Chapter 1: Public Health and Nursing Practice Multiple Choice Identify the choice that best completes the statement or answers the question. 1. Public health nurses (PHNs) know they must approach a public health issue with an understanding of the related underlying risk factors to develop effective nursing interventions. They evaluate these risk factors from two perspectives: 1. Disease; individual 2. Intervention; government 3. Epidemic; population 4. Individual; population 2. A nursing student is studying public health. She learns that, according to C.E.A. Winslow’s definition, some of the goals of public health include disease prevention, promoting health, control of communicable infections, and . 1. Risk assessment for disease 2. Promotion of primary care 3. Organization of medical and nursing services for the early diagnosis and preventive treatment of disease 4. Governmental safety regulations 3. If the international medical community was working to contain several worldwide pandemics, they would look to the World Health Organization (WHO), which is: 1. The public health arm of the United Nations. 2. Working to improve health and well-being for the global population. 3. Working with nurses to promote public health interventions. 4. All of the above. 4. The Institute of Medicine (IOM), now known as the Health and Medicine Division (HMD) of the National Academies of Sciences, Engineering, and Medicine, stated in their report, The Future of the Public’s Health, that there are three core functions that society carries out to collectively support the optimum conditions for public health. Which one of the following is not one of these functions? 1. Prevention 2. Assessment 3. Policy development 4. Assurance 5. With aging, there is an increased prevalence of both noncommunicable (chronic) and communicable disease (NCD). The most pressing issue from a public health perspective based on this increase is: 1. An increased demand for long-term care 2. An increased need for further research 3. Further exploration of the developmental stages related to aging 4. Decreased cost of medications. 6. A PHN would like to use the Dahlgren-Whitehead model to help herself and other local practitioners understand health in populations. She understands that the Dahlgren-Whitehead ecological model assumes that: 1. There are multiple determinants of health, and thus multiple strategies are needed. 2. A population and environmental approach is essential. 3. Linkages and relationships are crucial.
4. All of the above. 7. The PHN completed a community assessment and found that the obesity rate in one of the neighborhoods was higher than the other neighborhoods in the county. She suspects that this is partially due to limited access to full-service grocery stores and a lack of dedicated safe venues for exercise. Assuming her conclusion is correct, what category or categories of determinants of health would these issues within the community fall into? 1. Upstream determinants of health 2. Downstream determinants of health 3. Behavioral determinants of health 4. Genetic determinants of health 8. Two PHNs working in a large urban community notice that community members are rarely engaged in the process of planning interventions aimed at addressing a particular increase in a specific disease in the community. For their next project, they include community collaboration as an essential component of the development, implementation, and evaluation of the program. When questioned by others, they report that there is evidence that community collaboration increases effectiveness and productivity, empowers the participants, strengthens social engagement, and . 1. Decreases disease rates 2. Ensures accountability 3. Increases the availability of treatment for the targeted disease 4. Improves screening rates 9. Which one of the following scenarios is not an example of community collaboration? 1. Local service groups working to organize disaster relief for tornado victims 2. A city council passing an ordinance to stop smoking in restaurants 3. An advocacy group working with the local churches to improve health care for the indigent with mental health disorders 4. A school working with the local health department to start a school clinic 10. Which layer of government is primarily responsible for issuing quarantines during a communicable disease outbreak? 1. Federal 2. State 3. Local 4. All of the above 11. As a PHN in a small local public health department, you understand that based on federal mandates your public health department routinely performs all but which of the following? 1. Surveillance of disease at the local level 2. Investigation of disease outbreaks 3. Licensing of local hospitals 4. Quarantine 12. The PHN recognizes that environmental science, epidemiology, biostatistics, biomedical sciences, and form the foundational subjects of public health. 1. Economics 2. The humanities 3. Social and behavioral sciences 4. Anthropology 13. As defined by the World Health Organization (WHO), an example of a health promotion intervention is whereas a risk reduction/health protection intervention is .
1. 2. 3. 4.
