Primary Health Care and Community Nursing, Exams of Nursing

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When providing care within the context of primary health care, the most important person is/are:

The individual/family

The population

The primary-care physician

The medical specialist - - correct ans- - The individual/ Family A nurse is looking to reduce the number of adolescents in her community that are using tobacco. The nurse implements a community-wide program to raise awareness about the dangers of nicotine use and creates a support group specifically aimed at teens looking to quit smoking. This is an example of:

Health protection.

Health promotion.

Risk reduction.

Tertiary prevention. - - correct ans- - Health Promotion The nurse at a community-based primary care organization is educating newly hired nurses about the process used at the clinic for developing public health programs aimed at benefiting community members whether they attend the clinic or not. The nurse explains that even though the primary care offered at the clinic focuses on caring for an individual, the health promotion activities that they are developing for the community are focused on:

The family.

The health-care provider.

The health-care organization.

The population. - - correct ans- - The population A young woman presents to her primary care provider. Her mother has just been diagnosed with Huntington's disease, and several other members of her family have been diagnosed with the condition as well. She wants to know her options regarding testing to see if she is a genetic carrier. From an ethical perspective, what issue would be most important to discuss with the patient?

The cost of Huntington's disease screening

Whether the test is available at the local lab

What will happen when her insurance finds out the results

The fact that there is no known treatment that can alter the progression of the disease - - correct ans- - The fact there there is no known treatment that can alter the progression of the disease. A nurse is working with a community center that primarily serves a nearby Native American tribe. The nurse knows that many of the tribe members suffer from type 2 diabetes. which of the following interventions is an example of tertiary prevention?

Teaching school-aged children healthy exercise.

Conducting a blood glucose screening for program for the adults in the community.

Actively encouraging patients diagnosed with type 2 diabetes to have foot, eye, and hemoglobin A1C screening tests every 3 months.

Publishing a culturally grounded guide about preventing diabetes using input from the tribal leaders and distributing it to all persons who come to the clinic. - - correct ans- - Actively encouraging patients diagnosed with type 2 diabetes to have foot, eye, and hemoglobin A1C screening tests every 3 months. A nurse is speaking with her accountant about opening a free clinic as a 501(c)(3) organization. The accountant advises the nurse:

To charge patients his or her regular fees.

To waive her professional fees but charge for testing and more advanced care.

To charge a nominal fee if the patient can afford to pay but provide services regardless.

To charge a small fee, usually around 25% of the service value. - - correct ans- - To charge a nominal fee if the patient can afford to pay but provide services regardless. The public health department (PHD) is concerned about an outbreak of measles that has occurred in a country adjacent to theirs. Although there are currently no reported cases, as one of their actions the PHD reaches out to all the primary care providers to encourage all of their unvaccinated patients to get vaccinated and to encourage the parents of unvaccinated children to get their vaccinations up to date. Such a public health initiative is an example of:

A secondary prevention approach related to screening.

A primary prevention approach focused on health protection.

A primary prevention approach focused on health promotion.

A primary prevention approach focused on screening. - - correct ans- - Primary prevention approach focused on health protection. A nurse working in an inner-city community health clinic is concerned that her patient education efforts related to achieving a healthy lifestyle are not resulting in any substantial changes in her patients. When she discussed this with one mother whose children are struggling with obesity, the mother explained that she is unable to find fresh fruits and vegetables in their neighborhood and resorts to the use of fast food. This information makes the nurse wonder if this is true for other families. What should she do next?

Ask families she sees to keep a food journal to see what food substitutions could be made.

Perform a problem- or health-issue-based assessment beginning with an assessment of sources of healthy foods such as supermarkets and farmers markets available in the community.

Arrange for free bussing from the community center to the closest supermarket.

Refer them to the local supplemental nutri - - correct ans- - Perform a problem or health issue based assessment beginning with an assessment of sources of healthy foods such as supermarkets and farmers markets available in the community. A new strain of flu has emerged, and the CDC has released a new vaccine that is for use in high-risk populations. which population is most apt to be high-risk?

Pregnant women

Older adults

Children

All of the above - - correct ans- - Pregnant women, older adults, and children A nurse has worked at a community health center for many years. Over the last several months, the nurse has noticed a significant decline in community members using the resources available at the clinic. What is the first thing the nurse should do?

