the following best describes how public health nurses (PHNs) differed
from other health care professions in the early twentieth century?
a. PHNs contributed without receiving any salary for doing so.
b. PHNs created new settings where health care could be given.
c. PHNs gave care to powerless groups.
d. PHNs worked outside any organized health care system.
ANS: C
During this period, public health nurses worked with populations and in settings that
were not of interest to other health care disciplines or groups. Much public health
service was delivered to the poor and to women and children, who did not have
political power or voice.
9. Which of the following best describes the role of nursing in community health?
Application of nursing and public health theory in promoting, preserving, and maintainin
a. individuals, families, or communities
b. Health care provision offered in primary and secondary institutions or in the clients home
c. Provision of health care services in institutions located in the community but outside the
Use of the nursing process and evidence-based practice to meet Healthy People 2020obje
d. community health improvement
ANS: A
Nursing practice in community health is the synthesis of nursing theory and public
health theory applied to promoting, preserving, and maintaining the health of
populations through the delivery of personal health care services to individuals,
families, and groups. The focus of practice is health of individuals, families, and
groups. Care is provided within the context of preventing disease and disability and
promoting and protecting the health of the community as a whole.
10. A community health nurse is trying to decrease the incidence of emerging
infections caused by drug-resistant organisms. Which of the following actions would
be most appropriate for the nurse to implement?
a. Lobby for increased use of antibiotics in the treatment and prevention of communicable d
Notify the Centers for Disease Control regarding any unusual signs and symptoms relate
b. communicable illness.
c. Reinforce the importance of receiving vaccinations according to recommended schedules
Teach parents that antibiotics should not be used for treatment of viral infections or for p
d. bacterial infections.
ANS: D
The widespread, often inappropriate, use of antimicrobial drugs has resulted in loss of
effectiveness for some infections. Clients and health care providers are responsible for
the inappropriate use of antibiotics. The nurse can influence this trend by objecting to
inappropriate use of antibiotics by providers and by educating individuals, families,
health care providers, and the community about the dangers of misuse and overuse of
antibiotics.
11. A nurse is considering applying for a public health nurse position at a local health
department. Which of the following minimum levels of educational preparation
should the nurse have obtained?
a. Associate degree in nursing
b. Baccalaureate degree in nursing
c. Master of science degree in nursing
d. Training as a licensed practical nurse
ANS: B
Educational preparation of nurses in community health should be at least a
baccalaureate degree. Those registered nurses who have associate degrees are
encouraged to seek further degrees because of the increasing complexity of better care
delivery in public health. A masters degree would be even more useful, but for many,
advanced education may not be feasible.
12. A public health nurse has reviewed the objectives of Healthy People 2020. Which
of the following should be the focus for programming in the community related to
communicable diseases?
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 human immunodeficiency virus (HIV), acquired immunodeficiency syndrome
(AIDS), and sexually transmitted infections. One method to reduce the risk of
acquiring a communicable disease is by the public health nurse providing information
on the hazards of multiple sexual partners and street drug use.
13. Which of the following is a core competency required of public health nurses?
a. Knowledge in the use of high-technology diagnostics
b. Knowledge of the implementation of electronic medical records
c. Skill in the physical assessment of complex clients
d. Skill in developing policy and planning programs
ANS: D
The core public health competencies are divided into the following eight domains: (1)
analytic assessment skills; (2) basic public health sciences skills; (3) cultural
competency skills; (4) communication skills; (5) community dimensions of practice
skills; (6) financial planning and management skills; (7) leadership and systems
thinking skills; (8) policy development/program planning skills. The other
competencies listed are better suited for tertiary facilities such as hospitals.
14. Which of the following factors is causing nursing to change so quickly?
a. Economic issues
b. Increases in medical and nursing knowledge
c. Legislative issues
d. Technology changes
ANS: A
More than any other single factor, the driving force behind nursing changes is the
economy and the increase in managed care to decrease or control health care costs in
the United States.
15. A nurse is implementing a primary prevention activity to decrease the incidence of
communicable disease. Which of the following actions is the nurse most likely
taking?
a. Identifying and treating clients in a sexually transmitted disease clinic
Partnering with schoolteachers to teach and observe hand washing techniques in element
b. children
Providing case management services that link clients with communicable diseases to hea
c. community support services
d. Performing directly observed therapy (DOT) for clients with active tuberculosis
ANS: B
An example of primary prevention is to educate daycare centers, schools, and the
general community about the importance of hand hygiene to prevent transmission of
communicable diseases.
