Chapter 28: Nursing Practice at the Local, State, and National Levels in Public Health My Nursing Test Banks

Chapter 28: Nursing Practice at the Local, State, and National Levels in Public Health

Test Bank

MULTIPLE CHOICE

1. Which of the following is the underlying science or area of study on which public health is based?

a.

Biostatistics

b.

Epidemiology

c.

Medicine

d.

Social sciences

ANS: B

Public health uses biostatistics in its practice. It is not a branch of medicine; it is an organized community approach designed to prevent disease, promote health, and protect populations. It works across many disciplines and is based on the scientific core of epidemiology.

DIF: Cognitive Level: Remember (Knowledge) REF: p. 524

2. A nurse is employed at the state department of public health. Which of the following is a fundamental principle guiding his practice?

a.

Decisions are made at the federal level, disseminated at the state level, and carried out at the community level.

b.

Health of populations is only as good as the health of individuals that live and work in the community.

c.

Oversight of community health departments is the most important function.

d.

The interaction of the local-state-federal partnership is critical to success.

ANS: D

In the United States, the local-state-federal partnership includes federal agencies, the state and territorial public health agencies, and the local public health agencies. Their effective interaction is critical to the effective use of both financial and personnel resources to address the health of populations. Nurses working in all of these agencies work together to identify, develop, and implement interventions that will improve and maintain the nations health.

DIF: Cognitive Level: Apply (Application) REF: p. 524

3. The public health administrator is in the process of hiring a new public health nurse. Which of the following statements made by an applicant would most likely result in the applicant not being hired?

a.

I like to be the only person working on a project because individuals in teams have their own ideas and plans and the resulting debate slows progress.

b.

I prefer to work in teams because no single person has too much responsibility because the burden is shared.

c.

Teamwork is better than work done by individuals because teamwork incorporates different perspectives.

d.

Whether teamwork is better than work done by individuals depends on the nature of the work being performed.

ANS: A

Working in collaborative partnerships is an essential role of public health nursing. Partnerships and collaboration among groups are much more powerful in making change than the individual client and nurse working alone. Part of the reason is that multiple perspectives are examined in the process of coming to the best solution.

DIF: Cognitive Level: Apply (Application) REF: p. 524

4. Which of the following federal agencies is most influential in public health activities?

a.

The Agency for Healthcare, Research, and Quality

b.

Centers for Disease Control and Prevention

c.

Department of Health and Human Services

d.

Food and Drug Administration

ANS: C

The U.S. Department of Health and Human Services (USDHHS) and the Environmental Protection Agency (EPA) are the federal agencies that most influence public health activities at the state and local levels. The Agency for Healthcare, Research, and Quality, the Centers for Disease Control and Prevention, and the Food and Drug Administration are all pieces of the broader USDHHS.

DIF: Cognitive Level: Remember (Knowledge) REF: p. 524

5. Which of the following agencies are responsible for implementing and enforcing local, state, and federal public health codes and ordinances and providing essential public health programs to a community?

a.

Community health clinics

b.

Federal health agencies

c.

Local health agencies

d.

State health agencies

ANS: C

Local public health agencies are the agencies responsible for implementing and enforcing local, state, and federal public health codes and ordinances and providing essential public health programs to a community.

DIF: Cognitive Level: Understand (Comprehension) REF: pp. 524-525

6. A nurse at a migrant clinic assists clients with completing the application process to receive supplemental food assistance. Which of the following roles of the nurse is being used?

a.

Advocate

b.

Case manager

c.

Outreach worker

d.

Primary caregiver

ANS: A

As an advocate, the nurse collects, monitors, and analyzes data and discusses with the client which services are needed and whether the client is an individual, a family, or a group.

DIF: Cognitive Level: Apply (Application) REF: p. 530

7. Which of the following best describes the primary reason life spans have notably lengthened over the past 100 years?

a.

Advances in hospital care and procedures

b.

Advances in medicine and medical research

c.

Advances in nursing practice

d.

Advances in public health

ANS: D

A person born today can expect to live 30 years longer than someone born in 1900. Medical care accounts for 5 years of that increase, but public health is responsible for the additional 25 years, through prevention efforts brought about by changes in social policies, community actions, and individual and group behavior changes.

