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

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

 

Sample  Questions

 

Chapter 06: Application of Ethics in the Community

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

 

MULTIPLE CHOICE

 

  1. Which statement regarding Florence Nightingale’s ideas about ethics is correct?
a. Nursing is a call to service, and the moral character of persons entering nursing is important.
b. Ethical principles are based on the values of the individual nurse.
c. Society will dictate the ethical principles to which nurses must adhere.
d. Ethics are very important in times of war, such as in the Crimean War, when she set up public health centers.

 

 

ANS:   A

Florence Nightingale saw nursing as a call to service and viewed the moral character of persons entering nursing as important. Florence Nightingale did not set up public health centers. Florence Nightingale did not believe that nurses must adhere to society’s view of ethical principles. Ethical beliefs are based on the values of the individual nurse, not ethical principles.

 

DIF:    Cognitive level: Understanding         REF:    p. 122

TOP:    Nursing process: Assessment

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

 

  1. A nurse is applying the knowledge and processes of ethics to the examination of ethical problems in health care. Which of the following describes the actions of the nurse?
a. Values
b. Morality
c. Ethics
d. Bioethics

 

 

ANS:   D

Bioethics applies the knowledge and processes of ethics to the examination of ethical problems in health care. Values are beliefs about the worth or importance of what is right or esteemed. Morality is shared and generational societal norms about what constitutes right or wrong conduct. Ethics is a branch of philosophy that includes both a body of knowledge about the moral life and a process of reflection for determining what persons ought to do or be regarding this life.

 

DIF:    Cognitive level: Applying                  REF:    p. 123 (Box 6-1)

TOP:    Nursing process: Implementation

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

 

  1. A nurse who was working in the 1960s used the code of ethics to guide making an ethical decision. Which code of ethics would have been used?
a. Nightingale Pledge
b. Code for Professional Nurses
c. Code of Ethics for Nurses with Interpretive Statements
d. International Council of Nurses (ICN) Code of Ethics for Nurses

 

 

ANS:   B

Florence Nightingale lived in the 1800s. The Code for Professional Nurses was adopted in 1950, the Code of Ethics for Nurses with Interpretive Statements was adopted in 2001, and the ICN Code of Ethics for Nurses was adopted in 2000.

 

DIF:    Cognitive level: Applying                  REF:    p. 123

TOP:    Nursing process: Implementation

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

 

  1. An orderly process that considers ethical principles, client values, and professional obligations is:
a. moral distress.
b. ethical decision making.
c. a value.
d. a code of ethics.

 

 

ANS:   B

Ethical decision making is defined as an orderly process that considers ethical principles, client values, and professional obligations. Moral distress is an uncomfortable state of self when one is unable to act ethically. Values are beliefs about the worth or importance of what is right or esteemed. A code of ethics is a moral standard that delineates a profession’s values, goals, and obligations.

 

DIF:    Cognitive level: Understanding         REF:    pp. 123-124

TOP:    Nursing process: Assessment

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

 

  1. A public health nurse is examining several issues within daily practice. Which of the following issues would be considered an ethical dilemma?
a. Whether or not to establish a community health center in a rural area
b. Allocating resources in a natural disaster
c. Deciding to withdraw care on a hospice patient
d. Applying the principles of Florence Nightingale in Bangladesh

 

 

ANS:   B

When resources are scarce, a dilemma may exist as to how to allocate them. Considering establishing a community health center may be a dilemma, but it probably does not involve ethics. Withdrawing care from a hospice patient would most likely not be an issue encountered by a public health nurse, as this represents community health nursing practice, not public health nursing practice. Applying the principles of Florence Nightingale would not be ethical issue.

 

DIF:    Cognitive level: Applying                  REF:    pp. 123-124 (Box 6-1)

TOP:    Nursing process: Assessment

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

 

  1. The growing multiculturalism of American society can contribute to ethnicity conflicts when:
a. providing care to different cultural groups.
b. individual values align with the cultural norms.
c. ethnic groups overburden the health care system.
d. the greater community’s values are jeopardized by specific ethnic values.

 

 

ANS:   D

Callahan offered perspectives on judging diversity and suggests a thoughtful tolerance and some degree of moral persuasion (not coercion) for ethnic groups to alter values so that they are more in keeping with what is normative in American culture. Providing care to different cultural groups should not produce an ethnicity conflict. Individual alignment with cultural norms would make it less likely that an ethnicity conflict would occur. Ethnic groups using the health care system will not cause it to be overburdened or result in an ethnicity conflict.

 

DIF:    Cognitive level: Understanding         REF:    pp. 124-125

TOP:    Nursing process: Assessment

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

 

  1. There are two medically indigent clients in the clinic who have come to get their monthly supply of free insulin. There is only enough for one client. Which of the following actions would the nurse take first?
a. Identify all options
b. Make a decision
c. Gather additional information
d. Act and assess decisions made

 

 

ANS:   C

The steps of the ethical decision-making framework are to first identify the ethical issues and dilemmas, then place them within a meaningful context, obtain all relevant facts, reformulate ethical issues and dilemmas if needed, consider appropriate approaches to actions or options, make decisions and take action, and evaluate decisions and action.

 

DIF:    Cognitive level: Applying                  REF:    p. 124 (Table 6-1)

TOP:    Nursing process: Implementation

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

 

  1. A nurse has used the steps of the ethical decision-making process when making a decision. Which of the following is most similar to this process?
a. Healthy People 2010
b. Deontology
c. The nursing process
d. Advocacy

 

 

ANS:   C

The steps of the ethical decision-making framework are to first identify the ethical issues and dilemmas, then place them within a meaningful context, obtain all relevant facts, reformulate ethical issues and dilemmas if needed, consider appropriate approaches to actions or options, make decisions and take action, and evaluate decisions and action. The nursing process involves the same basic steps: assessment, diagnosis, planning, implementation, and evaluation. Healthy People 2010, deontology, and advocacy do not involve these multiple steps described by the ethical decision-making framework and the nursing process.

 

DIF:    Cognitive level: Analyzing                 REF:    p. 124 (Table 6-1)

TOP:    Nursing process: Implementation

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

 

  1. Which ethical principle requires “doing no harm?”
a. Respect for autonomy
b. Non-maleficence
c. Beneficence
d. Distributive justice

 

 

ANS:   B

Non-maleficence refers to doing no harm. Respect for autonomy requires that individuals be permitted to choose those actions and goals that fulfill their life plans unless those choices result in harm to another. Beneficence requires that we do good. Distributive justice requires that there be a fair distribution of the benefits and burdens in society based on the needs and contributions of its members.

 

DIF:    Cognitive level: Remembering           REF:    p. 126 (Box 6-2)

TOP:    Nursing process: Assessment

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

 

  1. A nurse is applying the ethical principle of non-maleficence. Which of the following describes the action that the nurse is taking?
a. Administering medications using the “five rights”
b. Allowing clients to be active participants in their care
c. Providing patient privacy when delivering care
d. Referring a client to a physical therapist

 

 

ANS:   A

Non-maleficence requires that one do no harm. It requires that health care professionals act according to the standards of due care, always seeking to produce the least amount of harm possible. Providing privacy when delivering care demonstrates the client’s right to privacy. Allowing clients to be active participants in their care refers to the ethical principle of the right to autonomy. Referring a client to a physical therapist demonstrates the nursing role of referral agent.

 

DIF:    Cognitive level: Analyzing                 REF:    p. 126 (Box 6-2)

TOP:    Nursing process: Implementation

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

 

  1. A nurse is applying the principle of distributive justice. Which of the following describes the benefits that will occur through application of this principle?
a. Basic needs, material and social goods, liberties, rights, and entitlements
b. Taxes, military service, location of incinerators or power plants
c. Entitlement to equal rights and equal treatment
d. The right to private property and personal assets

 

 

ANS:   A

Distributive justice requires that the distribution of benefits and burdens on a society be fair or equal. Entitlement to equal rights and equal treatment refers to egalitarianism. The right to private property and personal assets refers to libertarianism. Taxes, military service, and location of incinerators or power plants are not benefits associated with justice.

 

DIF:    Cognitive level: Applying                  REF:    p. 126 (Box 6-2)

TOP:    Nursing process: Implementation

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

 

  1. A nurse believes everyone is entitled to equal rights and equal treatment in society. Which of the following principles is being applied?
a. Distributive or social justice
b. Egalitarianism
c. Libertarian view of justice
d. Communitarianism

 

 

ANS:   B

Egalitarianism is defined as the view that everyone is entitled to equal rights and equal treatment in society. Distributive justice requires that the distribution of benefits and burdens on a society be fair or equal. The libertarian view of justice holds that the right to private property is the most important right. Communitarianism views that individual rights need to be balanced with social responsibilities; individuals do not live in isolation but are shaped by the values and culture of their communities.

 

DIF:    Cognitive level: Applying                  REF:    p. 127

TOP:    Nursing process: Assessment

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

 

  1. Which statement fits the Liberal Democratic Theory of John Rawls?
a. One should reject any idea that societies, states, or collectives of any form can be the bearers of rights or can owe duties.
b. Inequalities result from birth, natural endowment, and historic circumstances.
c. Everyone has a right to private property.
d. Government should be limited.

 

 

ANS:   B

Rawls acknowledges that inequities are inevitable in society, but he tries to justify them by establishing a system in which everyone benefits, especially the least advantaged. This is an attempt to address the inequalities that result from birth, natural endowments, and historic circumstances. The other choices relate to libertarianism.

 

DIF:    Cognitive level: Understanding         REF:    p. 127

TOP:    Nursing process: Assessment

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

 

  1. According to Leininger and Watson, the moral ideal of nursing is:
a. caring.
b. advocacy.
c. responsibility.
d. accountability.

 

 

ANS:   A

This conceptualization occurred as a response to the technological advances in health care science and the desire of nurses to differentiate nursing practice from medical practice. Advocacy, responsibility, and accountability are not part of the moral idea of nursing proposed by Leininger and Watson.

