Family Health Nursing and Community Health, Exams of Nursing

Download Family Health Nursing and Community Health and more Exams Nursing in PDF only on Docsity! N170: All NCLEX Practice Questions for Final Questions With Complete Solutions A breast cancer screening program screened 8000 women and discovered 35 women previously diagnosed with breast cancer and 20 women with no history of breast cancer diagnosed as a result of the screening. The prevalence proportion would reflect: A. current and past breast cancer events in this population of women. B. newly diagnosed cases of breast cancer in this population of women. C. past breast cancer events in this population of women. D. the population of women that had no evidence of breast cancer. Correct Answer *A. current and past breast cancer events in this population of women.* Rationale: The prevalence proportion is a measure of existing disease in a population at a particular time (i.e., the number of existing cases divided by the current population). A prevalence proportion is not an estimate of the risk of developing disease, because it is a function of both the rate at which new cases of the disease develop and how long those cases remain in the population. In this example, the prevalence of breast cancer in this population of women is a function of how many new cases develop and how long women live after the diagnosis of breast cancer. A business executive develops symptoms of the flu 1 day after returning by air from a cross-Atlantic business trip that ran for 2 consecutive stressful 10-hour days. This individual's development of flu symptoms illustrates the relationship between: A. host and agent. B. host, agent, and environment. C. risk and causality. D. morbidity and disease. Correct Answer *B. host, agent, and environment.* Rationale: Epidemiologists understand that disease results from complex relationships among causal agents, susceptible persons, and environmental factors. These three elements—agent, host, and environment—are called the epidemiologic triangle. Changes in one of the elements of the triangle can influence the occurrence of disease by decreasing or increasing a person's risk for disease. The associations between risk and causality, morbidity and disease do not demonstrate the relationship to the development of flu. A community-oriented nurse is interested in studying the hospital discharge data for facilities that typically provide services to members of the community where the nurse practices. The nurse accesses the National Hospital Discharge Survey database of the Department of Health and Human Services (DHHS) to identify data at national, regional, and local levels for comparison purposes. The government health care function being used by the nurse is: A) direct services. B) financing. C) information. C) let the child begin school but ensure that the school keeps the child separated from the other children. D) make sure the child does have an appointment for tomorrow. Correct Answer *B) explain to the parent that all required immunizations must be given before the child will be allowed to enter school.* Rationale: Community-oriented nursing practice interacts with many legal aspects of nursing in community health. Nurses employed by health departments or boards of education may deliver school and family health nursing, a specialty area of practice with its own legal aspects. School health legislation establishes a minimum of services that must be provided to children in public and private schools. Children must have immunizations against certain communicable diseases before entering school. A nurse doing a family assessment asks the client, "Have any of your blood relatives had mental illness?" The nurse is asking this question to: A. determine whether the family is stable. B. assess for biological risk factors. C. decide whether this family member needs medication. D. demonstrate open-mindedness about mental illness. Correct Answer *B. assess for biological risk factors.* Rationale: Healthy People 2020 (U.S. Department of Health and Human Services, 2010) identified the following major categories as being: inherited biological risk, including age-related risks, social and physical environmental risks and behavioral risks as well as health care risks. Although single risk factors can influence outcomes, the combined effect of several risks has greater influence. A nurse educator who teaches at the local community college takes the time to read and understand her community's disaster plans and participates in community mock disasters as a leader of the triage team. The best description of the nurse's activities would be: A. ARC disaster training. B. community preparedness. C. personal preparedness. D. professional preparedness. Correct Answer *C. professional preparedness.* Rationale: Preparedness can take place at three levels: personal, professional, and community. The nurse who is professionally prepared is aware of and understands the disaster plans at the workplace and in the community. Adequately prepared nurses can serve as leaders and assist others to have a smoother recovery phase. A nurse in community health decides to form a contract with a family. The contract states that the family will designate one night as a family night. The nurse is most likely using the contract to: A. make sure the family does what is expected. B. encourage the family to put plans in writing. C. let the family know that this is a legal agreement. D. shift the responsibility so that it becomes a shared effort. Correct Answer *D. shift the responsibility so that it becomes a shared effort.* Rationale: Contracting involves a shift in responsibility and control toward a shared effort by the client and professional as opposed to an effort by the professional alone. The premise of contracting is family control. It is assumed that when the family has legitimate control, its ability to make healthful choices is increased. Contracting is a strategy aimed at formally involving the family in the nursing process and jointly defining the roles of both the family members and the health professional. A nurse in community health in California has been working with a 6-year-old child that was rescued from a mudslide. The nurse will observe the child for which of the following stress effects? (Select all that apply.) A. Bed-wetting episodes B. Desire to return to school C. Fantasies of denial D. Increased playfulness with peers E. Thumb sucking Correct Answer *A. Bed-wetting episodes* *C. Fantasies of denial* *E. Thumb sucking* Rationale: The effects of disasters on children can be especially disruptive. They can resort to regressive behaviors such as sucking their thumb, wetting their bed, crying, and clinging to ever-present force over the lifetime of care. Families are more responsible than ever for assisting in the health care of ill family members. A nurse in community health is working with a single parent of three children, ages 4, 6, and 8. The 6-year-old has cerebral palsy. The 4-year-old has asthma. The maternal grandmother lives with the family and has diabetes. The nurse understands the importance of working within the context of the existing family structure and community resources because families are: A) resistive to outside intervention or involvement. B) responsible for providing/managing the care of their members. C) unable to manage the stress of complex health needs. D) restricted in their ability to identify interventions. Correct Answer *B) responsible for providing/managing the care of their members.