Conducting a health fair; funding a school exercise program Giving a free exercise class; conducting a flu vaccine outreach program Providing flu medication free to older adults; a diet class for teenagers Offering a tour of a hospital; a relaxation technique class
14. From a health promotion perspective, how could an occupational health nurse advise a company to encourage its employees to work towards good health? 1. Lower insurance premiums for employees who demonstrate good health habits 2. Have employee exercise classes or discounted health club memberships 3. Have incentives for healthy eating 4. All of the above 15. Diversity refers to all of but which of these concepts? 1. Race 2. Culture 3. Ethnicity 4. Environment Multiple Response Identify one or more choices that best complete the statement or answer the question. 16. Many of the emerging threats for public health are tied to increasing globalization. Which of the following reflect these globalization threats? (Select all that apply.) 1. Greater disparities between rich and poor 2. Greater need for newer technology 3. Greater distribution of tobacco and alcohol 4. Emergence or re-emergence of communicable diseases 5. Increased need for improved transportation 17. Several nurses who work in the emergency department of an urban hospital notice during the evening shift that a number of children in a certain ethnic population have all come in presenting with similar symptoms. The first step the nurses take to address the issue is which of the following? (Select all that apply.) 1. Increase antibiotic therapy availability 2. Identify characteristics of the disease 3. Group patients by diagnosis 4. Notify the public health department 5. Assess the environment of the patients 18. The six standards of practice for public health nursing include which of the following? (Select all that apply.) 1. Assessment 2. Population diagnosis and priorities 3. Outcomes identification 4. Planning 5. Mitigation 19. Which of the following activities of PHNs reflect the PHN Core Competencies? (Select all that apply.) 1. Develop policy for handling a local quarantine. 2. Understand dietary restrictions when planning a program for new immigrants. 3. Create a financial plan for implementing a community level health intervention. 4. Develop a treatment plan for persons with a specific communicable disease.
5. Analyze data to determine rates of disease in the community.
Chapter 1: Public Health and Nursing Practice Answer Section MULTIPLE CHOICE 1. ANS: 4 Objective: 5. Identify the key roles and responsibilities of public health nurses (PHNs). Page: Heading: Introduction to Public Health Integrated Processes: Nursing Process Client Need: Physiological Integrity Cognitive Level: Comprehension Concept: Critical Thinking, Promoting Health Difficulty: Easy Feedback 1 The approach cannot be disease based because diseases can affect populations in multiple locations, but the risk factors can be different. 2 Interventions occur after the public health event, and governments can only follow the evidence of public health studies. 3 An epidemic is an occurrence of a disease and has the same limitations as a disease-based approach. 4 PHNs assess risk for disease and other public health issues at both the individual level, so that they can intervene on a one-to-one situational basis, as well as at the population level to identify risk factors beyond the individual level and implement population-level interventions. PTS: 1 REF: 2 CON: Promoting Health | Critical Thinking 2. ANS: 3 Objective: 2. Describe public health in terms of current frameworks, community partnerships, and the concept of population health. Page: Heading: Public Health Science and Practice Integrated Processes: Nursing Process Client Needs: Health Promotion and Maintenance Cognitive Level: Knowledge Concept: Infection; Nursing Roles; Promoting Health Difficulty: Easy Feedback 1 Risk assessment is considered a part of disease prevention. 2 Promotion of primary care occurred through the Alma Ata World Health Organization conference not Winslow’s definition. 3 Health-care providers are an essential component of public health. 4 The goal of public health is to guide governmental policy but not to create regulations. PTS: 1 REF: 3 CON: Infection | Nursing Roles | Promoting Health 3. ANS: 4 Objective: 2. Describe public health in terms of current frameworks, community partnerships, and the concept of population health. Page:
Heading: Introduction to Public Health Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Application [Applying] Difficulty: Easy Concept: Promoting Health; Health-Care System; Management; Safety Difficulty: Easy Feedback 1 The World Health Organization (WHO) is the “directing and coordinating authority for health within the United Nations system”. 2 The WHO has the capability to monitor global epidemiological situations. 3 The WHO brings resources and knowledge to nurses who are working directly with patients for them to make informed decisions. 4 The WHO is the public health arm of the United Nations and works toward both of the previously mentioned goals. PTS: 1 REF: 15-17 CON: Promoting Health | Health-Care System | Management | Safety 4. ANS: 1 Objective: 4. Explore the connection between environment, resource availability, and health. Page: Heading: Public Health Science and Practice Integrated Processes: N/A Client Need: Health Promotion and Maintenance Cognitive Level: Knowledge Concept: Assessment; Promoting Health Difficulty: Easy Feedback 1 Prevention is not considered a core function of public health, as assessment, policy development, and assurance have prevention as an implied goal of each function. 2 Assessment focuses on analysis and collection of data, as well as the monitoring of health problems and needs. 3 Policy development uses the acquired knowledge from assessments to create useful public health policies. 4 Assurance creates trust in health-care agencies to provide necessary services that are in line with public health goals. PTS: 1 REF: 3 CON: Assessment | Promoting Health 5. ANS: 1 Objective: 2. Describe public health in terms of current frameworks, community partnerships, and the concept of population health. Page: Heading: Introduction to Public Health > Public Health Frameworks: Challenges and Trends Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Management of Care Cognitive Level: Analysis Concept: Immunity; Infection; Promoting Health Difficulty: Easy Feedback
1
2 3 4
As the percent of the population over the age of 65 increases, so does the prevalence of chronic disease and the need for long-term care. From a population public health perspective, decreased availability of care will result in increased morbidity and mortality, and decreased quality of life. An increased need for further research is important but is not the most pressing issue. Further exploration of developmental stages related to aging might help in understanding response to disease but is not the most pressing issue. Decreased cost of medications will assist in access to treatment but is only one aspect of long-term care needs.
