, TESTBANK FOR
Community Public Health Nursing 8th Edition Nies
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All available appendices and Excel files (if included in the original resources) are
provided.
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,Chapter 01: Health: A Community View
Nies: Community/Public Health Nursing, 8th Edition
MULTIPLE CHOICE
1. Which statement best describes the primary reason that Americans are concerned about health
care?
a. Politicians are discussing how to improve health care.
b. The media has provided mixed messages about the health care system.
c. Our national health care costs keep increasing.
d. The new health care system offers free services to Americans.
ANS: C
The primary reason for the focus on health care is the constantly increasing costs, which
cannot be sustained. The costs of caring for the sick accounted for the majority of escalating
health care dollars, which increased from 5.7% of the gross domestic product in 1965 to 18%
in 2018. Politicians and the media both influence Americans’ perceptions about health care;
however, they are not the primary reason why Americans are concerned. The new health care
system will change the health care access and availability but will not necessarily be offering
any free services to Americans.
DIF: Cognitive Level: Understand (Comprehension)
2. Why is it important for nurses to lobby with politicians for changes to the health care system?
a. Nurses, as central characters in several popular TV series, are currently very
visible in American media.
b. Nurses are primarily responsible for managing the various units in our health care
system.
c. Nurses are the largest segment of health care providers.
d. Nurses are the only group that is employed both inside and outside of hospitals.
ANS: C
Nurses constitute the largest segment of healthcare workers; therefore, they are instrumental
in creating a healthcare delivery system that will meet the health-oriented needs of the people.
As the largest segment of health care providers, nurses are informed about the current health
care system and all the problems that result from people not seeking care until they are
desperately ill. Nurses, as the American Nurses Association (ANA) emphasize, usually
believe that health care is a right, not a privilege. Therefore, nurses, whose work is central to
our current health care delivery system, can also be instrumental in working politically to
create a health care delivery system that will meet health needs. While nurses are in several
current TV series and are employed both inside and outside of hospitals, physicians and other
health care providers are as well. Nurses are often managers, but managers often have other
backgrounds, such as business administration.
DIF: Cognitive Level: Understand (Comprehension)
3. What conclusion can be drawn from examining where nurses are currently being employed?
a. There is a trend toward consolidation of health care into large central medical
centers.
b. There is an increased emphasis on health promotion and preventive care.
, c. There is an obvious need to decrease health care costs by cutting positions.
d. Managed care organizations (MCOs) are employing nurses to improve customer
relations.
ANS: B
The decline in the percentage of nurses employed in hospitals and the subsequent increase in
nurses employed in community settings suggests a shift in focus from illness and institution-
based care to health promotion and preventive care. This shift will likely continue into the
future as alternative delivery systems, such as ambulatory, home care, and hospice employ
more nurses. MCOs are employing nurses in many capacities. Although hospitals are closing
and acute care is increasingly found in central medical centers, the same trend may be seen in
an increase in neighborhood-based practice centers. While positions are cut in most industries,
health care is recognized as an area where growth in employment is expected. However,
nurses are increasingly employed in community settings as opposed to hospitals. This change
reflects the move toward community-based care rather than hospital-based tertiary care. To
help decrease the continued rise in health care costs, the increased emphasis is on disease
prevention rather than high-cost treatment.
DIF: Cognitive Level: Understand (Comprehension)
4. Which ethical belief is the basis of public health nursing?
a. Emphasis should be on individual and corporation freedom in the marketplace.
b. Emphasis should be on individual autonomy and freedom of choice.
c. Emphasis should be on social justice and collective responsibility.
d. Emphasis should be on the effectiveness of technology in resolving problems.
ANS: C
The mission of public health is social justice, which entitles all people to basic necessities
such as adequate income and health protection and accepts collective burdens to make it
possible. An overinvestment in technology and seeking of cures within the market justice
system has stifled the evolution of a health system to protect and preserve the health of the
population. Although individual autonomy and freedom of choice are important, so is the
recognition of collective responsibility in ensuring social justice, which entitles all people to
basic necessities.