 

DIF:    Cognitive level: Understanding         REF:    p. 128

TOP:    Nursing process: Assessment

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

 

  1. A nurse is using the principles of virtue ethics in decision making. Which of the following describes the action that the nurse would take?
a. Provide efficient and effective nursing care
b. Identify the meaningful facts in the situation
c. Seek ethical community support to enhance character development
d. Plan ways to restructure the social practices that oppress women

 

 

ANS:   C

According to Aristotle, virtues are acquired and include interest in the concept of the good, including benevolence, compassion, trustworthiness, and integrity. One part of the process is seeking ethical community support to enhance character development. Nurses can demonstrate advocacy when providing efficient and effective nursing care. Identifying the meaningful facts in the situation is part of the ethical decision-making process. Planning ways to restructure the social practices that oppress women is part of the feminist ethics decision-making process.

 

DIF:    Cognitive level: Analyzing                 REF:    p. 128

TOP:    Nursing process: Implementation

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

 

  1. Which statement about feminist ethics is correct?
a. Feminists include only women in their worldview.
b. Persons who ascribe to feminist ethics are passive and wish to pursue their ideals through the legislative process.
c. Feminists believe that men should not be nurses.
d. Women’s thinking and moral experiences are important and should be taken into account.

 

 

ANS:   D

Feminist theory ascribes to the idea that women’s thinking and moral experiences are important and should be considered. A feminist perspective leads us to think critically about connections among gender, disadvantage, and health as well as the distribution of power in public health processes. Feminists are women and men who hold a worldview advocating economic, social, and political equality for women that is equivalent to that of men.

 

DIF:    Cognitive level: Understanding         REF:    p. 129

TOP:    Nursing process: Assessment

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

 

  1. A nurse is providing care using the idea of “servicing citizens, not customers.” Which of the following ideas is being applied by the nurse?
a. Ethical tenets of policy development
b. Basic concepts of the feminist theory
c. Underlying premise of virtue ethics
d. Components of distributive justice

 

 

ANS:   A

There are three tenets of both policy and ethics. The approach is based on the voice of the community as the foundation on which policy is developed. The basic concept of feminist theory allows us to think critically about connections among gender, disadvantage, and health as well as the distribution of power in public health processes. The goal of virtue ethics is to enable persons to flourish as human beings. Distributive justice requires that there be a fair distribution of the benefits and burdens in society based on the needs and contributions of its members.

 

DIF:    Cognitive level: Applying                  REF:    p. 130

TOP:    Nursing process: Implementation

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

 

  1. Public health administrators in a community provide a health department to serve an indigent population of immigrants providing translators on certain days of the week. Which of the following best describes what is being done?
a. Policy development
b. Quality
c. Assurance
d. Libertarian philosophy

 

 

ANS:   C

Assurance refers to the role of public health in making sure that essential community-oriented health services are available, which may include providing essential personal health services for those who would otherwise not receive them. Policy development refers to the need to provide leadership in developing policies that support the health of the population, including the use of the scientific knowledge base in making decisions about policy. Quality refers to providing the best care possible. Libertarian philosophy refers to the view that the right to private property is the most important right.

 

DIF:    Cognitive level: Applying                  REF:    p. 130

TOP:    Nursing process: Implementation

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

 

  1. A nurse believes that all Americans should receive basic health care services. Which of the following core functions supports this belief?
a. Assessment
b. Assurance
c. Policy development
d. Advocacy

 

 

ANS:   B

Assurance purports that all persons should receive essential personal health services. Assessment refers to systematically collecting data on the population, monitoring the population’s health status, and making information available about the health of the community. Policy development refers to the need to provide leadership in developing policies that support the health of the population, including the use of the scientific knowledge base in making decisions about policy. Advocacy embodies an ethical focus grounded in quality of life.

 

DIF:    Cognitive level: Applying                  REF:    p. 130

TOP:    Nursing process: Implementation

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

 

  1. Which statement is discussed in the Code of Ethics for Nurses with Interpretive Statements?
a. The profession of nursing is responsible for making political statements and supporting nurse-friendly candidates for office.
b. The nurse’s primary focus is on acute bedside nursing, followed by community health care to promote seamless care.
c. The nurse owes duty primarily to the physician to strive to protect health, safety, and the rights of the patient.
d. The profession of nursing is responsible for articulating nursing values, for maintaining the integrity of the profession, and for shaping social policy.

 

 

ANS:   D

Provision 9 of the Code of Ethics for Nurses with Interpretive Statements discusses the need for the nursing profession to address national and global health concerns as well as be involved with shaping policies through political action. The Code of Ethics for Nurses with Interpretive Statements does not address the practice setting for nursing care. According to the Code of Ethics for Nurses with Interpretive Statements, public health should achieve community health in a way that respects the rights of individuals in the community, not owing duty primarily to the physician. Public health should seek the information needed to implement effective policies and programs that protect and promote health.

 

DIF:    Cognitive level: Understanding         REF:    p. 132 (Box 6-4)

TOP:    Nursing process: Assessment

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

 

  1. A nurse refers to the Code of Ethics for Nurses or the Public Health Code of Ethics. Which of the following describes why the nurse has referred to this document?
a. To provide answers for ethical dilemmas
b. To guide professional practice related to ethics
c. To increase moral leadership in ethics
d. To find a framework for ethical decision making

 

 

ANS:   B

These codes provide general ethical principles and guide personnel in thinking about the underlying ethics of the profession. They do not provide answers for ethical dilemmas, only serve as a guide. They do not increase moral leadership, nor do they provide a framework for ethical decision making.

 

DIF:    Cognitive level: Applying                  REF:    p. 132

TOP:    Nursing process: Planning

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

 

  1. A nurse is demonstrating advocacy in his nursing practice. Which of the following actions best demonstrates this principle?
a. Offering a smoking cessation program
b. Screening for hypertension
c. Lobbying for health care reform
d. Conducting home visits

 

 

ANS:   C

Nurses should participate in implementing new directions for health care and help envision these new directions. Nurses can be an important voice in advocating for access to consistent, effective, and efficient health care for all. This is best accomplished by performing interventions at the population level.

 

DIF:    Cognitive level: Applying                  REF:    pp. 132-133 & p. 135

TOP:    Nursing process: Implementation

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

 

  1. The community leaders in a lesser-developed country decide not to tell the citizens of a small village about a chemical spill at a major industrial facility that could produce harmful effects. Which of the following principles is being violated?
a. Morality
b. Advocacy
c. Caring
d. Virtue

 

 

ANS:   B

Advocacy requires that the community be properly informed, and this was violated in the above scenario. Morality is shared and generational societal norms about what constitutes right or wrong conduct. Caring represents the essence of nursing. Virtue demonstrates behavior showing high moral standards.

 

DIF:    Cognitive level: Applying                  REF:    pp. 134-135

TOP:    Nursing process: Evaluation

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

 

MULTIPLE RESPONSE

 

  1. Which of the following are ethical tenets that underlie the core function of assessment? (Select all that apply.)
a. Competency: the persons assigned to develop community knowledge are prepared to collect data on groups and populations
b. Moral character: the persons selected to develop, assess, and disseminate community knowledge possess integrity
c. Service to others over self: a necessary condition of what is “good” or “right” policy
d. “Do no harm”: disseminating appropriate information about groups and populations is morally necessary and sufficient
e. Providers of public health services should be competent and available

 

 

ANS:   A, B, D

Service to others over self is an ethical tenet of policy development. Providers of public health services should be competent and available is an ethical tenet of assurance. Competency, moral character, and “do no harm” are the ethical tenets of assessment.

 

DIF:    Cognitive level: Understanding         REF:    pp. 129-130

TOP:    Nursing process: Assessment

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

 

  1. A community health nurse is applying the Ethical Principles for Effective Advocacy. Which of the following best describes the action(s) of the nurse? (Select all that apply.)
a. Act in the health care provider’s best interest
b. Keep the client (group, community) properly informed
c. Maintain client confidentiality
d. Carry out instructions with diligence and competence
e. Provide advice to all members of the community

 

 

ANS:   A, B, C, D

Keep the client (group, community) properly informed, maintain client confidentiality, and carry out instructions with diligence and competence are ethical principles for effective advocacy. The nurse should act impartially and offer frank, independent advice, which does not necessarily mean that advice should be provided to all members of the community.

 

DIF:    Cognitive level: Applying                  REF:    p. 134 (Box 6-6)

TOP:    Nursing process: Implementation

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

Chapter 07: Cultural Diversity in the Community

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

 

MULTIPLE CHOICE

 

  1. Which statement about the nursing workforce is true?
a. The nursing workforce is overwhelmingly white.
b. The number of minority nurses meets the needs of the country’s demographics.
c. The nursing workforce is becoming increasingly diverse with increasing minorities.
d. Refugees make up a large part of the nursing workforce in some areas.

 

 

ANS:   A

The nursing workforce is 83% white. Because of the large percentage of white nurses this does not meet the needs of the country’s demographics. Unauthorized immigrants and refugees do not make up a part of the nursing workforce.

 

DIF:    Cognitive level: Understanding         REF:    pp. 140-141

TOP:    Nursing process: Assessment

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

 

  1. The Refugee Act of 1980 had what effect on refugees who were immigrating into the United States?
a. Allowed specific provisions for refugees from Southern and Eastern Europe
b. Provided a uniform procedure for refugees to be admitted into the United States
c. Permitted refugees to set up communities in or around major metropolitan areas
d. Allowed refugees access to “green cards” that would allow them to work in the United States

 

 

ANS:   B

The Refugee Act of 1980 provided a uniform procedure for refugees to be admitted into the United States. Refugees were immediately eligible to receive Temporary Assistance for Needy Families, Supplemental Security Income, and Medicaid. This procedure was in effect for all refugees not just those from specific countries. It did not provide “green card” access or permit development of specific communities for refugees.

 

DIF:    Cognitive level: Understanding         REF:    pp. 147-148

TOP:    Nursing process: Assessment

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

 

  1. A large portion of foreign-born residents of the United States:
a. work in service-producing and blue-collar sectors.
b. reside in rural areas.
c. have a high school education.
d. are refugees and nonimmigrants.