* Rationale: Health care decisions are made within the family, the basic social unit of society. Families are responsible for providing and managing the care of family members. Families are significant members of health care teams because they are an ever-present force over the lifetime of care. Families are more responsible than ever for assisting in the health care of ill family members. A nurse in community health may have state-granted personal immunity for particular practice areas such as giving immunizations. If the state legislature has granted personal immunity to nurses employed by public agencies to cover all aspects of their practice, the legal theory that applies is: A) case law. B) respondeat superior. C) sovereign immunity. D) worker's right to know. Correct Answer *C) sovereign immunity.* Rationale: In some states, the legislature has granted personal immunity to nurses employed by public agencies to cover all aspects of their practice under the legal theory of sovereign immunity. Respondeat superior occurs when a nurse is directed to carry out a particular function and the employer becomes responsible for negligence, along with the individual nurse. Case law and the worker's right to know are not associated with the granting of personal immunity to nurses. A nurse in community health that speaks out in a public hearing in support of changes to existing requirements for reporting any long-term effects of structural or organizational changes within the community's health care organizations would be demonstrating: A) legislative action. B) health policy. C) regulatory action. D) regulatory monitoring. Correct Answer *C) regulatory action.* Rationale: The regulatory process, although it may not be as visible as the legislative process, can also be used to shape laws and dramatically affect health policy. Because regulations flow from legislation, they have the force of law. The legislative process begins with ideas (policy options) that are developed into bills. At each level of government, the executive branch can and, in most cases, must prepare regulations for implementing policy and new programs. These regulations are detailed, and they establish, fix, and control standards and criteria for carrying out certain laws. A nurse in community health who teaches a client with asthma to recognize and avoid exposure to asthma triggers and assists the family in implementing specific protection strategies such as removing carpets and avoiding pets is intervening at the level of: A. assessment. B. primary prevention. C. secondary prevention. D. tertiary prevention. Correct Answer *C. secondary prevention.* Rationale: Primary prevention refers to interventions that promote health and prevent the occurrence of disease, injury, or disability. Interventions at this level are aimed at individuals and groups who are susceptible to disease but have no discernable pathology (state of prepathogenesis). In this case, the client has already has asthma, so the nurse teaches the client to recognize and avoid exposure to asthma triggers. This is an example of secondary prevention. Health screenings are at the core of routinely in the assessment process, identify the type of incontinence, and intervene appropriately. A public health nurse employed by the Department of Health is working on a team developing local health policy. The nurse recognizes which of the following about policy development? A) It is based on Socratic method. B) It is important that the policy has been approved by the American Nurses Association. C) It is primarily up to politicians to plan for health care. D) It is very similar to the nursing process. Correct Answer *D) It is very similar to the nursing process.* Rationale: Health policy is simply the process of turning health problems into workable action solutions. Thus, the policy process is very similar to the nursing process, but the focus is on the level of the larger society, and the adoption strategies require political action. The policy process includes the following: · Statement of a health care problem · Statement of policy options to address the health problem · Adoption of a particular policy option · Implementation of the policy product · Evaluation of the policy's intended and unintended consequences in solving the original health problem A public health nurse has identified the need to make amendments in an existing law concerning the TB health assessment of individuals sentenced to serve jail terms on weekends only, based on the current criminal justice system practices and potential health risk to the free-living community. To raise this concern, the nurse has several paths to follow, but the amendment of any existing laws would ultimately be decided by: A) the executive branch of the government. B) the legislative branch of the government. C) local representatives. D) senate hearings. Correct Answer *B) the legislative branch of the government.* Rationale: Each of the government branches at the federal, state, and local levels plays an important role in developing and implementing health law and public policy. Concerned citizens have many avenues to address issues related to required laws and regulations as well as existing laws and regulations. However, each branch of government has separate and important functions. The legislative branch identifies problems, proposes debates, and passes and modifies laws to address identified problems. A school nurse is working with the Parent Teacher Organization (PTO) to improve the health status of preschool students in a lower socioeconomic urban community. Given the demographics of the community, the nurse is aware that this population is at greatest risk for: A. asthma. B. attention deficit disorder (ADD). C. childhood obesity. D. poisoning. Correct Answer *C. childhood obesity.