DIF: Cognitive Level: Understand (Comprehension)
5. What is the primary problem seen in Healthy People 2020’s emphasis on choosing healthy
lifestyle behaviors, such as daily exercise or healthy food choices?
a. Emphasis on other lifestyle choices, such as not smoking and minimal use of
alcohol or drugs, is also needed.
b. All of us must work together to make unhealthy behaviors socially unacceptable.
c. It costs more to make healthy choices, such as buying and eating fresh fruits and
vegetables as opposed to quick and cheap fast-food choices.
d. Public policy emphasizes personal responsibility but ignores social and
environmental changes needed for well-being.
ANS: D
, Although all responses are accurate, the primary problem is the emphasis on personal choices
in the Healthy People 2020 objectives. Emphasis on personal choices ignores the need for
community responsibility and action that addresses environmental or cultural restraints to
health.
DIF: Cognitive Level: Understand (Comprehension)
6. What responsibility does the American Nurses Association (ANA) Code of Ethics require of
the nurse beyond giving excellent care to patients?
a. Accept longer work schedules to ensure that professional care is always available
to clients.
b. Recognize the need for experienced nurses to mentor new graduates to help
increase and expand the number of professionals available.
c. Support health legislation to improve accessibility and cost of health care.
d. Volunteer to work overtime as needed to ensure maximum quality of care.
ANS: C
The ANA Code of Ethics promotes social reform by focusing on health policy and legislation
to positively affect accessibility, quality, and cost of health care. The code does not directly
address workplace issues, such as work schedules or need for overtime.
DIF: Cognitive Level: Understand (Comprehension)
7. What is the community health nursing definition of health?
a. Health is a person’s goal-directed purposeful process toward well-being or
wholeness.
b. Health is an individual’s physical, mental, and social well-being, not merely the
absence of disease or infirmity.
c. Health is the mutual adaptation between a person and his or her environment in
meeting daily existence.
d. Health is families and groups choosing actions to ensure safety and well-being.
ANS: D
The text stresses that health is not just the result of an individual’s choices, but choices and
actions of individuals, families, groups, and communities that lead to better health.
DIF: Cognitive Level: Understand (Comprehension)
8. How does community health nursing define community?
a. A group of persons living within specific geographic boundaries
b. A group of persons who share a common identity and environment
c. A group of persons who work together to meet common goals
d. A group of persons who resolve a community concern
ANS: B
, Community health nurses work with both geopolitical groups (within specific geographic
boundaries) and phenomenological groups (who have a common identity based on culture,
history, or goals). A particular phenomenological group may or may not have been a planned
group—that is, a group that came together to resolve a recognized common problem or to
meet a common goal. However, of all the choices, a group of persons who share a common
identity (phenomenological group) and environment (which implies a specific geographic
setting) is the broadest and most complete definition.
DIF: Cognitive Level: Understand (Comprehension)
9. Which variable has a major influence on a community’s health?
a. Behavior choices made by persons in the community
b. Number of health care providers and hospitals in the community
c. Quality of the public safety officers (police officers, firefighters, etc.)
d. The number and credentials of public health officials in the community
ANS: A
Individual behavior choices are responsible for about 50% of health outcomes responsible for
premature deaths. Individual choices are affected through interaction with other individuals,
and their mutual social and physical environments. The number of health care providers has
not played a major role in the health outcomes in the community in comparison to individual
health behaviors. The quality of public safety officers and number of public health officials
have not been identified as major contributors to the determinants of health.
DIF: Cognitive Level: Understand (Comprehension)
10. What change could most effectively lead to a longer life span in Americans?
a. Parenting and sexual behavior classes in all public-school systems
b. Legislation restricting alcohol and drug use
c. Notably reducing speed limits on all state and federal highways, and changing the
age limit for driving to 21 years of age
d. The belief that smoking is shameful and disgusting, as well as expensive,
becoming the social norm
ANS: D
Smoking is responsible for almost 20% of all deaths in the United States. Although smoking is
an individual’s choice, all people are affected by social norms. Parenting and sexual behavior
classes and legislative changes may influence health but may not necessarily lead to a longer
lifespan. Community health nurses should recognize that health is influenced by a web of
factors, some that can be changed and some that cannot. Influencing social norms may better
promote change among Americans.
