NCM 113 Examination Coverage and Date

College of Health Sciences Education
3rd Floor, DPT Building

Matina Campus, Davao City
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A school nurse is teaching a class of sophomores about the relationship between the risk of sexually transmitted disease (STD) and risk-taking behaviors. A key point
to include is:
1. All STDs are easily preventable with consistent condom use.
2. Once a young woman is pregnant, she is no longer at risk for most STDs.
3. STDs are most likely to be transmitted during a student's initial sexual encounter.
4. Use of alcohol and drugs makes a student more likely to make decisions that result in exposure to and infection with STDs
Use of alcohol and drugs makes a student more likely to make decisions that result in exposure to and infection with STDs.
A client newly diagnosed with human papillomavirus (HPV) infection, herpes simplex virus 2 (HSV-2) infection, and syphilis asks, "Okay, so how do I get rid of all
this stuff?" In developing a plan of care, the nurse recognizes that it is essential to address:
1. Correct use of condoms to prevent transmission of all sexually transmitted diseases (STDs).
2. Cures for each of the STDs identified.
3. Risk of skin-to-skin contact in transmitting the identified STDs. Correct
4. Safety of sexual contact in the absence of lesions.
Risk of skin-to-skin contact in transmitting the identified STDs
A nurse is assigned to teach clients sexually transmitted disease (STD) prevention information. The nurse updates her teaching plan to incorporate new guidelines
from the Centers from Disease Control and Prevention (CDC). She includes which of the following as updated information during her next teaching session?
1. Always use spermicides with condoms to reduce the risk of contracting chlamydia or gonorrhea.
2. Condoms can be effective in preventing infections transmitted by fluids from mucosal surfaces but are not always effective in preventing infections transmitted by
skin-to-skin contact.
3. Condoms should not be used during oral sex, because they are not effective in preventing transmission of infection.
4. When genital ulcers are present, condoms should be used to prevent the spread of infection.
Condoms can be effective in preventing infections transmitted by fluids from mucosal surfaces but are not always effective in preventing infections transmitted by
skin-to-skin contact.
A woman comes to the community health center complaining of increasing lower abdominal pain, fever, and abnormal menses for several months. During the
assessment, the client indicates that she is aware that her husband has had multiple sex partners in the past two years. Appropriate intervention by the nurse would be
to:
1. Arrange to have the client referred for medical evaluation for pelvic inflammatory disease (PID) and appropriate intervention and treatment.
2. Contact the health department to confirm the spouse's diagnosis of Chlamydia infection to determine the client's exposure, give the client antibiotics, and have her
return to the clinic if symptoms worsen.
3. Provide sexually transmitted disease (STD) prevention and treatment education and refer the client to the health department for STD screening for gonorrhea
and/or Chlamydia infection.
4. Supply the client with nonsteroidal antiinflammatory drugs and caution her to call the after-hours call doctor if her symptoms worsen.
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Arrange to have the client referred for medical evaluation for pelvic inflammatory disease (PID) and appropriate intervention and treatment.
The clients most at risk of reactivation of latent infections of tuberculosis (TB) are:
1. Immunocompromised persons, substance abusers, and those with diabetes.
2. Individuals previously treated for TB.
3. Long-term cigarette smokers.
4. Persons with new-onset asthma or emphysema
Immunocompromised persons, substance abusers, and those with diabetes
Community health nurses conducting health education among populations vulnerable to HIV infection should explain the natural history of the infection, including
the fact that HIV infection may go undetected during the primary infection stage because:
1. Antibody test results are typically negative.
2. Antibody production by the immune system increases.
3. Incubation period is prolonged.
4. Symptoms include myalgias, sore throats, and rash.
Antibody test results are typically negative
A client comes to the local clinic with acute symptoms of fever, nausea, lack of appetite, malaise, and abdominal discomfort. During the course of the assessment, the
nurse determines that the client is a health care aide working at a daycare center. These facts are important because:
1. Acute hepatitis B is self-limiting.
2. Hepatitis A outbreaks commonly occur in facilities where staff change diapers.
3. Hepatitis C is a "silent stalker."
4. Individuals with chronic liver disease are at greater risk for hepatitis A.
Hepatitis A outbreaks commonly occur in facilities where staff change diapers.
Many behaviors place any individual-regardless of age, gender, ethnicity, or other characteristics-at greater risk for sexually transmitted diseases (STDs). The nurse
should include primary prevention interventions in all client encounters through the discussion of:
1. Partner notification.
2. Safer sex.
3. Standard precautions.
4. STD testing.
Safer sex
A population-level tertiary prevention intervention typically carried out by nurses caring for those with communicable disease in the community is:
1. HIV test results counseling.
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2. Needle exchange.
3. Partner notification.
4. Instruction in standard precautions
Instruction in standard precautions
A client diagnosed with human papillomavirus (HPV) infection states, "I'm not concerned, I know the warts disappear after a while." The nurse should counsel the
client regarding which of the following? Select all that apply.
1. Link between HPV and cervical cancer.
2. Status of HPV infection as a reportable disease.
3. Need to eliminate the warts.
4. Serious complications of HPV infection for men.
5. Lack of cure for HPV infection
Link between HPV and cervical cancer

Need to eliminate the warts
Lack of cure for HPV infection
Which of the following statements best summarizes Lillian Wald's achievements?

a.She suggested new nursing specialties.
b.She demonstrated how to improve health in communities.
c.She gave expert clinical nursing care to her clients.
d.She was appointed a national nursing leader.
b.She demonstrated how to improve health in communities.
Which of the following statements best describes "thinking upstream"?

a.Focus on economic, political, and environmental factors
b.Prepare for your nursing career long-term goals by planning now
c.Seek causes of water and air pollution "upstream" from cities
d.Try to understand how or why someone got ill
a.Focus on economic, political, and environmental factors
Which of the following statements best describes a weakness of early nursing theories?
a.Many nurses did not know or understand the theoretical basis of nursing practice.
b.Most nursing theories focused on microscopic individual concerns.
c.The theories did not reflect the actual world of nursing practice.
d. The theories had global applicability to nursing practice.
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b.Most nursing theories focused on microscopic individual concerns.
Which of the following best describes the primary purpose of nursing theory?
a.To improve nursing practice
b.To demonstrate that nursing is a profession
c.To organize nursing knowledge
d.To serve as a basis for ongoing nursing research
a.To improve nursing practice
A client did not attend the clinic for required follow-up care after his extensive surgery. Which of the following would be the most appropriate conclusion for the
nurse to make?
a.The client is noncompliant.
b.The client is suffering from self-neglect.
c.The health care system is not meeting the client's perceived needs.
d.The health care system is not accessible for the client.
e.The nurse has not motivated the client appropriately.
c.The health care system is not meeting the client's perceived needs.
which of the following assumptions makes Orem's theory difficult to use?

a.That nurses will always be caring for families and groups
b.That clients are able to control their environment
c.That clients recognize the need for nursing intervention
d.That teaching clients self-care is the primary goal of nursing practice
b.That clients are able to control their environment
Which of the following statements best describes the major assumption of the health belief model (HBM)?
a.People will act if action is both easy and convenient.
b.People will act if exposed to fear messages stressing their vulnerability.
c.The major determinant of preventive health behavior is avoiding disease.
d.The major determinant of preventive behavior is providing proper health education.
c.The major determinant of preventive health behavior is avoiding disease.
Which of the following assumptions of the health belief model (HBM) is problematic?
a.People have both free will and access to health resources.
b.People listen to the advice given by health care professionals.
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c.People are influenced by health messages given over media channels.
d.People make what they perceive as rational decisions in a given situation.
a.People have both free will and access to health resources.
A nurse is using Milio's framework for prevention to improve the health of clients. Which of the following would the nurse most likely implement?
a.Create appropriate national health policies
b.Develop health programs that make healthy choices the easiest choices
c.Promote nationwide educational programs with information on making healthy choices
d.Stress that clients are responsible for their own health
a.Create appropriate national health policies
Which of the following health-related variables is examined by the critical theoretical perspective?
a.Cultural beliefs
b.Effect of history and tradition
c.Ethnic and racial differences
d.Social inequalities
d.Social inequalities
A nurse is using the critical theoretical perspective in daily nursing practice. Which of the following activities would the nurse most likely complete?
a.Criticize health insurance programs as a barrier to health care
b.Expose social values underlying the health care system
c.Promote individual freedom and decision making
d.Exert control over the client's environment
b.Expose social values underlying the health care system
A nurse is using Healthy People 2020 as a guide to improve the health and well-being of the community. Which of the following strategies would the nurse most
likely implement?
a.Address the root causes of health problems
b.Choose one of the 28 focal areas for emphasis in funding and media attention
c.Concentrate on the goals of improving the quality of life
d.Continue funding expansion of the health care system
e.Expand efforts to put all medical records on electronic media
a.Address the r
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Which of the following is most closely associated with morbidity and mortality outcomes?
a.Number of physicians per capita
b.Insurance status
c.Crime rate
d.Personality traits
b.Insurance status
A nurse has accepted a new position in a public health department. Which of the following characteristics is crucial to the nurse's success?
a.Advanced educational preparation
b.Being knowledgeable about the community's needs
c.Listening and showing respect
d.Caring and empathetic personality
c.Listening and showing respect
A nurse is using a macroscopic approach when providing care. Which of the following would the nurse most likely demonstrate?
a.Emphasizing behaviors that will help in healing
b.Examining the family's responses to illness
c.Explaining how these actions will help in healing
d.Providing testimony to legislators concerning proposed legislation
d.Providing testimony to legislators concerning proposed legislation
A nurse is using Milio's framework to promote healthy eating choices among members of the community. Which of the following interventions would the nurse most
likely implement?
a.Provide community education about healthy food choices
b.Promote legislation to increase taxation on unhealthy food choices
c.Lobby for health insurance providers to pay for participation in health promotion programs
d.Encourage community members to be responsible for making healthy choices
b.Promote legislation to increase taxation on unhealthy food choices
A nurse has a broad, aggregate focus when providing care to clients. Which of the following best describes how this approach will help improve client outcomes?
(Select all that apply.)
a.Ensures that collaborative efforts of many professionals will be used
b.Confirms the individual's responsibility for resolving the health problem
c.Empowers decision-making based on both individual and community goals, needs, and priorities
d.Enables the nurse to ask for assistance from other community professionals
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e.Encourages allocation of time for population-focused preventive efforts
f.Upholds professional nursing standards of care
c.Empowers decision-making based on both individual and community goals, needs, and priorities
e.Encourages allocation of time for population-focused preventive efforts
A community health nurse is using the health belief model (HBM) as a basis for providing client care. Which of the following best describe the problems associated
with using the HBM? (Select all that apply.)
a.It ignores the need to reduce health system barriers to action.
b.It is extremely difficult to change the client's belief system.
c.It is the nurse's responsibility to persuade clients to engage in the appropriate behavior.
d.Clients do not have the knowledge to correctly analyze the seriousness of the disease or their susceptibility to it.
e.Clients expect health professionals to take preventive actions for them.
f.The choice and the burden for acting are entirely with the client.
a.It ignores the need to reduce health system barriers to action.

f.The choice and the burden for acting are entirely with the client.
A nurse is using the critical theoretical perspective in practice. Which of the following best describes how the nurse would respond when a client suggests that the
physician prescribe a widely advertised medication for tension and anxiety? (Select all that apply.)
a.Can you tell me what is going on in your life right now?
b.Do you know anyone else who is suffering such tension and anxiety?
c.How does your family feel about you having so much tension and anxiety?
d.Would you consider using the generic equivalent of this medication?
e.What led you to believe this medication would be of help to you?
f.What have you tried in the past to relieve tension and anxiety?
a.Can you tell me what is going on in your life right now?