* Rationale: Obesity among the youth of the nation has reached epidemic proportions. Many factors contribute to the likelihood that a child will become overweight or obese. Factors include genetics, family eating, and physical activity patterns and time spent inactive while viewing television, playing computer games, or using other electronic devices. The environment in which children live influences obesity. A useful way to distinguish between Medicare Part A and Medicare Part B is to recognize that: (select all that apply) A. Part A covers outpatient hospital care. B. Part B covers limited skilled nursing care. C. Part A is hospital insurance. D. Part B is noninstitutional care insurance. E. Part B is a voluntary supplemental program. Correct Answer *C. Part A is hospital insurance.* *D. Part B is noninstitutional care insurance.* *E. Part B is a voluntary supplemental program.* Rationale: The Medicare program, established in Title XVIII of the Social Security Act of 1965, provides hospital insurance and medical insurance to persons ages 65 years and older, permanently disabled persons, and persons with end-stage renal disease. Medicare has two parts: *Part A* (hospital insurance) covers hospital care, home care, and limited skilled nursing care, and *Part B* (noninstitutional care insurance) covers medical care, diagnostic services, and physiotherapy. Part B is a A. "God is loving and doesn't punish people." B. "Tell me more about your family's spiritual beliefs." C. "That is not part of my religious belief system, so I don't know." D. "Why do you think your family needed to be punished?" Correct Answer *B. "Tell me more about your family's spiritual beliefs."* Rationale: The focus of the Neuman Systems Model would be to assess the family's ability to adapt to this stressful change. Assessment of spirituality is an important variable in assessing family strengths and weaknesses. The Neuman Systems Model is a wellness-oriented model in which the nurse uses the strengths and resources of the family to maintain system stability while adjusting to stress reactions that may lead to health change and affect wellness. In other words, this model focuses on family wellness in the face of change. Elderly clients should be assessed for signs of abuse. The illegal use of a person for another person's profit is known as: A. neglect. B. incompetence. C. exploitation. D. self-determination. Correct Answer *C. exploitation.* Rationale: Neglect refers to a lack of services that are necessary for the physical and mental health of an individual by the individual or a caregiver. Older persons can make independent choices with which others may disagree. Their right to self- determination can be taken from them if they are declared incompetent. Exploitation is the illegal or improper use of a person or their resources for another's profit or advantage. During the assessment process, nurses need to be aware of conflicts between injuries and explanation of cause, dependency issues between client and caregiver, and substance abuse by the caregiver. Family health can be defined as a dynamic, changing, relative state of well-being that includes the biological, psychological, sociological, cultural, and spiritual factors of a family system. This family health approach would best include which of the following underlying principles? (Select all that apply.) A. Assessment of the individual's health does not determine the overall family system's health. B. Family functioning affects the health of individuals. C. Family system assessment specifically addresses the individual's health. D. The individual's health affects family functioning. E. Simultaneous assessment of individual family members and the family system as a whole is important to family health. Correct Answer *B. Family functioning affects the health of individuals.* *D. The individual's health affects family functioning.* *E. Simultaneous assessment of individual family members and the family system as a whole is important to family health.* Rationale: The bio/psycho/socio/spiritual approach to family health refers to individual members as well as the family unit as a whole. An individual's health (wellness-illness continuum) affects the entire family's functioning and, in turn, the family's functioning affects the health of individuals. Thus assessments of family health involve simultaneous assessment of individual members and the family system as a whole. Family health can be defined as a dynamic, changing, relative state of well-being that includes the biological, psychological, sociological, cultural, and spiritual factors of a family system. This family health approach would best include which of the following underlying principles? (Select all that apply.) A) Assessment of the individual's health does not determine the overall family system's health. B) Family functioning affects the health of individuals. C) Family system assessment specifically addresses the individual's health. D) The individual's health affects family functioning. E) Simultaneous assessment of individual family members and the family system as a whole is important to family health. Correct Answer *B) Family functioning affects the health of individuals.* *D) The individual's health affects family functioning.* *E) Simultaneous assessment of individual family members and the family system as a whole is important to family health.* Rationale: The bio/psycho/socio/spiritual approach to family health refers to individual members as well as the family unit as a whole. An individual's health (wellness-illness continuum) affects the entire family's functioning and, in turn, the family's functioning affects the health of individuals. Thus assessments of family shortages and professional competition are not factors with a direct influence on costs. If a small business employer desires to control company benefit expenditures by turning health care decision-making control over to the employees, the insurance reform effort that best addresses the shifting of responsibility, knowledge, and decision-making involvement to the individual receiving the care would be: A. health spending accounts (HSA). B. managed care. C. medical savings account (MSA). D. prospective payment. Correct Answer *C. medical savings account (MSA).* Rationale: Medical savings accounts (MSAs) are touted as a way of turning health care decision-making control over to the individual receiving the care. MSAs are tax-exempt accounts available to individuals who work for small companies, established usually through a bank or insurance company, that enable individuals to save money for future medical needs and expenses. The employer contributes money to an MSA, and the initial money put into an MSA does not come out of taxable income. Also, interest is earned in MSAs tax free, and unused MSA money can be held in the account from year to year until the money is used. This transfers responsibility for knowledge and decision making regarding cost/quality trade-offs to the individual. Managed care is the term used for a variety of health care arrangements that integrate the financing and the delivery of health care. Health spending accounts and prospective payment are not associated with health care decision making. In applying the developmental theory, a family nurse determines the developmental stage of the family based on: A. age of the eldest child. B. family strengths. C. individual growth patterns. D. overall tasks of the family. Correct Answer *A. age of the eldest child.