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Chapter 7: Population Based Health Care Practice
MULTIPLE CHOICE
1. In working as an advocate for specific population groups, the nurses recognize that they are engaging
in population-based nursing, which was established by:
a. Florence Nightingale. c. Clara Barton.
b. Faye Abdellah. d. Jane Delano.
ANS: A
Nightingale’s actions to improve the health care of soldiers on the battlefield and the poor and infirm
in London was directed at vulnerable populations. The primary thrust of this advocacy is directed at
population groups.
2. The development, provision, and evaluation of multidisciplinary health care services to population
groups experiencing increased health risks or disparities in partnership with health care consumers and
the community in order to improve the health of the community and its diverse population groups is
called:
a. population-focused nursing practice. c. population-based health care practice.
b. population-based nursing practice. d. population-based care.
ANS: C
Population-based health care practice is the development, provision, and evaluation of
multidisciplinary health care services to population groups experiencing increased health risks or
disparities, in partnership with health care consumers and the community in order to improve the
health of the community and its diverse population groups. Population-focused nursing practice is
defined by nursing activities that focus on all of the people and reflects responsibility to and for the
people. Population-based nursing practice is defined as the practice of nursing in which the focus of
care is to improve the health status of vulnerable or at-risk population groups within the community by
employing health promotion and disease prevention interventions across the health continuum.
Population-based care requires active partnership of both providers and recipients of care.
3. The nurse recognizes that there are certain variables that increase or decrease the probability of illness
or death, and that these variables can be modified. Such variables are called:
a. health determinants. c. vulnerable population groups.
b. underserved. d. health risk factors.
ANS: D
Health risk factors are variables that increase or decrease the probability of illness or death. Health risk
factors may be modifiable. Health determinants are variables that include biological, psychosocial,
environmental, and health system factors that may cause changes in the health status of individuals,
families, groups, populations, and communities. Vulnerable population groups are subgroups of a
community who are powerless, marginalized, or disenfranchised and are experiencing health
disparities. The underserved are those people who have not received adequate medical care services.
5. During the course of practice, the nurse must be aware of the health of an individual, family, group,
population, or community, also known as their:
a. health status. c. health needs.
b. quality of life. d. health assets.
ANS: A
Health status is the level of health of an individual, family, group, population, or community. Quality
of life is the level of satisfaction one has with the condition of one’s life. Health needs is not a level of
health. Health assets are health-promoting attributes of individuals, families, communities and
systems.
6. While caring for a population, the nurse recognizes that differences in health risks and health status
that reflect the groups' poor health status are known as:
a. illness prevention. c. health promotion.
b. health disparities. d. minority health.
ANS: B
Health disparities are differences in health risks and health status measures that reflect the poorer
health status that is found disproportionately in certain population groups.
7. According to the report Healthy People 2020, which of the following has occurred?
a. Significant reduction in both smoking and obesity
b. Significant reduction in smoking cessation
c. Significant reduction in obesity
d. Significant increase in smoking cessation
ANS: B
According to the report Healthy People 2020, there has been a significant reduction in smoking
cessation. There has also been a significant increase in obesity in the U.S. population during the first
decade of this century.
9. A staff nurse asks the nurse manager, “How can I tell if our organization provides culturally inclusive
health care?” The most appropriate response by the manager is that the organization:
a. includes multiple methods of providing health care.
b. will focus on serving two to three minority populations only.
c. has more men than women in the health care workforce.
d. uses standard interventions for all populations as a safeguard.
ANS: A
A culturally inclusive health care system promotes increased awareness of the injustices of the system,
will increase the diversity of health care workers, and includes multiple methods of providing health
care using a variety of intervention strategies to achieve outcome measures tailored to the diversity of
the population groups served.
10. As the nurse, if you were going to determine the health status of a community, as opposed to assessing
the health system or assessing the population, you would assess which of the following factors?
a. Level of education and socioeconomic status
b. Availability of health resources 24 hours per day
c. Age, gender, and ethnic patterns
d. Housing and safety of neighborhoods
ANS: D
Housing and safety of neighborhoods is directly related to community health. Availability of health
resources is related to assessing the health system level. Age, gender, and ethnic patterns comprise
assessing the individual population level, as well as assessing the level of education and
socioeconomic status.
11. As nurses whose population-focused efforts involve advocating for the rights of children, the mentally
ill, the indigent, and immigrants, these nurses recognize that they are advocating for the same groups
as which person who also helped to establish the Children's Bureau?
a. Dorothea Dix c. Lillian Wald
b. Mary Agnes Snivley d. Isabel Hampton Robb
ANS: C
Lillian Wald, well known for her establishment of the Henry Street Settlement, also helped establish
the Children’s Bureau. Dorothea Dix was superintendent of the Union Army Nurses. Mary Agnes
Snivley formed the Canadian Nurses Association. Isabel Hampton Robb was the first superintendent
of the John’s Hopkins Training School.