DIF: Cognitive Level: Apply (Application)
11. What of the following is the health issue at the center of concern in the United States today?
a. Diabetes epidemic
b. Increase in cardiac disease
c. Increase in obesity
d. Rise in cancer rates
ANS: C
, The widespread increase in incidence of overweight and obesity has led to calls for
population-based measures to address this issue. The overarching problem of obesity has led
to an increase in diabetes as well as cardiac disease. If this health issue was controlled, there
should be in a decrease in the other health issues.
DIF: Cognitive Level: Understand (Comprehension)
12. What factors are most responsible for the increasing length of life of Americans over the past
100 years?
a. Better nutrition and family planning options
b. Education concerning the need to reduce salt and fat in the diet
c. Improved medical care, including exciting new technologies
d. More efficient cancer screenings and early intervention
ANS: A
Average increased life span over the past 100 years can be largely attributed to higher
standards of living, better nutrition, a healthier environment, and having fewer children.
Public health efforts such as immunization and medical care have also contributed.
DIF: Cognitive Level: Understand (Comprehension)
13. Why would a public health nurse want to know about morbidity and mortality statistics on the
local, state, and national level?
a. To be able to share current trends in health problems with the community
b. To be able to observe the community’s statistics over time and compare the
community with other communities
c. To justify local budgets and the need for increased income from citizens
d. To publicize current health issues and suggest appropriate actions to citizens
ANS: B
Although being informed and being able to educate the public is always preferred and nurses
often do have to justify budgets, data are needed to compare the local community with itself
over time and with other communities so that problems may be recognized and action taken to
confront health issues. The first step is always to recognize problems as they develop.
DIF: Cognitive Level: Apply (Application)
14. How do public health efforts differ from medical efforts in improving the health of our
citizens?
a. Medical care providers autonomously choose appropriate interventions, whereas
public health care providers must engage in whatever actions legislation requires.
b. Medical care providers are self-employed or agency employed, whereas public
health care providers are employed by and paid through the government.
c. Medical care providers focus only on individuals, whereas public health care
providers focus only on aggregates.
d. Medical care providers focus on disease management and cure, whereas public
health care providers focus on health promotion and disease prevention.
ANS: D
, Contrasting with “medical care,” which focuses on disease management and “cure,” public
health efforts focus on health promotion and disease prevention. Medical care providers are
restricted by insurance and government regulations. Providers may also be employed in
government facilities, such as Veterans Administration facilities. Although medical care
providers primarily focus on individuals and public health care providers primarily focus on
aggregates, their practice is not limited to only individuals or only aggregates.
DIF: Cognitive Level: Understand (Comprehension)
15. Which primary prevention would the school nurse choose to address the school’s number of
unwed pregnancies?
a. Create a class on parenting for both the moms-to-be and the dads-to-be.
b. Convince the school board to allow sex education classes to include birth control
measures.
c. Employ the moms-to-be as 1-hour-a-day employees in the school daycare center
for children born to school students.
d. Establish a class where all the unwed moms-to-be can learn infant care.
ANS: B
Primary prevention relates to activities directed at preventing a problem before it occurs by
altering susceptibility or reducing exposure for susceptible individuals. Primary prevention
consists of two elements: general health promotion and specific protection. Health promotion
efforts enhance resiliency and protective factors and target essentially well populations.
Specific protection efforts reduce or eliminate risk factors. Although all choices would be
appropriate actions in a school, only education regarding sexuality and birth control would
help prevent future pregnancies.
DIF: Cognitive Level: Apply (Application)
16. What would be the proper term for the action of the school health nurse arranging for all the
students in the elementary school to receive H1N1 immunizations?
a. Health education
b. Secondary prevention
c. Specific protection
d. Tertiary prevention
ANS: C
Immunizations are a specific protection effort as part of primary prevention. Primary
prevention relates to activities directed at preventing a problem before it occurs by altering
susceptibility or reducing exposure for susceptible individuals. Primary prevention consists of
two elements: general health promotion and specific protection. Health promotion efforts
enhance resiliency and protective factors and target essentially well populations. Specific
protection efforts reduce or eliminate risk factors. Secondary prevention refers to early
detection and prompt intervention during the period of early disease pathogenesis. Tertiary
prevention targets populations that have experienced disease or injury and focuses on
limitation of disability and rehabilitation. Health education would relate to educating the
students about the immunization not making the arrangements for the immunization to be
given.