PTS: 1 REF: 4 CON: Immunity | Infection | Promoting Health 6. ANS: 4 Objective: 4. Explore the connection between environment, resource availability, and health. Page: Heading: Introduction to Public Health > Public Health Frameworks: Challenges and Trends Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Management of Care Cognitive Level: Analysis [Analyzing] Concept: Evidence-Based Practice; Promoting Health Difficulty: Moderate Feedback 1 Location and social systems are two of many determinants in the ecology of a public health problem. 2 This model asserts that the environment of the affected population is a key component in assessing risk factors. 3 Social systems, families, and communities play a role in the health or lack of health for an individual or a population. 4 The Dahlgren-Whitehead model is key to understanding the layers of influence and relationships regarding population health and how important environment is to said health. Thus, all of the answer choices together are correct. PTS: 1 REF: 5 CON: Evidence-Based Practice | Promoting Health 7. ANS: 1 Objective: 3. Investigate determinants of health within the context of culture. Page: Heading: Introduction to Public Health > Public Health Frameworks: Challenges and Trends Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Analysis Concept: Promoting Health; Economics Difficulty: Moderate Feedback 1 Upstream refers to determinants of health that include the physical as well as conditions in the social environment creating poor health, 2 Downstream refers to the biological and behavioral bases for disease. 3 Genetic determinants of health occur at the individual biological level. 4 Behavioral determinants of health occur at the individual level. PTS: 1
REF: 6
CON: Promoting Health | Economics
8. ANS: 2 Objective: 4. Explore the connection between environment, resource availability, and health. Page: Heading: Introduction to Public Health > Public Health Frameworks: Challenges and Trends Integrated Processes: Teaching/Learning Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Nursing Roles; Communication; Collaboration Difficulty: Easy Feedback 1 Although decreased disease rate is a definite sign that the health population is improving, community collaboration is a vehicle that brings participants together to address health issues such as rates of disease. Community collaboration efforts are a good way to achieve this. 2 Accountability among members of a community is improved when communities are actively engaged in health programs. 3 Availability of treatment may not be an identified risk factor for the increase in the rate. 4 Improving screening rates may not be an identified risk factor for the increase in the disease rate. PTS: 1 REF: 6 CON: Nursing Roles | Communication | Collaboration 9. ANS: 2 Objective: 2. Describe public health in terms of current frameworks, community partnerships, and the concept of population health. Page: Heading: Introduction to Public Health > Public Health Frameworks: Challenges and Trends Integrated Processes: Nursing Process Client Need: Communication and Documentation Cognitive Level: Application [Applying] Concept: Promoting Health; Collaboration Difficulty: Easy Feedback 1 This collaboration benefits the community’s public health after a natural disaster. 2 Community collaboration can include advocating for change in regulations but does not involve direct legislative activity that is the responsibility of governmental bodies. 3 A volunteer group can offer valuable services to enhance the lives of people suffering from mental illness. 4 This community-based institution is an example of a social system that can work with a health department to use each other’s strengths to produce a meaningful project. PTS: 1 REF: 6 CON: Promoting Health | Collaboration 10. ANS: 3 Objective: 6. Identify the formal organization of public health services from a global to local level. Page: Heading: Introduction to Public Health > Public Health Organization and Management Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Analysis Concept: Health-Care System, Regulation, Infection Difficulty: Easy
1
2 3 4
Feedback The Constitution did not provide for a national public health agency but rather assigned that duty to the states. Although the Centers for Disease Control and Prevention (CDC) provides ongoing research, sets guidelines, and offers support, quarantines are usually the responsibility of local health departments. State constitutions empower the states to establish state boards of health. Their duty is to protect the citizens, but quarantines are mostly managed at the local level. Quarantines are managed at the local level with assistance from the state if needed. All levels of government are not needed or agile enough to handle local health crises.
PTS: 1 REF: 17 CON: Health-Care System | Regulations | Infection 11. ANS: 3 Objective: 6. Identify the formal organization of public health services from a global to local level. Page: Heading: Introduction to Public Health > Public Health Organization and Management Integrated Processes: Communication and Documentation Client Need: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Application [Applying] Concept: Health-Care System, Regulations Difficulty: Easy Feedback 1 Local public health departments protect the health of the citizens that live in their county, municipality, or township. In conjunction with the state public health department and the Centers for Disease Control and Prevention, they conduct routine surveillance to help identify an increase in disease. 2 Once there is a disease outbreak, local health departments participate in the outbreak investigation in coordination with the state public health department and the Centers for Disease Control and Prevention. 3 Hospitals are licensed by state and federal agencies, not local health departments. 4 Local public health department in coordination with the state public health department and the Centers for Disease Control and Prevention implement and monitor quarantine efforts in the event of communicable disease outbreak that warrants isolation of those with the disease. PTS: 1 REF: 19 CON: Regulations | Health-Care System 12. ANS: 3 Objective: 1. Identify how public health plays a central role in the practice of nursing across settings and specialties. Page: Heading: Public Health as a Component of Nursing Practice Across Settings and Specialties > Health From a Population Perspective Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Knowledge Concept: Evidence-Based Practice; Promoting Health Difficulty: Moderate Feedback 1 Although economics could be a useful tool to assess the impact of a health program, it is not considered one of the foundational subjects of public health.