f.What have you tried in the past to relieve tension and anxiety?
According to the critical theoretical perspective, which of the following should be held responsible for many of the illnesses of Americans today? (Select all that
apply.)
a.Advertisers who market sugar- and fat-saturated food products
b.Alcoholic beverage manufacturers, marketers, and sellers
c.Manufacturers of products that increase morbidity and mortality
d.Corporations who modify their emission rates
e.Restaurants that attempt to keep meal costs low
f.Tobacco manufacturers who sponsor sports events
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a.Advertisers who market sugar- and fat-saturated food products
b.Alcoholic beverage manufacturers, marketers, and sellers
c.Manufacturers of products that increase morbidity and mortality
f.Tobacco manufacturers who sponsor sp
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 aggregates 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.
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 bio-terrorism:
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 bio-terrorism,
anthrax scares, and the emergence of modern-day epidemics have drawn attention to population-focused safety and services
Which of the following actions demonstrate(s) effective

public health nursing practice in the community? (Select all
that apply.)
a. Epidemiological investigations examine the environment

for health hazards.
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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 epidemiological studies
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.
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:
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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
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.
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
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?
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a. Increase the communities 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
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.
.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
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community to determine needed health services
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.
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
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
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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
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.
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.
When talking to a women's 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?
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a. Ensure that the women did not expect the nurse to solve
their problem
b. Demonstrate that the nurse understood the women's
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.
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 people not a to the people or for the people approach to
planning.
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
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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.
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.
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.
A community-oriented nurse has identified obesity as a

problem in the middle school. The next step in a
population-focused practice is to make information
available about the health of the middle school students.
This describes the public health core function of:
A. assessment.
B. assurance.
C. policy development.
D. research
ANS: A. assessment
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In a community clinic that screens and treats individuals for
cardiovascular disorders, the nurse practicing public
health/population-focused nursing would most likely
ascertain:
A. a holistic treatment plan.
B. a specific clinical diagnosis.
C. individual dietary interventions for cardiovascular
disorders.
D. the prevalence rate of cardiovascular disorders among
various groups.
ANS: D. the prevalence rate of cardiovascular

disorders among various groups.
In a federally funded preschool program such as Head Start,

nursing services that include conducting developmental level screening for cognitive and psycho-motor
development of individual children would most likely be
considered community-oriented nursing care when:
A. individual results are compared with established

standards for children of the same age group.
B. program characteristics are assessed for their
effectiveness in making the school population healthier.
C. referral is provided for a child identified with delayed
psycho-motor development.
D. treatment is initiated for a child with an identified
learning disability.
ANS: A. individual results are compared with established standards for children of the same age group
Jennifer is a nurse in a family medicine clinic. Today she is

assessing Jose, a 4-year-old who is being seen for an
earache. The type of nursing Jennifer practices is:
A. community-oriented nursing.
B. community-based nursing.
C. public health nursing.
D. tertiary health nursing.
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ANS: B. community-based nursing.
A nurse in a clinic that provides direct care services to

clients with tuberculosis would be classified as practicing:
A. community-based nursing.
B. community-oriented nursing.
C. institutional nursing.
D. public health nursing.
ANS: A. community-based nursing.
A nurse planning a smoking cessation clinic for adolescents

in the local middle schools and high schools is providing:
A. community-oriented care.
B. community-based care.
C. secondary care.
D. tertiary care.
ANS: A. community-oriented care.
The public health nurse deals with the examination of a

community setting to determine the community's health
status. Which of the following activities should be
considered in the assessment phase? (Select all that apply.)
A. Assisting communities to implement and evaluate plans

and projects
B. Building constituencies to work with the community
C. Collecting, analyzing, and disseminating information
D. Evaluating the social, economic, and environmental
characteristics of the population
E. Questioning the availability of health services to the
community
ANS: C. Collecting, analyzing, and disseminating

information
D. Evaluating the social, economic, and environmental
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characteristics of the population
E. Questioning the availability of health services to the
community
Public health nursing is a specialty with a distinct focus and scope of practice and requires a special knowledge base different from other specialty areas of nursing.
A public health nurse would first be interested in:
A. drug treatments for diabetes.

B. populations with the highest rate of diabetes.
C. educational materials for individuals with diabetes.
D. new technology for diabetic care.
ANS: B. populations with the

highest rate of diabetes
A school nurse teaches three middle school students with

asthma conditions techniques to minimize their incidence of
bronchial spasms. This is an application of:
A. community-based nursing.
B. community-oriented nursing.
C. institutional nursing.
D. public health nursing.
ANS: A. community-based nursing
A state agency has received multiple complaints regarding

the availability of elder transportation services to a specific county senior center. The state agency assigns a public health nurse to work with the community to
evaluate its
program for elder transportation services to publicly sponsored elder care programs. The public health core function applied is:
A. assurance.
B. policy development.
C. primary prevention.
D. public transportation.
ANS: A. assurance.
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Which statement MOST accurately describes the pharmacodynamics of vaccines?
A. Vaccines work by stimulating the humoral immune system.
B. Vaccines provide IgG antibodies to protect against infection.
C. Vaccines prevent the formation of antibodies against a specific antigen.
D. Vaccines work by suppressing the amino acid immunoglobulin sequence.
A. Vaccines work by stimulating the hormonal immune system

Vaccines work by stimulating the humoral immune system, which synthesizes immunoglobulins. They also stimulate the formation of antibodies against their specific
antigen, providing active immunity.
What is the priority nursing assessment to monitor when administering vaccinations?

A. Myalgias
B. Anaphylaxis
C. Symptoms of infection
D. Pain at the injection site
B. Anaphylaxis
Anaphylaxis is a potential life-threatening adverse reaction to vaccines. Pain and myalgias can occur but are not life threatening.
Administration of which substance provides passive immunity?

A. Vaccines
B. Toxoids
C. Antitoxins
D. Immunoglobulins
D. Immunoglobulins
Vaccines, antitoxins, and toxoids provide active immunity by stimulating the humoral immune system. Immunoglobulins provide passive immunity by giving the
patient substances to fight specific antigens.
What teaching would the nurse provide to a client receiving tetanus toxoid?
A. "You will have lifetime immunity from this injection."
B. "Soreness at the injection site is a common reaction."
C. "This medication must be repeated weekly for 4 weeks."
D. "Increase fluid and fiber in your diet to prevent constipation."
B. Soreness at the injection site is a common reaction

Soreness at the injection site is a common adverse effect of tetanus toxoid.
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An allergy to which substance is a contraindication to the administration of an immunizing drug?
A. Soy
B. Egg
C. Corn
D. Wheat
B.Egg
Contraindications to the administration of immunizing drugs include allergy to the immunization itself or allergy to any of its components, such as eggs or yeast.
The current immunization for tetanus and diphtheria toxoids and pertussis, Tdap, is administered to people in which age range?
A. Younger than 6 years of age
B. 11 years of age and older
C. Any age range
D. In the first 2 years of life

Currently, DTaP is the preferred preparation for primary and booster immunization against these diseases in children from 6 weeks to 6 years of age unless use of
the pertussis component is contraindicated. Tdap is the recommended vaccine for adolescents and adults, those over the age of 11 years.
Which vaccination was developed to prevent bacterial meningitis caused by Haemophilus influenzae?
A. Preener
B. Gardasil
C. Hepatitis B vaccine
D. Hib conjugate vaccine

H. influenzae type b (Hib) (HibTITER, ActHIB, Liquid PedvaxHIB) vaccine is a noninfectious, bacteria-derived vaccine. Before this vaccine was developed,
infections caused by Hib were the leading cause of bacterial meningitis in children 3 months to 5 years of age.
Which vaccination is marketed and recommended in the prevention of a virus that is known to cause cervical cancer?
A. Herpes zoster vaccine (Zostavax)
B. Papillomavirus vaccine (Gardasil)
C. Pneumococcal vaccine (Prevnar 13)
D. Hepatitis B virus vaccine (Recombivax HB)
B. Papillomavirus Vaccine
Human papillomavirus virus (HPV) is a common cause of genital warts and cervical cancer. The HPV vaccine (Gardasil, Cervarix) is the first and only vaccine
known to prevent cancer.
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The anthrax vaccine is recommended for which groups of people? (Select all that apply.)
A. Military personnel
B. Veterinarians
C. Workers who process imported animal hair
D. Emergency department health care providers
A , B, C
People at risk for exposure to the anthrax bacterium include military personnel, veterinarians, and workers who process imported animal hair.
The nurse is reviewing the Centers for Disease Control recommendations for vaccines. The pneumococcal vaccine (Pneumovax 23) is recommend for which group
A. Newborn infants
B. Patients who are immunosuppressed
C. Patients who are transplant candidates
D. Smokers between 19 and 64 years old
D. Smokers between the age of 19 and 64
During a routine checkup a 72 year old patient is advised to receive a influenza vaccine injection. He questions this saying "I had one last year. Why do I need
another one?" What is the nurses best response?
A. "The effectiveness of the vaccine wears off after 6 months."
B. "Each year a new vaccine is developed based on the flu strains that are likely to be in circulation."
C. "When you reach 65 years old, you need booster shots on an annual basis."
D. "Taking the flu vaccine each year allows you to build your immunity to a higher level each time."
B. "Each year a new vaccine is developed based on the flu strains that are likely to be in circulation."
when assessing a patient who will be receiving a measles vaccine, the nurse will consider which condition to be a potable contraindication?
A. Anemia
B. Pregnancy
C. Ear infection
D. Common Cold
B. Pregnancy
When giving a vaccine to an infant, the nurse will tell the mother to expect which adverse effect?
A. Fever over 101F
B. Rash
C. Soreness at the injection site
D. Chills
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C. Soreness at the injection site
A 28 year old patient is in the urgent care center after stepping on a rusty tent nail. The nurse evaluates the patient's immunity status and notes that the patient thinks
she had her tetanus booster about 10 years ago, just before starting college. Which immunization would be most appropriate at this time?
A. Immunoglobulin Intravenous
B. DTap
C. Tdap
D. No immunizations necessary
C. Tdap
the nurse is providing teaching after an adult receives a booster immunization. Which adverse reaction will the nurse immediately report to the health care provider?
(select all that apply)
A. swelling and redness at injection site
B. Fever of 100f
C. joint pain
D. Heat over injection site
E. Rash over the arms, back and chest
F. Shortness of breath
C, E, F
An animal control officer was bitten by a stray dog that showed signs of rabies. Which statement by the nurse is correct regarding the treatment for rabies
prophylaxis?
A. "you will receive treatment if you begin to show symptoms of rabies."
B. "you will receive one oral dose of medication today, and one more in 1 week."
C. "you will need to receive 3 subcutaneous injections over the next week."
D. "you will need to receive 5 intramuscular injections over the next 28 days."
D. You will need to receive 5 intramuscular injections over the next 28 days
Phases of COPAR
1.) pre-entry
2.) entry
3.) organization building
4.) sustenance and strengthening
Pre-entry phase
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initial phase
simple phase
Activity 1 of the pre-entry phase
selection of project site
preliminary social investigation
identification of staff house and host families
Entry phase
social preparation phase

"conscientization/helping people to realize they have within themseles the capacity to understand and change their situtation"
Activity 1 of the entry phase
integration = living with the people and absorbing their lifestyle
information campaign
deepening social investigation
Provision of basic health services
Identification of Potential Leaders

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Training on PAR
participatory action research
GROUP TRAINING phases of PAR
1.) problem identification

2.) identification of data needed
3.) identification of key informants
4.) selection of research tools
5.) formulation of research tools
CORE GROUP TRAINING phases of PAR
1.) data collection

2.) data tabulation
3.) data analysis
4.) presentation of data
Traditional Participation
subjects are regarded as objects of research
PAR participation
subjects are actual researchers and active collaborators
Traditional problem identification
based on discipline/ interest of researcher
PAR problem identification
community experiences the problem; only assisted by NGO researcher
Traditional data gathering
patterned after natural science
PAR data gathering

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no standard design; patterned @ local culture and innovativeness; informal (thru observation/discussion of villagers)
PAR use of results
people have access, are aware and have the capacity to change their situation
Organization - building phase
entails formation of FORMAL structure and procedures of planning, implementing, educating community wide activities
Core group
informal structure
CHO (Community Health Organization)
formal structure
Sustenenace and strengthening phase
community members actively participating in community-wide undertakings
How long is the pre-entry phase
1-2 months
How long is the sustenenace and strengthening phase
7-8 months
Tentative Program Planning
choosing one issue to work on in order to begin organizing people
ground working
goo before core group formation

-basic CO tactic
-going around and motivating ppl on 1-1 basis in order to do something
-mind setting among key leaders and members of community
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Health status of the community
product of the various interacting elements such as population, physical, and topographical characteristics, socio-economic and cultural factors, health and basic
health services and power structures within the community
Manpower (health resources)
geographical distribution, manpower-population ratio, categories of health manpower, distribution of health facilities, quality of health, existing manpower
development/policies
Material (health resources)
health budget and expenditures, sources of health unding, categories of health institutions, hospital bed-population ratio and service available
Data used for line graph
shows trend data or changes with time or age with respect to same variable
Data used for bar graph/pictograph
comparison of absolute or relative counts and rates between categories
Data used for pie-graph
shows breakdown of a group not more than 5 categories
5 Dimensions of program performance
1.) relevance
2.) progress
3.) effectiveness
4.) impact
5.) efficiency
The nurse is teaching a patient who is preparing to travel to a malarious country about the prophylactic medication chloroquine. The nurse would instruct the patient
to take chloroquine for how long after leaving the affected area?
A. 2 weeks
B.4 weeks
C.8 weeks
D.12 weeks
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C. 8 weeks
Treatment for malaria prophylaxis is usually started 2 weeks before travel and continues for 8 weeks after travel is completed.
When admitting a patient diagnosed with Pneumocystis jirovecii pneumonia, the nurse will anticipate administering which medication?
A.iodoquinol (Yodoxin)
B.pentamidine (Pentam)
C.paromomycin (Humatin)
D.albendazole (Albenza)
B. pentamidine (Pentam)
Iodoquinol and paromomycin are used to treat intestinal amebiasis, and albendazole is used to treat helminthic infections.
A patient taking an anthelmintic drug should be instructed to notify the physician immediately if he or she experiences which side effect?
A.Darkened urine
B.Light-colored stools
C.Anal irritation
D.Gastrointestinal discomfort
A. Darkened urine
Darkened urine may be a sign of hemolysis, a serious side effect of anthelmintic drugs.
The nurse would question an order for chloroquine in a patient also prescribed which medication?
A.valproic acid
B.doxycycline (Doryx)
C.clindamycin (Cleocin)
D.diazepam (Valium)
A. valproic acid
Concurrent use of chloroquine with valproic acid may reduce serum drug levels of valproic acid and thus increase the risk of seizure activity. Chloroquine may be
given concurrently with clindamycin or doxycycline for synergistic actions.
A patient is seen in the clinic for signs and symptoms of malaria after a trip to South America. What drug would the nurse expect to be prescribed?
A.chloroquine (Aralen)
B.penicillin
C.metronidazole (Flagyl)
D.pentamidine (Pentam)
A. chloroquine (Aralen)
Chloroquine is a standard drug used for the treatment of malaria in an acute stage.
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When preparing to administer metronidazole via an intravenous route, the nurse will anticipate administering the medication for how long?
A.1 to 5 minutes
B.5 to 10 minutes
C.15 to 30 minutes
D.30 to 60 minutes
D. 30 to 60 minutes
Infuse intravenous doses of metronidazole as ordered and generally over more than 30 to 60 minutes and never as an intravenous bolus.
When a patient is receiving metronidazole (Flagyl) via an intravenous route, what side effect would the nurse immediately report to the health care provider?
A.Elevated blood pressure
B.Diminished breath sounds
C.Dark colored urine
D.Dizziness or confusion, change in neurologic status
D. Dizziness or confusion, change in neurologic status

During use of this drug, metronidazole administered intravenously, report to the prescriber any changes in neurologic status (e.g., dizziness, confusion).
The nurse is providing education to a patient who is prescribed metronidazole (Flagyl) for trichomoniasis. What statement by the patient indicates the patient has
understood the teaching?
A."I will stop taking the medication when the discharge stops."
B."I will have my partner evaluated and treated."
C."I can continue to have intercourse as long as we use condoms."
D."I won't get this again since I have had it once."
B. "I will have my partner evaluated and treated."