DIF: Cognitive Level: Understand (Comprehension)
,17. Which action would probably result in the largest change in health care outcomes for
Americans?
a. Establish large numbers of scholarships for education of nurses, physicians, and
other health care providers.
b. Fund a one-time extremely large stimulus to allow all health care providers and
agencies to create and integrate computer network systems for client health care
records.
c. Increase funding for hospitals and medical centers to expand their neighborhood
clinics.
d. Redirect a large portion of federal funding from acute care to health promotion
activities.
ANS: D
Of the choices given, health promotion activities would make the largest difference. Increased
expenditures on acute care will not notably change the health of the population, whereas
funding that addresses health promotion such as education and safe environments would
improve the health of the aggregate.
DIF: Cognitive Level: Understand (Comprehension)
18. Which task will be most helpful in meeting the public health agency’s goals?
a. Complete staff evaluations in preparation for individual meetings to plan their
agency and individual goals for the next year.
b. Actively participate in community agencies’ collaborative action plan to meet the
community’s health goals for the year.
c. Meet with the college of nursing faculty to finalize student objectives and
schedules for the next semester.
d. Teach a free course in healthful living for community residents.
ANS: B
Although all tasks may be necessary and important, intra-agency cooperation to meet the
health goals of the community as a whole is more central to the agency’s mission than other
choices that meet the needs of individuals or groups rather than the community as a whole.
DIF: Cognitive Level: Analyze (Analysis)
19. A community health nurse is overwhelmed with all that needs to be done in one day. Which
task could most easily be postponed without directly affecting health promotion and disease
prevention outcomes?
a. Reviewing the most recent hospital patient data collected by the local college of
nursing
b. Deciding which of several possible new clinic options would be most effective in
better meeting the needs of the local community
c. Evaluating the results of the most recent community-wide screening program
before planning for the next community health program
d. Giving testimony to the state legislature on a new health and safety bill
ANS: A
, All of the tasks are related to assessing needs, implementing new care options, or evaluating
health outcomes measures in the community except reviewing hospital patient data. Hospital
patient data may be helpful but not directly related to the agency’s ability to promote primary
health and prevent disease.
DIF: Cognitive Level: Analyze (Analysis)
20. A nurse who works on the surgical unit at the local hospital was asked by the home health unit
to make a home visit to a patient who had been discharged the previous day and to give
follow-up care (for overload pay). What kind of nursing would this nurse be doing?
a. Acute care hospital nursing
b. Community-based nursing
c. Community health nursing
d. Public health nursing
ANS: B
The nurse is caring for a patient in the home. Community-based nursing is nursing somewhere
in the community. Community-based nursing practice refers to “application of the nursing
process in caring for individuals, families and groups where they live, work or go to school or
as they move through the health care system” (McEwen and Pullis, 2009, p. 6). Community-
based nursing is setting specific, and the emphasis is on acute and chronic care and includes
such practice areas as home health nursing and nursing in outpatient or ambulatory settings.
As the nurse is not focusing on the health of the community but on an individual, it is not
community or public health nursing. It is not acute care hospital nursing because the nurse is
seeing the patient in his or her home.
DIF: Cognitive Level: Understand (Comprehension)
21. Which task is most crucial for the community health nurse to do effectively?
a. Review the most recent morbidity and mortality data.
b. Create a new clinic to better meet local health needs.
c. Evaluate the results of the recent screening program.
d. Give testimony regarding proposed state health legislation.
ANS: D
Public health’s core functions are assurance, assessment, and policy development. Giving
testimony regarding legislation directly reflects policy development, which would have a
wider impact than the other options, which are more local and narrower in focus.
DIF: Cognitive Level: Analyze (Analysis)
22. A novice public health nurse carefully assessed all the local mortality and morbidity data in
preparation for making appropriate planning suggestions at a meeting next week. What other
action is crucial before the nurse can feel prepared?
a. Ask other nursing staff their perceptions of the community’s needs.
b. Assess the nurse’s own assets, strengths, and ability to contribute.
c. Meet members of the community to determine their culture and values.
d. Review discussions and decisions from previous meetings.
ANS: C
Community Public Health Nursing 8th Edition Nies
Important Notes
The file includes the complete test bank, organized chapter by chapter.
A sample of selected pages has been provided for preview.
