Regis NU 340, Community Health Nursing, SENIORS Spring 2018 Take-Home Exam One

Regis NU 340, Community Health Nursing, SENIORS Spring 2018 Take-Home Exam One Regis College School of Nursing NU 340, Community Health Nursing, SENIORS Spring 2018 Take-Home Exam One __________________________________________________________________________________ Directions:  Gather your textbook, PowerPoint slides, an d other anticipated resources.  Prior to starting the quiz, be sure to familiarize yourself with the following textbook content: Chapters 1, 2, 3, 28, and 12. In addition, please review related didactic and homework content (in addition to Nutrition ATI review).  Organize your individual testing resources. You are free to utilize your textbook, PowerPoint slides, online sites, and other materials to complete the exam.  Please avail yourself of all course Moodle site learning materials as well.  Your submission, despite the availability of open resources, is expected to be uniquely yours.  Multiple-choice and short-answer questions comprise this examination.  Clearly indicate your responses to the multiple choice questions (e.g., highlight in yellow the correct answer or delete all the incorrect responses). Please make your answers absolutely explicit.  Do submit your answers as a Microsoft Word document (i.e., not Pages, PDF, other). Other formatted submissions may not be accepted.  Any legitimate, scholarly reference (e.g., textbook, newspaper, journal, respectable online resource) is permitted when answering questions that request inclusion of a least one reference. Opinion blogs, Wikipedia, social media sites, and other such unsubstantiated, unscholarly resources are not acceptable references.  Be sure to include in-text citations in your short answer responses. Please do not simply write your response and include the reference citation(s) at the bottom of your answer. Be sure to demonstrate explicitly within the body of your answer how you have supported your response with the selected references. Failure to do so will result in lost points.  All references must be cited appropriately using APA (6th ed.) format.  Presentation/formatting issues (e.g., spelling, grammar, punctuation, APA, plagiarism, failure to cite, etc.) will result in lost points.  Submit your answers to the Moodle submission box on or before FEBRUARY 19, 2018, at the start of your designated class time. Be sure to include your name on the uploaded submission.  No late submissions will be accepted without prior written instructor approval.  Good luck! _____________________________________________________________________________________ QUESTIONS BY TEXTBOOK CHAPTER Point Value: 2.0 Points/Question Chapter One: 1. Which of the following best describes community-based nursing? a. A philosophy that guides family-centered illness care b. Giving care with a focus on the group’s needs c. Giving care with a focus on the aggregate’s needs d. Having the goal of giving optimal care to all clients NU 340, SENIORS, Take-Home Exam ONE Page 1 of 10 2. Which of the following best describes community-oriented nursing? a. Focusing on the provision of care to individuals and families b. Providing care to manage acute or chronic conditions c. Giving direct care to ill individuals within their family setting d. Having the goal of health promotion and disease prevention 3. Which of the following is the primary focus of public health nursing? a. Families and groups b. Illness-oriented care c. Individuals in their families d. Promotion of quality of life 4. Which of the following is a basic assumption of public health efforts: a. Health disparities among any groups are morally and legally wrong b. Health care is the most important priority in government planning and funding c. The health of individuals cannot be separated from the health of the community d. The government is responsible for lengthening the lifespan of Americans 5. Which of the following actions best represents public health nursing? a. Assessing the effectiveness of the large high school health clinic b. Caring for clients in their home following their outpatient surgeries c. Providing care to children and their families at the school clinic d. Administering follow-up care for pediatric clients at an outpatient clinic 6. Why are nurses increasingly providing care in clients’ homes rather than in hospitals? Select all that apply. a. Home care is less expensive b. It is much more efficient to give care in the home c. Nurses prefer to give home care with individual attention d. People prefer to receive care in their homes rather than in hospitals 7. Which of the following variables have led to a stronger commitment to population-focused services? Select all that apply. a. Economic turmoil and demand for high-technology care b. Emergence of new or drug-resistant infectious diseases c. Emphasis on overall health care needs rather than only on acute care treatment d. Threat of bioterrorism 8. One of the core public health functions is assessment of the health status of a community. Which of the following questions would be asked in the assessment phase? a. What