Inform the patient taking metronidazole for a sexually transmitted disease to avoid sexual intercourse until the prescriber states otherwise. The partner, any sexual
partners possibly exposed, need to be evaluated and treated if positive. All other statements would require further teaching by the nurse.
---------------- is the most significant protozoal disease in terms of morbidity and mortality.
Malaria
A client, who weighs 45.4 kg, is prescribed pyrantel (Pin-X) for a roundworm infection. The dosage is 11 mg/kg in one single dose to a maximum of 1 g. What is the
appropriate dosage for this client?
499 mg
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The nurse is teaching a patient who is starting antitubercular therapy with rifampin. Which adverse effects would the nurse expect to see?
a Headache and neck pain
b Gynecomastia
c Reddish brown urine
d Numbness or tingling of extremities
During antitubercular therapy with isoniazid, the patient received another prescription for pyridoxine. Which statement by the nurse best explains the rationale for
this second medication?
a "This vitamin will help to improve your energy levels."
b "This vitamin helps to prevent neurologic adverse effects."
c "This vitamin works to protect your heart from toxic effects."
d "This vitamin helps to reduce gastrointestinal adverse effects."
The nurse is counseling a woman who is beginning antitubercular therapy with rifampin. The patient also takes an oral contraceptive. Which statement by the nurse
is most accurate regarding potential drug interactions?
a "You will need to switch to another form of birth control while you are taking the rifampin."
b "Your birth control pills will remain effective while you are taking the rifampin."
c "You will need to take a stronger dose of birth control pills while you are on the rifampin."
d "You will need to abstain from sexual intercourse while on the rifampin to avoid pregnancy."
a
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When counseling a patient who has been newly diagnosed with TB, the nurse will make sure that the patient realizes that he or she is contagious
a during all phases of the illness.
b any time up to 18 months after therapy begins.
c during the postictal phase of TB.
d during the initial period of the illness and its diagnosis.
While monitoring a patient, the nurse knows that a therapeutic response to antitubercular drugs would be:
a The patient states that he or she is feeling much better.
b The patient's laboratory test results show a lower white blood cell count.
c The patient reports a decrease in cough and night sweats.
d There is a decrease in symptoms, along with improved chest radiograph and sputum culture results.
The nurse is monitoring for liver toxicity in a patient who has been receiving long-term isoniazid therapy. Manifestations of liver toxicity include: (Select all that
apply.)
a Orange discoloration of sweat and tears
b Darkened urine
c Dizziness
d Fatigue
e Visual disturbances
f Jaundice
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b,d,f
The order for isoniazid (INH) reads: "Give 5 mg/kg PO daily." The patient weighs 275 pounds. What is the amount per dose? Is this a safe dose?
625 mg/dose; no, maximum dose is 300 mg
A patient with tuberculosis has been taking antitubercular drugs. A sputum culture is ordered to test for acid-fast bacilli. When is the best time for the nurse to obtain
the sputum culture?
A. In the morning
B. Noon
C. Five o'clock in the evening
D. Ten o'clock in the evening
Correct answer: A
Rationale: If the prescriber has ordered collection of a sputum specimen to test for acid-fast bacilli, it is best to obtain the sample early in the morning. The most
common order is for three consecutive morning specimens, with a repeat specimen several weeks later.
A patient with a diagnosis of tuberculosis (TB) will be taking isoniazid (INH) as part of the anti-TB therapy. When reviewing the patient's chart, the nurse finds
documentation that the patient is a "slow acetylator." This means that:
A.the dosage of INH may need to be lower to prevent INH accumulation.

B.the dosage of INH may need to be higher due to the slow acetylation process.
C.he should not take INH.
D.he will need to take a combination of anti-TB drugs for successful therapy
Correct answer: A
Rationale: When INH is taken by slow acetylators, the INH accumulates because there are not enough liver enzymes to break down the INH. Therefore, the dosages
of INH may need to be adjusted downward to prevent toxicity.
A patient is receiving isoniazid (INH) for the treatment of tuberculosis. Which vitamin does the nurse anticipate administering with the INH to prevent isoniazid-
precipitated peripheral neuropathies?
A.Vitamin C
B.Vitamin B12
C.Vitamin D
D.Vitamin B6
Correct answer: D
Rationale: Pyridoxine (vitamin B6) may be indicated to prevent isoniazid-precipitated peripheral neuropathies and numbness, tingling, or burning of the extremities.
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Four weeks after beginning antitubercular drug therapy on an outpatient basis, the patient reports that he still experiences night sweats. What does the nurse identify
as the main concern at this time?
A.He is not taking his medication properly.
B.More time is needed to see a therapeutic response.
C.His infection may be resistant to the drug therapy ordered.
D.He may have contracted a different strain of tuberculosis (TB).
Correct answer: C
Rationale: The nurse should not jump to conclusions that the patient is not taking his medication properly. An improvement should start to occur within 2 weeks of
starting drug therapy, but this may not occur if the patient's TB is not sensitive to the prescribed drugs. An evaluation of the drug therapy will be needed.
A patient has an extremely severe infection with a Mycobacterium that is resistant to all but one antitubercular drug; however, the patient has had an allergic
reaction to that drug in the past. What does the nurse anticipate as being ordered for this patient?
A. A combination of anti tubercular drugs will be chosen to fight the infection.

B. The patient will receive the drug and supportive care to help him tolerate the anti tubercular therapy.
C. The patient will remain on isolation precautions until his cough clears.
D. There is nothing that can be done with this patient.
Correct answer: B
Rationale: It must be recognized that the urgency of treating a potentially fatal infection may have to be balanced against any prevailing contraindications. In
extreme cases, patients are sometimes given a drug to which they have some degree of allergy with supportive care that enables them at least to tolerate the
medication. Examples of such supportive care are treatment with antipyretics (e.g., acetaminophen), antihistamines (e.g., diphenhydramine), or even corticosteroids
(e.g., prednisone, methylprednisolone).
A home care nurse is visiting a patient with a diagnosis of TB. The patient traveled abroad two months ago. He lives with his wife and 5-year-old son. The patient
tells the nurse that he is concerned his son will also get TB so he wants to share his pills with his son. What is the best response by the nurse?
A. "That is a good idea. Children should not be exposed to TB."
B. "You should give your son half of the dose you take."
C. "Do not share any of your medications with anyone. Contact your son's health care provider to discuss your concerns."
D. "Children have an immune system that makes them immune to TB."
Correct answer: C
Rationale: Medications of any kind should never be shared with any other person. In particular, antitubercular drugs are age specific. Assessment of age is also
important, because the likelihood of adverse reactions and toxicity is increased in elderly patients due to age-related liver and kidney dysfunction. Additionally, the
safety of these drugs in children 13 years of age and younger has not been established.
The patient tells the nurse, "I had a shot after I returned from my trip overseas. I thought that was supposed to stop me from getting a tuberculosis infection." What
information regarding tuberculosis- related injections does the nurse identify as being true?
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A. BCG is used to prevent infection with tuberculosis for women of childbearing age.
B. A positive result for a PPD test is indicated by redness at the site of injection.
C. PPD is a diagnostic injection given intradermally to detect exposure to the TB organism.
D. BCG is a vaccine injection derived from an activated strain of Mycobacterium bovis.
Correct answer: C
Rationale: PPD is a diagnostic injection given intradermally in doses of 5 tuberculin units (0.1 mL) to detect exposure to the TB organism. A positive result is
indicated by induration (not erythema) at the site of injection and is known as the Mantoux reaction, named for the physician who described it. BCG is used in much
of the world to vaccinate young children against tuberculosis. Although it does not prevent infection, evidence indicates that it reduces active tuberculosis by 60% to
80% and is even more effective at preventing more severe cases involving dissemination of infection throughout the body.
The patient's wife is taking rifampin to prevent her from developing a tuberculosis infection. Which statement by the wife indicates that further teaching is needed?
A. "Because my oral contraceptives will not work while I am taking rifampin, I will use another form of birth control."
B. "I will take the medication for one week and then stop."
C. "I will avoid prolonged exposure to the sun."
D. "My urine may turn a reddish color when taking rifampin."
Correct answer: B
Rationale: Antitubercular therapy is taken for long periods of time, often 24 months. Although this patient does not have an active infection at this time and is taking
the rifampin to prevent an infection, the nurse should further investigate the length of time the medication is ordered. All other statements are true.
When reviewing a patient's medication regimen before discharge, the patient asks why he is taking pyridoxine when he is already taking isoniazid (INH) to treat
tuberculosis. What is the nurse's best response?
A "Pyridoxine is another antitubercular drug that will work synergistically with the isoniazid."
B "You really should not be on that drug. I will check with the doctor."
C"Pyridoxine will help prevent numbness and tingling that can occur secondary to the isoniazid."
D "Multidrug therapy is necessary to prevent the occurrence of resistant bacteria."
C
INH can cause neurotoxicity. Pyridoxine, vitamin B6, is the drug of choice to prevent this adverse reaction. It is not an antiinfective drug and thus will not work to
destroy the mycobacterium or prevent drug resistance.
What information must be provided to a patient receiving rifampin?

A. A nonharmful side effect of the drug is red-orange discoloration of urine, sweat, and tears.
B.Oral contraception is the preferred method of birth control when using rifampin.
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C.Peripheral neuropathy is an expected side effect, and the patient should report any numbness or tingling of the extremities.
D. The patient will only need to take this medication for the prescribed 14-day period.
A
Red-orange discoloration of body fluids is a common side effect of rifampin, but it is not harmful. Rifampin does not cause peripheral neuropathies (INH does), but it
does interfere with the effectiveness of oral contraceptives. All antitubercular drugs need to be taken long term in order to eradicate the slow-growing mycobacterium
lying deep within the tissues.
Which statement by the patient leads the nurse to believe that the patient has understood the teaching regarding ethambutol (Myambutol)?
A. "Dizziness, drowsiness, and decreased urinary output are common with this drug, but they will subside over time."
B "Constipation will be a problem, so I will increase the fiber in my diet."
C "I will need to have my eyes checked periodically while I am taking this drug."
D "This medication may cause my bodily secretions to turn red-orange."
Ethambutol can cause optic neuritis. Ophthalmologic examinations should be performed periodically to assess visual acuity.
The nurse will teach patients taking rifampin and INH prophylactically secondary to tuberculosis exposure that:
A. these drugs will only need to be taken for 7 to 10 days.

