Community Nurse

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  1. Which of the following best
    describes community-based nursing

    a. A philosophy that guides family-centered illness care
    b. Giving care with a focus on the group’s needs
    c. Giving care with a focus on the aggregate’s needs
    d. Having the goal of giving optimal care to all clients
    • ANS: A
    • By definition, community-based nursing is nursing that
    • focuses on family-centered illness care to individuals and families in the
    • community.
  2. Which of the following best
    describes community-oriented nursing?

    a. A practice that focuses on individuals and families
    b. Giving care to manage acute or chronic conditions
    c. Giving direct care to ill individuals within their family
    d. Having the goal of health promotion and disease
    • 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 to care to ill persons within their family setting, and help manage acute or chronic conditions.
  3. What is the unique primary focus
    of public health nursing?

    a. Families and groups
    b. Illness-oriented care
    c. Individuals in their families
    d. Promotion of quality of life
    ANS: D

    • The key difference between community-based and
    • community-oriented nursing is that community-based nurses deal primarily with illness-oriented care, whereas community-oriented nurses—or public health
    • nurses—provide health care to promote quality of life.
  4. Life expectancy increased dramatically during the twentieth century, primarily because of:

    a. Findings from medical laboratory research
    b. Incredible 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.
  5. What is the preferred public
    health approach to avoid premature deaths in America?

    a. Increasing the public’s knowledge concerning hospice care
    b. Influencing Americans’ lifestyle behavior choices
    c. Requiring employers to have wellness centers in each industrial site
    d. Requiring that all prospective parents receive
    appropriate prenatal care
    e. Timely and effective medical intervention and treatment
    • ANS: B
    • Public health approaches could help prevent
    • about 70% of early deaths through influencing the way people eat, drink, drive, engage in exercise, and treat the environment.
  6. What action would be most
    typical of a public health nurse?

    a. The nurse asks community leaders what interventions should be chosen.
    b. The nurse assesses the community and decides on
    appropriate interventions.
    c. The nurse uses data from the main health care
    institutions in the community to determine needed health services.
    d. The nurse works with community groups to create policies to improve the community’s environment.
    • ANS: D
    • Although the public health nurse might engage in any of the tasks listed, he or she primarily works 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.
  7. How is an aggregate

    a. A large group of persons
    b. A collection of individuals and families
    c. A group of persons who share one or more characteristics
    d. Another name for demographic group
    • ANS: C
    • An aggregate is defined as a collection of people who share one or more personal or environmental characteristics, such as geography or special interest.
  8. A registered nurse (RN) was just employed as a public health nurse. Which question might be very relevant as the nurse begins employment?

    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
    d. “Who is the nursing assistant to whom I can refer
    • ANS: A
    • Asking which groups are at greatest risk reflects a
    • community-oriented perspective. The other possible responses reflect a focus on individuals.
  9. When an RN talked to the women at the senior citizens’ center, the nurse reminded them that the only way the center would be able to afford a driver and van service for those who could no longer drive themselves would be to continue to write letters to their local city council representatives requesting funding for such a service. What was the nurse trying to accomplish?

    a. Ensuring that the women did not expect the nurse to solve their problem
    b. Demonstrating that the nurse understood the women’s concerns and needs
    c. Expressing empathy, support, and concern
    d. Helping the women engage in political action
    • ANS: D
    • Public health nurses engage themselves and others in policy development and encourage and assist persons with a need to communicate that need to those with the power to take action.
  10. What is a basic assumption of public health efforts?

    a. Any 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.
  11. Which public health nurse is most clearly fulfilling responsibilities?