Begin offering day care services and free transportation to the clinic to make it more convenient.

Reach out to former patients to determine why they are no longer returning to the clinic.

Perform a community assessment.

Begin offering a new patient reduced fee rate. - - correct ans- - Reach out to former patients to determine why they are no longer returning to the clinic. A nurse is meeting with a patient with no history of IV drug use after he has spoken with the doctor and received a diagnosis of hepatitis B and E/ The patient expresses concern that someone will find out about his diagnosis. How does the nurse respond? "I can understand that you are concerned about this.."

"You do not need to worry because this patient information is protected by HIPAA, and I am not allowed to provide this information to anyone who is not responsible for your clinical care."

"However, it is your responsibility to inform all of your previous sexual partners."

"However, this is a reportable disease in this state. This means the public health department will ask you for all your possible contacts that might requiring counseling and/or post-exposure prophylaxis."

None of the above. - - correct ans- - However, This is a reportable disease in this state. This means the public health department will ask you for all your possible contacts that might require counseling and/or post exposure prophylaxis A primary Health nurse has observed an increase in the rate of patients being treated for pertussis in her community. The nurse has seen multiple news reports on the issue and knows that this isn't an isolated problem. The nurse decides to brainstorm strategies to reduce the pertussis rate in her community. First, the nurse should:

Consult with local pediatricians about increasing vaccination rates in children.

Begin creating patient education materials to distribute in the waiting room.

Perform a health and cultural evaluation of her community.

Begin offering vaccinations free of charge. - - correct ans- - Perform a health and cultural evaluation of her community. A primary care nurse works at the Native American Health Center, a nonprofit organization serving the California Bay Area Native Population. The center has asked her to put together a comprehensive prevention plan related to type 2 diabetes. Which of the following interventions is an example of primary intervention?

Regular foot and eye care

Encouraging a healthy diet and weight loss if appropriate

Tight blood sugar control with every meal

Screening blood glucose yearly - - correct ans- - Encouraging a health diet and weight loss if appropriate. In response to the increase in opioid overdoses within their community, a primary care clinic could implement which of the following with patients who are experiencing chronic pain?

Screen appropriately.

Prescribe appropriately.

Use a statewide automated reporting system.

Help patients recognize potential problems.

All of the above. - - correct ans- - Screen appropriately, prescribe appropriately, use a statewide automated reporting system, and help patients recognize potential problems. A primary care nurse is volunteering at lead screening clinic for children living in an inner city community. After performing the screening tests, what is the most important thing for the nurse to do for the children with a positive screen?

Conduct a home visit.

Refer them to a pediatric specialist for further screening and possible treatment.

Offer parents educational materials related to reducing lead exposure in children.

Conduct a community-wide environmental assessment to determine the source of the lead exposure. - - correct ans- - Refer them to a pediatric specialist for further screening and possible treatment. A nurse is working in a primary health care setting that has had a recent influx of persons immigrating from a West African country. She wants to incorporate cultural components to

the care of patients from this country. What are possible aspects of the culture that she should learn more about?

Kinship

Source of income

Gender roles

Value of children - - correct ans- - Kinship, Gender roles, Value of Children A primary care clinic has decided to hire a nurse to serve as the clinics case manager. The essence of case management is the incorporation for the client, the family, and the community into meeting the needs of the patient. Based on current evidence related to this approach, it is primarily hoped that this will lead to:

Cost containment.

Increased patient satisfaction.

Improved patient outcomes.

Reduced time needed for each patient to spend with his or her primary health care provider. - - correct ans- - Cost Containment and Improved patient outcomes A hospital nurse is admitting a new patient and asks him if he has a primary care provider. He asks the nurse about the benefit of having a primary care provider, and the nurse replies with which of the following?

Increased access to health care

Decreased health-care costs

Focused on care of disease during the acute phase

Increased patient education and advocacy

Physician-focused treatment - - correct ans- - Increase access to health care, Decreased health care costs, and Increased patient education and advocacy. A nurse is working with a primary care physician who has made the decision to move to a patient-centered medical home (PCMH) model of care after reviewing research presented in the latest issue of a prominent medical journal. The nurse is preparing some education materials to present to the patients and mentions that the benefits of moving to this model of care include which of the following?