programs are available to reduce the risk of cardiac disease in the population? b. What educational materials are needed to inform the community about environmental risk factors? c. What is the prevalence rate of hypertension about various age, race, and gender groups in the community? d. What types of public transportation are needed in the community to ensure access to services? _____________________________________________________________________________________ Chapter Two: 9. How did health care and its delivery change during the 1980s? Select all that apply. NU 340, SENIORS, Take-Home Exam ONE Page 2 of 10 a. Funding to public health increased as funding for acute hospital care decreased. b. Laws began to be passed that discouraged the use of alcohol, drugs, and tobacco. c. Nurse practitioners were increasingly used to provide care. d. Public health programs suffered reduced political support, financing, and effectiveness. 10. The local public health department provides community health nursing services in a county population of 25,000 residents. The goal is to provide health promotion, surveillance, and disease prevention services to the residents of the county. The primary nurse at the public health department is preparing to offer an influenza vaccination clinic, which is being held at the mall. She has arranged to have several volunteer nurses assist with the effort and is expecting to treat approximately 1,000 individuals. Public health nursing emphasizes prevention of disease. What are the challenges associated with such a goal? SELECT ALL THAT APPLY. a. Increased costs and decreased funding b. Independence of problem-solving and decision-making c. It is easier to measure the effects of prevention. d. It is more difficult to measure the effects of prevention that the effects of treatment. e. Emerging communicable diseases continue to be a health threat. 11. A public health nurse is determining which type of programming should be developed for the community. Which of the following is the most crucial factor that will influence program development? a. Comprehensive assessment and planning done in the community b. Documented needs of the local community c. Federal funding for priority diseases or groups d. Nursing staff’s expertise and skills 12. A public health nurse is compiling information about how to promote early detection of breast cancer in women. Which document would most likely provide useful information about this topic? a. The Future of Public Health b. Healthy People 2020 c. Patient Protection and Affordable Care Act d. Scope and Standards of Public Health Nursing Practice 13. What was the outcome of the Shattuck Report? a. Efforts to control alcohol and drug abuse, as well as tobacco use, were initiated. b. Environmental sanitation efforts became an immediate priority. c. Guidelines for modern public health organization were eventually developed. d. Local and state governments immediately established boards of health after its publication. 14. Many of the varied and challenging public health nursing roles which originated in the late 1800s continue to be an issue today. Which factors continue to challenge public health nurses? SELECT ALL THAT APPLY. a. Control of sanitation b. Care of the aged in the hospital setting c. Environmental pollution control d. Natural disasters e. Emerging communicable diseases ____________________________________________________________________________________ NU 340, SENIORS, Take-Home Exam ONE Page 3 of 10 Chapter Three: 15. A public health agency is planning to implement the electronic health record. Which of the following is a benefit of this choice? a. Facilitation of interprofessional care b. Improved client compliance with medical regimens c. Cost savings to the agency d. Compliance with JCAHO standards 16. How does managed care (MC) attempt to control costs of care? a. By encouraging families to use the point-of-service list of individual practice associates b. By requiring families to choose a care provider from the MC network and not allowing access to other services without their provider’s permission c. By moving Medicaid-eligible families onto state Medicare enrollment d. By refusing permission for families to use urgent care or emergency department services 17. An 80 y/o female comes to the community health care facility with a large bag of medications. She tells the nurse that she can no longer afford these medications, because her only income is Social Security. Which statement is the best response by the nurse? a. “Let’s go through these medications and see which ones we can delete.” b. “You can get these medicines at this clinic for free.” c. “Let’s see if we can get some help from Medicare to help you pay for these medications.” d. “These medications are important. Do your best to pay for them.” 18. Which of the following principles has been used by the American Nurses Association (ANA) when encouraging health care reform? a. High-technology interventions to reduce nursing time, effort, and medical errors must be expanded b. Nurses must be recognized and rewarded for health promotion efforts