2 3 4
The humanities are not considered one of the foundational subjects of public health. Many branches of social and behavioral sciences are useful for analysis of public health issues. The study of man and his development is not considered one of the foundational subjects of public health.
PTS: 1 REF: 2 CON: Evidence-Based Practice | Promoting Health 13. ANS: 2 Objective: 2. Describe public health in terms of current frameworks, community partnerships, and the concept of population health. Page: Heading: Health Promotion, Risk Reduction, and Health Protection Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Promoting Health Difficulty: Easy Feedback 1 Both of these options are health promotions because they create opportunities to improve health through individual behavior change. 2 A health promotion intervention, such as an exercise class, creates an opportunity to improve health through individual behavioral change, whereas a risk reduction program, such as administering vaccinations, involves actions taken to reduce a person’s risk for disease. 3 Free medication for the flu is a treatment program that occurs when disease is present and not related to either health promotion or protection, and a diet class is a health promotion program aimed at individual behavior change. 4 The hospital tour is educational but not related to health promotion or protection, and the relaxation techniques class is health promotion exercise aimed at individual behavior change. PTS: 1 REF: 7 CON: Promoting Health 14. ANS: 4 Objective: 4. Explore the connection between environment, resource availability, and health. Page: Heading: Health Promotion, Risk Reduction, and Health Protection Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Promoting Health; Nursing Roles Difficulty: Moderate Feedback 1 Financial benefits or savings would promote behavioral change. 2 Health club memberships would facilitate the employees’ ability for change. 3 Encouraging a good diet through incentives would promote healthy behavior. 4 All of the options previously listed promote good health and reduce the risk for illness. PTS: 1 15. ANS: 4
REF: 15
CON: Promoting Health | Nursing Roles
Objective: 3. Investigate determinants of health within the context of culture. Page: Heading: Health Promotion, Risk Reduction, and Health Protection > The Context of Health Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Knowledge Concept: Diversity; Promoting Health Difficulty: Moderate Feedback 1 Race continues to be used to identify groups and as a marker for diversity. 2 Culture refers to beliefs, values, and norms shared across a group of people and reflects diverse world views. 3 Ethnicity reflects diversity in that specific groups differ based on geographic origin, language and dialect, religious faith, folklore, and food preferences. 4 Environment is an important factor in understanding the context of health but is separate from the concept of diversity. PTS: 1
REF: 7
CON: Diversity | Promoting Health
MULTIPLE RESPONSE 16. ANS: 1, 3, 4 Objective: 1. Identify how public health plays a central role in the practice of nursing across settings and specialties. Page: Heading: Introduction to Public Health > Public Health Frameworks: Challenges and Trends Integrated Processes: N/A Client Need: Health Promotion and Maintenance Cognitive Level: Comprehension [Understanding] Concept: Addiction; Promoting Health; Economics; Infection Difficulty: Easy
1 2 3 4
5
Feedback Globalization has resulted in widening of disparity between low-income and high-income countries especially in relation to food security and environmental degradation. In public health, better strategies for managing health care and current resources are needed more than newer technology. The widespread availability of tobacco and alcohol increases the abuse of these substances and the problems that accompany it. Some of the diseases that have emerged or re-emerged as a result of globalization are HIV, AIDS, severe acute respiratory syndrome, hepatitis, malaria, diphtheria, cholera, Ebola, and Zika virus. There is a need for planning for these possible pandemics using limited resources. Although improved transportation has resulted in increased globalization, further improvements are not a public health threat.
PTS: 1 REF: 4 CON: Addiction | Promoting Health | Economics | Infection 17. ANS: 2, 3, 4, 5 Objective: 4. Explore the connection between environment, resource availability, and health. Page:
Heading: Health Promotion, Risk Reduction, and Health Protection > Population-Focused Care Across Settings and Nursing Specialties Integrated Processes: Nursing Process Client Need: Physiological Integrity Cognitive Level: Synthesis Concept: Assessment; Critical Thinking Difficulty: Easy
1 2 3 4 5
Feedback Antibiotics may not be a necessary route of treatment for the diagnosis. The first step is to note and compare symptoms, onset, and other information to ascertain whether this is the same illness and if it is potentially due to a common cause. Grouping the patients according to diagnosis will allow the health-care team to give better care and help create a care map but would not be the first step. Once the data on symptoms, onset, and other key information has been gathered, the next step is to inform the public health department if warranted. Evaluating the environment of the patients may create an understanding of why the illness occurred and prevent a re-occurrence of the illness and would occur as part of the public health department’s outbreak investigation, if one is warranted.