Care focusing on the whole individual

Integrated care

Use of highly specialized PCMH physicians

Increased access to care

Access to private insurance, meaning the patient can move away from Medicaid - - correct ans- - Care focusing on the whole individual, Intergrated care, and increase access to care.

A public health nurse (PHN) has been tasked with addressing the rise in teen pregnancies in her communities. She wishes to create linkages among agencies that provide care to teens and/or obstetrical care generally. Which would be her first step based on the six-step guide created by The Center on Education and Training for Employment at The Ohio State University?

State the key challenges, articulate why they are better addressed by multiple agencies, and name potential key players.

Create a harmonious planning environment among agencies.

Assess the need to work in partnership with other agencies.

Make sure the members of the partnership are equally representative of the community-at- large in terms of culture, race, and perspective. - - correct ans- - Assess the need to work in partnership with other agencies. A nurse is moving to a rural area and beginning work at a health clinic there. The nurse is performing a basic community assessment to prepare for working with this new community. The nurse knows that which of the following is not characteristic of the needs of the rural population?

More likely to smoke tobacco and drink alcohol

Have less education and higher rate of poverty

More likely to have increased dental problems

More likely to have a higher life expectancy - - correct ans- - More likely to have a higher life expectancy A nurse is reviewing top 10 priorities from Rural Healthy People 2020 National Survey. Which of the following is not one of the top 10 priorities?

Access to quality health services

Diabetes

Mental health and mental disorders

Cancer - - correct ans- - cancer A nurse has been volunteering at a free clinic located at a community center in a rural area twice a month for several years. Over the last few months, the nurse has noticed that the patient load has increased substantially as the population of this community has aged. It is not feasible for the nurse to spend more time at this center. What might be the most feasible action she could take to continue to serve the needs of the community?

Try to hire a nurse to work at the free clinic.

Set up a telehealth arrangement so the nurse can answer simple questions from home or while on the road.

Set up a scheduling and triage system so the nurse only sees the neediest patients.

Consider closing the free clinic and opening a fee-for-service center. - - correct ans- - Set up a telehealth arrangement so the nurse can answer simple questions from home or while on the road. A nurse is working with several community members in an inner-city environment to help address broken windows and damaged buildings in their community. They've had several residents volunteer to form a group that will repair the damages and keep the community looking well cared for. This is an example of:

Community organization.

Community empowerment.

Community partnerships.

None of the above. - - correct ans- - Community organization. A nurse is looking to address teen gang violence in a nearby community using the principles of community organizing. The nurse has spent a great deal of time in the community performing a community assessment and getting to know residents and key stakeholders. What is the next step?

Identify core leaders to organize the community around the main issue.

Identify clear goals that relate to the overarching goal of reducing teen gang violence.

Identify available resources.

Create a plan to evaluate their actions. - - correct ans- - Identify core leaders to organize the community around the main issue. A nurse is working in a family planning clinic that provides treatment for sexually transmitted infections (STIs). The nurse has noticed a significant increase in the incidence rate of STIs in the young women being seen at the clinic and wonders if this is a community- wide problem. Which of the following techniques would be a helpful first step in answering her question?

Develop collaborative relationships with other health-care providers in the area concerned with STIs.

Perform a comprehensive community assessment.

Interview several key stakeholders in the community.

Create a federally qualified health center (FQHC). - - correct ans- - Develop collaborative relationships with other health-care providers in the area concerned with STIs. A nurse is working on his or her first community-based participatory research (CBPR) study. An essential factor specific to CBPR research that the nurse should be careful to address is:

The ethical protection of human participants.

Making sure that community members aren't directly involved in the research.

Ensuring there is a benefit to the community related to the study.

Choosing a topic that is neutral to the community. - - correct ans- - Ensuring there is a benefit to the community related to the study. A nurse is considering entering the specialty of parish nursing. Nurses working in this field perform which of the following activities specific to that of a parish nurse?

Advocating for individuals within the parish.

Improving spiritual health through practices such as grief counseling.

Providing health education.

Performing health screenings of parish members as needed. - - correct ans- - Improving spiritual health through practices such as grief counseling. A young college student in a rural community has called the health department to get a recommendation for a health center where she could be seen for a chronic health problem. She is uninsured and can't afford the private clinic in town. The PHN recommends that the student:

Visit the local health department for management and treatment of her care.

Proceed to the local emergency department.

Visit the community health center run by an advanced practice registered nurse (APRN).