* Rationale: Family developmental and life cycle theory provides a framework for understanding normal predicted stresses that families experience as they change and transition over time. The stages of family development are based on the age of the eldest child. Overall family tasks are identified that need to be accomplished for each stage of family development. In applying the developmental theory, a family nurse determines the developmental stage of the family based on: A) age of the eldest child. B) family strengths. C) individual growth patterns. D) overall tasks of the family. Correct Answer *A) age of the eldest child.* Rationale: Family developmental and life cycle theory provides a framework for understanding normal predicted stresses that families experience as they change and transition over time. The stages of family development are based on the age of the eldest child. Overall family tasks are identified that need to be accomplished for each stage of family development. In the event of a disaster, shelters are generally the responsibility of which of the following entities? A. Centers for Disease Control & Prevention (CDC) B. Federal Emergency Management Agency (FEMA) C. Public Health Service (PHS) D. Red Cross chapter Correct Answer *D. Red Cross chapter* Rationale: Shelters are generally the responsibility of the local Red Cross chapter, although in massive disasters the military may set up "tent cities" or bring in trailers for the masses who need temporary shelter. Nurses, because of their comfort with delivering aggregate health promotion, disease prevention, and emotional support, make ideal shelter managers and team members. Each person who comes to the shelter is assessed to determine what type of facility is most appropriate. Although initially physical health needs are the priority, especially among older adults and the chronically ill, many of the predominant problems in shelters revolve around stress. The shock of the disaster itself, the loss of personal possessions, the fear of the unknown, living in proximity to total strangers, and even boredom can cause stress. Many families have financial resources that allow them to maintain themselves but limit the quality of their purchasing power. Food high in fat and calories may be affordable, whereas of the incident, defining the specific health needs of the affected population, establishing priorities and objectives for action, identifying existing and potential public health problems, evaluating the capacity of the local response including resources and logistics, and determining the external resource needs for priority actions. Nurses should review which of the following reports to determine what pollutants have been found in the drinking water of a community? A. Point source report B. Consumer confidence report C. Material Safety Data Sheet D. Environmental standards report Correct Answer *C. Consumer confidence report* Rationale: When a community is provided drinking water by a water supplier (as opposed to individual wells), the water provider is responsible for testing the water according to EPA standards. The results of the testing must be reported to those who purchase the water, in the form of a consumer confidence report (CCR). Nurses should review consumer confidence reports, sometimes referred to as right-to-know reports, to learn what pollutants have been found in the drinking water. Pollution sources are characterized as point sources. A point-source pollutant is released into the environment from a single site, such as a smoke stack, a hazardous waste site, or an effluent pipe into a waterway. Environmental standards are reviewed at the community level. Material Safety Data Sheets provide information about the chemical makeup, the health risks, and any special guidance on safe use and handling of chemicals in the workplace. Nursing interventions and approaches for helping individuals and families to assume an active role in their care should focus on empowerment rather than on enabling. The underlying principle to empowerment is: A. client dominance. B. decreased competence. C. professional dominance. D. professional-client partnership. Correct Answer *D. professional-client partnership.* Rationale: Empowerment's underlying assumption is one of partnership between the professional and the client, as opposed to one in which the professional is dominant. Families are assumed to be either competent or capable of becoming competent. For families to become active participants, they need to feel a sense of personal competence and a desire for and willingness to take action. Of the four major factors that affect health care—personal behavior/lifestyle, environmental factors (physical, social, economic), human biology, and the health care system—medical services are said to have the least effect. Yet, the U.S. health care system remains reactionary with high-cost, high- technology, and disease-specific "sickness care." This statement supports the need for increased investment in: A. managed care. B. primary prevention. C. secondary prevention. D. tertiary prevention. Correct Answer *B. primary prevention.* Rationale: Behavior and lifestyle have been shown to have the greatest effect, with the environment and biology accounting for 70% of all illness, yet most health care dollars are spent on secondary and tertiary care. A more proactive investment in disease prevention and health promotion targeted at improving behaviors, lifestyle, and environment has the potential to improve health status, thereby improving the quality of life while reducing health care costs. One member of an older couple has just retired. This is considered a: A. developmental stage that will help the family with stress reduction. B. nonnormative event that will have psychological impact on the family. C. normative event and can increase the family's risk for illness. D. normative event and will have little effect on the family' well-being. Correct Answer *D. normative event and can increase the family's risk for illness.