PTS: 1 REF: 9 | 10 CON: Infection | Assessment 18. ANS: 1, 2, 3, 4 Objective: 5. Identify the key roles and responsibilities of public health nurses (PHNs). Page: Heading: Public Health Nursing as a Specialty > Public Health Nursing Scope and Standards of Practice Integrated Processes: N/A Client Need: N/A Cognitive Level: Knowledge Concept: Regulations; Nursing Roles Difficulty: Easy
1 2 3 4 5
Feedback The PHN collects comprehensive data pertinent to the health status of populations. The PHN analyzes the assessment data to determine the diagnoses or issues. The PHN identifies expected outcomes for a plan specific to the population or situation. The PHN develops a plan that prescribes strategies and alternatives to attain expected outcomes. Mitigation is a part of emergency preparedness and disaster management
PTS: 1 REF: 13 CON: Regulations | Nursing Roles 19. ANS: 1, 2, 3, 5 Objective: 5. Identify the key roles and responsibilities of public health nurses (PHNs). Page: Heading: Public Health Nursing as a Specialty > Public Health Nursing Scope and Standards of Practice Integrated Processes: N/A Client Need: N/A Cognitive Level: Application [Applying] Concept: Infection; Nutrition; Diversity; Nursing Roles Difficulty: Easy
1 2 3 4 5
Feedback Policy development/program planning is an essential skill for a PHN. To reach a population that might not receive adequate health care, cultural competency and communication skills are needed to overcome any barriers. Financial and management skills are needed to maintain the sustainability of programs. Development of individual treatment plans is part of the basic skills of all nurses and does not reflect a specific PHN competency. One of the new challenges PHNs face is preparing the public for sudden, catastrophic health events, such as bioterrorism.
PTS: 1
REF: 15
CON: Infection | Nutrition | Diversity | Nursing Roles
Chapter 2: Optimizing Population Health Multiple Choice Identify the choice that best completes the statement or answers the question. 1. In 2011, the National Prevention Strategy released a plan to increase the number of Americans who are healthy at every stage of life. Which of the following is not one of the strategic directions included in the strategy? 1. Eliminating health disparities 2. Building healthy and safe community efforts 3. Increasing access to care 4. Empowering people to make healthy choices 2. PHNs in a county with an increase in measles during the 2018-2019 outbreak used the natural history of disease framework to develop a primary prevention program aimed at preventing measles. Their first step was to: 1. Conduct an outreach to all parents to have their children vaccinated. 2. Educate health-care providers on the signs and symptoms of disease. 3. Start a screening program to identify persons who may have measles. 4. Provide an educational program for parents whose children have measles on the importance of keeping them home from school and away from public places. 3. Based on recent studies on risk for disease, the nurse working in a primary care clinic in a poorer urban community decides to develop an educational program on the importance of including whole grains, fruits and vegetables in her patient’s diets. To help guide the development of her program she first reviews the availability of fresh fruits and vegetables in the community. Her decision to gather information on these factors best reflects the ? 1. Ecological determinants of health 2. Social determinants of health 3. Individual behavioral determinants of health 4. Genetic determinants of health 4. The school nurse in a school district in southwestern Texas is working with the school cafeteria to revise their healthy choices menus for the school year. They have used as their guide the 2012 national law that calls for school lunch programs to have larger portions of fruits and vegetables, less sodium, and no trans fats. To help increase the success of the program, the nurse conducted a survey of parents to learn more about the cultural aspects of food choices related to fruits and vegetables. Providing a culturally appropriate menu that meets federal guidelines for the school children represents: 1. An upstream approach 2. A tertiary prevention approach 3. A socioecological approach 4. A and C 5. A PHN notices the rising incidence of H1N1 (swine flu) in a geographic area. The nurse considers possible interventions, knowing that the preclinical phase of H1N1 lasts: 1. 1 to 2 days 2. 2 to 4 days 3. 3 to 4 days 4. 5 to 7 days
6. In the traditional public health prevention framework, the level of prevention that includes early detection and initiation of treatment for disease, or screening, is referred to as the: 1. Clinical level 2. Primary level 3. Tertiary level 4. Secondary level 7. Attributable risk is the proportion of cases or injuries that would be eliminated if a risk factor did not occur, but preventable fraction is: 1. The number of cases that actually occur in a given population at a specific point in time. 2. What could be achieved with a program implemented in a community setting within the at-risk population when community members actually participate in the program. 3. The number of cases that require intervention in a community setting within the at-risk population. 4. An estimation of the number of cases with the high-risk factor(s) among the at-risk population when community members actually participate in the program. 8. Population attributable risk (PAR) is based on the assumption that the risk factor is removed from the entire population being targeted. It also can be used to calculate the cost benefit and the of a prevention program. 1. Cost effectiveness 2. Necessity 3. Population ecology 4. Percent of repeat participants 9. The PHNs within the public health department experiencing a measles outbreak decide to do Public Service Announcements (PSAs) on TV aimed at improving vaccination rates among the population, and letting parents know they can come to the PHD clinic to have their children vaccinated. The county their department serves has a large population of Mexican American families, so they work together with the Mexican American community to make sure the PSAs are culturally relevant. Which learning theory best matches their approach? 