All available appendices and Excel files (if included in the original resources) are
provided.
We continuously update our files to ensure you receive the latest and most accurate
editions.
New editions are added regularly – stay connected for updates!
Purchase Guarantee
If you believe you have purchased the wrong file, don’t worry. Contact us anytime and we
will gladly replace it with the correct version.
Contact Email:
,Chapter 01: Health: A Community View
Nies: Community/Public Health Nursing, 8th Edition
MULTIPLE CHOICE
1. Which statement best describes the primary reason that Americans are concerned about health
care?
a. Politicians are discussing how to improve health care.
b. The media has provided mixed messages about the health care system.
c. Our national health care costs keep increasing.
d. The new health care system offers free services to Americans.
ANS: C
The primary reason for the focus on health care is the constantly increasing costs, which
cannot be sustained. The costs of caring for the sick accounted for the majority of escalating
health care dollars, which increased from 5.7% of the gross domestic product in 1965 to 18%
in 2018. Politicians and the media both influence Americans’ perceptions about health care;
however, they are not the primary reason why Americans are concerned. The new health care
system will change the health care access and availability but will not necessarily be offering
any free services to Americans.
DIF: Cognitive Level: Understand (Comprehension)
2. Why is it important for nurses to lobby with politicians for changes to the health care system?
a. Nurses, as central characters in several popular TV series, are currently very
visible in American media.
b. Nurses are primarily responsible for managing the various units in our health care
system.
c. Nurses are the largest segment of health care providers.
d. Nurses are the only group that is employed both inside and outside of hospitals.
ANS: C
Nurses constitute the largest segment of healthcare workers; therefore, they are instrumental
in creating a healthcare delivery system that will meet the health-oriented needs of the people.
As the largest segment of health care providers, nurses are informed about the current health
care system and all the problems that result from people not seeking care until they are
desperately ill. Nurses, as the American Nurses Association (ANA) emphasize, usually
believe that health care is a right, not a privilege. Therefore, nurses, whose work is central to
our current health care delivery system, can also be instrumental in working politically to
create a health care delivery system that will meet health needs. While nurses are in several
current TV series and are employed both inside and outside of hospitals, physicians and other
health care providers are as well. Nurses are often managers, but managers often have other
backgrounds, such as business administration.
DIF: Cognitive Level: Understand (Comprehension)
3. What conclusion can be drawn from examining where nurses are currently being employed?
a. There is a trend toward consolidation of health care into large central medical
centers.
b. There is an increased emphasis on health promotion and preventive care.
, c. There is an obvious need to decrease health care costs by cutting positions.
d. Managed care organizations (MCOs) are employing nurses to improve customer
relations.
ANS: B
The decline in the percentage of nurses employed in hospitals and the subsequent increase in
nurses employed in community settings suggests a shift in focus from illness and institution-
based care to health promotion and preventive care. This shift will likely continue into the
future as alternative delivery systems, such as ambulatory, home care, and hospice employ
more nurses. MCOs are employing nurses in many capacities. Although hospitals are closing
and acute care is increasingly found in central medical centers, the same trend may be seen in
an increase in neighborhood-based practice centers. While positions are cut in most industries,
health care is recognized as an area where growth in employment is expected. However,
nurses are increasingly employed in community settings as opposed to hospitals. This change
reflects the move toward community-based care rather than hospital-based tertiary care. To
help decrease the continued rise in health care costs, the increased emphasis is on disease
prevention rather than high-cost treatment.
DIF: Cognitive Level: Understand (Comprehension)
4. Which ethical belief is the basis of public health nursing?
a. Emphasis should be on individual and corporation freedom in the marketplace.
b. Emphasis should be on individual autonomy and freedom of choice.
c. Emphasis should be on social justice and collective responsibility.
d. Emphasis should be on the effectiveness of technology in resolving problems.
ANS: C
The mission of public health is social justice, which entitles all people to basic necessities
such as adequate income and health protection and accepts collective burdens to make it
possible. An overinvestment in technology and seeking of cures within the market justice
system has stifled the evolution of a health system to protect and preserve the health of the
population. Although individual autonomy and freedom of choice are important, so is the
recognition of collective responsibility in ensuring social justice, which entitles all people to
basic necessities.