16. A public health nurse traces sexual contacts of clients with sexually transmitted
diseases for screening and treatment. Which of the following levels of prevention is
being implemented?
d. Secondary and tertiary prevention
ANS: B
Tracing individuals exposed to a client with a sexually transmitted disease is
secondary prevention because the nurse is attempting to find those exposed and screen
them. Once the exposed persons have been located, screening is another secondary
prevention activity.
17. A community mental health nurse is implementing a tertiary prevention activity.
Which of the following interventions is most likely being completed?
a. Disseminating information about mental health to community organizations
Partnering with school health nurses for early identification of children who have eviden
b. health problems
c. Providing case management services that link clients with serious mental illnesses to me
community support services
d. Screening high-risk clients for the presence of mental disorders
ANS: C
An example of tertiary prevention is the provision of case management services that
link clients identified with serious mental illnesses to mental health and community
support services.
18. A nurse is working at a local health department. Which of the following would
most likely be completed by this agency?
a. Enforcement of laws and regulations related to public health nationwide
b. Filing of a certificate for any birth or death in a community
c. Providing experts in various specialties to answer questions and respond as needed
d. Surveying the states public health needs
ANS: B
Local public health agencies provide and disseminate health information, provide
leadership in health planning, provide essential public health and environmental
services, analyze statistics on births to monitor community health status, and file a
certificate for every birth or death in the community.
MULTIPLE RESPONSE
1. A nurse is employed by a state public health department. Which of the following
functions would most likely be completed by this agency? (Select all that apply.)
a. Delegating power to engage in certain activities such as quarantine
b. Enforcing laws and regulations that protect public health
c. Filing birth and death certificates whenever these occur within the state
d. Monitoring health status of citizens within its geographic boundaries
ANS: A, B, D
State public health agencies are responsible for monitoring health status and enforcing
laws and regulations that protect and improve the publics health. These agencies
receive funding from federal agencies for the implementation of public health
interventions such as the maternal and child health programs. State agencies distribute
federal and state funds to the local public health agencies to implement programs and
provide oversight and consultation for local public health agencies. State health
agencies also delegate some public health powers, such as the power to quarantine, to
local health officers. Local departments file birth and death certificates and often ask
for volunteers to assist.
2. Which of the following activities are addressed by most public health departments
on the federal, state, and local levels? (Select all that apply.)
a. Collecting and analyzing various health statistics
b. Fining or terminating business at any facility that engages in unsafe commercial practice
c. Identifying and planning for high-risk populations
d. Planning for and responding to emergencies
ANS: A, C, D
The majority of local, state, and federal public health agencies engage in collecting
and analyzing vital statistics, providing health education and information, receiving
reports about and investigating and controlling communicable diseases, protecting the
environment to reduce the risk to health, providing some health services to particular
populations at risk, planning for and responding to natural and human-made disasters
and emergencies, identifying public health problems for at-risk and high-risk
populations, conducting community assessments to identify community assets and
gaps, and partnering with other organizations to develop and implement responses to
identified public health concerns.
3. What did events after September 11, 2001, clearly demonstrate? (Select all that
apply.)
a. A strong public health structure ready to respond effectively to a crisis
b. Public healths need for additional funding and resources
c. The unrecognized importance of nurses in lowering health care costs
d. Lack of adequate vaccines to meet communitys needs
ANS: B, C, D
The anthrax exposures after 9/11 alerted policymakers to the weakening public health
infrastructure required to respond to bioterrorism events. Unprecedented influenza,
tetanus, and childhood vaccine shortages and emerging infections competed with
bioterrorism activities for resources. The general public was not informed about how
immunizations by nurses improved health and lowered health care cost. For public
health services to receive adequate funding, it is necessary for the public and the
government to be aware of the benefits provided to a community by nurses.

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Chapter 01: Community-Oriented Nursing and Community-Based Nursing

Chapter 04: Ethics in Community Health Nursing Practice

Chapter 05: Cultural Influences in Nursing in Community Health

Chapter 06: Environmental Health

Chapter 08: Economic Influences My Nursing Test Banks

Chapter 09: Epidemiological Applications My Nursing Test

Chapter 10: Evidence-Based Practice My Nursing Test

Chapter 13: Case Management My Nursing Test Banks

Chapter 18: Family Development and Family Nursing

Chapter 21: Vulnerability and Vulnerable Populations: An

Chapter 24: Alcohol, Tobacco, and Other Drug Problems in

Chapter 26: Infectious Disease Prevention and Control My

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