 

 

ANS:   A

Two-thirds of the foreign-born population lives in or around major metropolitan areas and works in mainly service-producing and blue-collar sectors. They are also more likely to be poorer. The majority of foreign born are legal immigrants (85%). More than 54% of the foreign-born adults in the labor force have completed high school, which would not be considered a large portion.

 

DIF:    Cognitive level: Understanding         REF:    p. 147

TOP:    Nursing process: Assessment

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

 

  1. A 35-year-old man from Russia comes to the United States seeking asylum because of religious persecution in his native country. Which of the following best describes this type of immigrant?
a. Legal immigrant
b. Lawful permanent resident
c. Refugee
d. Unauthorized immigrant

 

 

ANS:   C

Refugees are people who seek protection in the United States because of fear of persecution in their homeland. Legal immigrants are people who are not citizens but are legally allowed to live and work in United States, usually because they fulfill labor demands or have family ties. Lawful permanent resident is another name for legal immigrants. Unauthorized immigrants may have crossed a border into the United States illegally, or their legal permission to stay in the United States may have expired.

 

DIF:    Cognitive level: Applying                  REF:    pp. 147-148

TOP:    Nursing process: Assessment

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

 

  1. A visitor from Japan comes to the United States for a 2-week vacation. Which of the following best describes this person?
a. Nonimmigrant
b. Refugee
c. Legal immigrant
d. Lawful permanent resident

 

 

ANS:   A

A nonimmigrant is admitted for a limited duration for a specific purpose. Refugees are people who seek protection in the United States because of fear of persecution in their homeland. Legal immigrants are people who are not citizens but are legally allowed to live and work in United States, usually because they fulfill labor demands or have family ties. Lawful permanent resident is another name for legal immigrants.

 

DIF:    Cognitive level: Applying                  REF:    p. 148

TOP:    Nursing process: Assessment

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

 

  1. A nurse is observing behaviors that may be defined by culture. Which of the following is the nurse most likely to observe?
a. Speaking a dialect of a language in a local region
b. Standing when an older adult gets on the bus to give him a seat
c. Immigrating to the United States and seeking work
d. An organizational structure of a cultural group

 

 

ANS:   B

Culture is a set of beliefs, values, and assumptions about life that are widely held among a group of people and is transmitted intergenerationally. Behaviors may be culturally determined, as illustrated in the correct response. This behavior is based on the value of respect of elderly people. Speaking a particular dialect in a local area would not fit the definition of culture. An organizational structure of a group is not an observable behavior. Immigrating to the United States does not demonstrate culture.

 

DIF:    Cognitive level: Analyzing                 REF:    p. 141

TOP:    Nursing process: Assessment

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

 

  1. A nurse states that the client has exhibited an explicit cultural behavior. Which of the following has the nurse most likely observed?
a. Verbal communication
b. Body language
c. Use of titles
d. Perception of health and illness

 

 

ANS:   A

Explicit behaviors are straightforward and do not leave room for misinterpretation of what the person wants to communicate, such as when using verbal communication. Implicit behaviors are less exact and may be difficult to interpret, including body language, use of titles, and perception of health and illness.

 

DIF:    Cognitive level: Applying                  REF:    p. 141

TOP:    Nursing process: Assessment

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

 

  1. A nurse is working with an immigrant population. Which of the following should be the first action taken by the nurse?
a. Be aware of one’s own culture
b. Become familiar with traditional practices of the immigrants
c. Try to see things from the immigrant’s viewpoint
d. Learn to speak the language of the immigrant population

 

 

ANS:   A

Cultural competence is one of the core attributes of public health nurses. Nurses come from a variety of cultural backgrounds and have their own cultural traditions. Nurses also bring their biomedical beliefs and values to the practice environment that may differ from the client’s own beliefs and values. Because nurses recognize their own culture, they are better able to understand that there are differences among cultures. Being aware of one’s own culture should be done before completing the other tasks of increasing familiarity with traditional practices, trying to see things from the other’s point of view, or learning to speak the language.

 

DIF:    Cognitive level: Applying                  REF:    p. 152

TOP:    Nursing process: Implementation

MSC:   NCLEX: Health Promotion and Maintenance

 

  1. Which of the following statements about race is true?
a. In the United States, children of biracial parents are usually assigned the race of the father.
b. Ethnicity and race are synonymous terms.
c. Individuals may be of the same race but of different cultures.
d. No social significance is usually placed on race.

 

 

ANS:   C

It is often a misconception that persons of the same race have the same culture. For example, African Americans may have been born in Africa, the Caribbean, North America, or elsewhere and have very different cultures. In the United States, children of biracial parents are usually assigned the race of the mother. Ethnicity is a contrasting term to race. Race is a characteristic that allows for some groups to be separated, treated as superior, and given access to power and other valued resources, while others are treated as inferior and have limited access to power and resources.

 

DIF:    Cognitive level: Understanding         REF:    p. 142

TOP:    Nursing process: Assessment

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

 

  1. A nurse is working with a population that exhibits a large amount of diversity. The nurse recognizes that skin color of individuals within this population is an example of:
a. multiculturalism.
b. ethnicity.
c. race.
d. culture.

 

 

ANS:   C

Race is primarily a social classification that relies on physical markers. Multiculturalism is the blending of diverse cultures. Ethnicity is the shared feeling of peoplehood among a group of individuals and relates to cultural factors, such as nationality, geographic region, culture, ancestry, language, beliefs, and traditions. Culture is a set of beliefs, values, and assumptions about life that are widely held among a group of people and transmitted intergenerationally.

 

DIF:    Cognitive level: Applying                  REF:    p. 142

TOP:    Nursing process: Assessment

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

 

  1. A client shares with the nurse that her grandparents immigrated to the United States from Germany. Which of the following best describes what she has disclosed?
a. Multiculturalism
b. Ethnicity
c. Race
d. Culture

 

 

ANS:   B

Ethnicity represents the identifying characteristics of culture, such as race, religion, or natural origin. Multiculturalism is the blending of diverse cultures. Race is primarily a social classification that relies on physical markers. Culture is a set of beliefs, values, and assumptions about life that are widely held among a group of people and transmitted intergenerationally.

 

DIF:    Cognitive level: Applying                  REF:    p. 142

TOP:    Nursing process: Assessment

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

 

  1. A nurse implements nursing interventions considering the uniqueness of the person’s culture. Which of the following best describes this action?
a. Cultural diversity
b. Cultural knowledge
c. Cultural competence
d. Cultural awareness

 

 

ANS:   C

Providing care based on the uniqueness of the client’s cultural norms and values is one of the three guiding principles of culturally competent nursing care. Cultural diversity refers to the degrees of variation represented among populations based on lifestyle, ethnicity, race, interest, across place, and place of origin across time. Cultural knowledge refers to the process of searching for and obtaining a sound educational understanding about culturally diverse groups. Cultural awareness refers to the self-examination and in-depth exploration of one’s own biases, stereotypes, and prejudices as they influence behavior toward other cultural groups.

 

DIF:    Cognitive level: Applying                  REF:    pp. 151-152

TOP:    Nursing process: Implementation

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

 

  1. A nurse is unable to provide culturally competent care to a population within the community. Which of the following is an effect of this type of care?
a. Enhanced communication
b. Increased cost of health care
c. Achievement of health indicators
d. Improvement in client compliance

 

 

ANS:   B

Care that is not culturally competent may increase health care costs and decrease positive client outcomes. Communication is inhibited through care that is not culturally competent. It is not possible to achieve health indicators if culturally competent care is not given. Client compliance decreases if culturally competent care is not provided.

 

DIF:    Cognitive level: Applying                  REF:    p. 164

TOP:    Nursing process: Evaluation

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

 

  1. A nurse is striving to be culturally competent. Which of the following actions would most likely be taken by the nurse?
a. Respect individuals from different cultures and value diversity
b. Immerse themselves in different cultures
c. Design care for special ethnic groups
d. Give explicit instructions to avoid client decision making

 

 

ANS:   A

Nurses who strive to be culturally competent respect individuals from different cultures and value diversity. Immersing oneself in a different culture, designing care for special ethnic groups, and giving explicit instructions so the client does not have to make a decision does not demonstrate cultural competence.

 

DIF:    Cognitive level: Applying                  REF:    p. 152

TOP:    Nursing process: Implementation

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

 

  1. A nurse wants to obtain information on the alternative methods of health care her 45-year-old female client uses. Who would be the best person to ask about this?
a. The husband of the client
b. A community leader of the ethnic group
c. The client herself
d. The religious leader of the ethnic group

 

 

ANS:   C

Clients provide a rich source of information about their own cultures. The client would be the preferred person to collect this information instead of the husband, community leader, or religious leader.

 

DIF:    Cognitive level: Analyzing                 REF:    p. 154

TOP:    Nursing process: Assessment

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

 

  1. A nurse has experienced a cultural encounter. Which of the following best describes what has happened?
a. Sharing significant assessment findings with members of a racial minority
b. Visiting the native land of the clients served at a community health center
c. Telephoning the priest at a Hispanic church to discuss the health issues of a client
d. Learning about traditional healing practices from an American Indian client

 

 

ANS:   D

Cultural encounter refers to the process that permits nurses to seek opportunities to directly engage in cross-cultural interactions with clients of diverse cultures to modify existing beliefs about a specific cultural group and possibly avoid stereotyping. Learning about traditional healing practices is an example of a direct cultural encounter. This occurs when a nurse engages in cross-cultural interactions. Sharing significant assessment findings demonstrates the nurse sharing information, not an engagement with the population. When visiting a native land, there may not be interaction with any other culture. Telephoning a priest at a Hispanic church does not demonstrate an interaction, but rather the nurse calling the priest to accomplish a nursing task.

 

DIF:    Cognitive level: Applying                  REF:    p. 155

TOP:    Nursing process: Assessment

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

 

  1. A nurse demonstrates cultural desire to provide culturally competent care. Which of the following actions would be taken by the nurse?
a. Relying on a textbook for information about an ethnic group
b. Bringing a translator to the local community clinic
c. Taking Spanish classes in the evening at a local college
d. Judging others using his or her own cultural values

 

 

ANS:   C

Cultural desire refers to the nurse’s intrinsic motivation to want to engage in the elements necessary to provide culturally competent care. The activity that suits the definition of cultural desire is one that a nurse would want to do instead of being directed to do so, referring to the intrinsic motivation of the nurse. Relying on a textbook for information, bringing a translator, and judging others do not demonstrate the definition of cultural desire as they are not demonstrating the intrinsic motivation of the nurse.