DIF: Cognitive Level: Understand (Comprehension)
5. What is the primary problem seen in Healthy People 2020’s emphasis on choosing healthy
lifestyle behaviors, such as daily exercise or healthy food choices?
a. Emphasis on other lifestyle choices, such as not smoking and minimal use of
alcohol or drugs, is also needed.
b. All of us must work together to make unhealthy behaviors socially unacceptable.
c. It costs more to make healthy choices, such as buying and eating fresh fruits and
vegetables as opposed to quick and cheap fast-food choices.
d. Public policy emphasizes personal responsibility but ignores social and
environmental changes needed for well-being.
ANS: D
, Although all responses are accurate, the primary problem is the emphasis on personal choices
in the Healthy People 2020 objectives. Emphasis on personal choices ignores the need for
community responsibility and action that addresses environmental or cultural restraints to
health.
DIF: Cognitive Level: Understand (Comprehension)
6. What responsibility does the American Nurses Association (ANA) Code of Ethics require of
the nurse beyond giving excellent care to patients?
a. Accept longer work schedules to ensure that professional care is always available
to clients.
b. Recognize the need for experienced nurses to mentor new graduates to help
increase and expand the number of professionals available.
c. Support health legislation to improve accessibility and cost of health care.
d. Volunteer to work overtime as needed to ensure maximum quality of care.
ANS: C
The ANA Code of Ethics promotes social reform by focusing on health policy and legislation
to positively affect accessibility, quality, and cost of health care. The code does not directly
address workplace issues, such as work schedules or need for overtime.
DIF: Cognitive Level: Understand (Comprehension)
7. What is the community health nursing definition of health?
a. Health is a person’s goal-directed purposeful process toward well-being or
wholeness.
b. Health is an individual’s physical, mental, and social well-being, not merely the
absence of disease or infirmity.
c. Health is the mutual adaptation between a person and his or her environment in
meeting daily existence.
d. Health is families and groups choosing actions to ensure safety and well-being.
ANS: D
The text stresses that health is not just the result of an individual’s choices, but choices and
actions of individuals, families, groups, and communities that lead to better health.
DIF: Cognitive Level: Understand (Comprehension)
8. How does community health nursing define community?
a. A group of persons living within specific geographic boundaries
b. A group of persons who share a common identity and environment
c. A group of persons who work together to meet common goals
d. A group of persons who resolve a community concern
ANS: B
, Community health nurses work with both geopolitical groups (within specific geographic
boundaries) and phenomenological groups (who have a common identity based on culture,
history, or goals). A particular phenomenological group may or may not have been a planned
group—that is, a group that came together to resolve a recognized common problem or to
meet a common goal. However, of all the choices, a group of persons who share a common
identity (phenomenological group) and environment (which implies a specific geographic
setting) is the broadest and most complete definition.
DIF: Cognitive Level: Understand (Comprehension)
9. Which variable has a major influence on a community’s health?
a. Behavior choices made by persons in the community
b. Number of health care providers and hospitals in the community
c. Quality of the public safety officers (police officers, firefighters, etc.)
d. The number and credentials of public health officials in the community
ANS: A
Individual behavior choices are responsible for about 50% of health outcomes responsible for
premature deaths. Individual choices are affected through interaction with other individuals,
and their mutual social and physical environments. The number of health care providers has
not played a major role in the health outcomes in the community in comparison to individual
health behaviors. The quality of public safety officers and number of public health officials
have not been identified as major contributors to the determinants of health.
DIF: Cognitive Level: Understand (Comprehension)
10. What change could most effectively lead to a longer life span in Americans?
a. Parenting and sexual behavior classes in all public-school systems
b. Legislation restricting alcohol and drug use
c. Notably reducing speed limits on all state and federal highways, and changing the
age limit for driving to 21 years of age
d. The belief that smoking is shameful and disgusting, as well as expensive,
becoming the social norm
ANS: D
Smoking is responsible for almost 20% of all deaths in the United States. Although smoking is
an individual’s choice, all people are affected by social norms. Parenting and sexual behavior
classes and legislative changes may influence health but may not necessarily lead to a longer
lifespan. Community health nurses should recognize that health is influenced by a web of
factors, some that can be changed and some that cannot. Influencing social norms may better
promote change among Americans.