B. INH may decrease serum glucose in susceptible people.
C.oral contraceptives become ineffective when given with rifampin.
D. tanning beds may be used to counteract the pale skin tone caused by these medications.
Women taking oral contraceptives who are prescribed rifampin must be switched to another form of birth control because oral contraceptives become ineffective
when given with rifampin. These medications must be taken long term because mycobacterium is slow growing. They can cause photosensitivity, necessitating the use
of sunscreen, not tanning beds. Finally, INH may increase, not decrease, serum glucose levels.
The nurse anticipates an order for vitamin supplementation for a patient who is receiving INH therapy. What vitamin supplement is usually used with INH?
A Folate
B Vitamin B6
C Vitamin E
D Calcium
B
Pyridoxine (vitamin B6) is typically ordered to assist in prevention of the neurologic side effects of the INH.
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When assessing for adverse reactions to Rifamate (combination isoniazid and rifampin), the nurse would monitor which laboratory values? (Select all that apply.)
A Liver function tests
B CBC
C Sputum cultures
D Uric acid levels
E Cholesterol
A,B
Rifamate can lead to impairment of liver function as well as hematologic disorders. Assessment of sputum cultures confirms the diagnosis but is not related to
adverse effects. The drug does not affect uric acid levels or cholesterol.
"A patient will be receiving long-term isoniazid (INH) therapy. What laboratory tests are most important for the nurse to monitor during therapy?
a. Liver enzyme levels
b. Hematocrit and hemoglobin level
c. Creatinine level
d. Platelet count"
"The nurse should include which information in the teaching plan for a patient who is taking isoniazid (INH)?
a. Urine and saliva may be reddish-orange.
b. Pyridoxine (vitamin B6) may be needed to prevent neurotoxicity.
c. Injection sites should be rotated daily.
d. The medication should be taken with an antacid
to reduce gastric distress."
Patients who are in the initial period of treatment for tuberculosis need to be taught to perform which procedures? (Select all that apply.)
a. Wash their hands and cover their mouths when

coughing or sneezing to reduce the spread of
tuberculosis.
b. Throw away dirty tissues in the proper
receptacle.
c. Be sure to get adequate rest, nutrition, and
relaxation.
d. Skip medication doses occasionally if gastric
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distress occurs.
e. Avoid all visitor"
abc
"A patient newly diagnosed with tuberculosis asks the nurse how long he will need to take "all this medicine." The nurse replies that drug therapy for active
tuberculosis may need to last how long?
a. 6 months
b. 12 months
c. 24 months
d. A lifetime"
"The nurse is explaining antitubercular therapy to a patient. The patient asks, "Why do I have to take so many different medications?" What is the nurse's best
response?
a. "It helps to prevent the tuberculosis from be- coming resistant to the drugs."
b. "It makes sure that the disease is cured."
c. "These medications will reduce symptoms
immediately."
d. "You will have fewer side effects.""
"The nurse is reviewing the medication list of a patient who has been newly diagnosed with tuberculosis and will be taking rifampin (Rifadin). Which class of
drugs, if taken with the rifampin, may cause increased metabolism? (Select all that apply.)
a. Beta blockers
b. Proton pump inhibitors
c. Selective serotonin reuptake inhibitors
d. Oral anticoagulants
e. Oral antidiabetic drugs
ade
"The patient is to receive isoniazid (INH) 0.3 g daily. The medication is available as 100-mg tablets. How many tablets will the nurse administer per dose?"
3 tablets
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"The patient has new orders for pyrazinamide, 30 mg/ kg/day. The patient weighs 132 pounds. How many milligrams will the patient receive per day? Is this dosage
safe? "
1800mg
yes
max dose is 2 grams (2000mg)
Which statement MOST accurately describes the pharmacodynamics of vaccines?

A. Vaccines work by stimulating the humoral immune system.
B. Vaccines provide IgG antibodies to protect against infection.
C. Vaccines prevent the formation of antibodies against a specific antigen.
D. Vaccines work by suppressing the amino acid immunoglobulin sequence.
A. Vaccines work by stimulating the hormonal immune system

Vaccines work by stimulating the humoral immune system, which synthesizes immunoglobulins. They also stimulate the formation of antibodies against their specific
antigen, providing active immunity.
What is the priority nursing assessment to monitor when administering vaccinations?

A. Myalgias
B. Anaphylaxis
C. Symptoms of infection
D. Pain at the injection site
B. Anaphylaxis
Anaphylaxis is a potential life-threatening adverse reaction to vaccines. Pain and myalgias can occur but are not life threatening.
Administration of which substance provides passive immunity?

A. Vaccines
B. Toxoids
C. Antitoxins
D. Immunoglobulins
D. Immunoglobulins
Vaccines, antitoxins, and toxoids provide active immunity by stimulating the humoral immune system. Immunoglobulins provide passive immunity by giving the
patient substances to fight specific antigens.
What teaching would the nurse provide to a client receiving tetanus toxoid?
A. "You will have lifetime immunity from this injection."
B. "Soreness at the injection site is a common reaction."
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C. "This medication must be repeated weekly for 4 weeks."
D. "Increase fluid and fiber in your diet to prevent constipation."
B. Soreness at the injection site is a common reaction

Soreness at the injection site is a common adverse effect of tetanus toxoid.
An allergy to which substance is a contraindication to the administration of an immunizing drug?

A. Soy
B. Egg
C. Corn
D. Wheat
B.Egg
Contraindications to the administration of immunizing drugs include allergy to the immunization itself or allergy to any of its components, such as eggs or yeast.
The current immunization for tetanus and diphtheria toxoids and pertussis, Tdap, is administered to people in which age range?
A. Younger than 6 years of age
C. Any age range
D. In the first 2 years of life

Currently, DTaP is the preferred preparation for primary and booster immunization against these diseases in children from 6 weeks to 6 years of age unless use of
the pertussis component is contraindicated. Tdap is the recommended vaccine for adolescents and adults, those over the age of 11 years.
Which vaccination was developed to prevent bacterial meningitis caused by Haemophilus influenzae?
A. Preener
B. Gardasil
C. Hepatitis B vaccine

H. influenzae type b (Hib) (HibTITER, ActHIB, Liquid PedvaxHIB) vaccine is a noninfectious, bacteria-derived vaccine. Before this vaccine was developed,
infections caused by Hib were the leading cause of bacterial meningitis in children 3 months to 5 years of age.
Which vaccination is marketed and recommended in the prevention of a virus that is known to cause cervical cancer?
A. Herpes zoster vaccine (Zostavax)
B. Papillomavirus vaccine (Gardasil)
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C. Pneumococcal vaccine (Prevnar 13)
D. Hepatitis B virus vaccine (Recombivax HB)
B. Papillomavirus Vaccine
Human papillomavirus virus (HPV) is a common cause of genital warts and cervical cancer. The HPV vaccine (Gardasil, Cervarix) is the first and only vaccine
known to prevent cancer.
The anthrax vaccine is recommended for which groups of people? (Select all that apply.)
A. Military personnel
B. Veterinarians
C. Workers who process imported animal hair
D. Emergency department health care providers
A , B, C
People at risk for exposure to the anthrax bacterium include military personnel, veterinarians, and workers who process imported animal hair.
The nurse provides instructions to the mother of a child with mumps regarding respiratory precautions and the mother asks the nurse about the length of time
required for the respiratory precautions. The nurse should make which statement to the mother?
1. Droplet precautions are not necessary once the swelling appears
2. Droplet precautions are not necessary before the swelling begins
3. Droplet precautions are indicated during the period of communicability
4. Droplet precautions are indicated for 18 days following the onset of parotid swelling.
3. Droplet precautions are indicated during the period of communicability
A mother brings her 6-year-old child to the clinic because the child has developed a rash on the trunk and scalp. The mother reports that the child has had a low-
grade fever, has not felt like eating, and has been tired. The child is diagnosed with chickenpox. The mother inquires about the communicable period associated with
chickenpox, and the nurse bases the response on which statement?
1. The communicable period is unknown.

2. The communicable period ranges from 2 weeks or less to 4 weeks.
3. The communicable period is 10 days before the onset of symptoms to 15 days after the rash appears.
4. The communicable period is 1 to 2 days before the onset of the rash to 6 days after the first crop of vesicles, when crusts have formed.
4. The communicable period is 1 to 2 days before the onset of the rash to 6 days after the first crop of vesicles, when crusts have formed.
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A child hospitalized with pertussis is in the convalescent stage, and the nurse is preparing the child for discharge. The nurse has provided instructions to the parents
for home care of the child. Which statement by a parent indicates a need for further teaching?
1. "It is important that my child drinks plenty of fluids."
2. "A quiet environment helps to prevent episodes of coughing spells."
3. "We need to teach the other members of the family how to use good hand washing techniques to prevent the spread of infection."
4. "I need to make sure that the child is isolated from the other children for at least 2 weeks to prevent the spread of the virus to them."
4. "I need to make sure that the child is isolated from the other children for at least 2 weeks to prevent the spread of the virus to them."
An infant receives a diphtheria, tetanus, and acellular pertussis (DTaP) immunization at a well-baby clinic. The parent returns home and calls the clinic to report
that the infant has developed swelling and redness at the site of injection. Which intervention should the nurse suggest to the parent?
1. Monitor the infant for a fever.

2. Bring the infant back to the clinic.
3. Apply a hot pack to the injection site.
4. Apply a cold pack to the injection site.
4. Apply a cold pack to the injection site.
The home health nurse visits a child with infectious mononucleosis and provides home care instructions to the parents about the care of the child. Which instruction
should the nurse give to the parents?
1. Maintain the child on bed rest for 2 weeks.

2. Maintain respiratory precautions for 1 week.
3. Notify the health care provider (HCP) if the child develops a fever.
4. Notify the HCP if the child develops abdominal pain or left shoulder pain.
4. Notify the HCP if the child develops abdominal pain or left shoulder pain.
The mother of a preschooler who attends day care calls a clinic nurse and tells the nurse that the child is constantly scratching the perianal area and that the area is
irritated. The nurse suspects the possibility of pinworm infection (enterobiasis) and instructs the mother to obtain a rectal specimen by a tape test. At what time
should the nurse tell the mother to obtain the specimen?
1. After bathing
2. After toileting
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3. When the child is put to bed
4. In the morning, when the child awakens
4. In the morning, when the child awakens
A parent brings her 4-month-old infant to a well-baby clinic for immunizations. The child is up to date with the immunization schedule. The nurse should prepare to
administer which immunizations to this infant?
1. Varicella, hepatitis B vaccine (HepB)
2. Diphtheria, tetanus, acellular pertussis (DTaP); measles, mumps, rubella (MMR); inactivated poliovirus vaccine (IPV)
3. MMR, Haemophilus influenzae type b (Hib), DTaP
4. DTaP, Hib, IPV, pneumococcal vaccine (PCV), rotavirus (RV)
4. DTaP, Hib, IPV, pneumococcal vaccine (PCV), rotavirus (RV)
The clinic nurse prepares to administer a measles, mumps, rubella (MMR) vaccine to a 5-year-old child. The nurse should administer this vaccine by which route
and in which best site?
1. Subcutaneously in the gluteal muscle
2. Intramuscularly in the deltoid muscle
3. Subcutaneously in the outer aspect of the upper arm
4. Intramuscularly in the anterolateral aspect of the thigh
3. Subcutaneously in the outer aspect of the upper arm
A child is scheduled to receive inactivated polio vaccine (IPV), and the nurse preparing to administer the vaccine reviews the child's record. The nurse questions the
administration of IPV if which is documented in the child's record?
1. Recent recovery from a cold
2. A history of frequent respiratory infections
3. A history of an anaphylactic reaction to neomycin

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4. A local reaction at the site of injection of a previous IPV
3. A history of an anaphylactic reaction to neomycin
A child is receiving a series of the hepatitis B vaccine and arrives at the clinic with his parent for the second dose. Before administering the vaccine, the nurse should
ask the child and parent about a history of a severe allergy to which substance?
1. Eggs
2. Penicillin
3. Sulfonamides
4. A previous dose of hepatitis B vaccine or component
4. A previous dose of hepatitis B vaccine or component
A child with rubeola (measles) is being admitted to the hospital. In preparing for the admission of the child, the nurse should plan to place the child on which
precautions?
1. Enteric
2. Airborne
3. Protective
4. Neutropenic
2. Airborne
Several children have contracted rubeola (measles) in a local school, and the school nurse conducts a teaching session for the parents of the schoolchildren. Which
statement made by a parent indicates a need for further teaching regarding this communicable disease?
1. "Small blue-white spots with a red base may appear in the mouth."
2. "The rash usually begins on the face and spreads downward toward the feet."
3. "The disease can be spread to others 10 days before any sign of the disease appears to 15 days after the rash appears."
4. "Respiratory symptoms such as a profuse runny nose, cough, and fever occur before the development of a rash."
3. "The disease can be spread to others 10 days before any sign of the disease appears to 15 days after the rash appears."
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The clinic nurse is assessing a child who is scheduled to receive a live virus vaccine (immunization). What are the general contraindications associated with receiving
a live virus vaccine? Select all that apply.
1. The child has symptoms of a cold.

2. The child had a previous anaphylactic reaction to the vaccine.
3. Mother reports that the child is having intermittent episodes of diarrhea.
4. Mother reports that the child has not had an appetite and has been fussy.
5. The child has a disorder that caused a severely deficient immune system.
6. Mother reports that the child has recently been exposed to an infectious disease.
2. The child had a previous anaphylactic reaction to the vaccine.