DIF: Cognitive Level: Understand (Comprehension) REF: p. 525

8. Which of the following best describes how public health nurses (PHNs) differed from other health care professions in the early twentieth century?

a.

PHNs contributed without receiving any salary for doing so.

b.

PHNs created new settings where health care could be given.

c.

PHNs gave care to powerless groups.

d.

PHNs worked outside any organized health care system.

ANS: C

During this period, public health nurses worked with populations and in settings that were not of interest to other health care disciplines or groups. Much public health service was delivered to the poor and to women and children, who did not have political power or voice.

DIF: Cognitive Level: Understand (Comprehension) REF: p. 525

9. Which of the following best describes 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 clients 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 2020objectives for community health improvement

ANS: A

Nursing practice in community health is the synthesis of nursing theory and public health theory applied to promoting, preserving, and maintaining the health of populations through the delivery of personal health care services to individuals, families, and groups. The focus of practice is health of individuals, families, and groups. Care is provided within the context of preventing disease and disability and promoting and protecting the health of the community as a whole.

DIF: Cognitive Level: Understand (Comprehension) REF: p. 526

10. A community health nurse is trying to decrease the incidence of emerging infections caused by drug-resistant 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 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.

ANS: D

The widespread, often inappropriate, use of antimicrobial drugs has resulted in loss of effectiveness for some infections. Clients and health care providers are responsible for the inappropriate use of antibiotics. The nurse can influence this trend by objecting to inappropriate use of antibiotics by providers and by educating individuals, families, health care providers, and the community about the dangers of misuse and overuse of antibiotics.

DIF: Cognitive Level: Apply (Application) REF: p. 528

11. A nurse is considering applying for a public health nurse position at a local health department. Which of the following minimum levels of educational preparation should the nurse have obtained?

a.

Associate degree in nursing

b.

Baccalaureate degree in nursing

c.

Master of science degree in nursing

d.

Training as a licensed practical nurse

ANS: B

Educational preparation of nurses in community health should be at least a baccalaureate degree. Those registered nurses who have associate degrees are encouraged to seek further degrees because of the increasing complexity of better care delivery in public health. A masters degree would be even more useful, but for many, advanced education may not be feasible.

DIF: Cognitive Level: Apply (Application) REF: p. 529

12. A public health nurse has reviewed the objectives of Healthy People 2020. Which of the following should be the focus for programming in the community related to communicable diseases?

a.

Encouraging community members to engage in healthy behaviors

b.

Identifying high-risk sexual behaviors among community members

c.

Monitoring the sexual activity of adolescents

d.

Providing information about the hazards of multiple sexual partners

ANS: D

Healthy People 2020 lists communicable disease as an area of focus including levels of human immunodeficiency virus (HIV), acquired immunodeficiency syndrome (AIDS), and sexually transmitted infections. One method to reduce the risk of acquiring a communicable disease is by the public health nurse providing information on the hazards of multiple sexual partners and street drug use.

DIF: Cognitive Level: Analyze (Analysis) REF: p. 530

13. Which of the following is a core competency required of public health nurses?

a.

Knowledge in the use of high-technology diagnostics

b.

Knowledge of the implementation of electronic medical records

c.

Skill in the physical assessment of complex clients

d.

Skill in developing policy and planning programs

ANS: D

The core public health competencies are divided into the following eight domains: (1) analytic assessment skills; (2) basic public health sciences skills; (3) cultural competency skills; (4) communication skills; (5) community dimensions of practice skills; (6) financial planning and management skills; (7) leadership and systems thinking skills; (8) policy development/program planning skills. The other competencies listed are better suited for tertiary facilities such as hospitals.

DIF: Cognitive Level: Understand (Comprehension) REF: p. 529

14. 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

ANS: A

More than any other single factor, the driving force behind nursing changes is the economy and the increase in managed care to decrease or control health care costs in the United States.

DIF: Cognitive Level: Understand (Comprehension) REF: p. 533

15. 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 schoolteachers 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

ANS: B

An example of primary prevention is to educate daycare centers, schools, and the general community about the importance of hand hygiene to prevent transmission of communicable diseases.