DIF: Cognitive Level: Apply (Application)
11. What of the following is the health issue at the center of concern in the United States today?
a. Diabetes epidemic
b. Increase in cardiac disease
c. Increase in obesity
d. Rise in cancer rates
ANS: C
, The widespread increase in incidence of overweight and obesity has led to calls for
population-based measures to address this issue. The overarching problem of obesity has led
to an increase in diabetes as well as cardiac disease. If this health issue was controlled, there
should be in a decrease in the other health issues.
DIF: Cognitive Level: Understand (Comprehension)
12. What factors are most responsible for the increasing length of life of Americans over the past
100 years?
a. Better nutrition and family planning options
b. Education concerning the need to reduce salt and fat in the diet
c. Improved medical care, including exciting new technologies
d. More efficient cancer screenings and early intervention
ANS: A
Average increased life span over the past 100 years can be largely attributed to higher
standards of living, better nutrition, a healthier environment, and having fewer children.
Public health efforts such as immunization and medical care have also contributed.
DIF: Cognitive Level: Understand (Comprehension)
13. Why would a public health nurse want to know about morbidity and mortality statistics on the
local, state, and national level?
a. To be able to share current trends in health problems with the community
b. To be able to observe the community’s statistics over time and compare the
community with other communities
c. To justify local budgets and the need for increased income from citizens
d. To publicize current health issues and suggest appropriate actions to citizens
ANS: B
Although being informed and being able to educate the public is always preferred and nurses
often do have to justify budgets, data are needed to compare the local community with itself
over time and with other communities so that problems may be recognized and action taken to
confront health issues. The first step is always to recognize problems as they develop.
DIF: Cognitive Level: Apply (Application)
14. How do public health efforts differ from medical efforts in improving the health of our
citizens?
a. Medical care providers autonomously choose appropriate interventions, whereas
public health care providers must engage in whatever actions legislation requires.
b. Medical care providers are self-employed or agency employed, whereas public
health care providers are employed by and paid through the government.
c. Medical care providers focus only on individuals, whereas public health care
providers focus only on aggregates.
d. Medical care providers focus on disease management and cure, whereas public
health care providers focus on health promotion and disease prevention.
ANS: D
, Contrasting with “medical care,” which focuses on disease management and “cure,” public
health efforts focus on health promotion and disease prevention. Medical care providers are
restricted by insurance and government regulations. Providers may also be employed in
government facilities, such as Veterans Administration facilities. Although medical care
providers primarily focus on individuals and public health care providers primarily focus on
aggregates, their practice is not limited to only individuals or only aggregates.
DIF: Cognitive Level: Understand (Comprehension)
15. Which primary prevention would the school nurse choose to address the school’s number of
unwed pregnancies?
a. Create a class on parenting for both the moms-to-be and the dads-to-be.
b. Convince the school board to allow sex education classes to include birth control
measures.
c. Employ the moms-to-be as 1-hour-a-day employees in the school daycare center
for children born to school students.
d. Establish a class where all the unwed moms-to-be can learn infant care.
ANS: B
Primary prevention relates to activities directed at preventing a problem before it occurs by
altering susceptibility or reducing exposure for susceptible individuals. Primary prevention
consists of two elements: general health promotion and specific protection. Health promotion
efforts enhance resiliency and protective factors and target essentially well populations.
Specific protection efforts reduce or eliminate risk factors. Although all choices would be
appropriate actions in a school, only education regarding sexuality and birth control would
help prevent future pregnancies.
DIF: Cognitive Level: Apply (Application)
16. What would be the proper term for the action of the school health nurse arranging for all the
students in the elementary school to receive H1N1 immunizations?
a. Health education
b. Secondary prevention
c. Specific protection
d. Tertiary prevention
ANS: C
Immunizations are a specific protection effort as part of primary prevention. Primary
prevention relates to activities directed at preventing a problem before it occurs by altering
susceptibility or reducing exposure for susceptible individuals. Primary prevention consists of
two elements: general health promotion and specific protection. Health promotion efforts
enhance resiliency and protective factors and target essentially well populations. Specific
protection efforts reduce or eliminate risk factors. Secondary prevention refers to early
detection and prompt intervention during the period of early disease pathogenesis. Tertiary
prevention targets populations that have experienced disease or injury and focuses on
limitation of disability and rehabilitation. Health education would relate to educating the
students about the immunization not making the arrangements for the immunization to be
given.