PTS: 1 DIF: Application REF: POPULATION-BASED NURSING PRACTICE
12. The nurse recognizes that clients may have strengths and resources that they can use to combat health
threats. These strengths and resources are called:
a. protective factors. c. defense mechanisms.
b. activities of daily living. d. holistic interventions.
ANS: A
Protective factors are client strengths and resources that can be used to combat health threats.
13. When a nurse employs population-based interventions that focus on changing the law, the nurse’s
interventions are considered at which of the following levels?
a. Community c. Individual
b. Systems d. Group
ANS: B
Population-based interventions at the systems level focus practice on changing laws, power structures,
policies, and organizations. Population-based interventions at the community level focus practice on
changes involving community norms, attitudes, practices, and behaviors. Population-based
interventions at the individual level focus practice on changes in the knowledge, attitudes, beliefs,
practices, and behaviors of individuals, families, and groups.
14. The nurse understands that when using a nontraditional model of population-based nursing practice,
the primary goal is to:
a. contain costs. c. maintain quality of care.
b. increase costs. d. decrease quality of care.
ANS: A
The primary goal of a nontraditional model of population-based nursing practice is to contain or
reduce costs. The secondary goal is to improve the quality of care.
15. A nurse implementing a nontraditional population-based nursing practice model would recognize
which of the following?
a. The total community is the primary focus.
b. Identifying at-risk or vulnerable population groups is a strategy.
c. An at-risk or high-risk population is the primary focus.
d. Assessing the total community’s needs is a strategy.
ANS: C
The nontraditional population-based nursing practice model includes the at-risk or high-risk population
as the primary focus. The traditional population-based nursing practice model includes total
community is the primary focus. Assessing total community’s needs and identifying at-risk or
vulnerable population groups are not population-based strategies.
16. When assessing, diagnosing, planning, implementing, and evaluating nursing practice in a
population-based nursing practice, the nurse is using which of the following?
a. NANDA c. Nursing process
b. Comorbidities d. Population assessment
ANS: C
The nursing process is used in population-based nursing practice to assess, diagnose, plan, implement,
and evaluate nursing practice. The North American Nursing Diagnosis Association (NANDA)
develops nursing diagnoses. Population groups may have multiple diagnoses, called comorbidities.
Population assessment is structured by using this model as a guide for data collection.
17. As a community health nurse, you are planning interventions for the community. Which of the
following should be considered first?
a. Interventions must be thoroughly researched to ensure they are evidence based.
b. Interventions must be designed to include specific culturally diverse populations of the
community.
c. Key community or population group representatives must be included in the planning.
d. Interventions must be planned to be cost effective and to include complementary therapies.
ANS: C
Planning always involves a collaborative process with the clients first to ensure the intervention is
designed to fit the specific needs of the clients, to build on assets, to take into account existing
resources, and to ensure that follow-through is more likely. Interventions need to be evidence based
whenever possible. Cultural diversity should also be taken into consideration when designing
interventions.
18. In evaluating a population-based nursing practice, the nurse asks, “Did their health status improve?”
The nurse asks this question to address which goal?
a. Access c. Cost
b. Quality d. Equity
ANS: B
The goal of quality would address the question, “Did their health status improve?” Other questions
that would be addressed include “Were their health risks reduced?” and “Were they satisfied with the
services they received?”
19. In evaluating a population-based nursing practice, the nurse asks, “Were patients able to afford what
we had to offer?” The nurse would ask this question to address which of the following goal?
a. Access c. Cost
b. Quality d. Equity
ANS: C
The nurse’s question—“Were patients able to afford what we had to offer?”—focuses on cost.
Questions related to access would focus on finding and providing services to high-risk, underserved,
vulnerable populations. Questions of quality would relate to changes in health status as a result of
interventions, and questions related to the goal of equity would focus on the use of resources to meet
the needs of the population.
20. In evaluating a population-based nursing practice, the nurse asks, “Did we offer service regardless of
age, gender, race, ethnicity, health care status, or location?” The nurse asks this question to address
which goal?
a. Access c. Cost
b. Quality d. Equity
ANS: A
The goal of access would address the question, “Did we offer service regardless of age, gender, race,
ethnicity, health care status, or location?” Questions of quality would relate to changes in health status
as a result of the interventions. Questions related to the goal of equity would focus on the use of
resources to meet needs, and questions related to cost would focus on affordability.