1. Constructivism 2. Cognitivist 3. Bandura’s theory of social learning 4. Behaviorism 10. A patient diagnosed with diabetes buys books, reads articles, talks with knowledgeable people, informs himself about what he can do to improve his health, and takes action. The nurse recognizes that this method of adult learning is best described as: 1. Pedagogy 2. Andragogy 3. Constructivism 4. Humanism 11. A nurse working in a busy primary care clinic wonders why Mr. Smith, a 65-year old insulin dependent man recently diagnosed with type 2 diabetes, keeps coming back with elevated A1Cs. The nurse knows that he has given Mr. Smith the literature on how to manage type 2 diabetes and, as time allowed, reviewed it with him. He doesn’t understand why Mr. Smith is still struggling with managing his disease. What should he check first before providing Mr. Smith with more information? 1. His level of health literacy 2. Whether or not he can afford his medication 3. His eating habits
4. His routine for checking his A1C 12. Two nurses working in a head, nose, and throat oncology unit noticed that many of their patients not only smoked but used alcohol. They had been to a recent conference and learned about evidence-based screening tools for alcohol use that were different from the tool they were currently using. They approached the director of the unit and suggested that they use the newer screening tools. Screening for alcohol use is primarily done: 1. Only with persons whose clinical presentation appears to indicate heavy alcohol use. 2. Only to detect those who are currently using alcohol to avoid an interaction with treatment modalities. 3. Only to detect those who may have an alcohol use disorder 4. To detect those at risk for disease or injury who do not yet meet the criteria for having an alcohol use disorder as well as those who may have an alcohol use disorder. 13. A clinical group of nursing students was assigned, during their public health rotation, to the local public health department (LPHD). The LPHD was just beginning to start a “Breast is Best” campaign in the community. The students were asked to come up with ideas for the campaign. The LPHD had found that the lowest breastfeeding rates were in one of the ethnic communities. The students agreed to conduct a preliminary outreach program with pregnant women coming to the LPHD’s prenatal clinic that had the highest number of women in that ethnic group. This is an example of what level of intervention using the Substance Abuse and Mental Health Services Administration (SAMSHA) framework? 1. Universal 2. Indicated 3. Primary 4. Selected Completion Complete each statement. 14. If the total number of cases of a disease is 100, and the total number of persons in a population is 1,000, what would the prevalence be? Record answer as a decimal. 15. In a hypertensive study, nurses took the blood pressure readings of 250 participants. To determine the accuracy of their readings, they wanted to test the sensitivity of their instruments. If the number of true positives is 40, and the total number of participants with disease (true positives plus false negatives) is 55, the sensitivity of the instrument is . Record answer with one decimal place. Multiple Response Identify one or more choices that best complete the statement or answer the question. 16. A nurse working in the emergency department (ED) has noticed over the past year the increasing number of young patients being treated for conditions that could be handled in primary care. She overhears a colleague wondering why their parents don’t just go to the clinic. To help better understand the issue, the nurse tells her colleague that perhaps they should be looking at other determinants of health besides the parents’ behavior. She explains that the four broad levels of determinants of health included in the social ecological model would be a good start to help determine what factors might be driving the increased use of the ED for non-emergent pediatric care. Which of the following determinants of health are included in the model? (Select all that apply.) 1. Communication 2. Relationship 3. Policy
4. Genetics 5. Societal 17. When screening for, monitoring, and diagnosing disease, a health-care provider always evaluates a measurement tool for which of the following attributes? (Select all that apply.) 1. Reliability 2. Validity 3. Functionality 4. Sensitivity 5. Specificity 18. To assess the prevalence of a disease in a population, a public health nurse (PHN) can use the prevalence pot to help better understand the occurrence of disease in her or his community. The prevalence pot: (Select all that apply.) 1. Depicts the total number of current cases in the population. 2. Takes into account duration and incidence of the disease. 3. Includes assessing the total number of cases of a disease taking into account all of the stages of the disease. 4. Is a method of calculating the potential number of new cases in a population. 5. Determines the amount of primary medications used to treat diseases in a certain population. 19. Based on the Social-Ecological model of health, which of the following are components of health? (Select all that apply.) 1. Physical environments 2. Social environments 3. Social relations 4. Political systems 5. Health-care systems
Chapter 2: Optimizing Population Health Answer Section MULTIPLE CHOICE 1. ANS: 3 Objective: 2. Describe current public health frameworks that guide prevention efforts from a local to a global perspective. Page: Heading: Introduction Integrated Processes: Nursing Process Client Needs: Health Promotion and Maintenance Concept: Promoting Health, Legal Cognitive Level: Knowledge Difficulty: Easy
1 2 3 4
Feedback Eliminating health disparities is one of the four fundamental strategies. Building healthy and safe community efforts is one of the four fundamental strategies. Although the National Prevention Strategy was authorized by the Affordable Care Act, the focus is to promote health and not increase access to care. Empowering people to make healthy choices is one of the four fundamental strategies.