DIF: Cognitive Level: Understand (Comprehension)
,17. Which action would probably result in the largest change in health care outcomes for
Americans?
a. Establish large numbers of scholarships for education of nurses, physicians, and
other health care providers.
b. Fund a one-time extremely large stimulus to allow all health care providers and
agencies to create and integrate computer network systems for client health care
records.
c. Increase funding for hospitals and medical centers to expand their neighborhood
clinics.
d. Redirect a large portion of federal funding from acute care to health promotion
activities.
ANS: D
Of the choices given, health promotion activities would make the largest difference. Increased
expenditures on acute care will not notably change the health of the population, whereas
funding that addresses health promotion such as education and safe environments would
improve the health of the aggregate.
DIF: Cognitive Level: Understand (Comprehension)
18. Which task will be most helpful in meeting the public health agency’s goals?
a. Complete staff evaluations in preparation for individual meetings to plan their
agency and individual goals for the next year.
b. Actively participate in community agencies’ collaborative action plan to meet the
community’s health goals for the year.
c. Meet with the college of nursing faculty to finalize student objectives and
schedules for the next semester.
d. Teach a free course in healthful living for community residents.
ANS: B
Although all tasks may be necessary and important, intra-agency cooperation to meet the
health goals of the community as a whole is more central to the agency’s mission than other
choices that meet the needs of individuals or groups rather than the community as a whole.
DIF: Cognitive Level: Analyze (Analysis)
19. A community health nurse is overwhelmed with all that needs to be done in one day. Which
task could most easily be postponed without directly affecting health promotion and disease
prevention outcomes?
a. Reviewing the most recent hospital patient data collected by the local college of
nursing
b. Deciding which of several possible new clinic options would be most effective in
better meeting the needs of the local community
c. Evaluating the results of the most recent community-wide screening program
before planning for the next community health program
d. Giving testimony to the state legislature on a new health and safety bill
ANS: A
, All of the tasks are related to assessing needs, implementing new care options, or evaluating
health outcomes measures in the community except reviewing hospital patient data. Hospital
patient data may be helpful but not directly related to the agency’s ability to promote primary
health and prevent disease.
DIF: Cognitive Level: Analyze (Analysis)
20. A nurse who works on the surgical unit at the local hospital was asked by the home health unit
to make a home visit to a patient who had been discharged the previous day and to give
follow-up care (for overload pay). What kind of nursing would this nurse be doing?
a. Acute care hospital nursing
b. Community-based nursing
c. Community health nursing
d. Public health nursing
ANS: B
The nurse is caring for a patient in the home. Community-based nursing is nursing somewhere
in the community. Community-based nursing practice refers to “application of the nursing
process in caring for individuals, families and groups where they live, work or go to school or
as they move through the health care system” (McEwen and Pullis, 2009, p. 6). Community-
based nursing is setting specific, and the emphasis is on acute and chronic care and includes
such practice areas as home health nursing and nursing in outpatient or ambulatory settings.
As the nurse is not focusing on the health of the community but on an individual, it is not
community or public health nursing. It is not acute care hospital nursing because the nurse is
seeing the patient in his or her home.
DIF: Cognitive Level: Understand (Comprehension)
21. Which task is most crucial for the community health nurse to do effectively?
a. Review the most recent morbidity and mortality data.
b. Create a new clinic to better meet local health needs.
c. Evaluate the results of the recent screening program.
d. Give testimony regarding proposed state health legislation.
ANS: D
Public health’s core functions are assurance, assessment, and policy development. Giving
testimony regarding legislation directly reflects policy development, which would have a
wider impact than the other options, which are more local and narrower in focus.
DIF: Cognitive Level: Analyze (Analysis)
22. A novice public health nurse carefully assessed all the local mortality and morbidity data in
preparation for making appropriate planning suggestions at a meeting next week. What other
action is crucial before the nurse can feel prepared?
a. Ask other nursing staff their perceptions of the community’s needs.
b. Assess the nurse’s own assets, strengths, and ability to contribute.
c. Meet members of the community to determine their culture and values.
d. Review discussions and decisions from previous meetings.
ANS: C