c. Nursing research into patient care outcomes must be expanded and funded d. Universal access to essential health services should be available for all citizens 19. African-American females have a higher mortality rate from breast cancer than white females. This is an example of what? a. Projection b. Disparity c. Racism d. A sentinel event 20. Carolyn Mason is a nurse working in a community health setting. One of her roles is to organize screenings and clinics in local retirement communities. She is conducting a diabetes screening clinic in a lower-income retirement complex. The center has access to transportation for the residents to visit primary care providers. The residents live independently and prepare their own meals. Carolyn Mason utilizes technology to upload glucose readings to primary care providers to ensure that they are aware of trends. What are the most significant negative aspects of the use of new technology? SELECT ALL THAT APPLY. a. High cost of equipment b. Potential for privacy breach c. More convenient for providers d. Increased legal liability e. Increased efficiency NU 340, SENIORS, Take-Home Exam ONE Page 4 of 10 21. How does the Department of Agriculture promote the health of United States citizens? a. By collecting surplus food left after mechanical harvests and distributing it to the poor b. By inspecting food so no foodborne illnesses can occur c. By collaborating with others to provide food or food stamps to needy persons d. By providing direct education and grants to dietitians and nutritionists _____________________________________________________________________________________ Chapter Twenty-Eight: 22. Which of the following factors is causing nursing to change so quickly? a. Economic issues b. Increases in medical and nursing knowledge c. Legislative issues d. Technology changes 23. A nurse is implementing a primary prevention activity to decrease the incidence of communicable disease. Which of the following actions is the nurse most likely taking? a. Identifying and treating clients in a sexually transmitted disease clinic b. Partnering with school teachers to teach and observe hand washing techniques in elementary school children c. Providing case management services that link clients with communicable diseases to health care and community support services d. Performing directly observed therapy (DOT) for clients with active tuberculosis 24. A community health nurse is trying to decrease the incidence of emerging infections caused by drugresistant organisms. Which of the following actions would be most appropriate for the nurse to implement? a. Lobby for increased use of antibiotics in the treatment and prevention of communicable diseases. b. Notify the Centers for Disease Control and Prevention regarding any unusual signs and symptoms related to a communicable illness. c. Reinforce the importance of receiving vaccinations according to recommended schedules. d. Teach parents that antibiotics should not be used for treatment of viral infections or for prevention of bacterial infections. 25. Which of the following federal agencies is most influential in public health activities? a. Agency for Healthcare Research and Quality b. Centers for Disease Control and Prevention c. U.S. Department of Health and Human Services d. Food and Drug Administration 26. Which best summarizes the role of nursing in community health? a. Application of nursing and public health theory in promoting, preserving, and maintaining health of individuals, families, or communities b. Health care provision offered in primary and secondary institutions or in the client’s home c. Provision of health care services in institutions located in the community but outside the hospital d. Use of the nursing process and evidence-based practice to meet Healthy People 2020 objectives for community health improvement NU 340, SENIORS, Take-Home Exam ONE Page 5 of 10 27. Vulnerable populations remain a significant concern to nurses in the public health department. What is currently the highest risk group? a. Homeless adults b. Pregnant substance abusers c. Adolescents d. Infants 28. Emerging infections remain a twenty-first century public health challenge because of: a. Drug-resistant organisms b. Shortages of antibiotics c. Welfare reform and spending d. Behavioral influences _____________________________________________________________________________________ Chapter Twelve: 29. Alan is a public health nurse assigned to assess the health care needs of aging baby boomers in Duxbury County. Currently, 25% of the population in Duxbury County is older than age 65 years; however, in 25 years, this percentage is expected to increase to more than 50%. Five primary care providers (PCPs) are practicing in the county, and service waiting lists range from one to three weeks, and only of these PCPs specializes in geriatric care. A single 54-bed long-term nursing care facility is located in the northern region of the spacious county. Because of the rural roads, no public transit system is in place. The first step in community assessment is to define the community. What (or who) is the community