    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.
  12. The nurse often has to make resource allocation decisions. What best describes the criterion the nurse
    should use in such cases?

    a. A specific moral or ethical principle
    b. The cheapest, most economical approach
    c. The most rational probable outcome
    d. The needs of the aggregate rather than a few individuals
    • ANS: D
    • Although all of the choices represent components of a
    • decision that the nurse might consider, the dominant needs of the population outweigh the expressed needs of one or a few people.
  13. Which action best represents public health nursing?

    a. Assessing the effectiveness of the large high school
    health clinic
    b. Caring for clients in their home after their outpatient
    c. Giving care to children and their families at the school clinic
    d. Following 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.
  14. Which public health service represents secondary health prevention?

    a. Developing a health education program on the dangers of smoking
    b. Providing a diabetes clinic for adults in low-income
    c. Providing an influenza vaccination program in a community retirement village
    d. Teaching school-age children about the positive effects of exercise
    • ANS: C
    • Although all of these services are appropriate and valuable, providing the flu vaccine to healthy adults is the only choice that represents a secondary health prevention action.
  15. It is very clear to the public health nurse what needs to be done and where to begin to improve the health of
    a certain community. So why does this nurse spend time meeting with community groups to discuss what is the most important task to be addressed first?

    a. To increase the group’s 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.
  16. Two nurses plan to walk under a huge downtown bridge where various homeless persons live. Why would the two nurses go to such an unsafe area?

    a. To assess 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 their members need to contribute
    • 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.
  17. What 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. Need to reduce constantly increasing costs of health care
    e. Threat of bioterrorism and recent weather disasters
    f. Widespread weather disasters (hurricanes, floods) with concurrent illnesses
    • ANS: B, C, D, E, F
    • As overall health needs become the focus of care in the United States, a stronger commitment to population-focused services is emerging. Threats of bioterrorism, anthrax scares, and the emergence of
    • modern-day epidemics have drawn attention to population-focused safety and services. Although the textbook does not mention widespread weather disasters, the inevitability of these events, along with concurrent illnesses and the magnitude of need during such disasters, would clearly support a commitment to
    • population-focused services.
  18. What actions would demonstrate effective public health nursing practice in the community? Select all that

    a. Epidemiologic investigations examine the environment for health hazards.
    b. New services are organized where particular vulnerable populations live.
    c. Partnerships are established with community coalitions.
    d. Staff members at the public health agency continue to increase in number.
    e. The emergency department continues to see more patients each week.
    f. The nurses continue to make presentations at the city
    council about health needs.
    • ANS: A, B, C, F
    • 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; participating in epidemiologic studies; and working with policymakers for policy change.
  19. 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
    d. People prefer to receive care in their homes rather than in hospitals.
    e. People expect hospital staff to act like those in TV dramas and are invariably disappointed.
    f. Physicians find it more convenient to visit in the home to educate families about client care.
    • ANS: A, D
    • Home care is growing because it is less expensive and
    • because clients prefer to receive care in familiar and comfortable settings. It is not more efficient or more convenient, since travel time has to be considered. Nurses differ as to their preferred employment setting.
  20. What is an important reason to study nursing history?

    a. Fulfill state board of nursing requirements
    b. Help meet the necessary credit hours for graduation
    c. Meet accreditation requirements
    d. Understand the present and plan for tomorrow
    • ANS: D
    • One of the best ways to make plans for today and tomorrow is to look at the past to see what did and did not work.
  21. Why is public health nursing appealing to many nurses?

    a. Its autonomy and independence
    b. Its focus on acute care and immediately visible outcomes
    c. The backup support of other health care professionals
    d. The rapport among the nursing staff
    • ANS: A
    • Inpatient acute care nurses (not public health nurses)
    • focus on acute care with outcomes known fairly quickly. Unlike inpatient nursing, in which there are other health care professionals and staff with whom
    • to interact, public health nursing is known for its autonomy and independence.
  22. Which of the following accurately describes the first people to give care in hospitals?

    a. Feudal lords used servants with the goal of keeping their peons working.
    b. Small towns hired men to care for their citizens.
    c. The military employed local men with the goal of enabling soldiers to keep fighting.
    d. Religious women in urban areas cared for the sick, poor, and neglected.
    • ANS: D
    • Most people were responsible for their own services, but religious convents and monasteries established hospitals to care for the elderly, disabled, sick, poor, and neglected.
  23. How did the Industrial Revolution result in previous caregiving approaches, such as care by families, friends, and neighbors, becoming inadequate?