5. The child has a disorder that caused a severely deficient immune system.
A child diagnosed with scarlet fever is being cared for at home. The home health nurse performs an assessment on the child and checks for which clinical
manifestations of this disease? Select all that apply.
1. Pastia's sign
2. Koplik's spots
3. White strawberry tongue
4. Edematous and beefy-red pharynx
5. Petechial red, pinpoint spots on the soft palate
6. Small red spots with a bluish-white center and a red base located on the buccal mucosa
1. Pastia's sign
3. White strawberry tongue
4. Edematous and beefy-red pharynx
Pastia's sign
Koplik's spots
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White strawberry tongue
Edematous and beefy-red pharynx
A nurse is preparing to administer a measles, mumps, rubella (MMR) vaccination to a 1-year-old child. List the steps that the nurse should take when administering
this vaccination. (place in order)
1. Obtain parental consent

2. Select the appropriate site
3. administer the vaccination
4. Verify the order for immunization
5. Document the lot number of the vaccination
6. provide a vaccination record for parents to keep
2. Select the appropriate site

4. Verify the order for immunization
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5. Document the lot number of the vaccination
1. Obtain parental consent
3. administer the vaccination
6. provide a vaccination record for parents to ke
The nurse is preparing written information regarding healthy lifestyle choices to be distributed to a groups of middle school children. To best assure the information
will be understood, which must the nurse do first?
a) Determine how the informational sheets will be distributed to the children
b) Assess the interest level that the children have about the information
c) Identify when to distribute the informational sheets to the children
d) Effectively encode the message for middle school children
d) Effectively encode the message for middle school children
To transmit the message, the sender must decide when specific signals or codes, such as language, words, gestures, and body language, to use. The reciever's ability
to decode the message is influenced by knowledge of the topic, skills in reading and listening, and attitudes, beliefs, and sociocultural values. Determining methods
for distribution and assessing interest are important, but not the first thing to do to assure understanding.
The nurse is discussing the impact of pesticides on the food Americans eat with a groups of sixth graders. The nurse is most confident the students understand ways
of minimizing the negative effects of pesticides when:
a) The nurse overhears students talking about how much they liked the class, "that talked about safe food"
b) During the discussion a student asked where to buy pesticide-free foods
c) The class places a poster in the cafeteria that states, "Wash your fruit before you eat it"
d) The principal shares that the students would like another class on how to grow
c) The class places a poster in the cafeteria that states, "Wash your fruit before you eat it"
The final part of the communication process, the feedback loop, allows both the sender and the receiver to check on the success of the transference of meaning an to
renegotiate the message to allow for clarity and better understanding and a poster identifying action to prevent is an example of this understanding. General
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statements about safe food and interest in an additional class do not measure transference of meaning, but identify a desire for pesticide-free food does not address
the objective outlined.
Which is true regarding nonverbal communication?
a) It basically focuses on transferring ideas an information to the receiver
b) It is often more important than verbal communication
c) It is more often misinterpreted than verbal communication
d) It relays very little of the senders true emotions and attitudes
b) It is often more important than verbal communication
Nonverbal messages, those conveyed without words, constitute a large portion of the messages transmitted in normal communication. Nonverbal statements may
enhance or discredit what someone says verbally and thus are even more important than the spoken words. People send messages nonverbally in many ways.
Nonverbal messages can be sent through personal appearance, dress, posture, facial expression, gestures, and physical distance between sender and receiver. Body
language often speaks louder than words. Facial expressions can convey acceptance, or rejection, interest or boredom, anger or patience, and fear or confidence.
Gestures and bodily movements, such as clenched hands, crossed arms, tapping fingers, hands on hips, or a turned shoulder, can negatively effect communication.
Eye contact or lack of it, tone of voice, and use of silence also send important nonverbal messages. A nurse's awareness that nonverbal messages may have different
cultural meanings or social interpretations can save considerable misunderstandings.
Which statement, when made by a nurse, most effectively demonstrates the concept of empathy?
a) "I'm sorry I don't have the scheduled time for your brain scan but I will let you know as soon as I know"
b) "I have always felt the greatest respect for individuals like you who are dealing with a progressive disease like Parkinson's"
c) "Mr. Smith, I am your nurse and should you need anything please don't hesitate to let me know"
d) "If you were dealing with cancer like you are, I would be angry. Does your diagnosis make you angry?"
d) "If you were dealing with cancer like you are, I would be angry. Does your diagnosis make you angry?"
Empathy is a critical component of the communication process, as it involves not only understanding a client's feelings, but also involves a level of self-awareness
that allows an individual to accurately demonstrate this understanding to the client. We show empathy by striving to put ourselves in out client's shoes - by reflecting
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their feelings and expressing the message in the receiver's language. Reassuring the client to let his needs be known and apologizing for not knowing scheduled time
are examples of developing trust and rapport, showing respect is the third interpersonal skill needed for effective commuication
What impact does poor health literacy among the older adult population have on their individual personal health care issues?
a) They are most likely to use the staff of the local hospital's emergency department as their primary HCP.
b) Poor health literacy in this population results in a reduction in their heath care costs
c) Personal interest in health care has more impact on their wellness than does their ability to read well
d) They are more likely to respond to health promotion interventions than to disease prevention interventions
a) They are most likely to use the staff of the local hospital's emergency department as their primary HCP.
Findings show evidence that a substantial portion of clients seen in EDs have limited health literacy and that adults age 65 or over with lower health literacy were
more likely to use the ED as a primary source for care, thus increasing health care costs. Health literacy is characterized as critical to health promotion and disease
prevention. Older adults, recent immigrants, migrants, ethnic minorities, and those with low levels of education and dominant language proficiency are most often to
be unable to effectively manage their health, gain service access, and understand information presented to them; they are also proportionately more likely to have
chronic illnesses such as diabetes, heart disease, and other noncommunicable diseases
The nurse is preparing to lead a group tasked with identifying and brainstorming possible solutions for health risks among those senior citizens living in urban
tenement. When does the nurse demonstrate and understanding of group development.
a) Planning an icebreaker for the first time the group meets
b) Defining the norming stage as when there is a normal lack of unity among members
c) Introducing sensitive topics early to help the group focus better
d) Setting the group rules as soon as the group is in the storming phase
a) Planning an icebreaker for the first time the group meets
"Ice breaker" activities, to introduces members to each other and move past the awkwardness and hesitancy, are often used at the first group meeting. Group rules
are identified and set after initial instructions. Sensitive topics should be introduced after the group is in the performing stage. The norming stage occurs when signs
of cohesiveness appear and the work begins.
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Which statement made by a community health team member best reflects one of the core functions of an effective group?
a) "We plan to suggest the same solution as we did before since the problems are similar"
b) "The group works well since everyone is either a nurse or a doctor"
c) "The group does so much better when we have a near unlimited time line for the solution process"
d) "We spend most of the meeting sharing information about the problem"
d) "We spend most of the meeting sharing information about the problem"
Four function of particular relevance to group decision making include the following: Group members share information. In community health nursing, groups
often include clients, health professionals, and community members who share their experience and expertise to arrive at solutions an decisions. Groups are
heterogeneous and present diverse views that enrich the number and types of alternative in the problem-solving process. Groups influence their members, thinking by
broadening their perspectives and presenting new ways of thinking about the issues. Group progress toward consensus or resolution by planning tasks that allow
members to discuss a set of alternatives and arrive at solutions to meet established goals.
A community health nurse have contracted to lead an informational support group that is composed of minority single mothers. Which activity demonstrated the
contract's aspects of partnership and mutuality?
a) The woman and the nurse decide upon which topics will be discussed during their meetings
b) The nurse identifies that there is space for the group to meet on Mon and Thurs afternoons
c) The group members agree on the rules that include arriving on time & staying for the entire meeting
d) The members determine that the group will meet two times a week for 8 consecutive weeks
a) The woman and the nurse decide upon which topics will be discussed during their meetings
The concept of contracting, as used in the collaborative relationship, incorporates four distinctive characteristics: partnership & mutuality, commitment, format, and
negotiation. Partnership and mutuality: All aspects of contracting involve shared participation and agreement between team members; they become partners in the
relationship. Commitment: In community health collaboration, contracting does not mean making a binding agreement in the legal sense, but it is a pledge of trust
and dedication. Format, the third distinctive feature of contracting, involves outlining the specific terms of the relationship. Negotiation: The nurse and other team
members propose to accept certain responsibilities and then ask whether the client agree.
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Which client will likely experience limited values from entering into a nurse-client contract that focuses on the client losing weight?
a) A 60-year-old adult female
b) A cognitively impaired 20-year-old
c) A 40 year-old adult male
d) A 10-year-old Hispanic male
b) A cognitively impaired 20-year-old
Developmentally delayed clients and those with serious mental or cognitive impairments may be unable to fully participate in the nurse-client contract. There would
be no issues with motivated adults or children utilizing effective contracts.
Which is true regarding an informal contract?
a) Notarization of the document
b) Signatures of the involved parties
c) Applies to serious agreements
d) Involves a verbal agreement
d) Involves a verbal agreement
Informal contracting involves some form of verbal agreement about relatively clear-cut purposes and tasks. Legal contracts, which are written and legally binding,
would include notarization and signatures and would be applied to serious agreements.
Which statement would be heard during the unfreezing stage of change?
a) "I haven't smoked in over 72 hours."
b) "I'm so glad I stopped smoking."
c) "I really want to stop smoking."

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d) "I've gotten a prescription to help me stop smoking."
c) "I really want to stop smoking."
The first stage, unfreezing, occurs when a developing need for change causes
disequilibrium in the system and an openness to change. Statements about getting a prescription medication and not smoking for a period of time are in the changing
stage (new ideas are accepted and tried out). Noting one is glad to have stopped smoking occurs during refreezing (change is integrated and stabilized in practice).
A key consideration to achieving a successful change is that it must:
a) save resources and inspire hope.
b) be popular and economic.
c) have a purpose and be planned.
d) easily implemented and timely.
c) have a purpose and be planned.
Achieving success is based on the fact that the change is purposeful and intentional; that is, there are specific reasons or goals prompting the change. Saving
resources, inspiring hope, and easy implementation are important aspects of change, but they do not necessarily lead to achievement of change. Successful change is
not always popular.
Place the planned change steps in sequential order:
1. analyze alternative solutions

2. diagnose need
3. implement the change
4. stabilize the change
5. recognize symptoms
6. evaluate the change
7. plan the change
8. select a change
1. recognize symptoms
2. diagnose need
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3. analyze alternative solutions
4. select a change
5. plan the change
6. implement the change
7. evaluate the change
8. stabilize the change
The planned change process is as follows: (1) recognize symptoms; (2) diagnose need; (3) analyze alternative solutions; (4) select a change; (5) plan the change; (6)
implement the change; (7) evaluate the change; and (8) stabilize the change.
When considering a change, the nurse understands the importance of selecting the appropriate goal. Which should the nurse ask?
a) "Is this something I can really do?"
b) "What makes me think this will solve the problem?"
c) "How will I determine if the goal is met?"
d) "How much time will it take to implement this change?"
a) "Is this something I can really do?"
Determining if something can be accomplished is an example of a useful goal, which should be (1) specific; (2) attainable (doable); and (3) forgiving [less than
perfect]. Determining if something will solve a problem is opinion related. Determining the amount of time is time-related. Determining how to evaluate success
addresses the outcome.
A community nurse is planning a neighborhood awareness program that focuses on the health risks caused by illegal drug use. The nurse demonstrates an
understanding of the principle of participation and its affect on change by first:
a) petitioning the local government to provide the money necessary to stage the planned event.
b) inviting members of the community, teachers, clergy, health care professionals, and police to serve on the planning committee.
c) securing a promise from at least half of the neighborhood's residents to participate in the various activities.
d) planning a media campaign to convince the residents that change is possible and attainable.
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b) inviting members of the community, teachers, clergy, health care professionals, and police to serve on the planning committee.
Persons affected by a proposed change should participate as much as possible in every step of the planned change process. Securing promises from half the residents
would be very time consuming and difficult. Petitioning government for money and planning a media campaign would be helpful and necessary but not part of the
principle of participation.
What is the primary reason that a nurse carefully selects the information that will be presented to members of
a post-myocardial infarction (MI) support group regarding changes they will be encouraged to make in their
current lifestyle?
a) People often experience short attention spans during their post-Ml period.
b) The members will need to understand why the changes will be beneficial to them.
c) There will be only a very limited amount of time for this discussion to occur.
d) There is a tremendous amount of misinformation on the topic out there.
b) The members will need to understand why the changes will be beneficial to them.
People do not undertake a change until they are convinced of its worth. Even with limited time, understanding benefits is important. Short attention spans and
misinformation are not pertinent.
Knowledge-level learning is best suited for which client?
a) A 5-year-old who is learning about crossing the street safely
b) A 15-year-old being taught to help manage his type 1 diabetes
c) A 10-year-old who needs to describe when his cast is too tight
d) A 20-year-old who must decide how to make up of a missed dose of medication
a) A 5-year-old who is learning about crossing the street safely
The knowledge level may be used with clients who are unable to understand underlying reasons or rationales, such as young children or people who have had
strokes. A 10-year-old, a 15-year-old, and a 20-year-old clients can make decisions and understand the reasons for doing so.
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Which activity is considered the basis of community health nursing practice?
a) Belonging to a community taskforce that is researching health risks among urban poor
b) Surveying the health needs of newborns from minority populations
c) Teaching a group of older adults how to personalize an appropriate exercise routine
d) Attending a political rally for a pro health candidate running for local office
c) Teaching a group of older adults how to personalize an appropriate exercise routine
For the community health nurse, health education is a foundation of practice. Belonging to a community taskforce, attending a political rally if a prohealth
candidate, and surveying the health needs of newborns are also community health nursing practice, but not the foundation.
Helping a mother recognize the meaning of her newborns various types of crying, is an example of what level
of learning?
a) Creating
b) Applying
c) Analyzing
d) Understanding
c) Analyzing
Analyzing involves having the learner break down material into parts, distinguishes between elements, and understands the relationships among the parts. A mother
analyzes when she seeks to determine the cause of an infant's crying. Creating is the ability not only to break down and understand the elements of a situation but
also to form elements into a new whole. Applying is when the learner cannot only understand material but also apply it to new situations. Understanding combines
remembering with connecting facts.
Which is the best way to handle unexpected challenges when teaching a special needs client?
a) Be firm but flexible when problems occur
b) Prepare in advance to deal with a variety of common challenges