 

DIF:    Cognitive level: Applying                  REF:    pp. 155-156

TOP:    Nursing process: Implementation

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

 

  1. To meet a client’s needs, it is sometimes necessary to integrate into the client’s care a culturally relevant practice that lacks scientific utility. Which of the following best describes this action?
a. Cultural accommodation
b. Cultural awareness
c. Cultural preservation
d. Cultural repatterning

 

 

ANS:   A

Cultural accommodation refers to assistive, supportive, facilitative, or enabling nurse actions and decisions that help people of a particular culture to accept nursing strategies, or to negotiate with nurses to achieve satisfying health care outcomes. Cultural awareness refers to the self-examination and in-depth exploration of one’s own biases, stereotypes, and prejudices as they influence behavior toward other cultural groups. Cultural preservation refers to assistive, supportive, facilitative, or enabling nurse actions and decisions that help the clients of a particular culture to retain and preserve traditional values so they can maintain, promote, and restore health. Cultural repatterning refers to assistive, supportive, facilitative, or enabling nurse actions and decisions that help clients of a particular culture to change or modify a cultural practice for new or different health care patterns that are meaningful, satisfying, and beneficial.

 

DIF:    Cognitive level: Applying                  REF:    p. 159

TOP:    Nursing process: Implementation

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

 

  1. A Mexican American mother insists on using special candles to help her daughter’s ear infection. The nurse asks the mother if she would also give her daughter antibiotics. Which of the following best describes the action of the nurse?
a. Cultural accommodation
b. Cultural repatterning
c. Culture brokering
d. Cultural awareness

 

 

ANS:   A

This means that the nurse supports and facilitates the use of cultural practices with interventions from the biomedical health care system. Cultural accommodation refers to assistive, supportive, facilitative, or enabling nurse actions and decisions that help clients of a particular culture accept nursing strategies or negotiate with nurses to achieve satisfying health care outcomes. Cultural repatterning refers to assistive, supportive, facilitative, or enabling nurse actions and decisions that help clients of a particular culture to change or modify a cultural practice for new or different health care patterns that are meaningful, satisfying, and beneficial. Culture brokering is advocating, mediating, negotiating, and intervening between the client’s culture and the biomedical health care culture on behalf of clients. Cultural awareness refers to the self-examination and in-depth exploration of one’s own biases, stereotypes, and prejudices as they influence behavior toward other cultural groups.

 

DIF:    Cognitive level: Applying                  REF:    p. 159

TOP:    Nursing process: Implementation

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

 

  1. A nurse supports the use of traditional home remedies in conjunction with Western medicine to promote healthy behaviors. Which of the following is being demonstrated by the nurse?
a. Cultural accommodation
b. Cultural awareness
c. Cultural preservation
d. Cultural repatterning

 

 

ANS:   C

Cultural preservation refers to assistive, supportive, facilitative, or enabling nurse actions and decisions that help the clients of a particular culture to retain and preserve traditional values, so they can maintain, promote, and restore health. Cultural accommodation refers to assistive, supportive, facilitative, or enabling nurse actions and decisions that help clients of a particular culture accept nursing strategies or negotiate with nurses to achieve satisfying health care outcomes. Cultural awareness refers to the self-examination and in-depth exploration of one’s own biases, stereotypes, and prejudices as they influence behavior toward other cultural groups. Cultural repatterning refers to assistive, supportive, facilitative, or enabling nurse actions and decisions that help clients of a particular culture to change or modify a cultural practice for new or different health care patterns that are meaningful, satisfying, and beneficial.

 

DIF:    Cognitive level: Analyzing                 REF:    pp. 158-159

TOP:    Nursing process: Implementation

MSC:   NCLEX: Health Promotion and Maintenance

 

  1. A city council discusses how former city laws promoted segregation in the community years ago. Which of the following was being demonstrated when segregation occurred?
a. Prejudice
b. Cultural imposition
c. Racism
d. Stereotyping

 

 

ANS:   C

Racism is a form of prejudice that occurs through the exercise of power by individuals and institutions against people who are judged to be inferior in, for example, intelligence, morals, beauty, and self-worth. Prejudice is the emotional manifestation of deeply held beliefs about a group. Cultural imposition is the act of imposing one’s cultural beliefs, values, and practices on individuals from another country. Stereotyping is ascribing certain beliefs and behaviors about a given racial and ethnic group to an individual without assessing for individual differences.

 

DIF:    Cognitive level: Applying                  REF:    pp. 156-157

TOP:    Nursing process: Assessment

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

 

  1. The nurse labels a patient an alcoholic because of his ethnicity. Which of the following best describes this action by the nurse?
a. Stereotyping
b. Prejudice
c. Racism
d. Ethnocentrism

 

 

ANS:   A

Stereotyping is ascribing certain beliefs and behaviors about a given racial and ethnic group to an individual without assessing for individual differences. Prejudice is the emotional manifestation of deeply held beliefs about a group. Racism is a form of prejudice that occurs through the exercise of power by individuals and institutions against people who are judged to be inferior in, for example, intelligence, morals, beauty, and self-worth. Ethnocentrism is the belief that one’s own cultural group determines the standards by which another group’s behavior is judged.

 

DIF:    Cognitive level: Applying                  REF:    p. 156

TOP:    Nursing process: Assessment

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

 

  1. A nurse advocates and intervenes between the health care system and the client’s cultural beliefs on behalf of the client. Which of the following best describes the nurse’s action?
a. Cultural accommodation
b. Culture brokering
c. Cultural preservation
d. Cultural repatterning

 

 

ANS:   B

Culture brokering is advocating, mediating, negotiating, and intervening between the client’s culture and the biomedical health care culture on behalf of clients. Cultural accommodation refers to assistive, supportive, facilitative, or enabling nurse actions and decisions that help clients of a particular culture accept nursing strategies or negotiate with nurses to achieve satisfying health care outcomes. Cultural preservation refers to assistive, supportive, facilitative, or enabling nurse actions and decisions that help the clients of a particular culture to retain and preserve traditional values, so they can maintain, promote, and restore health. Cultural repatterning refers to assistive, supportive, facilitative, or enabling nurse actions and decisions that help clients of a particular culture to change or modify a cultural practice for new or different health care patterns that are meaningful, satisfying, and beneficial.

 

DIF:    Cognitive level: Applying                  REF:    pp. 159-160

TOP:    Nursing process: Implementation

MSC:   NCLEX: Health Promotion and Maintenance

 

  1. A nurse believes that the best treatment for illness is the use of Western medicine and alternative therapies should not be used for healing. Which of the following best describes what has happened?
a. Ethnocentrism
b. Cultural imposition
c. Racism
d. Stereotyping

 

 

ANS:   A

Ethnocentrism is the belief that one’s own cultural group determines the standards by which another group’s behavior is judged. Cultural imposition is the act of imposing one’s cultural beliefs, values, and practices on individuals from another culture. Racism is a form of prejudice that occurs through the exercise of power by individuals and institutions against people who are judged to be inferior on the basis of intelligence, morals, beauty, inheritance, and self-worth. Stereotyping is ascribing certain beliefs and behaviors about a given racial and ethnic group to an individual without assessing for individual differences.

 

DIF:    Cognitive level: Applying                  REF:    p. 157

TOP:    Nursing process: Implementation

MSC:   NCLEX: Health Promotion and Maintenance

 

  1. The tendency to ignore all differences between cultures and to act as though the differences do not exist is defined as:
a. cultural conflict.
b. culture shock.
c. cultural blindness.
d. cultural imposition.

 

 

ANS:   C

Cultural blindness occurs when people state that everyone is treated the same, regardless of their cultural orientation. Cultural conflict is a perceived threat that may arise from a misunderstanding of expectations when nurses are unable to respond appropriately to another individual’s cultural practice because of unfamiliarity with the practice. Culture shock is the feeling of helplessness, discomfort, and disorientation experienced by an individual attempting to understand or effectively adapt to a cultural group whose beliefs and values are radically different from the individual’s culture. Cultural imposition is the act of imposing one’s cultural beliefs, values, and practices on individuals from another country.

 

DIF:    Cognitive level: Understanding         REF:    p. 157

TOP:    Nursing process: Assessment

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

 

  1. A nurse resigns from a position in a hospital to accept a job in a community setting. After starting the new job, the nurse feels helpless and confused, wondering if this was the right career choice. Which of the following terms best describes how the nurse is feeling?
a. Cultural conflict
b. Cultural relativism
c. Culture shock
d. Culture brokering

 

 

ANS:   C

Culture shock can happen to individuals within their own culture when they are having experiences such as starting a new job or career. Culture shock is brought on by anxiety from losing familiar signs and symbols of social interaction. Feelings associated with culture shock are helplessness, discomfort, and disorientation. Cultural conflict is a perceived threat that may arise from a misunderstanding of expectations when nurses are unable to respond appropriately to another individual’s cultural practice because of unfamiliarity with the practice. Cultural relativism recognizes that clients have different approaches to health, and that each culture should be judged on its own merit and not on the nurse’s personal beliefs. Culture brokering is advocating, mediating, negotiating, and intervening between the client’s culture and the biomedical health care culture on behalf of clients.

 

DIF:    Cognitive level: Applying                  REF:    p. 158

TOP:    Nursing process: Evaluation

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

 

  1. A client comes into the clinic and tells the nurse he goes to an acupuncturist for pain. The nurse says he should take pain medication instead. Which of the following best describes the action taken by the nurse?
a. Cultural conflict
b. Cultural blindness
c. Cultural relativism
d. Cultural imposition

 

 

ANS:   D

This is an example of cultural imposition—the act of imposing one’s cultural beliefs, values, and practices on individuals from another culture. Cultural conflict is a perceived threat that may arise from a misunderstanding of expectations when nurses are unable to respond appropriately to another individual’s cultural practice because of unfamiliarity with the practice. Cultural blindness occurs when people state that everyone is treated the same, regardless of their cultural orientation. Cultural relativism recognizes that clients have different approaches to health, and that each culture should be judged on its own merit and not on the nurse’s personal beliefs.