    a. Economic and political wars resulted in frequent death and injuries.
    b. Incredible plagues consistently and constantly swept the European continent.
    c. Migration and urbanization resulted in increased demand for care.
    d. Caregivers could easily find other employment, so they demanded to be paid.
    • ANS: C
    • Care became inadequate because of the social changes in Europe, with great advances in transportation, communication, and other technologies. The increased mobility led to migration and urbanization, which in turn led to increased need for care.
  24. What event most notably changed health care?

    a. Florence Nightingale created the discipline of nursing.
    b. Nuns formed into Sisterhoods, who gave care.
    c. The order of Sisters of Mercy was established in Dublin.
    d. St. Vincent de Paul formed the Dames de Charite.
    • ANS: A
    • Many events led to improvements in care, but Florence
    • Nightingale revolutionized health care.
  25. Why did American citizens become interested in establishing government-controlled boards of health?

    a. They were afraid of infectious diseases such as yellow fever.
    b. The government could force the poverty-stricken to accept care.
    c. Such boards could tax and thereby ensure adequate funds to pay for care.
    d. Such a system would allow for accurate records of births and deaths.
    • ANS: A
    • Threat of disease, especially yellow fever, led to public
    • interest in establishing government-sponsored, or official, boards of health.
  26. The Marine Hospital Service was established to protect seacoast cities from epidemics. This service evolved into which of the following?

    a. A role model for all later hospitals, beginning in larger cities such as Philadelphia
    b. The beginning of the Veterans Administration Medical System
    c. The Centers for Disease Control and Prevention
    d. The Public Health Service
    • ANS: D
    • The Marine Hospital Service, established in part because many communicable diseases entered through sea ports, became the Public Health Service.
  27. What was the outcome of the Shattuck Report?

    a. It began efforts to control alcohol and drug abuse, as well as tobacco use.
    b. Environmental sanitation efforts became an immediate priority.
    c. It eventually resulted in guidelines for modern public
    health organization.
    d. Local and state governments immediately established boards of health.
    • ANS: C
    • It took 19 years for the first of Shattuck’s
    • recommendations to be implemented, but his report was the first effort to create a modern public health organization.
  28. Which nurse is famous for creating public health nursing in the United States?

    a. Florence Nightingale
    b. Frances Root
    c. Lillian Wald
    d. Mrs. Solomon Loeb
    • ANS: C
    • Lillian Wald established the Henry Street Settlement and later emerged as the established leader of public health nursing during its early decades.
  29. What fact led Lillian Wald to suggest nurses practice in schools?

    a. Over 20% of children were absent from school each day.
    b. Nurses had to enter the schools to assess and care for the children of families receiving care in their homes.
    c. Nurses needed employment, and hospitals did not want to increase their nursing staff.
    d. It was less expensive to employ nurses in schools than physicians.
    • ANS: A
    • In New York City in 1902, more than 20% of children might be absent from school on a single day.
  30. In what way did the National Organization for Public Health Nursing differ from all other nursing organizations?

    a. Allowed LPNs as well as RNs to join the organization
    b. Encouraged nurses who were not public health nurses to join
    c. Included both nurses and their lay supporters
    d. Used lottery methods to choose its leaders and officers
    • ANS: C
    • The NOPHN, unlike other professional nursing organizations, included both nurses and their lay supporters. Lay supporters were a source of funding and political support.
  31. Why were nurses so unprepared for public health nursing in the early twentieth century?

    a. Community health nursing had not yet been created as a field.
    b. No one would teach the nurses how to engage in public health activities.
    c. Nightingale’s textbook did not include content on public health nursing.
    d. Nurses were educated in diploma schools, which focused on hospital nursing.
    • ANS: D
    • Nursing school courses taught in diploma schools of nursing emphasized hospital care of patients; thus nurses were unprepared for home visiting.
  32. What was the major obstacle to expanding public health nursing during the epidemics and the war efforts in the early twentieth century?

    a. Adequate funds were not available.
    b. The American Red Cross was meeting the public health needs at the time.
    c. Women did not want careers; they wanted to remain homemakers.
    d. Women were in the military helping in the cause to win WWI.
    • ANS: A
    • A lack of adequate funds was the major obstacle to
    • extending nursing services in the community. Wealthy and middle-class supporters were relied on for contributions.
  33. Why did the Metropolitan Life Insurance Company establish and retain for several years the first community nursing health program for policyholders?