DIF: Cognitive Level: Analyze (Analysis) REF: p. 527

16. A public health nurse traces sexual contacts of clients with sexually transmitted diseases for screening and treatment. Which of the following levels of prevention is being implemented?

a.

Primary prevention

b.

Secondary prevention

c.

Tertiary prevention

d.

Secondary and tertiary prevention

ANS: B

Tracing individuals exposed to a client with a sexually transmitted disease is secondary prevention because the nurse is attempting to find those exposed and screen them. Once the exposed persons have been located, screening is another secondary prevention activity.

DIF: Cognitive Level: Apply (Application) REF: p. 527

17. A community mental health nurse is implementing a tertiary prevention activity. Which of the following interventions is most likely being completed?

a.

Disseminating information about mental health to community organizations

b.

Partnering with school health nurses for early identification of children who have evidence of mental health problems

c.

Providing case management services that link clients with serious mental illnesses to mental health and community support services

d.

Screening high-risk clients for the presence of mental disorders

ANS: C

An example of tertiary prevention is the provision of case management services that link clients identified with serious mental illnesses to mental health and community support services.

DIF: Cognitive Level: Apply (Application) REF: p. 527

18. A nurse is working at a local health department. Which of the following would most likely be completed by this agency?

a.

Enforcement of laws and regulations related to public health nationwide

b.

Filing of a certificate for any birth or death in a community

c.

Providing experts in various specialties to answer questions and respond as needed

d.

Surveying the states public health needs

ANS: B

Local public health agencies provide and disseminate health information, provide leadership in health planning, provide essential public health and environmental services, analyze statistics on births to monitor community health status, and file a certificate for every birth or death in the community.

DIF: Cognitive Level: Apply (Application) REF: p. 524

MULTIPLE RESPONSE

1. A nurse is employed by a state public health department. Which of the following functions would most likely be completed by this agency? (Select all that apply.)

a.

Delegating power to engage in certain activities such as quarantine

b.

Enforcing laws and regulations that protect public health

c.

Filing birth and death certificates whenever these occur within the state

d.

Monitoring health status of citizens within its geographic boundaries

ANS: A, B, D

State public health agencies are responsible for monitoring health status and enforcing laws and regulations that protect and improve the publics health. These agencies receive funding from federal agencies for the implementation of public health interventions such as the maternal and child health programs. State agencies distribute federal and state funds to the local public health agencies to implement programs and provide oversight and consultation for local public health agencies. State health agencies also delegate some public health powers, such as the power to quarantine, to local health officers. Local departments file birth and death certificates and often ask for volunteers to assist.

DIF: Cognitive Level: Apply (Application) REF: p. 524

2. Which of the following activities are addressed by most public health departments on the federal, state, and local levels? (Select all that apply.)

a.

Collecting and analyzing various health statistics

b.

Fining or terminating business at any facility that engages in unsafe commercial practices

c.

Identifying and planning for high-risk populations

d.

Planning for and responding to emergencies

ANS: A, C, D

The majority of local, state, and federal public health agencies engage in collecting and analyzing vital statistics, providing health education and information, receiving reports about and investigating and controlling communicable diseases, protecting the environment to reduce the risk to health, providing some health services to particular populations at risk, planning for and responding to natural and human-made disasters and emergencies, identifying public health problems for at-risk and high-risk populations, conducting community assessments to identify community assets and gaps, and partnering with other organizations to develop and implement responses to identified public health concerns.

DIF: Cognitive Level: Understand (Comprehension) REF: p. 525

3. What did events after September 11, 2001, clearly demonstrate? (Select all that apply.)

a.

A strong public health structure ready to respond effectively to a crisis

b.

Public healths need for additional funding and resources

c.

The unrecognized importance of nurses in lowering health care costs

d.

Lack of adequate vaccines to meet communitys needs

ANS: B, C, D

The anthrax exposures after 9/11 alerted policymakers to the weakening public health infrastructure required to respond to bioterrorism events. Unprecedented influenza, tetanus, and childhood vaccine shortages and emerging infections competed with bioterrorism activities for resources. The general public was not informed about how immunizations by nurses improved health and lowered health care cost. For public health services to receive adequate funding, it is necessary for the public and the government to be aware of the benefits provided to a community by nurses.

DIF: Cognitive Level: Understand (Comprehension) REF: p. 526

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