* Rationale: Life events can increase the risk for illness. Normative events are those that are generally expected to occur at a particular stage of development or the life span. If the event is normative, families may be able to identify needed resources, make plans to cope with the change, learn new skills, and prevention and control, environmental health, and health promotion and education activities designed to improve the health of the people of the United States. The Centers for Medicare and Medicaid Services (CMS) administer Medicare and Medicaid accounts and guide payment policy and delivery rules for services for the poor, elderly, disabled, and unemployed. HRSA has been a long-standing contributor to the improved health status of Americans through the programs of services and health professions education that it funds. The NINR is the focal point of the nation's nursing research activities. Since 1998, nurse practitioners (NPs) and clinical nurse specialists (CNSs) are reimbursed by Medicare Part B at a rate that is what percent of physician rates for the same service? A. 50% B. 70% C. 85% D. 95% Correct Answer *C. 85%* Rationale: Spurred by efforts to control the costs of medical care, effective January 1, 1998, nurse practitioners (NPs) and clinical nurse specialists (CNSs) were granted third-party reimbursement for Medicare Part B services only. The reimbursement rate was set at 85% of physician rates for the same service. The new law was an extension of previous legislation that allowed the same rate of reimbursement to NPs and CNSs practicing in rural areas. The 1989 changes to Medicaid required states to provide care for children younger than 6 years and to pregnant women under 133% of the poverty level. These changes also ensured adequate access to qualified providers by: A. adding coverage for the medically indigent. B. reimbursing early periodic screening, diagnosis, and treatment (EPSDT) for those younger than 21 years. C. reimbursing pediatric and family nurse practitioners. D. reimbursing skilled and intermediate nursing home care. Correct Answer *C. reimbursing pediatric and family nurse practitioners.* Rationale: Any state participating in the Medicaid program is required to provide the following: · Inpatient and outpatient hospital care · Laboratory and radiology services · Physician services · Skilled nursing care at home or in a nursing home for people older than 21 years · Early periodic screening, diagnosis, and treatment (EPSDT) for those younger than 21 years · Family planning In 1989 changes in Medicaid required states to provide care for children younger than 6 years and to pregnant women under 133% of the poverty level. These changes also ensured adequate access to qualified providers to meet the demand of the required changes by providing reimbursement for pediatric and family nurse practitioners. The aging population is expected to affect health services more than will any other demographic factor. Another demographic population factor that affects health care costs can be related to: A. consumer demand. B. illnesses such as AIDS. C. marketing practices for new drugs. D. technology advancement. Correct Answer *B. illnesses such as AIDS.* Rationale: Because the majority of older adults and other special populations receive services through publicly funded programs, the growing health needs among these populations have a great effect on costs, payments, and providers associated with Medicaid and Medicare programs. The introduction of new technology enhances the delivery of care, but it also has the potential to increase the costs of care. Consumer demand and pharmaceutical marketing are factors not associated with demographics. The Clean Air Act of 1970 was amended in 1990 to meet unaddressed or insufficiently addressed problems that included which of the following? (Select all that apply.) A. Addressing acid rain B. Addressing excessive noise and heat or cold extremes C. Addressing ground-level ozone D. Addressing stratospheric ozone depletion E. Tracking 75,000 industrial chemicals Correct Answer *A. Addressing acid rain* *C. Addressing ground-level ozone* C. retrospective payment. D. third-party payer. Correct Answer *B. consumer education.* Rationale: The concept of managed care is based on the notion that use of costly care could be reduced if consumers had access to care and services that would prevent illness through consumer education and health maintenance. Therefore, managed care uses disease prevention, health promotion, wellness, and consumer education. Managed care also makes use of utilization management that often includes using less expensive alternative services to redirect care away from hospital care, preauthorization of inpatient admissions when essential, and reducing length of stay. Managed care is typically provided through an HMO or PPO and is not related to ambulatory payment classes. The current-day definition of family refers to two or more individuals who depend on one another for emotional, physical, and/or financial support. Which of the following is the most important principle to support this broader definition? A. Families are defined by genetic ties. B. Family names are needed to confer status. C. Members of a family are self-defined. D. Traditional family functions have been redefined. Correct Answer *C. Members of a family are self-defined.* Rationale: The members of a family are self-defined. Nurses working with families should ask the people whom they consider to be their family and then include those members in health care planning. The family may range from traditional nuclear and extended family to "postmodern" family structures such as single-parent families, stepfamilies, same-gender families, and families consisting of friends. The current-day definition of family refers to two or more individuals who depend on one another for emotional, physical, and/or financial support. Which of the following is the most important principle to support this broader definition? A) Families are defined by genetic ties. B) Family names are needed to confer status. C) Members of a family are self-defined. D) Traditional family functions have been redefined. Correct Answer *C) Members of a family are self-defined.* Rationale: The members of a family are self-defined. Nurses working with families should ask the people whom they consider to be their family and then include those members in health care planning. The family may range from traditional nuclear and extended family to "postmodern" family structures such as single-parent families, stepfamilies, same-gender families, and families consisting of friends. The family nurse conducts the family nursing assessment with the family as a unit. Using a systematic process, family problems are identified and family strengths are emphasized as building blocks for interventions. Which of the following best completes the statement to demonstrate the importance of assessment to outcomes? Integrating the extended families: A. fosters equal family and provider commitment to success. B. facilitates outcomes-oriented family nursing research. C. decreases the need for nurse contact and intervention. D. removes barriers to needed services to achieve success. Correct Answer *A. fosters equal family and provider commitment to success.