None of the above. - - correct ans- - Visit the community health center run by an advanced practice registered nurse (APRN).

A nursing professor is looking to give students clinical experience in relation to health program planning with a focus on implementation. The professor proposes which of the following projects to the curriculum committee?

A community assessment of three different neighborhoods

A mock community assessment and health policy development for a hypothetical community

A requirement that each student complete a paper about the history of health policy in the United States

Placement of students in a local community center that has requested the school partner with them on population-level health interventions they would like to put in place - - correct ans- - Placement of students in a local community center that has requested the school partner with them on population-level health interventions they would like to put in place A nurse is performing an assessment of a community where the population totals 55, persons and has a population density of 1,000 persons per square mile. How does the nurse classify the area?

Rural

Suburban

Urban cluster

Urbanized area - - correct ans- - Urbanized area

A student nurse is reviewing important global communities for ideas about a final research project. The student nurse discovers a movement in Europe that focuses on reducing health disparities and involving the local community in program design and implementation. What program does this describe?

Healthy Cities

Healthy People

Medical Homes

Racial and Ethnic Approaches to Community Health - - correct ans- - Healthy Cities Jacob has worked as a PHN in urban areas and has just now moved to a rural area and taken a job in the public health department in charge of county outreach programs. Based on data he recently reviewed from the Federal Office of Rural Health Policy, the following might be programs he should consider except:

An oral health program.

A chronic disease self-management program.

An internet-based health education program.

A mobile pharmacy program. - - correct ans- - A chronic disease self-management program.

The state public health department in a large northern state has convened a task force to help optimize the health of the populations living in the state's rural communities by addressing major barriers to promoting optimal health in those rural communities. Which of the following is a major barrier? (Select all that apply.)

Decreased access health care

Lack of funding for safety net programs

Difficulty recruiting physicians, physician assistants, and nurse practitioners

Migration of people from other areas - - correct ans- - Decreased access health care, Lack of funding for safety net programs, and Difficulty recruiting physicians, physician assistants, and nurse practitioners For the PHN working in a large urban public health department, what are possible health issues facing the population as a whole? (Select all that apply.)

Higher crime rates

Higher levels of air pollution

Lower socioeconomic status

Higher incidence of sexually transmitted infections - - correct ans- - Higher crime rates, Higher levels of air pollution

A nurse is looking to develop a coalition of women's health providers and experts in the community. Which of the following strategies would be effective in helping to build a coalition? (Select all that apply.)

Create detailed objectives and activities

Address diversity among the membership

Map assets

Convene the coalition prior to drafting a mission statement and structure

Maintain and evaluate the vitality of the coalition - - correct ans- - Create detailed objectives and activities, Address diversity among the membership, Map assets, Maintain and evaluate the vitality of the coalition A nurse is speaking with members of a community center about using community organization as a process for change. The nurse explains that there are several specific principles for creating change within the community. Which of the following are examples of these principles? (Select all that apply.)

Use nonviolence as a tool.

Apply downstream assessment principles.

The nurse will provide solutions for the community to follow.

Increase the community's decision-making ability.

Aim to minimize social and economic disparities. - - correct ans- - Use nonviolence as a tool, Increase the community's decision-making ability, Aim to minimize social and economic disparities. Nurses at a large urban medical center have noticed that the number of patients with type 2 diabetes being seen at the diabetes clinic with uncontrolled A1C has increased. They have decided to conduct a focused assessment. Which factors specific to the urban environment might be an issue for their population? (Select all that apply.)

Not enough pharmacies that carry needed mediations

Lack of grocery stores with healthy food choices

Increased numbers of patients with different cultural perspectives on food and health

Limited access to safe areas for exercise - - correct ans- - Lack of grocery stores with healthy food choices, Increased numbers of patients with different cultural perspectives on food and health, Limited access to safe areas for exercise A group of nurses wants to develop a collaborative effort that works to reduce the obesity rate in their community. Place the following steps in the order in which they should be performed (A-D): _____ A. Describe the major problems and issues and determine how a partnership would benefit their goals. _____ B. Identify the key stakeholders within the community and beneficial collaborators.

_____ C. Determine if there is a need to collaborate with other agencies or individuals. _____ D. Establish mutual goals and a plan that addresses those goals. - - correct ans- - C, A, B, D