PTS: 1 REF: 25 CON: Promoting Health | Legal 2. ANS: 1 Objective: 2. Describe current public health frameworks that guide prevention efforts from a local to a global perspective. Page: Heading: Prevention Frameworks > Natural History of Disease Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Concept: Promoting Health | Health-Care System Cognitive Level: Analysis Difficulty: Moderate Feedback 1 Using the natural history of disease, the best approach for the primary prevention of measles is to vaccinate the population and would be the first step. 2 Educating health-care providers to recognize the disease might help identify patients earlier and would occur during the clinical phase of the natural history of disease. It might also help reduce other’s exposure to the virus if parents were instructed to keep their children out of school and public places but would not be the first step in a primary prevention program. 3 Screening occurs during the subclinical phase of the natural history of disease to detect the disease and would not be the first step. 4 Educating parents on the importance of keeping their children who have the measles out of school and public places could result in reduced transmission of the measles virus but would not be the first step. PTS: 1
REF: 28-30
CON: Promoting Health | Health-Care System
3. ANS: 2 Objective: 2. Describe current public health frameworks that guide prevention efforts from a local to a global perspective. Page: Heading: Population Health Promotion, Health Protection, and Risk Reduction > Health Promotion Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Concept: Nutrition | Promoting Health | Assessment Cognitive Level: Application [Applying] Difficulty: Moderate Feedback 1 Ecological determinants of health include “…potable water and sanitation, affordable and clean energy, climate action, life below water, and life on land”. Resource availability is considered a social determinant of health. 2 Social determinants of health, according to the WHO “…are the conditions in which people are born, grow, live, work and age. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels”. 3 Behavioral determinants of health are at the individual level. 4 Genetic determinants of health are at the individual level. PTS: 1 REF: 26 CON: Nutrition | Promoting Health | Nursing Roles 4. ANS: 4 Objective: 2. Describe current public health frameworks that guide prevention efforts from a local to a global perspective. Page: Heading: Population Health Promotion, Health Protection, and Risk Reduction > Health Promotion Integrated Processes: Nursing Process, Culture and Spirituality Client Need: Health Promotion and Maintenance Concepts: Nutrition | Promoting Health | Legal Cognitive Level: Application [Applying] Difficulty: Easy
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Feedback A healthy school menu is an example of an upstream approach and addresses the role healthy nutrition plays in improving health and preventing disease. Addressing the upstream issue of adequate nutrition to improve health is a primary prevention approach, not tertiary. A socioecological approach takes into account the role of culture on health. Combining culturally relevant food choices and a healthy choices menu in a school setting is an example of using an upstream approach within the context of socioecological model.
PTS: 1 REF: 26 CON: Nutrition | Promoting Health | Legal 5. ANS: 1 Objective: 3. Apply public health prevention frameworks to specific diseases. Page: Heading: Prevention Frameworks > Natural History of Disease Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Safety and Infection Control Concepts: Infection | Critical Thinking
Cognitive Level: Application [Applying] Difficulty: Difficult Feedback 1 The preclinical phase of H1N1 lasts 1 to 2 days, and people who are infected can infect others on the first day. Symptoms develop rapidly, and intervention cannot prevent progression to the clinical phase. 2 This is past the preclinical phase of H1N1. The preclinical phase lasts only 1 to 2 days. 3 This is past the preclinical phase of H1N1. The preclinical phase lasts only 1 to 2 days. 4 This is past the preclinical phase of H1N1. The preclinical phase lasts only 1 to 2 days. PTS: 1 REF: 29 CON: Infection | Critical Thinking 6. ANS: 4 Objective: 2. Describe current public health frameworks that guide prevention efforts from a local to a global perspective. Page: Heading: Prevention Frameworks > Public Health Prevention Frameworks Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Concepts: Promoting Health Cognitive Level: Knowledge Difficulty: Easy Feedback 1 The clinical level is not a level of prevention in the traditional public health framework. 2 The primary level of prevention includes interventions aimed at preventing disease in those who currently do not have the disease. 3 The tertiary level includes prevention of disability and premature death in those who are already diagnosed with the disease. 4 The secondary level includes screening to help detect disease among persons who are apparently well during the preclinical phase of the disease. PTS: 1 REF: 30 CON: Promoting Health 7. ANS: 2 Objective: 4. Compare and contrast different levels of health promotion, protection, and risk reduction interventions. Page: Heading: Prevention Frameworks > Public Health Prevention Frameworks Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Concept: Evidence-Based Practice, Promoting Health Cognitive Level: Comprehension Difficulty: Moderate Feedback 1 Preventable fraction is not the number of cases that actually occur. 2 Preventable fraction includes the portion of the population at risk that actually participates in a program and the number of cases prevented. 3 The preventable fraction includes the number of cases that have been prevented from happening, not the cases that now require intervention. 4 The estimated number of cases with high-risk factors is included in attributable risk.