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c) Set limits and expectations prior to beginning the learning session
d) Assure the client that learning is the primary goal
b) Prepare in advance to deal with a variety of common challenges
Regardless of the situation, the nurse will feel most comfortable and confident if he is prepared to deal with these situations before they are experienced. Being firm
but flexible, assuring that learning is the primary goal, and setting limits and expectations are good strategies during the class, but preparation to deal with situations
is key.
The nurse is confirming that a community health issue has sufficient importance to justify a major change in
the way it has been previously managed. What would the nurse do?
a) Consider the cost as well as the effort necessary to implement the necessary changes
b) Determine whether at least 50% of the target population agrees that the issue has importance
c) Consult the Healthy People 2020 goals and determine whether the issue meets one of the objectives
d) Confirm that a major change will be necessary regardless of the importance of the issue
c) Consult the Healthy People 2020 goals and determine whether the issue meets one of the objectives
Several methods can be used to validate the importance of the issue. One method would be to consider Healthy People 2020 objectives for the nation. Percentage of
population agreeing is important for successful change, however, more than 50% would be needed. Considering the cost and confirming a change are necessary
regardless of the importance of the issue pertain to resource management, which are both important; however, they do not address sufficiency of the health issue.
Which scenario best demonstrates that a nurse understands the concept of authoritative knowledge?
a) The nurse seeks the opinion of a diabetic client on how to best adjust his or her diet as he or she
trains for a marathon.
b) The nurse asks a registered dietitian to create a month-long menu plan for a client newly diagnosed
with a dairy allergy.
c) The nurse reviews the food diary of a client diagnosed with anorexia nervosa.
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d) The nurse encourages a pregnant client to limit salt intake when she gains 2 kg in 1 week
a) The nurse seeks the opinion of a diabetic client on how to best adjust his or her diet as he or she
trains for a marathon.
It is crucial that the views of the target population be heard and respected.
Anthropologists talk about a concept called "authoritative knowledge." This is "whose knowledge is respected," not "whose knowledge is right." Seeking the opinion
of a diabetic client meets this goal. Asking a dietitian for input and encouraging a specific diet relate to clinical expertise and evidence-based practice. Reviewing the
client's food diary is assessment.
The nurse is attempting to implement a change that affects the health risks of a target population. Which
action by the nurse would best ensure a successful change?
a) Write behavioral objectives that are reasonable as well as time sensitive
b) Seek the input of an advisory group that includes the population's formal and informal leaders
c) Include both local and state government officers in the decision making process
d) Create a thorough survey to identify health risks that are viewed as important by the population
b) Seek the input of an advisory group that includes the population's formal and informal leaders
As nurses work with community members to identify factors contributing to a health problem, individuals will begin to stand out because of their knowledge, their
network capabilities, and their interest in the subject, so seeking input will provide buy-in from the constituents. Creating and implementing a survey will identify
issues. Including government officers will assist with resources and policy. Writing behavioral objectives will guide activities. Although these three actions are
important, they do not ensure successful change.
Which outcome measure is SMART?
a) Four risk factors will be identified.
b) Fifth grade girls will verbalize three healthy food choices by the end of the education session.
c) Lose 15 kg the first week of the program.
d) The Spanish-speaking children will speak English by the end of the year.
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b) Fifth grade girls will verbalize three healthy food choices by the end of the education session.
The acronym SMART stands for specific, measurable, attainable, relevant, and timely. The outcome regarding losing 15 kg in the first week is not attainable. The
outcome regarding the fifth grade girls includes SMART components. The outcome regarding learning English is not attainable or specific as to which Spanish-
speaking children. The outcome regarding the four risk factors is not specific or timely.
To prioritize behavioral factors for change, how should items be rated?
a) People focused and community driven
b) Initiated by the people and government funded.
c) Importance and ease to bring about
d) Economic and culturally sensitive
c) Importance and ease to bring about
To achieve success, it has been suggested that change should be rated in terms of importance and changeability. The change should be both important and easy to
change. Economic, culturally sensitive, initiated and focused by people, government funded, and community driven are important factors to consider for success for
change, but not directly related to prioritization.
Which question concerning a change being proposed is not relevant to determining the necessary behavioral
objectives?
a) How will the success of the change be determined?
b) What is the expected cost of the change?
c) What is the expected outcome of the change?
d) Who is expected to be affected by the change?
b) What is the expected cost of the change?
Behavioral objectives identified who was targeted, what they hoped would change or what action would be taken, how the change would be measured, and what the
timeframe was for achieving the expected outcome.
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The benchmarking process is used by agencies striving for excellence and best practice. An example of
external benchmarking is:
a) comparing face-to-face client agency visits for immunizations and health maintenance services.
b) reviewing 3-year data for trends on the number of influenza vaccine administered.
c) implementing the CHF protocol from a neighboring public health agency.
d) measuring compliance with agency catheter procedures
c) implementing the CHF protocol from a neighboring public health agency.
External benchmarking is a comparison that occurs between similar agencies.

Implementing the CHF protocol from a neighboring public health agency is external benchmarking. Internal benchmarking is a comparison that occurs within an
organization. Measuring compliance with agency catheter procedures, comparing face-to-face client agency visits for immunizations and health maintenance
services, and reviewing 3-year data for trends on the number of influenza vaccine administered are internal benchmarking.
Appropriately stated goal setting is vital to what component of program planning and development?
a) Problem identification
b) Assessment
c) Evaluation
d) Contributing factors survey
c) Evaluation
Measurable goals are examined during the program evaluation. Without such statements, accurate evaluations cannot be conducted. Problem identification,
assessment, and surveys are part of program planning and implementation.
When conducting periodic reviews of service standards, a community health department pays particular
attention to:
a) client outcomes.
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b) cost analyses.
c) revenue sources.
d) staff credentials.
a) client outcomes.
Incidents of poor client outcomes are important areas for review and further study. All standards are measured by outcome for success. Cost, staff, and revenue are
important for agency purposes; however, for service to the population, client outcomes are directly related to services provided
Which model is recognized as being excellent, simplistic, and basic for measuring quality?
a) Quality health outcomes model
b) Omaha system
c) The quality practice setting attributes model
d) Donabedian model
d) Donabedian model
The Donabedian model is recognized as a simplistic and basic method of measuring quality, which includes structure, process, and outcome measures. The quality
health outcomes model is a more complex model and proposes a two-dimensional relationship. The Omaha system is useful for determining the quality of nursing
care provided to individuals, families, and communities. The quality practice setting attributes model provides the foundational framework for a quality improvement
approach for creating quality practice environments.
The public health nurse will be assessing one of the most common measurements of a community's health.
Which will the nurse review?
a) Number of available health care delivery systems
b) Types of accessible health care services
c) Activism of its community members
d) Morbidity data
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d) Morbidity data
Status/people is the most common measure of the health of a community. It typically comprises morbidity and mortality data identifying the physical, emotional, and
social determinants of health. The number of available health care delivery systems and the types of accessible health care services are parts of the structure.
Activism of a community's members is process related. Although important, status/people is the most common and readily available.
Which statement, when made by a community health nurse, demonstrates that a community is functioning
competently?
a) "I believe that the neighborhood is a safe place to live, raise a family, and work."
b) "The group decided that street lights were needed at several locations in the neighborhood."
c) "All neighborhoods should be well lighted, so safety can be assured."
d) "The mayor needs to budget for more street lights in the neighborhood."
b) "The group decided that street lights were needed at several locations in the neighborhood."
A competent community can collaborate effectively in identifying community needs and problems, achieve a working consensus on goals and priorities, agree on
ways and means to implement the agreed-upon goals, and collaborate effectively to take the required actions. The other answer choices are individual beliefs and
general statements.
Which question would the nurse would ask when engaging in an assessment that is focused on identifying the
community's boundaries?
a) "Are the bridges in the neighborhood well maintained?"
b) "Is the neighborhood a part of a larger community?"
c) "Is there bus service within the neighborhood?"
d) "Is there an acute care hospital in the neighborhood?"
b) "Is the neighborhood a part of a larger community?"
Community boundaries serve as basis for measuring incidence of wellness and illness and for determining spread of disease. Availability of hospital and bus service
and well-maintained bridge are characteristics of the community related to services.
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Which characteristic of low-density community has a significant negative impact on the health of its
population?
a) Increased risk of respiratory infections
b) Population tends to be older
c) Few health care providers
d) Poor housing options
c) Few health care providers
Rural communities often suffer from inadequate distribution of health care personnel, including private physicians and community health nurses. Other rural health
risks include greater rates of injuries from traffic and illnesses related to agricultural pesticide exposure. Recent studies have also found an association between
increasing pesticide exposure and ADHD.
The community health nurse is new to the community and has no first-hand data about the area. Which
method would be best for the nurse to obtain and find health, social, and governmental services?
a) Community Profile Inventory: Location Perspective
b) Community Familiarization (Windshield) Survey
c) Community Profile Inventory: Population Perspective
d) Community Profile Inventory: Social System Perspective
b) Community Familiarization (Windshield) Survey
A familiarization assessment is a common starting place for evaluation of a community. Such an approach may utilize a windshield survey—an activity often used by
nursing students in public health courses and by new staff members in community health agencies. Nurses drive (or walk) around the community of interest; find
health, social, and governmental services; obtain literature; introduce themselves and explain that they are working in the area; and generally become familiar with
the community and its residents. The community profile inventory methods are effective; however, they are more detailed and time consuming and would not be a
good use of resources at this time.
The nurse will focus on which demographic characteristic when analyzing the potential for high health risks
within a population of older adults?
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a) Intelligence
b) Gender
c) Occupation
d) Spirituality
c) Occupation
Class rankings based on occupation, education, and wealth (income plus assets) seem to correlate with many different social patterns and are used frequently in
research. Occupational level, in particular, has historically and consistently proven to be a reliable measure, with surprisingly similar rankings among all societies
for which data exist
Why does the nursing process serve well as a community health tool?
a) It provides a means of evaluating the outcomes of actions implemented for the purpose of change.
b) It stresses critical thinking and can be applied to a variety of social issues.
c) It supports problem solving and the management of change actions that ultimately improve health.
d) It is an established, reliable tool that is regularly used by the professional nurse
c) It supports problem solving and the management of change actions that ultimately improve health.
Five components—assessment, diagnosis, planning, implementation, and evaluation— give direction to the dynamics for solving problems, managing nursing
actions, and improving the health of communities and community health nursing practice.
What is the basis for successful community health nursing?
a) The nurse's ability to identify and solve problems
b) The nurse's willingness to tirelessly advocate for the community
c) A mutually respectful nurse-client relationship

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d) Effective interprofessional team work
c) A mutually respectful nurse-client relationship
The nurse-client interaction is an essential first consideration for community health nursing. Problem identification and solving, teamwork, and advocacy are
necessary; however, interactions are key.
Which nursing activity is the key step in effective positive change in the health of a community?
a) Addressing the county commission to advocate for additional funding for a local free clinic
b) Performing an evaluation of the outcomes based on standards and goals
c) Performing a community needs assessment using the Mobilizing for Action Planning and Partnerships
(MAPP) framework
d) Joining an interprofessional team that focuses on the rate contagious childhood diseases are spread
among low income families
c) Performing a community needs assessment using the Mobilizing for Action Planning and Partnerships (MAPP) framework
Assessment is the key initial step of the nursing process. Assessment for nurses means collecting and evaluating information about a community's health status to
discover existing or potential needs and assets as a basis for planning future action. Three models/frameworks can be used: MAPP, Protocol for Assessing
Community Excellence in Environmental Health (PACE EH), and an earlier tool Planned Approach to Community Health (PATCH). Participation on
interprofessional teams and requesting funding are important steps; however, beginning with assessment is priority. Evaluation occurs after planning and
implementation are complete.
Which is a qualitative assessment method designed to gather the opinion of a neighborhood community on a
particular topic?
a) Town Hall Meeting
b) Survey
c) Descriptive Epidemiologic Study
d) Geographic information system (GIS)

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a) Town Hall Meeting
The community forum or town hall meeting is a qualitative assessment method designed to obtain community opinions. GIS technology collects, organizes, and
displays public health data. Survey method asks a series of questions that provide quantitative information. Descriptive epidemiologic studies examine the amount
and distribution of a disease of health condition in a population.
1. Because several disciplines support the foundation of informatics nursing, it is important for the informatics nurse to understand that:
A) informatics nursing differs from other disciplines, as it focuses on supporting the process of obtaining data.
B) informatics nursing uses the concepts, tools, and methods of various disciplines to facilitate nursing process.
C) information technology and nursing technology are synonymous, as they have the same goal.
D) the boundaries between the various disciplines are clearly defined.
Knowledge that is patterned for use in reasoning is known as:

A) artificial intelligence.
B) knowledge query
.C) knowledge representation.
D) neural computing.
Which document articulates the primary factors that guide professional nursing judgment, regarding confidential patient information?
A) Administrative Simplification Provisions.
B) Code of Ethics for Nurses with Interpretive Statements.
C) Health Insurance Portability and Accountability Act.
D) Nursing Informatics: Scope and Standards of Practice.
In promoting change, the people who are recognized as opinion leaders and role models are known as the:
A) early adopters.
B) early majority.
C) innovators.
D) risk takers.
a
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The basic network protocol that determines the rules used to create and route packets of data between computers is:
A) HL7.
B) URL.
C) TCP/IP.
D) XML.
Applications that are designed to run on a common platform, operate in a common environment, and communicate through direct data transfer are known as:
A) integrated.
B) interfaced.
C) normalized.
D) optimized.
What is the most common risk to patient privacy and confidentiality? A) An organization's employees
.B) Inadequate firewall protection
.C) Inadequate system design.
D) Viruses, worms, and Trojan horses.
Adherence to a standardized nursing language will lead to:

A) a barrier in national interoperability.
B) a larger database of interventions.
C) improved evaluation of nursing outcomes.
D) increased nursing competencies.
The informatics nurse violates a patient's legal right to privacy and confidentiality, by:
A) discussing a patient's diagnosis with an authorized family member.
B) discussing care-related information with the patient's physical therapist.
C) looking up a colleague's diagnosis and laboratory results while he or she is hospitalized.
D) providing a handoff report containing patient information to another department.
c
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Using parallel strategy for the roll-out of an electronic medication administration system means that all:
A) data entries are cosigned by two health care team members.
B) medications are documented using both the current method and the new system.
C) notebook computers and bar code scanners are positioned on the same surface.
D) vital signs are entered on the same screen as is medication administration.
In project management, the critical path is best described as a series of activities that:
A) includes the path with the most slack or float.
B) indicates the earliest possible time a project can be completed.
C) is scheduled for the next current phase of the process.
D) shows the shortest path through the network diagram.
The foundation of strategic system planning begins with a review of the:

A) existing computing environment.
B) health care industry.
C) information system plan.
D) organization's business mission.
The focus of data analysis is to:

A) collect data from various sources.
B) evaluate data for efficiency.
C) identify data sources for later inclusion.
D) transform data into a usable form.
Which tool tracks resources, milestones, and time frames associated with the implementation of a new clinical program?
A) A database.
B) An expert system.
C) Project management software.
D) Spreadsheet software.
c
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What process produces a blueprint that details how hardware and software meet the needs of the organization?
A) Benchmarking.
B) Feasibility study.
C) System analysis.
D) System design.
A downtime of the electronic health record (EHR) system is planned for three months from today. The informatics nurse is formulating a communication plan for
the clinical staff about the downtime. The nurse plans to:
A) announce the upcoming downtime at system-wide meetings, and at department meetings of specific system hospitals affected by the downtime.
B) bring copies of the communication plan to IT meetings, and discuss it with the IT directors and managers.
C) present the information at the super-user meetings, department and unit meetings, and at other specialty clinician meetings, in addition to having a message
posted on the message-of-the-day screen in the EHR.
D) print fliers with the downtime plan and post them in bathrooms and breakrooms, as well as on bulletin boards in various locations in the hospitals.
Adult learners most effectively learn about a new clinical information system when the instructor:
A) assumes that the learner knows nothing about the system.
B) begins the formal training as early as possible in the implementation process.
C) emphasizes the technical specifications of the structure of the system.
D) encourages the learner to use previous experience to interpret new learning.
As an ambulatory provider reviews the patient's chart, the provider reads lab data from an external organization. This scenario exemplifies:
A) a health information exchange.
B) a system to update patient records.
C) a violation of privacy regulations.
D) an electronic health record.
19. The problems of an existing system have been identified, along with possible solutions. What is the next step in the systems analysis stage?
A) A feasibility study.
B) Requirements gathering.
C) Systems design.
D) Systems testing.
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a
What type of testing is performed on functionally grouped components to ensure that the subset works with the entire system?
A) Integration.
B) System.
C) Unit.
D) User acceptance.
The informatics nurse is working on a chart to demonstrate the increasing incidence of obesity in the patient population at a health clinic. The data will represent
patients who are of normal weight, overweight, obese, and morbidly obese, and it will include the percentage of the total population for each group. This type of data
is most effectively represented by a:
A) bar chart.
B) column chart.
C) line chart.
D) pie chart.
Integrating clinical practice guidelines with an electronic health record facilitates quality improvement measurement by:
A) comparing guideline parameters to clinical outcomes.
B) presenting results at the point of treatment decisions.
C) providing reference information to measurement staff.
D) representing patient acuity data.
System analysis is the process by which:

A) a proposed design is reviewed for feasibility.
B) potential vendor solutions are explored.
C) the management needs are identified.
D) the system's functional requirements are derived from users' needs.
A home health care nurse is using the steps of the SDLC, to design a new system for home health care documentation. The nurse analyzes the old system and
develops plans for the new system. What is the next step of the nurse in this process?
A) Test
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B) Design
C) Implement
D) Evaluate
After instituting a new system for recording patient data, a nurse evaluates the "usability" of the system. Which actions by the nurse BEST reflect this goal? Select
all that apply.
A) The nurse checks that the screens are formatted to allow for ease of data entry.
B) The nurse reorders the screen sequencing to maximize effective use of the system.
C) The nurse ensures that the computers can be used by specified users effectively.
D) The nurse checks that the system is intuitive, and supportive of nurses.
E) The nurse improves end-user skills and satisfaction with the new system.
F) The nurse ensures patient data is able to be shared across health care systems.
a,c,d
A nurse is using informatics technology to decide which patients may be at risk for readmission. What is the term for this type of analytic?
A) Data visualization
B) Predictive analytics
C) Big data
D) Data recall
Population health addresses the health status and health issues of aggregate populations and addresses ways in which resources may be allocated to address these
concerns. What is the driving force behind the use by health corporations of analytics and big data to support population health?
A) The transition from fee-for-service models to value-based payment models
B) A growing older population with more complicated health needs
C) The overcrowding and understaffing of hospitals
D) The shortage of health care professionals, particularly nurses
Nurses incorporate telecare in patient care plans. Which services are MOST representative of this technologic advance? Select all that apply.
A) Diagnostic testing
B) Easy access to specialists
C) Health and fitness apps
D) Early warning and detection technologies
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E) Digital medication reminder systems
F) Monitoring of progress following treatment
b,c,d
A nurse is testing a new computer program designed to store patient data. In what phase of testing would the nurse determine if the system can handle high volumes
of end-users or care providers using the system at the same time?
A) Unit
B) Function
C) Integration
D) Performance
Nurses test new technology in phases. In which phase would the nurse "test drive" the new system?
A) Unit
B) Function
C) User acceptance
D) Integration
A nurse is using the steps in informatics evaluation to evaluate the use of a portal as a patient resource. What are examples of activities that might occur in the
"determining the question" step? Select all that apply.
A) The nurse develops a clear, focused question to determine the data to be collected.
B) The nurse determines what to evaluate.
C) The nurse determines how the data ultimately should be reported.
D) The nurse decides what specific data elements need to be collected.
E) The nurse clarifies exactly how the data will be collected.
F) The nurse performs comprehensive documentation of the data collected.
a,c
A nurse is using information from informatics technology that is synthesized so that relationships between lung cancer diagnoses and smoking are identified. What
part of "DIKW" does this represent?
A) Data
B) Information
C) Knowledge
D) Wisdom
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c
A nurse designing a new EHR system for a pediatric office follows usability concepts in system design. Which concepts are recommended in system design? Select all
that apply.
A) Users should not explore with forgiveness for unintended consequences.
B) Shortcuts for frequent users should not be incorporated into the system.
C) Content emphasis should be on information needed for decision making.
D) The less times users need to apply prior experience to a new system the better.
E) All the information needed should be presented to reduce cognitive load.
F) The number of steps it takes to complete tasks should be minimized.
c,e,f
What is the purpose of the Health Insurance Portability and Accountability Act?
a. To safeguard an individual's health information.

b. To provide incentives when metrics are met by both physician practices and hospitals to move toward electronic documentation and processes to improve patient
care.
c. To enforce penalties when standards of care are not met.
d. To enhance communication among health care professionals to ensure quality and evidence-based patient care.
Answer: A
Rationale: The purpose of HIPAA is to ensure the safety and confidentiality of the patient's health information.
The nursing manager of a surgical unit has been asked by administration to evaluate client outcomes post cardiac catheterization. Using data about client outcomes
post cardiac catheterization for the past 6 months so as to modify practice is an example of:
a. Information.
b. Cost-effective care.
c. Meeting standards.
d. Evidence-based practice.
Answer: D
Rationale: Technology enables evidence-based practice by collecting good clinical knowledge, translating nursing knowledge into reference materials that can be
accessed at the point-of-care, and, potentially, assisting nurses to take action based on best evidence for practice.
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The clinic nurse has just accessed a client's chart on the computer. The resident comes over and asks her to stay logged on because he needs to add a note to that
client's chart. She should say:
a. "No problem. Just log me off when you're done."

b. "I'll put the note in for you. What do you want to say?"
c. "Just make sure that you sign your note because it's under my password."
d. "I'm sorry, but you will have to enter the information using your own password."
Answer: D
Rationale: System users must never share the passwords that allow them access to information in computerized clinical information systems. Each password uniquely
identifies a user to the system by name and title, gives approval to carry out certain functions, and provides access to data appropriate to the user. All users must be
aware of their responsibilities for the confidentiality and security of the data they gather and for the security of their passwords.
Nurses need to know how to operate a computer, compare data across time, and look for patterns in client responses to treatments. These are examples of:
a. JCAHO standards.
b. Information systems.
c. Informatics competencies.
d. Requirements for nursing licensure.
Answer: C
Rationale: The Quality and Safety Education for Nurses (QSEN) project identified informatics competency as a necessary component of the knowledge, skills, and
attitudes for quality patient care. Nurses are anticipated to be able to use information and technology to communicate, manage knowledge, mitigate error, and
support decision making. Nurses must utilize hospital database management, decision support, and expert system programs to access information and analyze data
from disparate sources for use in planning for patient care processes and systems.
The nurse calls the heathcare provider (HCP) regarding a new medication prescription because the dosage prescribed is higher than the recommended dosage. The
nurse is unable to locate the HCP, and the medication is due to be administered. Which action should the nurse take?
a. Contact the nursing supervisor.

b. Administer the dose prescribed.
c. Hold the medication until the HCP can be contacted.
d. Administer the recommended dose until the HCP can be located.
Answer: A
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Rationale: If the HCP writes a prescription that requires clarification, the nurse's responsibility is to contact the HCP. If there is no resolution regarding the
prescription because the HCP cannot be located or because the prescription remains as it was written after talking with the HCP, the nurse should contact the nurse
manager or nursing supervisor for further clarification as to what the next step should be. Under no circumstances should the nurse proceed to carry out the
prescription until obtaining clarification.
The nurse hears a client calling out for help, hurries down the hallway to the client's room, and finds the client lying on the floor. The nurse performs an assessment,
assists the client back to bed, notifies the health care provider of the incident, and completes an incident report. Which statement should the nurse document on the
incident report?
a. The client fell out of bed.

b. The client climbed over the side rails.
c. The client was found lying on the floor.
d. The client became restless and tried to get out of bed.
Answer: C
Rationale: The incident report should contain a factual description of the incident, any injuries experienced by those involved, and the outcome of the situation.
The informatics nurse violates a patient's legal right to privacy and confidentiality, by:
a. discussing a patient's diagnosis with an authorized family member.

b. discussing care-related information with the patient's physical therapist.
c. looking up a colleague's diagnosis and laboratory results while he or she is hospitalized.
d. providing a handoff report containing patient information to another department.
Answer: C
Rationale: This is an example of a breach of privacy.
A nurse has taught the staff about informatics. Which statement indicates that the staff needs more education?
a. If a nurse has computer competency, the nurse is competent in informatics.

b. To be proficient in informatics, a nurse should be able to discover, retrieve, and use information in practice.
c. A nurse needs to know how to acquire, critique, and apply scientific evidence from literature databases.
d. Nursing informatics integrates nursing science, computer science, and information science to manage and communicate information in nursing practice
Answer: A
Rationale: If the staff needs more education, then an incorrect statement is made. Competence in informatics is not the same as computer competency. To become
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competent in informatics, you need to be able to use evolving methods of discovering, retrieving, and using information in practice. This means that you learn to
recognize when information is needed and have the skills to find, evaluate, and use that information effectively.
A nurse wants to reduce data entry errors on the computer system. Which behavior should the nurse implement?
a. Use the same password all the time.

b. Share password with only one other staff member.
c. Print out and review computer nursing notes at home.
d. Chart on the computer immediately after care is provided.
Answer: D
Rationale: To increase accuracy and decrease unnecessary duplication, many health care agencies keep records or computers near a patient's bedside to facilitate
immediate documentation of information as it is collected from a patient.
Which descriptions are advantages of healthcare information technology (IT)? (Select all that apply.)
a. Increases health care delivery costs

b. Improves communication among providers
c. Improves administration functions
d. Increases time necessary to document care
e. Decreases the safety of providing care
Answer: B,C
Rationale: Health care IT improves communication among providers by providing immediate access that is legible and standardized to patient data by all providers.
IT improves administrative functions by addressing the issues of quality, cost-effectiveness, and outcomes of care. Although there are initial costs to purchase
hardware and software, these systems are cost-effective in the long run. Systems that support data collection at the point of care can directly enhance patient care by
decreasing the time spent on documentation, reducing the potential for errors, and supporting improved assessment and data communication.
Nursing administration is also affected by information technology. Which of the following can be considered as benefits from IT? (Select all that apply)
A. It provides absolute protection from web threats