    a. Creating such a service was the morally correct thing to do.
    b. Employing nurses directly was less expensive than paying taxes to the city for the same purpose.
    c. Having the company’s nurses make home visits increased worker morale.
    d. Having public health nurses visit policyholders and their families led to a decline in policyholder deaths, thus lowering costs for the insurance company.
    • ANS: D
    • Metropolitan Life saw an average decline of 7% in the
    • mortality rate of policyholders and almost a 20% decline in the deaths of children. The insurance company attributed this improvement and the associated reduced costs to the visiting nurses.
  34. What effect did the passage of the Social Security Act have on nurses?
    a. Funding was made available for nurses to learn public health.
    b. Funds were available for expanding hospitals (size of hospital and number of beds).
    c. Government monies would pay for hospital care of
    low-income persons.
    d. More elderly persons demanded home health care from nurses.
    • ANS: A
    • The Social Security Act of 1935 tried to overcome the
    • national setbacks of the Depression. Title VI of this act provided funding to expand opportunities for health protection and promotion through education and
    • employment of public health nurses.
  35. What is the most crucial factor that determines which programs community agencies emphasize?

    a. Comprehensive assessment and planning done in the
    b. Documented needs of the local community
    c. Federal funding for priority diseases or groups
    d. Nursing staff’s expertise and skills
    • ANS: C
    • Programs are designed to fit funding priorities—thus the areas supported by Congress determine the categories in which most effort is focused locally.
  36. During World War II incredible numbers of nurses volunteered for the war effort, resulting in fewer nurses in the United States. How did hospitals and visiting nurse agencies cope with the shortage?

    a. Closed many hospital units due to lack of staff
    b. Increased benefits to nurses who would renew their
    employment contracts
    c. Offered high salaries and bonuses to nurses who accepted employment
    d. Used nurse’s aides and other nonprofessionals to give care
    • ANS: D
    • Without professional nurses, nonnursing personnel gave much of the care, including more than 215,000 certified volunteer nurse’s aides. Families were also forced to assume more responsibility for care of their family members.
  37. How did Florence Nightingale help bring about community health nursing? Select all that apply.

    a. She convinced socially prominent wealthy women to
    volunteer to give care.
    b. She focused on all soldiers and their environment.
    c. She interacted with each individual person, assessing his or her needs and acting to meet those needs.
    d. She kept careful records on what was done and what were the results.
    e. She promoted health using nutrition, rest, and hygienic measures.
    f. She stressed the importance of keeping the ill soldiers together so they could support each other emotionally.
    • ANS: B, D, E
    • Nightingale progressively improved the soldiers’ health using a population-based approach that improved both environmental conditions and nursing care. Using simple epidemiology measures, she documented a decreased mortality rate to demonstrate the outcomes. Nightingale thought that nursing should promote health and prevent illness, and she emphasized proper nutrition, rest, sanitation, and hygiene
  38. The Maternity and Infancy Act provided funds for maternal and child health divisions in state health
    departments and clearly saved many lives. Why was the program ended? Select all that apply.

    a. All newborns were essentially healthy following education to mothers.
    b. Most states didn’t feel a need for such a program in
    their state.
    c. States disagreed with the federal government concerning the amount of matching funds to be contributed by the states.
    d. The AMA felt the federal government was encroaching on medical practice.
    e. The AMA charged that the program was too much like socialized medicine.
    f. There were too few trained nurses to staff all the
    • ANS: D, E
    • The American Medical Association (AMA) had concerns that the legislation gave too much power to the federal government and too closely resembled socialized medicine.
  39. For what activities is Mary Breckinridge remembered? Select all that apply.

    a. She created the first home nursing program in the Western states.
    b. She established the Frontier Nursing Service.
    c. She increased nursing’s efforts to care for the urban
    d. She introduced the first nurse-midwives in the United States.
    e. She obtained the initial donations allowing the first
    efforts in home health care outside major cities.
    f. She was the first nurse employee of the Vermont Marble Company, thereby becoming the first occupational health nurse.
    • ANS: B, D
    • Mary Breckinridge established the Frontier Nursing Service and introduced the first nurse-midwives into the United States. Lillian Wald obtained the initial donations allowing the first efforts in home health care outside major cities. Ada Mayo Stewart was the first nurse employee of the Vermont Marble Company, thereby becoming the first occupational health nurse.
  40. How did nursing education change in the 1950s? Select all that apply.