PTS: 1 REF: 34 CON: Evidence-Based Practice | Promoting Health 8. ANS: 1 Objective: 4. Compare and contrast different levels of health promotion, protection, and risk reduction interventions. Page: Heading: Prevention Frameworks > Public Health Prevention Frameworks Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Concept: Evidence-Based Practice, Promoting Health; Economics Cognitive Level: Knowledge Difficulty: Moderate Feedback 1 PAR can be used as a measurement of the cost benefit and cost effectiveness of a prevention program, which is based on the strength of the risk factor and the prevalence of the risk factor in a population. 2 PAR can be used to estimate the cost effectiveness of a prevention program. The estimation of the cost effectiveness of a program is a separate issue from whether a program is necessary or not. 3 PAR can be used to estimate the cost effectiveness of a prevention program. There is no measurement of the population ecology, only of the strength and prevalence of the risk factor. 4 PAR can be used to estimate the cost effectiveness of a prevention program. The percent of repeat participants is not a measure of the cost effectiveness of the program when the risk factor has been removed from the targeted population. PTS: 1 REF: 34 CON: Promoting Health | Economics | Evidence-Based Practice 9. ANS: 3 Objective: 5. Identify health education strategies and chronic disease self-management within the context of prevention frameworks. Page: Heading: A Primary Prevention Approach: Health Education > Theories of Education Integrated Processes: Teaching/Learning Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Difficulty: Moderate Feedback 1 Constructivism is a learning theory that includes reflecting on our own experiences and knowledge. 2 Cognitivist focuses on inner mental activity and knowledge that has changed thought patterns through rationally responding to an external stimulus. 3 Bandura’s theory of learning specifically connects understanding, behavior, and environment, and is the best match to their approach using PSAs. The use of PSAs is a good example of this theory because they portray an action and the audience, seeing it as desirable, is encouraged to model or imitate that behavior. 4 Behaviorism includes the theory of classical conditioning, which emphasizes that change comes with an environmental stimulus resulting in a response. Learning is based on reward and punishment by conditioning. PTS: 1 REF: 37 CON: Evidence-Based Practice | Promoting Health | Nursing Roles
10. ANS: 4 Objective: 5. Identify health education strategies and chronic disease self-management within the context of prevention frameworks. Page: Heading: A Primary Prevention Approach: Health Education > Theories of Education Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Difficulty: Easy Feedback 1 Pedagogy is the correct use of teaching strategies to provide the best learning. 2 Andragogy is the art and science of helping adults learn. 3 Constructivism is a learning theory that includes reflecting on our own experiences and knowledge. 4 Humanism is defined as self-directed learning through examining personal motivation and goals. It also includes the development of personal actions to fulfill one’s personal motivation and goals. PTS: 1 REF: 37 CON: Evidence-Based Practice | Promoting Health 11. ANS: 1 Objective: 5. Identify health education strategies and chronic disease self-management within the context of prevention frameworks. Page: Heading: A Primary Prevention Approach: Health Education > Health Literacy Integrated Processes: Teaching/Learning Client Need: Physiological Integrity; Reduction of Risk Potential Cognitive Level: Application [Applying] Difficulty: Moderate Feedback 1 Because health literacy is defined as “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions”, the first step before providing Mr. Smith with more information is to check his level of health literacy. 2 Lack of ability to pay for insulin is a real problem and should be included in the nurse’s assessment of Mr. Smith. However, establishing his level of health literacy is the first step because he might not fully understand the need for self-managing his disease with medication. 3 Establishing Mr. Smith’s level of health literacy is the first step because he might not fully understand the need for self-managing his disease with diet. 4 Establishing Mr. Smith’s level of health literacy is the first step because he might not fully understand the need for self-managing his disease through routine monitoring of his A1C. PTS: 1 REF: 38 CON: Promoting Health | Nursing Roles | Evidence-Based Practice 12. ANS: 4 Objective: 6. Describe components of screening from a population and individual perspective. Page: Heading: A Secondary Prevention Approach: Screening and Early Identification Integrated Processes: Nursing Process