 

DIF:    Cognitive level: Applying                  REF:    p. 157

TOP:    Nursing process: Implementation

MSC:   NCLEX: Health Promotion and Maintenance

 

  1. Hispanics tend to believe that the needs of the family take priority over those of the individual. Which of the following types of cultural variations is being demonstrated?
a. Communication
b. Personal space
c. Social organization
d. Environmental control

 

 

ANS:   C

Social organization refers to the way in which a cultural group structures itself around the family to carry out role functions. Communication is the means by which culture is shared (verbal and nonverbal). Personal space is the physical distance between two individuals during an interaction. Environmental control refers to the person’s relationship with nature and to plan and direct factors in the environment that affect them.

 

DIF:    Cognitive level: Applying                  REF:    p. 145

TOP:    Nursing process: Assessment

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

 

  1. In the Vietnamese culture, individuals may focus on wishes and memories of their ancestors and look to them to provide direction for current situations. Which of the following types of cultural variations is being demonstrated?
a. Communication
b. Personal space
c. Social organization
d. Perception of time

 

 

ANS:   D

Perception of time is the duration or period between successive events, where some cultures assign greater or lesser emphasis to events that occur in the past, present, or future. Communication is the means by which culture is shared (verbal and nonverbal). Personal space is the physical distance between two individuals during an interaction. Social organization refers to the way in which a cultural group structures itself around the family to carry out role functions.

 

DIF:    Cognitive level: Applying                  REF:    pp. 144-145

TOP:    Nursing process: Assessment

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

 

  1. Asians may perceive illness as disharmony with other forces and that medicine is only able to relieve the symptoms rather than cure the disease. They may look to naturalistic solutions and acupuncture to resolve or cure health problems. Which of the following types of cultural variations is being demonstrated?
a. Communication
b. Personal space
c. Social organization
d. Environmental control

 

 

ANS:   D

Environmental control refers to the ability of individuals to control nature and to influence factors in the environment that affect them. Communication is the means by which culture is shared (verbal and nonverbal). Personal space is the physical distance between two individuals during an interaction. Social organization refers to the way in which a cultural group structures itself around the family to carry out role functions.

 

DIF:    Cognitive level: Applying                  REF:    p. 145

TOP:    Nursing process: Assessment

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

 

  1. Research has shown that Asian men tend to have a greater sensitivity than white Europeans to codeine, and they experience significantly weaker effects from the drug. Which of the following types of cultural variations is being demonstrated?
a. Biological variations
b. Personal space
c. Social organization
d. Perception of time

 

 

ANS:   A

Biological variations are the physical, biological, and physiological differences that exist between racial groups and distinguish one group from another. Personal space is the physical distance between two individuals during an interaction. Social organization refers to the way in which a cultural group structures itself around the family to carry out role functions. Perception of time is the duration or period between successive events, where some cultures assign greater or lesser emphasis to events that occur in the past, present, or future.

 

DIF:    Cognitive level: Applying                  REF:    p. 143

TOP:    Nursing process: Assessment

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

 

MULTIPLE RESPONSE

 

  1. A nurse is planning a refugee outreach clinic at the neighborhood health center. Which of the following considerations should be made by the nurse in order to provide culturally competent care? (Select all that apply.)
a. Their own background, beliefs, and knowledge may be significantly different from those of the people receiving care.
b. Language barriers may interfere with efforts to provide assistance.
c. Certain risk factors may be present for a given population.
d. Certain groups may use nontraditional healing practices.
e. Introduction of the American culture will be an important part of the encounter.

 

 

ANS:   A, B, C, D

When working with immigrants, it is important to be aware of one’s own beliefs while realizing that language barriers may exist, that different populations experience different risk factors and illnesses, and that nontraditional healing practices may be used. It would not be appropriate to impose the American culture into the encounter.

 

DIF:    Cognitive level: Applying                  REF:    pp. 148-149

TOP:    Nursing process: Planning

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

 

  1. A nurse will be using an interpreter during a client encounter. Which of the following considerations should be made by the nurse? (Select all that apply.)
a. It is appropriate to use family members as interpreters.
b. Written materials should be available in the client’s primary language.
c. Observe the interpreter’s gestures to assure client understanding.
d. The gender, age, and educational level of the interpreter should be evaluated.
e. The nurse should face the interpreter when speaking.

 

 

ANS:   B, D

Family members should be used with caution. The client’s gestures and nonverbal messages should be observed to assure understanding. Written materials should be available in the client’s primary language. The gender, age, educational level, socioeconomic status, religion, and dialect should all be considered when selecting the proper interpreter. The nurse should face the client during the dialogue, not the interpreter.

 

DIF:    Cognitive level: Applying                  REF:    p. 149 (How to Box)

TOP:    Nursing process: Planning

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

 

Chapter 09: Population-Based Public Health Nursing Practice: The Intervention Wheel

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

 

MULTIPLE CHOICE

 

  1. Which statement about the Intervention Wheel is true?
a. It provides a graphic illustration of population-based public health practice.
b. It describes in detail the components of public health nursing.
c. It demonstrates the practice of community health nurses for policy and lawmakers.
d. It is a framework used by all health departments in the United States.

 

 

ANS:   A

The Intervention Wheel provides a graphic illustration that gives public health nurses (PHNs) a means to describe the full scope and breadth of their practice. The Wheel was derived from the practice of PHNs and intended to support their work. It gives PHNs a means to describe the full scope and breadth of their practice. It serves as a model for practice in many state and local health departments, but not all.

 

DIF:    Cognitive level: Understanding         REF:    p. 191

TOP:    Nursing process: Assessment

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

 

  1. Since the Intervention Wheel was first published in 1998, it has:
a. guided national policy.
b. been used as a tool in deciding licensure issues for State Boards of Nursing.
c. been incorporated into the public health curricula of many nursing programs.
d. gained wide acceptance internationally.

 

 

ANS:   C

Since being published, the Intervention Wheel has been incorporated into the public/community health coursework of numerous undergraduate and graduate curricula. The Wheel was derived from the practice of PHNs and intended to support their work. It gives PHNs a means to describe the full scope and breadth of their practice. It serves as a model for practice in many state and local health departments. It has been presented internationally, but is not used widely at the international level.

 

DIF:    Cognitive level: Understanding         REF:    p. 192

TOP:    Nursing process: Assessment

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

 

  1. Public health interventions are implemented with:
a. legislators, policy makers, and community leaders.
b. individuals and families, communities, and systems.
c. children, adolescents, and adults.
d. health departments, public health agencies, and visiting nurses associations.

 

 

ANS:   B

It is important to know that PHNs work with individuals and families, communities, and systems. The other answers may have true parts, but the second option lists the overall groups where PHNs are intervening.

 

DIF:    Cognitive level: Understanding         REF:    p. 192

TOP:    Nursing process: Implementation

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

 

  1. Which statement is true about the origins of the Intervention Wheel?
a. A panel of nurses from Iowa, Minnesota, North Dakota, South Dakota, and Wisconsin developed and refined the Intervention Wheel.
b. It was conceived by a group of international nurses from Norway, Kazakhstan, and Japan.
c. It was a result of a qualitative analysis carried out by the State Boards of Nursing.
d. It resulted from a grounded theory process carried out by public health consultants at the Minnesota Department of Health.

 

 

ANS:   D

Public health consultants with the Minnesota Department of Health carried out a grounded theory process in response to uncertainty about the contributions of public health nursing to population health level improvement, resulting in the identification of the Intervention Wheel components. It was not developed by a panel of nurses in the Midwest or by a group of international nurses. It was not a qualitative analysis process and the State Boards of Nursing were not involved in its development.

 

DIF:    Cognitive level: Understanding         REF:    p. 192

TOP:    Nursing process: Assessment

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

 

  1. A social marketing campaign urging community members to avoid driving motorized vehicles after consuming alcohol is implemented in a local community. Which of the following levels of practice is being demonstrated?
a. Individual
b. Systems
c. Community
d. Government

 

 

ANS:   C

Community level interventions are carried out with the community as a whole. This level changes community norms, attitudes, awareness, practices, and behaviors. It is directed toward entire populations within the community or occasionally toward populations at risk or populations of interest. Individual level intervention changes knowledge, attitudes, beliefs, practices, and behaviors of individuals. Systems level interventions change organizations, policies, laws, and power structures within communities. Government is not a level of intervention described by “The Wheel.”

 

DIF:    Cognitive level: Applying                  REF:    pp. 194-195

TOP:    Nursing process: Implementation

MSC:   NCLEX: Health Promotion and Maintenance

 

  1. A PHN uses Assumption 2, “Public health nursing practice focuses on populations,” to guide practice. Which of the following would be considered a population of interest?
a. Healthy school children
b. Homeless individuals
c. A person recently diagnosed with diabetes
d. Teenage parents

 

 

ANS:   A

A population is a collection of individuals who have one or more personal or environmental characteristics in common. Populations of interest are populations that are essentially healthy but could improve factors that promote or protect health; one such population is healthy school children. Homeless individuals and teenage parents would both be considered a population at risk. A person recently diagnosed with diabetes is not a population.

 

DIF:    Cognitive level: Analyzing                 REF:    p. 193

TOP:    Nursing process: Assessment

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

 

  1. A PHN is conducting an assessment of the community’s health. Which of the following is being accomplished through this activity?
a. Define one problem that will be the focus for a year
b. Assess a social network of interacting individuals usually in a defined territory
c. Minimize the effects of health risks and hazards
d. Intervene at the population level by changing laws and regulations

 

 

ANS:   B

A community is defined as a social network of interacting individuals, usually concentrated in a defined territory. The community assessment generally results in a lengthy list of community problems and issues. Intervention and minimization do not take place during the assessment phase.