    a. Baccalaureate nursing programs typically included public health nursing concepts.
    b. Diploma schools of nursing continued to expand their student numbers.
    c. Junior and community colleges began offering nursing programs.
    d. Nurses were strongly encouraged to have a scientific basis for their practice.
    e. Research became a required course in all nursing
    f. The need for more education (more credits) to complete a nursing major became obvious.
    • ANS: A, C
    • In the 1950s, public health nursing became a required part of most baccalaureate nursing education programs. In 1952, nursing education programs began in junior and community colleges.
  41. How did health care and its delivery change during the 1980s? Select all that apply.

    a. Funding to public health increased as funding for acute hospital care decreased.
    b. Laws began to be passed that discouraged the use of alcohol, drugs, and tobacco.
    c. Nurse practitioners were increasingly used to provide care.
    d. Public health programs suffered reduced political
    support, financing, and effectiveness.
    e. The National Center for Nursing Research (NCNR) was established.
    f. Use of health maintenance organizations was encouraged.
    • ANS: B, C, D, E, F
    • During the 1980s funding began to shift to meet the costs of acute hospital care, medical procedures, and institutional long-term care. The use of health maintenance organizations was encouraged, and the use of nurse practitioners increased. Consumer and professional advocacy groups urged the passage of laws to prohibit unhealthy practices such as smoking and driving under the influence of alcohol. By the late 1980s, public health had declined in political support, financing, and effectiveness. After a lengthy political
    • battle, the National Center for Nursing Research (NCNR) was established in 1985.
  42. How would you describe ideal primary health care?

    a. Based on a multidisciplinary group of health care
    providers that work as a team
    b. Essential care available to all community members, which encourages self-management and self-reliance
    c. Focused on health promotion and disease prevention for everyone enrolled in the health center
    d. Local efforts to meet the Declaration of Alma Ata principles
    • ANS: B
    • Primary health care is generally defined as essential care made universally accessible to individuals and families in a community with their full participation and at a cost that the community can afford
  43. What is the United States’ approach to the primary health care movement, which includes health policies, social and economic development, and provision of health care?

    a. Cooperates fully with member World Health Organization nations in implementing the plan internationally
    b. Disagrees that the goal of health is for all citizens to
    live socially and economically productive lives
    c. Enthusiastically endorses and has attempted to implement the goals in every way possible
    d. Has focused primarily on disease prevention and health promotion in selected areas
    • ANS: D
    • The primary health care movement, based on the assumptionthat all citizens of the world should be able to live socially and economically productive lives, is a political statement encouraging each country to interpret it according to its own culture, needs, resources, and government. The United States
    • has endorsed primary health care as a strategy but focuses more on disease prevention and health promotion than the other strategies.
  44. Medicaid is increasingly using a managed care (MC) model in caring for enrollees. How does this model attempt to control costs of care?

    a. By requiring families to use the point of service list of individual practice associates
    b. By requiring families to choose a care provider from the MC network and not allowing access to other services without their provider’s permission
    c. By moving Medicaid-eligible families onto state Medicare enrollment
    d. By refusing permission for families to use urgent care or emergency department services
    • ANS: B
    • Managed care is a system in which care is delivered by a specific network of providers. Each provider serves as a gatekeeper who controls access to other providers and services. Cost is reduced, since members cannot use specialists or seek hospital or other care without permission from their primary care provider. Thus those enrolled in Medicaid managed care have restrictions that help keep costs down for government (and for taxpayers).
  45. What determines which health care services are offered at the local level in public health clinics?

    a. Local public health clinics are restricted to those
    services allowed by federal legislation.
    b. Local public health clinics may offer whatever services local taxpayers are willing to pay for.
    c. Local public health clinics must follow the recommendations of Healthy People 2010.
    d. Local public health clinics must offer whatever services the state mandates they offer.
    • ANS: D
    • At the local level, health departments provide care that is
    • mandated by state and federal regulations.
  46. Which government agency attempts to ensure delivery of health care to communities or aggregates that are
    medically underserved?