* Rationale: Building the interventions with family-identified problems and strengths allows for equal family and provider commitment to the solutions and ensures more successful interventions. The interactions between family members become the target for nursing interventions (e.g., the direct interactions between the parents, or the indirect interaction between the parents and the child). The systems approach to family always implies that when something happens to one family member, the other members of the family system are affected. The family nurse conducts the family nursing assessment with the family as a unit. Using a systematic process, family problems are identified and family strengths are emphasized as building blocks for interventions. Which of the following best completes the statement to demonstrate the importance of assessment to outcomes? Integrating the extended families: A) fosters equal family and provider commitment to success. B) facilitates outcomes-oriented family nursing research. C) decreases the need for nurse contact and intervention. D) removes barriers to needed services to achieve success. Correct Answer *A) fosters equal family and provider commitment to success.* A. Emergency Planning and Community Right-to-Know Act (EPCRA). B. National Environmental Policy Act (NEPA). C. Pollution Prevention Act (PPA). D. Resource Conservation and Recovery Act (RCRA). Correct Answer *D. Resource Conservation and Recovery Act (RCRA).* Rationale: The Resource Conservation and Recovery Act (RCRA) gave the EPA the authority to control the generation, transportation, treatment, storage, and disposal of hazardous waste. The 1984 federal Hazardous and Solid Waste Amendment to this act required phasing out land disposal of hazardous waste. The NEPA established the Environmental Protection Agency (EPA) and a national policy for the environment and provides for the establishment of a Council on Environmental Policy. The EPCRA was enacted to help local communities protect public health safety and the environment from chemical hazards. The PPA focused industry, government, and public attention on reduction of the amount of pollution through cost-effective changes in production, operation, and use of raw materials. The Food Quality Protection Act of 1996 increased the protection of infants and children from pesticide exposure from multiple sources by establishing a new health-based standard of reasonable certainty of "no harm" that: A. considers the cumulative impacts of all pesticides that may share a common mechanism of action. B. establishes a 15-year renewal process for all pesticides. C. prohibits taking into account economic considerations when children are at risk. D. uses an additional tenfold margin of safety when there are adequate data indicating developmental risks. Correct Answer *C. prohibits taking into account economic considerations when children are at risk.* Rationale: The Food Quality Protection Act of 1996 added new provisions related to protection of infants and children from pesticide exposure from multiple sources. The law established a health-based standard of reasonable certainty of "no harm" that prohibits taking into account economic considerations when children are at risk. Other safeguards under the FQPA include the use of an additional tenfold margin of safety when there are adequate data to assess prenatal and postnatal developmental risks, a 15-year renewal process for all pesticides to ensure that they have up-to-date scientific evaluations over time, and a cumulative impact consideration. The later years of life for many older adults mark a period of abruptly changing social dynamics over which the older adult has very little control. The nurse should understand that this phenomenon of later life challenges: A. adapting and coping responses. B. intellectual capacity. C. socioeconomic status. D. spiritual awareness. Correct Answer *A. adapting and coping responses.* Rationale: Eighty-five percent of all elderly people live in homes alone, with spouses or other family or friends. For many families the caregiving experience is a positive, rewarding, and fulfilling one. Nursing intervention can facilitate good health for older persons and their caregivers and contribute to meaningful family relationships during this period. The major factor that has increased Florida's vulnerability to natural disasters in recent decades has been: A. El Niño. B. geography. C. trade winds. D. urbanization. Correct Answer *D. Urbanization.* Rationale: The urbanizing and the overcrowding of cities have increased the danger from natural disasters because communities have been built in areas that are vulnerable to disasters, such as in known hurricane, flood, and tornado zones. Increases in population and developing for habitation of areas vulnerable to natural disasters have led to major increases in insurance payouts in the United States in every decade. Projections suggest that by 2050, at least 46% of the world's population will live in areas vulnerable to natural floods, earthquakes, and severe storms. The monitoring and public reporting of air quality in a local community to alert individuals with asthma or other respiratory conditions would illustrate: A. compliance and enforcement. C) family health. D) family resilience. Correct Answer *A) family demographics.* Rationale: Family demographics is the study of the structure of families and households and the family-related events, such as marriage and divorce, that alter the structure through their number, timing, and sequencing. Nurses must be knowledgeable about family structures, functions, processes, and roles. In addition, nurses must be aware of and understand their own values and attitudes pertaining to their own families, as well as being open to different family structures and cultures. The Patient Self-Determination Act of 1991 requires that providers receiving Medicare and Medicaid funds give clients written information regarding: A. legal options for treatment choices in the event the person becomes incapacitated. B. patient rights. C. the cost of services. D. patient privacy. Correct Answer *A. legal options for treatment choices in the event the person becomes incapacitated.