 

DIF:    Cognitive level: Applying                  REF:    p. 194

TOP:    Nursing process: Evaluation

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

 

  1. A PHN utilizes the nursing process at all levels of practice. Which of the following demonstrates how this is accomplished?
a. Including specific goals for community health nurses
b. Developing an accurate nursing diagnosis
c. Analyzing the needs of the community, systems, individuals, and families
d. Utilizing primary, secondary, and tertiary prevention

 

 

ANS:   C

PHNs must customize the nursing process to consider the community, systems, and individual/family levels of practice. The levels of practice are not used for developing nursing diagnoses or goals. The levels of practice are not demonstrated utilizing the levels of prevention.

 

DIF:    Cognitive level: Analyzing                 REF:    p. 195

TOP:    Nursing process: Assessment

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

 

  1. PHNs across the United States implement similar types of interventions to improve the health of various groups. Which of the following explains why a common set of interventions is used?
a. Describe the proper order of implementation
b. Emphasize surveillance as the main focus of public health practice
c. Guide practice and generate agency protocols
d. Improve the health status of communities, systems, individuals, and families

 

 

ANS:   D

Interventions are actions taken on behalf of communities, systems, individuals, and families to improve or protect health status. The interventions do not describe a particular order for implementation. Surveillance is only one of the 17 interventions described. PHNs may use any or all of the interventions. No single PHN is expected to perform every intervention at all three levels of practice.

 

DIF:    Cognitive level: Analyzing                 REF:    pp. 195-198

TOP:    Nursing process: Evaluation

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

 

  1. What is the purpose of the color-coded wedges on the Intervention Wheel?
a. The interventions are grouped together in related wedges.
b. The wedges consist of referral information for each wedge.
c. The element of health teaching is the predominant feature of each wedge.
d. Coalition building must be implemented with each wedge.

 

 

ANS:   A

Each wedge consists of related interventions. The other answers describe some of the individual wedges.

 

DIF:    Cognitive level: Understanding         REF:    p. 195

TOP:    Nursing process: Assessment

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

 

  1. A PHN is using collaboration, coalition building, and community organizing to develop a new program in the community. Which of the following strategies is the nurse most likely using?
a. Providing case management, referral, and follow-up services with individuals
b. Carrying out collective action at the systems or community levels of practice
c. Conducting a community assessment
d. Implementing primary and secondary prevention strategies

 

 

ANS:   B

Collaboration, coalition building, and community organizing are the interventions often carried out at the systems and community levels of practice. These interventions can be used at all levels of prevention. Providing case management, referral, and follow-up services with individuals represents another group of interventions described by the green wedge. These interventions are not part of conducting a community assessment.

 

DIF:    Cognitive level: Analyzing                 REF:    p. 195

TOP:    Nursing process: Implementation

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

 

  1. The levels of practice encompassed by the Intervention Wheel are:
a. communities, individuals and families, and systems.
b. assessment, diagnosis, and evaluation.
c. primary, secondary, and tertiary.
d. communities, populations, and aggregates.

 

 

ANS:   A

Communities, individuals and families, and systems are the three levels of public health nursing practice. The other responses do not describe the levels of practice.

 

DIF:    Cognitive level: Understanding         REF:    pp. 194-195

TOP:    Nursing process: Assessment

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

 

  1. PHNs utilize registries to identify children with delayed or missing immunizations. They subsequently follow up with families by phone calls or home visits. Which of the following levels of practice is being implemented?
a. Systems
b. Community
c. Policy
d. Individual

 

 

ANS:   D

The individual level of practice focuses on interventions that involve working with individuals, either singly, or in groups, and with families. Individual level intervention changes knowledge, attitudes, beliefs, practices, and behaviors of individuals. Community level interventions are carried out with the community as a whole. This level of intervention changes community norms, attitudes, awareness, practices, and behaviors. Systems level interventions change organizations, policies, laws, and power structures within communities. Policy is not a level of intervention described by “The Wheel.”

 

DIF:    Cognitive level: Applying                  REF:    p. 195

TOP:    Nursing process: Implementation

MSC:   NCLEX: Health Promotion and Maintenance

 

  1. An occupational health nurse works with an employer to develop a workplace wellness program for its employees. Which of the following levels of practice is being implemented?
a. Individual
b. Systems
c. Community
d. Government

 

 

ANS:   B

Systems level of practice consists of changing laws, policies, and practices that influence population-based issues. The individual level of practice focuses on interventions that involve working with individuals, either singly, or in groups, and with families. Individual level intervention changes knowledge, attitudes, beliefs, practices, and behaviors of individuals. Community level interventions are carried out with the community as a whole. This level of intervention changes community norms, attitudes, awareness, practices, and behaviors. Government is not a level of intervention described by “The Wheel.”

 

DIF:    Cognitive level: Applying                  REF:    p. 195

TOP:    Nursing process: Implementation

MSC:   NCLEX: Health Promotion and Maintenance

 

  1. A PHN is implementing interventions at the systems level of practice. Which of the following interventions would be used by the nurse?
a. Involve the entire community in solving the health problem
b. Identify health problems in the community
c. Change laws, policies, and practices that influence population-based issues
d. Provide outreach services to populations at risk

 

 

ANS:   C

Systems level practice consists of changing laws, policies, and practices that influence population-based issues. The individual level of practice focuses on interventions that involve working with individuals, either singly, or in groups, and with families is demonstrated through providing outreach. Community level interventions are carried out with the community as a whole and is demonstrated by involving the entire community in identifying and solving health problems.

 

DIF:    Cognitive level: Analyzing                 REF:    p. 195

TOP:    Nursing process: Implementation

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

 

  1. A PHN is implementing the public health intervention of health teaching at the systems level of practice. Which of the following interventions is most likely being implemented by the nurse?
a. Participating in the “Great American Smokeout”
b. Working with a local employer to provide smoking cessation education
c. Providing one-on-one counseling to smokers
d. Advocating for increased taxes on tobacco products

 

 

ANS:   B

Working with a local employer to provide smoking cessation education is the only example of health teaching at the systems level of practice. Participating in the “Great American Smokeout” occurs at the community level and is not health teaching. Providing one-on-one counseling to smokers is health teaching at the individual level of practice. Advocating for increased taxes on tobacco products occurs at the systems level of practice, but it is not health teaching.

 

DIF:    Cognitive level: Analyzing                 REF:    p. 195

TOP:    Nursing process: Implementation

MSC:   NCLEX: Health Promotion and Maintenance

 

  1. A nurse is involved in identifying individuals with unrecognized health risk factors or asymptomatic disease. Which of the following public health interventions is being applied?
a. Screening
b. Referral and follow-up
c. Surveillance
d. Health teaching

 

 

ANS:   A

Screening involves identifying individuals with unrecognized health risk factors or asymptomatic disease. Referral and follow-up assists individuals, families, groups, organizations, and/or communities to identify and access necessary resources in order to prevent or resolve problems or concerns. Surveillance describes and monitors health events through ongoing and systematic collection, analysis, and interpretation of health data. Health teaching communicates facts, ideas, and skills that change knowledge, attitudes, values, beliefs, behaviors, and practices of individuals, families, systems, and/or communities.

 

DIF:    Cognitive level: Applying                  REF:    p. 200

TOP:    Nursing process: Implementation

MSC:   NCLEX: Health Promotion and Maintenance

 

  1. A nurse promotes alliances among organizations for a common purpose. Which of the following public health interventions is being implemented?
a. Health teaching
b. Coalition building
c. Surveillance
d. Referral and follow-up

 

 

ANS:   B

One example of coalition building is promoting alliances among organizations for a common purpose. Referral and follow-up assists individuals, families, groups, organizations, and/or communities to identify and access necessary resources in order to prevent or resolve problems or concerns. Surveillance describes and monitors health events through ongoing and systematic collection, analysis, and interpretation of health data. Health teaching communicates facts, ideas, and skills that change knowledge, attitudes, values, beliefs, behaviors, and practices of individuals, families, systems, and/or communities.

 

DIF:    Cognitive level: Applying                  REF:    p. 206

TOP:    Nursing process: Implementation

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

 

  1. A nursing student develops a teaching plan about hand washing to present to a group of elementary school children at the local school. Which of the following public health interventions is being implemented?
a. Collaboration
b. Surveillance
c. Health teaching
d. Screening

 

 

ANS:   C

Health teaching communicates facts, ideas, and skills that change knowledge, attitudes, values, beliefs, and practices of individuals, families, systems, and/or communities. Collaboration commits two or more persons or organizations to achieve a common goal through enhancing the capacity of one or more of the members to promote and protect health. Surveillance describes and monitors health events through ongoing and systematic collection, analysis, and interpretation of health data. Screening involves identifying individuals with unrecognized health risk factors or asymptomatic disease.

 

DIF:    Cognitive level: Applying                  REF:    p. 206

TOP:    Nursing process: Implementation

MSC:   NCLEX: Health Promotion and Maintenance

 

  1. A PHN is conducting a community assessment. Which of the following is the best example of this action?
a. Visiting an elderly person at home to assess and evaluate safety and fall risk
b. Developing diagnoses to identify nursing interventions at a health clinic
c. Evaluating services at an immunization clinic where a translator provides services
d. Compiling recent data from the county health department on child abuse cases

 

 

ANS:   D

Compiling recent data from the county health department on child abuse cases is an example of community assessment, assessing needs and data within a community. Community assessment does not happen with an individual. Community assessment must be completed before diagnoses can be developed. Evaluation of services is not part of community assessment.

 

DIF:    Cognitive level: Applying                  REF:    p. 210

TOP:    Nursing process: Assessment

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

 

  1. A PHN is developing a measurable outcome health status indicator that can be used at the individual level of practice. Which of the following would the nurse most likely use?
a. A 50-year-old woman receives annual mammograms
b. School absences in a community decline
c. Teachers have increased awareness of health problems
d. Those in poverty utilize the free mammogram program

 

 

ANS:   A

Outcome health status indicators are used to measure the impact of the interventions on population health. In this case, a 50-year-old woman receiving an annual mammogram will have an impact on the population health when considering those who are receiving the screening. The other examples do not look at population health as an outcome or are not occurring at the individual level.