of interest that Alan and his committee must assess? Answer: Baby boomers (the population older than 65 years old) in Duxbury 30. Patricia Jones is a public health nurse who participates in making home visits in a large retirement community. A community assessment of retirement centers within the city limits has been requested by community leaders. The goal is to identify the community health problems of the residents and the strengths of the communities, as well as the types of resources which will be needed to meet the needs of the individuals. Ms. Jones has determined that she will start her community assessment with data gathering through the county website. Following this, she will conduct a windshield survey using the public bus system. This method will enable her to observe the characteristics of the individuals utilizing public transportation. What windshield survey components can be assessed through utilizing public transportation? Select all that apply? a. What are the religious practices of the residents? b. How frequently is public transportation available? c. Are there common characteristics of the people on the bus? d. What are the socioeconomic characteristics of the residents? e. What are the goals and perceived needs of the residents? 31. Persons often point out that smokers choose to light their cigarettes, alcoholics lift the glass to their mouth, and drug addicts inject or ingest their drugs. Why then do not nurses simply focus on helping persons who engage in poor health behaviors to behave appropriately? NU 340, SENIORS, Take-Home Exam ONE Page 6 of 10 a. Addicts don’t have the willpower to change their behavior. b. It is too rewarding to continue the behavior for a person to be able to change. c. Laws and policies must reward healthy behaviors and punish unhealthy behaviors to help recognize the importance of change. d. Society must offer healthy choices, provide support, and practice helpful policies. 32. During the assessment phase, the nurse compiles and interprets available data and draws conclusions as to the community's strengths and concerns. Why might the nurse go on to continue to observe and interview key informants? a. To ensure that others agree with the nurse’s plans for interventions b. To confirm the nurse’s initial findings and conclusions c. To encourage community partners to feel they “own” the data d. To generate non-statistical data such as values, beliefs, and perceived needs 33. A new nurse is overwhelmed with the needs of the community. In deciding which problem should have first priority, the nurse should choose: a. A problem that affects the most disadvantaged residents in the community, since there is a moral obligation to do so b. A problem that is very easy and inexpensive to address c. A particular problem in an area in which the nurse is very comfortable and has a great deal of expertise d. A problem that is of high concern to the community 34. What will the nurse who wishes to assess the status of a community's health examine? a. Vital statistics b. Community awareness c. Health facilities d. Health care manpower 35. Which is the best brief definition of community? a. A geographic area or political division under common leadership b. A social group sharing a common culture within a geographic area c. A group sharing a common bond such as a profession or occupation d. A group working together to confront a common problem _____________________________________________________________________________________ Assorted Content: 36. A nurse in an assisted living facility is caring for an older adult client. The nurse should recognize that older adults have decreased absorption of which of the following? Select all that apply. a. Calcium b. Chloride c. Folic acid NU 340, SENIORS, Take-Home Exam ONE Page 7 of 10 d. Magnesium e. Phosphorus 37. Residents of rural communities report that they must travel long distances in order to receive health services. As a result, some residents report receiving health care services only for severe or lifethreatening emergencies. Which of the following United States health care issues does this situation represent? a. Quality of care b. Access to care c. Cost of care d. Adequacy of diagnostic health care facilities 38. A visiting nurse makes a home visit to a patient. The patient’s chart reveals a recent physician order for Synthroid 75 mcg PO daily. The pharmacy filled the patient’s Synthroid prescription as 0.15 mg tab (scored). How may tablets will the nurse instruct the patient to take daily? Please show actual calculation. Answer: 75 mcg 0.075mg/0.15mg = 0.5 tablets 39. A client with chronic obstructive pulmonary disease (COPD), who is on home oxygen at 2 liters per minute, presents to the local community health center. The client’s respiratory rate is 22 breaths per minute, and the client is complaining of dyspnea. The nurse would initially: a. Determine the need to increase the oxygen b. Collect additional information regarding the client’s respiratory status c. Call emergency services d. Reassure the client that there is no need to worry 40 The U.S. Department of Health and Human