* Rationale: The Patient Self-Determination Act of 1991 (PL 103- 43) requires that providers receiving Medicare and Medicaid funds give clients written information regarding their legal options for treatment choices if they become incapacitated. A routine discussion of advance medical directives can help ease the difficult discussions faced by health care professionals, family, and clients. The nurse can assist an individual to complete a values history instrument. These instruments ask questions about specific wishes regarding different medical situations. The primary reasons for delay, difficulty, or failure to access care include which of the following factors? (Select all that apply.) A. The increase in safety net providers B. Inability to afford health care and a variety of insurance- related reasons C. Lack of transportation D. Refusal of services by providers E. Resolved nursing shortage Correct Answer *B. Inability to afford health care and a variety of insurance-related reasons* *C. Lack of transportation* *D. Refusal of services by providers* Rationale: The primary reasons for delay, difficulty, or failure to access care include the inability to afford health care and a variety of insurance-related reasons. Other barriers include lack of transportation, physical barriers, communication problems, childcare needs, lack of time or information, or refusal of services by providers. Additionally, lack of after-hours care, long office waits, and long travel distance are cited as access barriers. Community characteristics also contribute to the ability of individuals to access care. For example, the prevalence of managed care and the number of safety net providers, as well as the wealth and size of the community, affect accessibility. The problem of the working poor and uninsured places a major burden on the current health care system that affects those families and the community in general. Nurses in community health see this as a major: (select all that apply) A. behavioral issue. B. policy issue. C. health risk issue. D. social issue. E. nursing issue. Correct Answer *B. policy issue.* *C. health risk issue.* *D. social issue.* Rationale: Economic risk is one of the foremost predictors of health. It is useful to know whether families' resources are adequate to meet their needs. The standard of living they are comfortable with is not the measure of risk. If the main wage earner is employed but receives no medical benefits, and the salary is not sufficient for health promotion or illness-related care, the family may qualify for available government-sponsored programs. This is a major policy issue of concern to nurses. The recovery phase of a disaster can take a very long time. Nurses need to be aware that despite effective disaster preparedness and response efforts: A. environmental hazards are minimal. B. individuals must ultimately recover on their own. C. the government provides economic support. Rationale: An incidence rate quantifies the rate of development of new cases in a population at risk, whereas an incidence proportion indicates the proportion of the population at risk that experiences the event over some period of time (Rothman, 2002). The population at risk is considered to be persons without the event or outcome of interest but who are at risk of experiencing it. People who already have the disease or outcome of interest are excluded from the population at risk for this calculation because they already have the condition and are no longer at risk of developing it. What terms are used to describe healthy families? (Select all that apply.) A. Families with strengths B. Dysfunctional C. Functional families D. Resilient families E. Resistant families Correct Answer *A. Families with strengths* *C. Functional families* *D. Resilient families* Rationale: Families with strengths, functional families, and resilient families are terms often used to refer to healthy families. Research has been conducted about healthy families, but it is clear that the issues examined all relate to those of relational needs. This means that in healthy families, the basic survival needs are met. The traits ascribed to healthy families are based on attachment and are affectionate in nature. What terms are used to describe healthy families? (Select all that apply.) A) Families with strengths B) Dysfunctional C) Functional families D) Resilient families E) Resistant families Correct Answer *A) Families with strengths* *C) Functional families* *D) Resilient families* Rationale: Families with strengths, functional families, and resilient families are terms often used to refer to healthy families. Research has been conducted about healthy families, but it is clear that the issues examined all relate to those of relational needs. This means that in healthy families, the basic survival needs are met. The traits ascribed to healthy families are based on attachment and are affectionate in nature. When a community health nurse evaluates the completeness and accuracy of information made available to community residents regarding the impact of rezoning land parcels for industrial use, the nurse is: A. advocating for ethical choices. B. communicating risk. C. controlling environmental damage. D. volunteering for service on state boards. Correct Answer *A. advocating for ethical choices.* Rationale: Understanding ethics is essential for nurses making their own choices, in describing issues and options within groups, and in advocating for ethical choices. Ethical issues likely to arise in environmental health decisions are the following: · Who has access to information and when? · How complete and accurate is the available information? · Who is included in the decision making and when? · What and whose values and priorities are given weight in decisions? · How are short-term and long-term consequences considered? When applying the nursing process to environmental health, the community health nurse would examine criteria that include the immediate and long-term responses of the client to the planned interventions. Another important factor to consider in the evaluation process would be: A. recidivism of the problem for the client. B. consideration of community policy and laws. C. relationship between the disease and the environmental factors. D. coordination of actions to meet the client's needs. Correct Answer *A. recidivism of the problem for the client.* Rationale: If the community health nurse suspects that a client's health problem is being influenced by environmental factors, the nurse should follow the nursing process and note the health care rationing. Health care rationing becomes a public health and nursing issue because: A. Medicare reimbursement needs to be higher. B. proactive primary prevention orientation is cost effective. C. public health systems and nurses must ensure that essential clinical services are available. D. sufficient resources are available in the public health system to meet the unmet need. Correct Answer *C. public health systems and nurses must ensure that essential clinical services are available.