 

DIF:    Cognitive level: Applying                  REF:    p. 211

TOP:    Nursing process: Planning

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

 

  1. A PHN is addressing the problem of obesity at the community level of practice. Which of the following nursing diagnoses would be most appropriate for the nurse to use?
a. Alteration in nutrition: More than body requirements
b. Need for increased knowledge of proper nutrition
c. Families at risk for obesity because of inactivity
d. Overweight child related to poor dietary habits

 

 

ANS:   C

Nursing diagnoses must be modified to meet the needs of population-focused care in public health nursing practice. Families at risk for obesity because of inactivity is the only nursing diagnosis that addresses a community group that is in need of further intervention. The alteration in nutrition and overweight child nursing diagnoses both address the individual level, not the community level. Need for increased knowledge does not identify the level that is being addressed.

 

DIF:    Cognitive level: Analyzing                 REF:    p. 211

TOP:    Nursing process: Diagnosis

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

 

MULTIPLE RESPONSE

 

  1. The cornerstones of public health nursing practice include which of the following? (Select all that apply.)
a. Focus on the health of the entire population
b. Reflect community priorities and needs
c. Promote health through strategies driven by epidemiological evidence
d. Are grounded in an ethic of collaboration.
e. Provide a framework for ethical decision making

 

 

ANS:   A, B, C

Cornerstones of public health nursing practice focus on the health of the entire population, reflect community priorities and needs, promote health strategies driven by epidemiological evidence, and are grounded in social justice. Nursing is grounded in an ethic of caring.

 

DIF:    Cognitive level: Understanding         REF:    p. 198 (Box 9-1)

TOP:    Nursing process: Assessment

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

Chapter 13: Infectious Disease Prevention and Control

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

 

MULTIPLE CHOICE

 

  1. A community health nurse is caring for a client with methicillin-resistant Staphylococcus aureus (MRSA). Which of the following should the nurse be aware of?
a. Persons with MRSA usually have a chronic illness.
b. MRSA is a hospital-acquired infection and not often seen in the community.
c. Vancomycin-resistant Staphylococcus aureus (VRE) follows MRSA.
d. MRSA is becoming more common in the community.

 

 

ANS:   D

MRSA is being seen more and more in the community with outbreaks frequently associated with school athletic programs and prison populations. MRSA is still largely a health care-associated infection, but it is becoming more common. VRE was found before MRSA. MRSA is not associated with chronic illness.

 

DIF:    Cognitive level: Applying                  REF:    p. 288

TOP:    Nursing process: Planning

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

 

  1. The ability of an agent to produce a severe pathologic reaction is known as:
a. antigenicity.
b. invasiveness.
c. toxicity.
d. virulence.

 

 

ANS:   D

The ability of an agent to produce a severe pathologic reaction is known as virulence. Antigenicity is the ability to stimulate an immunological response. Invasiveness is the ability to penetrate and spread throughout a tissue. Toxicity is the ability to produce a poisonous reaction.

 

DIF:    Cognitive level: Remembering           REF:    p. 290 (Box 13-1)

TOP:    Nursing process: Assessment

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

 

  1. Immunity is a characteristic of the:
a. agent factor.
b. host factor.
c. environmental factor.
d. epidemiologic triad.

 

 

ANS:   B

Immunity refers to species-determined resistance to an infectious agent and is determined by the characteristics of the host. The agent is the infection that is causing the infection/disease. Environmental factors may influence the susceptibility of the host. The epidemiologic triad involves the interaction of the host, agent, and environment.

 

DIF:    Cognitive level: Understanding         REF:    p. 290

TOP:    Nursing process: Assessment

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

 

  1. A nurse is investigating the role of the agent in the cause of an illness. Which of the following best describes what the nurse is examining?
a. Host resilience
b. Virus
c. Infectiousness
d. Bug bite

 

 

ANS:   B

An agent is described by its ability to cause disease and the nature and the severity of the disease. The four major categories of agents are: (1) bacteria, (2) parasites, (3) fungi, and (4) viruses. Host resilience is a host factor. Infectiousness is the measure of the potential ability of an infected host to transmit the infection to other hosts. Environmental factors facilitate the transmission of an infectious agent from an infected host to other susceptible hosts, such as a bug bite.

 

DIF:    Cognitive level: Applying                  REF:    p. 290

TOP:    Nursing process: Evaluation

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

 

  1. A nurse is providing education to a mother about the importance of having her infant immunized for measles, mumps, and rubella. Which of the following best describes the type of immunity that will be provided?
a. Active
b. Passive
c. Natural
d. Acquired

 

 

ANS:   A

Active immunity refers to the immunization of an individual by administration of an antigen (infectious agent or vaccine) and is usually characterized by the presence of an antibody produced by the individual host. Passive immunity refers to immunization through the transfer of a specific antibody from an immunized individual to a non-immunized individual. Natural immunity refers to species-determined, innate resistance to an infectious agent. Acquired immunity is the resistance acquired by a host as a result of previous natural exposure to an infectious agent.

 

DIF:    Cognitive level: Applying                  REF:    pp. 290-291

TOP:    Nursing process: Evaluation

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

 

  1. The nurse teaches food handlers to wash utensils after contact with raw meat. Which of the following best describes the focus of this education?
a. Agent
b. Host
c. Environment
d. Food handler

 

 

ANS:   C

Environmental factors facilitate the transmission of an infectious agent from an infected host to other susceptible hosts. Teaching food handlers to wash utensils after contact with raw meat is a prevention that focuses on the environment. An agent is described by its ability to cause disease and the nature and the severity of the disease. The four major categories of agents are: (1) bacteria, (2) parasites, (3) fungi, and (4) viruses. A food handler is an example of a host, which is a human or animal that can harbor an infectious agent.

 

DIF:    Cognitive level: Applying                  REF:    p. 291

TOP:    Nursing process: Implementation

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

 

  1. The time interval between invasion by an infectious agent and the first appearance of signs and symptoms of the disease is called:
a. communicable period.
b. incubation period.
c. infectiousness.
d. endemic.

 

 

ANS:   B

The incubation period is the time interval between invasion by an infectious agent and the first appearance of signs and symptoms. The communicable period is the interval during which an infectious agent may be transferred directly or indirectly from an infected person to another person. Infectiousness is the measure of the potential ability of an infected host to transmit the infection to other hosts. Endemic refers to the constant presence of a disease within a geographic area or a population.

 

DIF:    Cognitive level: Remembering           REF:    p. 291

TOP:    Nursing process: Assessment

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

 

  1. A nurse is teaching members of the community about vertical transmission of a disease. Which of the following would the nurse most likely discuss?
a. Transmission through breast milk
b. Transmission through sexual contact
c. Transmission from mosquito bites
d. Transmission through contaminated food

 

 

ANS:   A

Vertical transmission is the passing of infection from parent to offspring via sperm, placenta, milk, or contact in the vaginal canal at birth. Transmission through sexual contact is horizontal transmission. Transmission from mosquito bites is vector transmission. Transmission from contaminated food is common vehicle transmission.

 

DIF:    Cognitive level: Applying                  REF:    p. 291

TOP:    Nursing process: Implementation

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

 

  1. A nurse is discussing the role of a vector in the spread of disease. Which of the following is the nurse most likely referring to?
a. Contaminated water
b. A tick
c. A dirty needle
d. An infected person

 

 

ANS:   B

Vectors are arthropods such as ticks and mosquitoes that transmit the infectious agent by biting or depositing the infective material near the host. Contaminated water, a dirty needle, and an infected person would be common vehicles.

 

DIF:    Cognitive level: Applying                  REF:    p. 291

TOP:    Nursing process: Implementation

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

 

  1. One case of smallpox occurs in a population in which it was considered to be previously eliminated. Which of the following best describes what has occurred?
a. Endemic
b. Epidemic
c. Pandemic
d. Infectivity

 

 

ANS:   B

The occurrence of one case of smallpox in a population in which it was considered to be previously eliminated is an epidemic. Endemic refers to the constant presence of a disease within a geographic area or population. Pandemic refers to an epidemic occurring worldwide and affecting large populations. Infectivity is the ability to enter and multiply in the host.

 

DIF:    Cognitive level: Applying                  REF:    p. 292

TOP:    Nursing process: Evaluation

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

 

  1. Requirements for disease reporting in the United States are mandated by:
a. the Centers for Disease Control and Prevention (CDC).
b. federal laws.
c. state laws and regulations.
d. the World Health Organization (WHO).

 

 

ANS:   C

Requirements for disease reporting in the United States are mandated by state laws and regulations. These diseases are then reported to the CDC. State public health officials collaborate with the CDC to determine which diseases should be nationally notifiable. The federal government and WHO are not involved in disease reporting.

 

DIF:    Cognitive level: Understanding         REF:    pp. 292-293

TOP:    Nursing process: Implementation

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

 

  1. A community health nurse has recently become involved in surveillance. Which of the following describes the situation that the nurse is in?
a. Educating clients about influenza immunizations
b. Collecting information about occurrence of measles
c. Evaluating the effectiveness of an HIV/AIDS prevention program
d. Advocating for changes in the national disease reporting requirements

 

 

ANS:   B

Surveillance gathers the “who, when, where, and what”; these elements are then used to answer “why.” Nurses are frequently involved in surveillance by collecting data, making diagnoses, investigating and reporting cases, and providing information to the general public. Client education, program evaluation, and advocating for changes are not part of the surveillance process.

 

DIF:    Cognitive level: Analyzing                 REF:    p. 292

TOP:    Nursing process: Implementation

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

 

  1. A nurse is working in a health department when a patient arrives who has been traveling to South America and has been diagnosed with malaria. Which of the following considerations should be made by the nurse?
a. The Morbidity and Mortality Weekly Report should be consulted to investigate the rate of malaria in the United States.
b. This is a disease that must be reported to the state health department.
c. The nurse should take precautions to wear a mask and gown to avoid exposure.
d. The patient is very ill and should be sent to the hospital immediately.