    a. Administration for Children and Families
    b. Centers for Disease Control and Prevention
    c. Health Resources and Services Administration
    d. The National Institutes of Health
    • ANS: C
    • The Health Resources and Services Administration (HRSA) directs grant programs to expand access to primary care for low-income and uninsured people. HRSA serves as a national focus for efforts to ensure the delivery of health care to residents of medically underserved areas and to persons with special health care needs. HRSA funds more than 3650 health center delivery sites in every state and in Puerto Rico.
  47. Which national agency’s mission is to conduct research on patient care outcomes?

    a. Agency for Health Care Research and Quality
    b. Federal Agency for Patient Care Outcomes
    c. National Center for Nursing Research
    d. U.S. Agency for Patient Care Effectiveness
    • ANS: A
    • The Agency for Health Care Research and Quality conducts research on health care systems, health care quality and cost issues, access to health care, and effectiveness of medical treatments. It provides evidence-based information on health care outcomes and quality of care.
  48. How is the Department of Agriculture promoting the health of U.S. citizens?

    a. By collecting surplus food left after mechanical harvests and distributing it to the poor
    b. By inspecting food, so no foodborne illnesses can occur
    c. In collaboration with others, by providing food or food stamps to needy persons
    d. Through direct education and grants to dietitians and nutritionists
    • ANS: C
    • The Department of Agriculture collaborates with state and local government welfare agencies to provide food stamps to needy persons to increase their food-purchasing power. Other programs include school breakfast and lunch programs; the Supplemental Food Program for Women, Infants, and Children (WIC); and grants to states for nutrition education training. The Department of Agriculture also engages in plant, product, and animal inspections, but limited funding prevents absolute surety that food is safe to eat.
  49. Local, state, and federal governmental agencies have started to cooperate and collaborate more closely in
    the last few years because of:

    a. Administrative pressures to demonstrate improvement in outcomes
    b. The need to focus on emergency preparedness and response
    c. Taxpayers’ complaints and general unhappiness
    d. Pressure to decrease overlap in services and thereby decrease costs
    • ANS: B
    • Since the tragedy of September 11, 2001, health departments have increasingly focused on emergency preparedness and response. In case of an emergency event, state and local health departments in the affected area will be expected to collect data and accurately report the situation, to respond appropriately to any type of emergency, and to ensure the safety of the residents of the immediate area, while protecting those just outside the danger zone. This goal—to enable public health agencies to anticipate, prepare for, recognize, and respond to terrorist threats or natural disasters—has required an unprecedented level of interstate and federal-local planning and cooperation among these agencies.
  50. What have managed care organizations done to better balance consumer and purchaser demands and still
    maintain their profits?

    a. Created alliances, mergers, and joint cooperative
    ventures while downsizing
    b. Engaged in massive marketing campaigns to increase the number of employers using them
    c. Publicized awards and recognition to encourage consumers to demand to use their facilities
    d. Purchased newspaper, radio, and TV time to share the problems that they are having in meeting everyone’s demands
    • ANS: A
    • Although managed care organizations might do any of these, their primary efforts have been focused on creating alliances, mergers, and joint ventures while also downsizing.
  51. The American Nurses Association (ANA) has strongly encouraged reform based on what principle?

    a. Electronic medical records and other high-technology interventions to reduce nursing time, effort, and medical errors must be expanded.
    b. Nurses must be recognized and rewarded for health
    promotion efforts.
    c. Nursing research into patient care outcomes must be expanded and funded.
    d. We must implement universal access to essential health services for all citizens.
    • ANS: D
    • The ANA’s position is based on the belief that health care is a basic human right. Thus a restructured health care system must ensure universal access to a standard package of essential health care services for all citizens and residents.
  52. How would health care in the United States be most accurately described?