* Rationale: Rationing of health care is a public health issue. Where care is not provided, the public health system and nurses must ensure that essential clinical services are available. Which of the following factors have had an impact on the complex relationship among nursing practice, health policy, and politics? (Select all that apply.) A) Categorical funding B) Death penalty C) Head Start D) Health fairs E) Statutory authority for the profession Correct Answer *A) Categorical funding* *C) Head Start* *E) Statutory authority for the profession* Rationale: Constitutional law, judicial and common law, legislation, regulation, and funding mandates are the key factors of health policy and politics that affect nursing practice in a complex relationship: · Categorical funding, designating funding for specific needs, has led to the special and more narrowly shaped nursing roles and tasks in community-oriented nursing (e.g., home health care, school nursing, and family planning). Government funds assigned to specific programs or purposes cannot be used to support other services. This factor has restricted the broader development of a public and community-oriented nursing role to meet unanticipated needs since funding drives programming, which drives services, which drives roles. · School health legislation establishes a minimum of services that must be provided to children in public and private schools. Examples of such federally legislated programs that affect nursing practice in the schools and with families are Head Start, early diagnostic screening programs, nutritional programs, services for the handicapped, and special education. · Despite the broad nature and varied roles of nurses in practice, two legal arenas are most applicable to nurse practice situations. The first is the statutory authority for the profession and its scope of practice, and the second is professional negligence or malpractice. The issue of scope of practice involves defining nursing, setting its credentials, and then distinguishing between the practices of nurses, physicians, and other health care providers. The issue is of particular importance to community- oriented nurses who traditionally practiced with much autonomy. Which of the following social science theories is used by public health nursing to describe how environments and systems outside of the family influence the development of a child over time? A. Life cycle theory B. Family developmental theory C. Family systems theory D. Bioecological systems theory Correct Answer *D. Bioecological systems theory* Rationale: The bioecological systems theory describes how environments and systems outside of the family influence the development of a child over time. Family developmental and life cycle theory provides a framework for understanding normal predicted stresses that families experience as they change and transition over time. The stages of family development are based on the age of the eldest child. Overall family tasks are identified that need to be accomplished for each stage of family development. Nurses use family systems theory to understand how a family is an organized whole as well as composed of individuals. Which of the following social science theories is used by public health nursing to describe how environments and systems outside of the family influence the development of a child over time? A) Life cycle theory B) Family developmental theory C) Family systems theory D. More males die from suicide. E. Men often incur more work related injuries than women. Correct Answer *B. Fewer health services are offered to men.* *C. Men often put work ahead of their health needs.* *E. Men often incur more work related injuries than women.* Rationale: Although health policies, campaigns, and community health organizations offer services for men, women's health is more often emphasized. Treadwell and Marguerite (2008) noted that virtually no health services were offered to men, especially to men at the lowest socioeconomic levels or to those unable to work. Men often put work ahead of their own health needs. Large numbers of men do not receive the health screenings intended to prevent and identify disease. Men are more often employed in dangerous jobs and incur more work-related injuries than women. Which of the following statements best explains the need for geologists, meteorologists, and chemists on the multidisciplinary team in environmental health? A. Earth sciences explain how pollutants travel in air, water, and soil. B. Earth sciences help us understand the strength of the association between exposures and health effects in human populations. C. Earth scientists study the negative effects of chemical exposure. D. Earth scientists work with the community to coordinate services to meet the community's needs. Correct Answer *A. Earth sciences explain how pollutants travel in air, water, and soil.* Rationale: Toxicology is the basic science that studies the health effects associated with chemical exposure. Epidemiology, an applied use in environmental health, helps us understand the strength of association between exposures and health effects in human populations. Environmental epidemiology is the study of the effect on human health of physical, chemical, and biological factors in the external environment. To understand how and when humans may be exposed to hazardous chemicals, radiation, and biochemical contaminants, earth sciences are used to help explain how pollutants travel in air, water, and soil. Therefore environmental health requires a multidisciplinary approach to assess and decrease environmental health risks. This may involve geologists, meteorologists, chemists, food safety specialists, sanitarians, radiation specialists, industrial hygienists, housing inspectors, clinical specialists, laboratory workers, and/or remediation specialists. This may also involve interagency cooperation (i.e., health department, department of environmental protection, housing department, public/private laboratories, tertiary care facilities, department of agriculture, transportation department). Which of the following tools are used in analytic epidemiology? (Select all that apply.) A. cohort study B. case-control study C. cross-sectional study D. clinical trials E. community trials Correct Answer *A. cohort study* *B. case-control study* *C. cross-sectional study* Rationale: Analytic epidemiology deals with the factors that influence the observed patterns of health and disease and increase or decrease the risk of adverse outcomes. Analytic study designs include cohort studies, case-control studies, and cross-sectional studies. In experimental or intervention studies, the investigator initiates a treatment or intervention to influence the risk or course of disease. These studies test whether interventions can prevent disease or improve health. Clinical trials and community trials are examples of experimental studies.