 

 

ANS:   B

Malaria is on the list of infectious diseases notifiable at the national level. The Morbidity and Mortality Weekly Report is published weekly with the rates of disease; however, this would not be the first consideration by the nurse. Malaria is not spread by direct contact, rather from a bite from an infected mosquito. Malaria begins with flu-like symptoms, or the client may have very few symptoms.

 

DIF:    Cognitive level: Analyzing                 REF:    p. 293 (Box 13-3)

TOP:    Nursing process: Planning

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

 

  1. A public health nurse (PHN) understands that the emergence of new infectious diseases is influenced by the:
a. increased availability of immunizations.
b. globalization of food supplies.
c. decreased use of child care facilities.
d. creation of sanitation systems in third world countries.

 

 

ANS:   B

Globalization of food supplies is one of the many factors that can influence the emergence of infectious diseases. The increased use of childcare facilities could contribute to the emergence of new infectious diseases. The lack of sanitation systems in third world countries could contribute to the emergence of new infectious diseases. The increased availability of immunizations should decrease the emergence of diseases.

 

DIF:    Cognitive level: Understanding         REF:    p. 294 (Table 13-1)

TOP:    Nursing process: Assessment

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

 

  1. A nurse is providing information to a local newspaper about the presence of infectious diseases in the United States. Which of the following statements by the nurse is accurate?
a. “It is the goal of the WHO to prevent the transmission of the plague by avoiding direct contact with inflicted individuals.”
b. “Rabies is easily spread by contact with animals.”
c. “The United States is a certified polio free country.”
d. “The onset of tularemia is characterized by a distinct skin lesion often called a bull’s-eye lesion.”

 

 

ANS:   C

The Americas are certified polio free. The plague is a vector-borne disease and cannot be spread by direct contact with inflicted individuals. Rabies is a rare event because of the widespread vaccination of dogs in the 1950s. The Americas were certified as polio free in 1994. The onset of Lyme’s disease is characterized by a bull’s-eye lesion.

 

DIF:    Cognitive level: Analyzing                 REF:    pp. 296-297

TOP:    Nursing process: Evaluation

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

 

  1. The nurse provides footwear and gloves to leprosy clients to prevent trauma to their insensitive and deformed hands and feet. Which of the following best describes the intervention used by the nurse?
a. Primary level of prevention
b. Secondary level of prevention
c. Tertiary level of prevention
d. Primary health care

 

 

ANS:   C

Tertiary prevention reduces complications through treatment and rehabilitation. Primary prevention seeks to reduce the incidence of disease by preventing occurrence. Secondary prevention seeks to prevent the spread of infection and/or disease once it occurs. Primary health care is considered to be the essential health care services provided by physicians and other health care providers.

 

DIF:    Cognitive level: Applying                  REF:    p. 297

TOP:    Nursing process: Implementation

MSC:   NCLEX: Health Promotion and Maintenance

 

  1. A nurse administers a rabies immunization post-exposure to an animal bite. Considering the interventions used with infectious disease, which of the following levels of prevention is being used?
a. Primary prevention
b. Secondary prevention
c. Tertiary prevention
d. Assessment

 

 

ANS:   B

Secondary prevention focuses on early detection and prompt treatment of disease, injury, or disability. Primary prevention seeks to reduce the incidence of disease by preventing occurrence. Tertiary prevention reduces complications through treatment and rehabilitation. Assessment refers to the systematic collection of data.

 

DIF:    Cognitive level: Applying                  REF:    p. 297

TOP:    Nursing process: Implementation

MSC:   NCLEX: Health Promotion and Maintenance

 

  1. A nurse is presenting information to the county health department about potential bioterrorism threats. Which of the following agents would the nurse discuss in this presentation?
a. Smallpox
b. West Nile Virus
c. Severe acute respiratory syndrome (SARS)
d. Novel influenza A (H1N1)

 

 

ANS:   A

Susceptibility to smallpox is 100% in the unvaccinated and fatality rate is estimated at 20-40% or higher. The agents of highest concern are anthrax, plague, smallpox, botulism, tularemia, and selected hemorrhagic viruses. West Nile Virus, SARS, and H1N1 are not viruses that would be used for bioterrorism.

 

DIF:    Cognitive level: Applying                  REF:    p. 299

TOP:    Nursing process: Implementation

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

 

  1. A PHN would like to increase the immunization coverage of infants and toddlers. Which of the following strategies would be appropriate for the nurse to use?
a. Read the Mortality and Morbidity Weekly Report to learn about vaccinations
b. Require that children have all their immunizations before going to public school
c. Track children known to be at risk for underimmunization
d. Lead teams of health care workers to enforce laws related to immunizations

 

 

ANS:   C

Tracking children known to be at risk for underimmunization is a function of PHNs who work in health departments where immunizations are given and tracked. Reading the Mortality and Morbidity Weekly Report, requiring that children have all of their immunizations before attending school, and leading teams of health care workers would not be as effective in increasing immunization coverage for this population.

 

DIF:    Cognitive level: Analyzing                 REF:    p. 301

TOP:    Nursing process: Planning

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

 

  1. Food intoxication is caused by:
a. toxins produced by bacterial growth and chemical contaminants.
b. bacterial, viral, or parasitic invasion of food.
c. overcooking of meat and produce.
d. adding too many spices or ingredients to food.

 

 

ANS:   A

Food intoxication is caused by toxins produced by bacterial growth, chemical containments, and a variety of disease-producing substances found naturally in certain foods such as mushrooms and some seafood. Bacterial, viral, or parasitic invasion of food is not a cause of food intoxication. Food intoxication is not caused by overcooking meat or adding too many ingredients to food.

 

DIF:    Cognitive level: Understanding         REF:    pp. 306-307

TOP:    Nursing process: Assessment

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

 

  1. The most common vector-borne disease in the United States is:
a. malaria.
b. yellow fever.
c. Lyme disease.
d. Rocky Mountain spotted fever.

 

 

ANS:   C

Lyme disease is the most common vector-borne disease in the United States, with over 30,000 confirmed cases and probable cases reported to CDC in 2012. Yellow fever and Rocky Mountain spotted fever are both vector-borne diseases, but are not the most common. Malaria is most prevalent vector-borne disease worldwide.

 

DIF:    Cognitive level: Remembering           REF:    p. 309

TOP:    Nursing process: Assessment

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

 

  1. A nurse is caring for a client who has been diagnosed with West Nile Virus. Which of the following types of illness does the client have?
a. Food-borne
b. Vector-borne
c. Water-borne
d. Zoonoses

 

 

ANS:   B

West Nile virus is carried by a mosquito, which is a vector. Food-borne illnesses are carried by food. Water-borne illnesses are transmitted through water. Zoonoses are infections that are transmitted from vertebrate animal to a human under natural conditions.

 

DIF:    Cognitive level: Applying                  REF:    p. 294

TOP:    Nursing process: Diagnosis

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

 

  1. A community health nurse investigates an outbreak of pinworm at a local day care center. In order to minimize the spread of infection, which of the following suggestions would the nurse provide to the day care workers?
a. Close the day care until all surfaces are cleaned.
b. No action is necessary because it is easily treated with oral vermicides.
c. Using good hand washing is important to prevent the transmission.
d. Every child in the day care should be treated because they all are probably infected.

 

 

ANS:   C

Transmission of pinworm occurs through the fecal-oral route, so good hand washing after toileting is essential. It is not necessary to treat all children or close the day care. It is necessary that action be taken, as without any action being taken, the pinworm outbreak will continue.

 

DIF:    Cognitive level: Analyzing                 REF:    p. 313

TOP:    Nursing process: Implementation

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

 

  1. What is the best method for preventing health care-associated infections?
a. Perform good hand washing before and after approaching every patient.
b. Prevention is almost impossible due to the high infection rates in hospitals.
c. Isolate every patient having surgery.
d. Use contact isolation for every patient at risk.

 

 

ANS:   A

Hand washing is the best way to prevent infection. If good hand washing is in place, it is not necessary to isolate patients or implement contact isolation. Prevention is possible with the use of good hand washing.

 

DIF:    Cognitive level: Understanding         REF:    p. 314

TOP:    Nursing process: Implementation

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

 

  1. A nurse promotes the use of universal precautions by all health care workers. Which of the following best describes the action that was taken by the nurse?
a. Primary prevention
b. Secondary prevention
c. Tertiary prevention
d. Health care-associated infection

 

 

ANS:   A

Primary prevention refers to those interventions aimed at preventing the occurrence of disease, injury, or disability. Secondary prevention seeks to prevent the spread of infection and/or disease once it occurs. Tertiary prevention reduces complications through treatment and rehabilitation. Health care-associated infections are prevented through the use of good hand washing.

 

DIF:    Cognitive level: Applying                  REF:    p. 297

TOP:    Nursing process: Implementation

MSC:   NCLEX: Health Promotion and Maintenance

 

  1. A nurse is caring for a client who has been diagnosed with a parasitic infection. Which of the following information should the nurse know when caring for this client?
a. The medication to prescribe to treat these infections
b. The nature and symptoms of all parasitic illnesses
c. What specimens to collect and how and when to collect them
d. Public policy about parasitic infections

 

 

ANS:   C

Nurses need to be cognizant about what specimens to collect, how and when to collect, and what laboratory techniques to use. Proper specimen collection is necessary so that the clinical diagnosis can be confirmed. It is not necessary for the nurse to know the signs and symptoms for all parasitic infections in order to provide care for the client. Public policy about parasitic infections is not important to know when providing care for the client.

 

DIF:    Cognitive level: Applying                  REF:    pp. 313-314

TOP:    Nursing process: Planning

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

 

MULTIPLE RESPONSE

 

  1. Which elements of surveillance does a nurse use? (Select all that apply.)
a. Mortality registration
b. Epidemic field investigation
c. Laboratory reporting
d. Individual case investigation
e. Application of research

 

 

ANS:   A, B, C, D

There are 10 basic elements of surveillance. Mortality registration, epidemic field investigation, laboratory reporting, and individual case investigation are among them. Application of research is not part of the 10 basic elements of surveillance.

 

DIF:    Cognitive level: Understanding         REF:    p. 292 (Box 13-2)

TOP:    Nursing process: Assessment

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