    a. A logical rational approach to meeting expressed needs while still trying to control costs
    b. A system in the process of reform as problems have become increasingly apparent
    c. Private health care for those with insurance or money and public health care for those without either
    d. The best in the world with outstanding research and
    high-technology care available to all
    • ANS: C
    • Health care in the United States consists of a personal care system and a public health system, with overlap between the two.
  53. Based on previous research, what might be an effective approach to increase enrollment in SCHIP?

    a. Explaining the program to children enrolled in public
    school systems
    b. Handing out SCHIP applications to uninsured children seen in local hospital emergency departments
    c. Having a newspaper campaign with information and
    applications printed in the newspaper
    d. Sending literature about the SCHIP program home with school children each year
    • ANS: B
    • Particularly among minority children not otherwise involved with the social welfare system, handing out insurance applications in the emergency department could be an effective SCHIP enrollment strategy. The textbook gives a research example of the effectiveness of this approach.
  54. Which of the following statements are accurate descriptions of current social and economic trends in
    the United States? Select all that apply.

    a. Citizens are appreciating the quality of life enjoyed in the United States.
    b. Enjoying life is not as important as the need to take
    care of oneself.
    c. Many families are seeing decreases in family income.
    d. Massive and unexpected social and economic changes have occurred.
    e. Public health and preventive health care (health
    promotion) have become very important.
    f. The gap between the richest and the poorest in the United States is becoming narrower.
    • ANS: C, D
    • The first decade of the twenty-first century has added massive and unexpected changes to health, economic, and social conditions in the form of terrorist attacks, hurricanes, fires, floods, and infectious diseases. In addition to layoffs, outsourcing, and other economic forces, many families are seeing wage decreases. The gap between the richest 25% and the poorest 25% is widening. Unfortunately, we have still not embraced the need for health promotion and disease prevention but continue to expend funds primarily on acute care needs.
  55. What do demographic figures suggest about the ways in which the population of the United States is changing? Select all that apply.

    a. Approximately 12% of the U.S. population was born in a different country.
    b. Hispanics are the largest minority group population.
    c. Households consisting primarily of intact families
    continue to grow.
    d. Mortality for both genders in all age-groups declined.
    e. Of the foreign born, most are from Asia.
    f. Overall the population of the United States is declining.
    • ANS: A, B, D
    • Demographic figures confirm that 12% of the current U.S. population was foreign-born, with most immigrants coming from Latin America and about half as many from Asia. Families make up about 69% of all households, a decline from 81% in 1970. Although African-Americans used to be the largest minority group, as of 2003, Hispanics now have that distinction. The population of the United States continues to increase, and mortality for both genders from all age-groups has declined.
  56. Which of the following are evidence that the U.S. health care system is in crisis? Select all that apply.

    a. Full-time employees may not have health insurance as a benefit.
    b. Incompetent or negligent nurses are an ongoing source of medical errors.
    c. Long work hours and provider fatigue are a major factor in medical errors.
    d. More punitive measures must be taken to decrease provider errors.
    e. The United States spends more on health care than any other country in the world.
    f. Universities are not making any effort to expand educational programs for health care providers.
    • ANS: A, C, E
    • The United States spends more than any other country (16%) on health care, but many employers cannot afford to give health care as a benefit, even to full-time employees. As a result of the nursing shortage, nurses work longer hours and provider fatigue is a major factor in errors. The Institute of Medicine’s (IOM) report To Err Is Human recommends that we stop blaming and punishing individuals for errors and instead begin identifying and correcting system failures by designing safety into the process of care.
  57. What functions do state health departments typically provide? Select all that apply.

    a. Administering Medicaid
    b. Assessing the health needs of the state’s citizens
    c. Employing and supervising school health nurses
    d. Establishing and maintaining free clinics for HIV-positive drug abusers
    e. Licensing facilities and personnel
    f. Regulating the health insurance industry
    • ANS: A, B, E, F
    • State health departments try to prevent and respond to infectious disease outbreaks. They also are responsible for health care financing and administering Medicaid, providing mental health and professional education, establishing health codes, licensing facilities and personnel, and regulating the insurance industry. State health departments also give direct assistance to local health departments in such areas as ongoing assessment of health needs.
Card Set
Community Nurse
Exam 1 for community nursing
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