21. In evaluating a population-based nursing practice, the nurse asks, “Did we have enough resources left
over to meet the essential health needs of lower-risk population groups?” The nurse asks this question
to address which goal?
a. Access c. Cost
b. Quality d. Equity
ANS: D
The goal of equity would address the question, “Did we have enough resources left over to meet the
essential health needs of lower-risk population groups?” Questions related to quality would focus on
changes in health status as a result of interventions. Questions related to the goal of access would
focus on providing services regardless of age, gender, race, ethnicity, and health care status.
Questions of cost would focus on affordability.
22. The local nursing program has opened a nurse-run health clinic. Services at the clinic will be
available to poor, minority families who have not benefited from the services that have been accessible
in their community. The nursing program is primarily addressing which of the goals of Healthy
People 2020?
a. Create social and physical environments that promote good health for al
b. Attain high quality, long lives free of preventable diseases, disability, injury, and
premature death.
c. Achieve health equity, eliminate disparities, and improve the health of all groups.
d. Promote quality of life, healthy development and healthy behaviors across all life stages.
ANS: C
The nursing program is addressing the Healthy People 2020 goal of achieving health equity,
eliminating disparities, and improving the health of all groups. This nurse-run clinic will address the
health disparities that exist. Research has documented that the needs of poor, minority individuals
have not been sufficiently addressed.
24. A nurse works in a local, free community clinic. The nurse uses an assets-based approach, in which
the community group’s strengths and resources are identified first. The nurse’s approach facilitates
which of the following?
a. Development of partnerships c. Ultimate power of the community agency
b. Ultimate power of the nurse d. Development of a contract
ANS: A
An assets-based approach lends itself to identifying how the community can manage its own health
needs by building on community and population group strengths and resources. Identifying assets
and resources would be one of the first steps to developing a partnership. In a true partnership,
neither the nurse nor the community have all of the power because it is a mutual relationship.
25. A nurse wanting to determine the health status of a community would most likely do which of the
following?
a. Identify the number of hospitals in the community
b. Review the crime statistics for the community
c. Speak with the ministers and teachers in the community
d. Examine the morbidity and mortality rates of the community
ANS: D
To determine the health status of the community, the nurse should examine morbidity and mortality
rates for the community. Other indications of the community’s health status may include birth and
death rates, life satisfaction inventories, and lifestyle functioning measures.
26. According to a 2010 report from the Institute of Medicine (IOM), by 2045 half of the people in the
United States will be:
a. Hispanic Americans.
b. African Americans.
c. Asian Americans.
d. Members of racial minority population groups.
ANS: D
According to the IOM, by 2045 half of the people in the United States will be members of racial
minority population groups. This includes Hispanic Americans, African Americans, and Asian
Americans combined with other racial minority population groups. No one racial minority population
group will represent half of the population.
MULTIPLE RESPONSE
1. Which of the following statements is true regarding health disparities? Select all that apply.
a. Maternal mortality is higher among African American women.
b. Among the elderly, men’s health and functional status are worse than women’s.
c. Poor or fair health (contrasted with good, very good, or excellent health) is more prevalent
among children in low-income families.
d. African American infants have a higher mortality rate than Caucasian infants.
e. Caucasian women are more likely than African American women to die from breast
cancer.
f. In elderly adults, disability rates are inversely related to income.
ANS: A, C, D, F
Some of the health disparities that exist in the United States include the fact that the infant and
mortality rates are higher for African Americans than Caucasians. Also, poor or fair health (contrasted
with good, very good, or excellent health) is more prevalent among children in low-income families,
and disability rates for elderly adults are inversely related to income.
2. Nurses in a small town that experienced the devastation of a number of tornados last year have formed
a group to address the issue of disaster planning in their community. Which of the following are
actions the nurses might take to prepare for another potential disaster? Select all that apply.
a. Form a disaster plan for their own families
b. Complete continuing education in disaster preparedness
c. Encourage all residents of the town to move to a more urban area
d. Become a volunteer for local or national disaster relief organizations
e. Obtain information about rights and responsibilities in employment settings and under
state law
f. Do nothing because disasters such as tornados cannot be prevented
ANS: A, B, D, E
The nurses could take several actions including forming a disaster plan for their own families,
completing continuing education in disaster preparedness, becoming a volunteer for local or national
disaster relief organizations, and obtaining information about rights and responsibilities in employment
settings and under state law. It would be unrealistic to encourage all residents of the town to move to
a more urban area. While the nurses cannot prevent future tornados, they should be knowledgeable in
methods related to disaster preparedness.
Taikka:
*****
Intia eli näitä järkyttäviä kohtaloita, kun toinen edellistä vielä paljon
vakavampi asia, englantilaisen hallituksen tekemä juhlallisten
sitoumusten loukkaus, todellakin murskasi täydellisesti lopunkin
luottamuksen, mikä maalla vielä voi olla eurooppalaisten
rehellisyyteen, ja aukaisi padot suurelle vallankumoukselle.