Services (USDHHS) is considered to be the federal agency most heavily involved in the health and welfare of U.S. citizens. Which of the following organizations are included in the organization of the USDHHS? Select all that apply. a. Councils on Aging (COA) b. Centers for Medicare & Medicaid Services (CMS) c. Food and Drug Administration (FDA) d. Centers for Disease Control and Prevention (CDC) _____________________________________________________________________________________ SHORT ANSWER Point Value: 10 Points Directions: In recognition of National Public Health Week in April 2017, the Agency for Healthcare Research and Quality (AHRQ) formally thanked the public health community for its contributions to quality and safety promotion, maintenance, and measurement. How are healthcare quality and patient safety defined and measured? What is nursing’s role with respect to healthcare quality and patient safety? Health care quality and patient safety are defined as “the degree to which health care services for individuals and populations increase the likelihood of desired health outcomes and are NU 340, SENIORS, Take-Home Exam ONE Page 8 of 10 consistent with current professional knowledge.”( The Institute of Medicine,2015) and patient safety is defined as ensuring that people are being taken care of to the best of provider’s ability and to further their quality of life not just a short term fix. These are measured by surveys and making sure diseases are at bay or being contained. Upon the 6 domains of health care quality they are being safe, effective, patient -centered, timely, efficient and equitable. The two most important out of these six domains, in my opinion are safe and the effectiveness of the treatment and health care method. By providing services that keep the patient and their best interest in mind regarding healthcare it assures the effectiveness and safety of the treatment plan. Nursing’s role with respect to healthcare quality and patient’s safety is to ensure that the patient is receiving the best care they could possibly be given and making sure there’s no harmful care being provided to the patient. Nursing plays an integrative part when involved in healthcare quality and patient safety because the nurses are the implementers of various medical rules and guidelines, such as medication passing to the sickest of the sick in order for the to get better. By following these guidelines and maneuvering in between what is safe for the patient and what is harmful nurses are able to find a happy medium in between the most curative care and keeping patients safety in mind. Please note: Proper spelling, grammar, and punctuation are expected. Your response must not exceed three well-developed paragraphs. Formatting errors (e.g., spelling, grammar, punctuation, response length, APA, etc.) will result in lost points. Be certain to consult the posted rubric for additional grading details. SHORT ANSWER Point Value: 10 Points Directions: Medicaid exists to cover the associated health care costs for low-income persons. Why then do low-income persons still have comparatively poorer health outcomes? NU 340, SENIORS, Take-Home Exam ONE Page 9 of 10 Medicaid’s purpose is to provide coverage for some low income families, but not all. There are various health checks and those who qualify are considered “medically needy” as according to M. .There may be some states that have various conditions that need to be met before qualifying such as exhausting all personal funds directed towards medical expenses. Over 68 million people are covered by Medicaid but there are still various lower income persons whom refuse to go to the doctor or to see a health care provider. Such as adults without children whom are ineligible for Medicaid unless their child is disabled. There are still a lot of people in the United Sates who are uninsured these limits on eligibility are one of the main reasons why 40 percent of near poor women and 50 percent of near poor men are uninsured. Along with various standards and disparities that must be met in order to qualify for Medicaid, there also have been cuts that effect the mentally ill. Many Mediciad cuts target counseling services for the mentally ill whom are often the most neglected and forgotten about. Medicaid is supposed to help the most disadvantaged people who don’t have the allocated resources and means to provide for themselves so this leaves many at a loss which is ethically violating and morally unjust. Overall, Medicaid is a very reasonable choice for those who meet the qualifications, but for those who are affected by the limited federal funding and limitations and qualifications it leaves the most medically needy high and dry when they need quality medical care now more than ever. Please note: Proper spelling, grammar, and punctuation are expected. Your response must not exceed three well-developed paragraphs. Formatting errors (e.g., spelling, grammar, punctuation, response length, APA, etc.) will result in lost points. Be certain to consult the posted rubric for additional grading details. NU 340, SENIORS, Take-Home Exam ONE Page 10 of 10