B. Projection of trends in terms of cases, patients and medical diagnosis can be done
C. It limits errors in various fields
D. Help in communication between different employees
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Answer: A, C, D
Rationale: Nurse leaders and managers are critical to maintaining successful data security.
A doctorate of nursing practice student is in your clinical area; she states that she is data mining on urological procedures done in the clinic versus the hospital. This
means that she is doing what with the data?
A. Placing it in a database for later use

B. Extracting potentially useful information to see if there are relationships
C. Information technology exchange of information
D. Using rules and alerts for nurses to follow for these patients
Answer: B
Rationale: Data mining is the process of extracting specific data or knowledge that was previously unknown. This process can be used to understand patients'
symptoms, predict diseases, and identify possible interventions.
Adherence to standardized nursing language will lead to:
A. Improved evaluation of nursing outcomes

B. Larger database of interventions
C. Increased nursing competencies
D. A barrier in national interoperability
Answer: A
Rationale: Standardized languages are used in information systems to enable understanding among disciplines and across the information systems. This common
language allows for streamlined sharing of information because the same terms are used by everyone to describe the condition.
Integrating clinical practice guidelines with an electronic health record facilitates quality improvement measures by which of the following?
A. Representing patient acuity data

B. Comparing guideline parameters to clinical outcomes
C. Providing reference information to measure staff
D. Presenting results at the point of treatment decisions
Answer: B
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Rationale: The strength of the data in an EHR can be augmented through the use of tools for financials and clinical decision support. These tools provide the ability
to compare or combine data from clinical, financial, and distractive sources, thus supplying an added benefit to the organization.
Examples of ways that information technology aides in providing quality and safe patient care include which of the following? (Select all that apply)
A. Offers real-time display of pertinent patient data

B. Ability to handwrite progress notes
C. Documentation tools that coordinate with best nursing practice
D. Provides data elements for data collection
E. Offers ability to make intraprofessional coordination for appointments
Answer: A, C & D
Rationale: IT combines computer technology with data and telecommunication technologies to provide solutions to the health-care industry.
A patient's electronic medical record (EMR) is going to be transmitted to another provider via the internet, what must be done before it can be sent to prevent
unauthorized access?
A. Zip file
B. Encryption
C. Personal health record (PCR)
D. Database
Answer: B
Rationale: Data that are transmitted can be encrypted, and firewalls can be put in place to prevent unauthorized access. Data encryption is a tool used to protect
information that is transferred electronically (e-mail) or physically (laptop computer). This process transforms the data into an unreadable form by using
mathematical formulas.
A nurse manager is auditing patient records for intravenous lines that had been infiltrated. When creating a chart, what must happen to the patient data before
presenting the chart to the nursing staff in the infection control meeting?
A. Nothing, you cannot identify them with this chart

B. Make sure that last name then first name is listed correctly on the chart
C. De-identify all patients used on this chart
D. Make sure to include the nurse who started the infiltrated IV
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Answer: C
Rationale: You must omit patient identifiers
Which of the following can be considered as benefits from IT? (Select all that apply)
A. Provide cues in the tools that are used for documentation

B. Providing data elements for data collections
C. Protect against web threats
D. Real-time display of pertinent patient information
Answer: A,B,C
Rationale - 1.) Providing cues in the tools that are used for documentation that align with nursing best practice; 2) providing data elements for data collection; and 3)
real-time display of pertinent patient information
Which of the following can be considered as major development in Health care environment in terms of information technology?
A. Medication dispensing
B. Telehealth
C. Patient Monitoring
D. Prevention of epidemiological diseases through quality care
Answer: B
Rationale- Telehealth is a specialty in health care in which electronic devices and telecommunication technology are used to serve education and health care to
clinicians and patients.
A teacher is explaining to the student nurse about the meaning of technology and informatics. Which statement best explain that the teaching was effective?
a. "Nurses use computers to chart medication administration only."

b. "Nurses do not need to be proficient in informatics to care for clients."
c. "Information technology is data and telecommunication technologies that provide solutions to the health -care industry
d. "Physicians use computers more than nurses."
Answer: C
Rationale- Information technology combines technology with data and telecommunication technologies to provide solutions to the healthcare industry
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What are the defining characteristics of a healthcare organization (HCO)? SATA
a. unique purpose
b. specific uniforms
c. specialized workforce
d. public trust
e. non-profit status
a,c,d
The nurses that work at a large, regional hospital have transitioned to the use of a new EMR system. By learning, adjusting, and adapting to their new roles as a
group, the nurses are modeling which theory?
a. bureaucracy
b. systems theory
c. organizational professionalism
d. complex adaptive systems
The management of a local orthopedic surgery clinic that treats a large amount of the elderly population in the surrounding community are meeting to discuss the
threats of rising healthcare insurance premiums that are predicted to go in effect the following year. Some discussion topics on the agenda are how they can continue
to serve populations that healthcare coverage may be out of reach and how they will offset costs related to this continuation of care. The management team is using
what approach to help define the goals?
a. mission statement
b. strategic planning
c. futures thinking
d. magnet hospitals
Several directors of an acute health care clinic are discussing expanding their practices to 4 surrounding states. During a recent meeting, the directors shared points
concerning reasons they should or should not make this a goal by the end of the year. Some of the positive points discussed were increased technological
advancements available for treatments and increased funding the clinic has received through grants. Some negative points discussed were the nursing shortages
being experienced in the proposed areas and the increased healthcare regulations that are a threat to the proposed communities in the coming year. The directors are
using what form of analysis to discuss the proposed plan?
a. organization structure
b. continuum of care
c. centralized structure
d. SWOT analysis
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d
The charge nurse is teaching the new graduate nurse about the learning organization theory and the five disciplines that the organizations need to adopt in order to
properly utilize this theory. Which of the following are part of the disciplines this theory utilizes? SATA
a. systems thinking
b. physiological model
c. interprofessional learning
d. personal mastery
e. mental model
a,d,e
A client has been seeing their family care physician since he was born to present day. The client is admitted to the hospital for a spiked temperature of 102 and
symptoms of dehydration and the flu. The client is treated for their illness and is discharged to go home once the client is stabilized. The nurse sets up a follow- up
appointment with the client's family care physician. What element is the nurse using in this type of health care organization level of care?
a. secondary care
b. organizational structure
c. continuum of care
d. primary care
When seeking the relevant opportunities that could emerge from the future and strategizing how to make the most of them, this would be an example of which of the
following?
a. Strategic planning
b. Futures thinking
c. Strategic foresight
d. Philosophy
Why is it important for companies to evaluate managerial decisions using a SWOT Analysis?
a. It analyzes strengths, weaknesses, obligations, and threats.
b. It analyzes strong points, weak points, opportunities, and threats.
c. It analyzes strengths, weaknesses, opportunities, and threats.
d. It analyzes strengths, weaknesses, opportunities, and time.
a
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Nurse leaders and managers play a significant role in strategic planning process by?
a. Seeing the relevant opportunities that could emerge from the future and strategizing how to make the most of them.
b. Helping to define describes how the mission will be achieved
c. Performing a community needs assessment
d. Identifying the strengths of the unit and/ or staff, areas for improvement and opportunities for facilitating positive change
Which of these goals makes a hospital recognized as a Magnet Hospital? Select all that apply.
a. Promote quality in a setting that supports professional practice
b. Identify excellence in the delivery of nursing services to patients or residents
c. Promotes quality of care by following core measures
d. Level one trauma hospital
e. Disseminate best practices in nursing services
a,b,e
A nursing student is being taught by a senior nurse about organizational environments of a healthcare organization, which comment by the nursing student indicates
a need for correction?
a. "Organizational culture and information systems make up the internal environment of the HCO."
b. "When integrated into their environments, organizations will also change the structure of the environment in some ways."
c. "There is little interaction between internal environments and external environments when considering the structure of the HCO."
d. "External environments consist of conditions or events that directly affects the organization."
Which of the following makes up an organizational culture? Select all that apply.
a. Mission statement
b. Strategic planning
c. Span of control
d. Philosophy
e. Vision statement
a,d,e
During an interview, the nurse manager ask the new nurse if he knows about Magnet Recognition Program. Which answer indicate that the new nurse understands
the meaning of Magnet Recognition hospitals?
a. To recognize hospitals that make the most money
b. To provide a framework to bring people together to accomplish patient care
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c. A credential that organizations earn in recognition for quality patient care, nursing excellence and innovations.
d. Bringing vision to the planning process, seeing the relevant opportunities emerging
Health care organization is considered which system of theory?

a. Open system
b. Closed system
c. Simple system
d. Implement system
Within the HCO structure, which system describes the manager's scope of responsibility and and reflects the number of employees who report to a given manager?
a. Unity of Command
b. Chain of Command
c. Centralized Structure
d. Span of control
How are Not For Profit hospitals funded? Select all that apply.
a. Government
b. Grants
c. Stockholders
d. Donations
e. Corporate
a,b,d
What is a possible downside in running a not-for-profit Healthcare organization compared to a for-profit one?
a. They must set aside funds to pay their stockholders
b. They are required to lower cost care
c. They have to adhere to qualifications set forth by Medicare and Medicaid to be reimbursed
d. They may have to cut services or make other sacrifices to maintain a positive cash flow
d
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What are some qualities that a hospital must possess to maintain Magnet recognition? Select all that apply.
a. Encourage futuristic thinking through strategic planning programs
b. Promote quality in a setting that supports professional practice
c. Identify excellence in the delivery of nursing services to patients or residents
d. Disseminate best practices in nursing services
e. Pursue career learning through consistent education
b,c,d
A nurse is discussing the general systems theory to a nursing student asking about the role of nursing in health promotion. Which statements imply that the student
understands the material? Select all that apply.
a. "The whole system is greater than the sum of its parts."
b. "It's a constant cycle of input, throughput, and output."
c. "The theory suggests that relationships are the key to everything."
d. "The overall effectiveness relies on interdependent functioning of the subsystems."
e. "It is composed of five disciplines that organizations should adopt and practice."
a,b,d
A nurse is providing primary healthcare to patients in a healthcare facility. Which patients are receiving this care? Select all that apply.
a. A patient enters a primary care provider's office for a yearly check-up
b. A patient is admitted into the hospital following a cerebrovascular accident.
c. A patient enters to receive an influenza vaccination.
d. A mother brings her toddler into an urgent care after nausea and vomiting
e. A patient is transferred to a cardiac rehabilitation center following open heart surgery.
a,c

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College of Health Sciences Education

3rd Floor, DPT Building

Risk of skin-to-skin contact in transmitting the identified STDs

Immunocompromised persons, substance abusers, and those with diabetes

Antibody test results are typically negative

Hepatitis A outbreaks commonly occur in facilities where staff change diapers.

Instruction in standard precautions

Link between HPV and cervical cancer

Which of the following statements best summarizes Lillian Wald's achievements?

b.She demonstrated how to improve health in communities.

Which of the following statements best describes "thinking upstream"?

a.Focus on economic, political, and environmental factors

a.To improve nursing practice

which of the following assumptions makes Orem's theory difficult to use?

b.That clients are able to control their environment

c.The major determinant of preventive health behavior is avoiding disease.

a.People have both free will and access to health resources.

a.Create appropriate national health policies

b.Expose social values underlying the health care system

c.Listening and showing respect

d.Providing testimony to legislators concerning proposed legislation

b.Promote legislation to increase taxation on unhealthy food choices

a.It ignores the need to reduce health system barriers to action.

a.Can you tell me what is going on in your life right now?

Which of the following best describes community-based

a. A philosophy that guides family-centered illness care

Which of the following variables have led to a stronger

a. Economic turmoil and demand for high-technology care

Which of the following actions demonstrate(s) effective

a. Epidemiological investigations examine the environment

Which of the following best describes community-oriented

a. Focusing on the provision of care to individuals and

Which of the following is the primary focus of public health

a. Families and groups

Why are nurses increasingly providing care in clients

a. Home care is less expensive.

Which of the following is responsible for the dramatic

a. Technology increases in the field of medical laboratory

A nurse is developing a plan to decrease the number of

a. Increase the communities knowledge about hospice care.

Which of the following is a basic assumption of public

a. Health disparities among any groups are morally and

.Which of the following actions would most likely be

a. Asking community leaders what interventions should be

Which of the following public health nurses most clearly

a. The nurse who met with several groups to discuss

Which of the following best defines aggregate?

a. A large group of persons

A registered nurse was just employed as a public health

a. Which groups are at the greatest risk for problems?

Making sure that essential community-oriented health

When talking to a women's group at the senior citizens

The public health nurse has a clear vision of what needs

a. To increase the groups self-esteem

a. The specific moral or ethical principle related to the situation

Which of the following actions best represents public health nursing?

a. Assessing the effectiveness of the large high school health clinic

a. To assess the needs of the homeless who live there