Community & Public Health Nursing Promoting the Public’s Health 8th ed by Allender , Judith – Test Bank A+

$35.00

Community & Public Health Nursing Promoting the Public’s Health 8th ed by Allender , Judith – Test Bank A+

Name: Community & Public Health Nursing Promoting the Public’s Health 8th ed by Allender , Judith – Test Bank A+
SKU: Community & Public Health Nursing Promoting the Public’s Health 8th ed by Allender , Judith – Test Bank A+
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$35.00

SKU: Community & Public Health Nursing Promoting the Public’s Health 8th ed by Allender , Judith – Test Bank A+

Description

1.	After teaching a group of nursing students about the similarities and differences between public health and community health, which of the following statements by a nursing student would indicate knowledge of the similarities and differences between public health and community health?
	A)	“Community health nursing is defined as nursing care that is provided in a community setting, rather than an institutional setting.”
	B)	“Public health nursing is defined as nursing care that is provided in an institutional setting.”
	C)	“Public health nursing is focused on the health of individuals.”
	D)	“Community health nursing can shape the quality of community health services and improve the health of the general public.”
	Ans:	D
	Feedback:
	Operating within an environment of rapid change and increasingly complex challenges, this nursing specialty holds the potential to shape the quality of community health services and improve the health of the general public.

2.	Which of the following statements would best describe the difference between public health nursing and community health nursing?
	A)	Public health nursing is focused on the private aspects of health, and community health nursing is focused on the public aspects of health.
	B)	In our textbook, the term community health practice refers to a focus on specific, designated communities and is a part of the larger public health effort.
	C)	Public health nursing and community health nursing relate to the very same types of services and perspectives.
	D)	Both public health nursing and community health nursing are practiced exclusively within institutions.
	Ans:	B
	Feedback:
	In this textbook, community health practice refers to a focus on specific, designated communities. It is a part of the larger public health effort and recognizes the fundamental concepts and principles of public health as its birthright and foundation for practice. Public health nursing is focused on the public aspects of health. Public health nursing and community health nursing have distinctive types of services and perspectives. Neither public health nursing nor community health nursing is practiced exclusively within institutions.

3.	Which of the following is most accurate about the concept of community?
	A)	A community is a collection of people who share some important features of their lives.
	B)	Community members live in the same geographic location.
	C)	Community members are biologically related.
	D)	A community is made up of people who do not necessarily interact with one another and do not necessarily share a sense of belonging to that group.
	Ans:	A
	Feedback:
	The broad definition of a community is a collection of people who share some important features of their lives. Community members may not live in the same geographic location as in a common-interest community or a community of solution. A population is made up of people who do not necessarily interact with one another and do not necessarily share a sense of belonging to that group.

4.	A group of students are reviewing material for a test on populations, communities, and aggregates. Which of the following indicates that the students understand these concepts?
	A)	Members of a population share a sense of belonging.
	B)	Communities and populations are types of aggregates.
	C)	Individuals of a community are loosely connected.
	D)	Members of an aggregate share a strong bond.
	Ans:	B
	Feedback:
	An aggregate refers to a mass of grouping of distinct individuals who are considered as a whole and who are loosely associated with one another. Communities and populations are types of aggregates. A population is made up of people who do not necessarily interact with one another and do not necessarily share a sense of belonging to the group. A community is a collection of people who chose to interact with one another because of common interests, characteristics, or goals, which form the basis for a sense of unity or belonging.

5.	Which of the following would a community health nurse identify as a community of common interest?
	A)	The global community
	B)	Small rural town in a northern state
	C)	National professional organization
	D)	Counties addressing water pollution
	Ans:	C
	Feedback:
	A common-interest community shares a common interest or goal that binds the members together. Membership in a national professional organization is one example. The global community and a small rural town in a northern state would be examples of a geographic community. Counties addressing a water pollution problem would be an example of a community of solution.

6.	The nurse is working with a community of solution. Which of the following would the nurse expect to find?
	A)	A health problem affecting the group
	B)	Common goal binding members together
	C)	Sharing of a similar goal
	D)	Locational boundaries
	Ans:	A
	Feedback:
	A community of solution involves a group of people coming together to solve a problem that affects them. A common-interest community involves a collection of people widely scattered geographically who have an interest or goal that binds the members together. A geographical community is one defined by its geographical or locational boundaries.

7.	Which one of the following statements made by a student would the nurse educator recognize as evidence that a student understands the health continuum?
	A)	The distinction between health and illness is well demarcated.
	B)	Illness refers to a state of being relatively unhealthy.
	C)	The term health is limited to reflect an individual’s state.
	D)	Treatment of acute conditions reflects the current focus of health care.
	Ans:	B
	Feedback:
	Although society typically depicts an absolute line of difference between being either well or ill, health is considered a relative term. Thus, illness is viewed as a state of being relatively unhealthy. Health is typically described as a continuum that involves a range of degrees from optimal health at one end to total disability or death at the other. The line of demarcation is not clear. Health applies to individuals, families, and communities. Traditionally, most health care has focused on the treatment of acute and chronic conditions at the illness end of the continuum, but this emphasis is shifting to focus on the wellness end.

8.	When discussing the concept of the health continuum with a class, the nurse educator would be certain to include which statement in the description?
	A)	Wellness is a relative concept, not an absolute, and illness is a state of being relatively unhealthy.
	B)	A client’s placement on the health continuum is static throughout time.
	C)	Health is best described as cyclic.
	D)	The health continuum can only be applied to individuals.
	Ans:	A
	Feedback:
	Wellness is a relative concept, not an absolute, and illness is a state of being relatively unhealthy. The continuum can change. Because health involves a range of degrees from optimal health at one end to total disability or death at the other, it is often described as a continuum. The health continuum applies not only to individuals but also to families and communities.

9.	After discussing the leading health indicators with a class, which condition if stated by the class as one of these indicators suggests that the class has understood the information?
	A)	Cardiac disease
	B)	Mental health
	C)	Sedentary lifestyle
	D)	Maternal health care
	Ans:	B
	Feedback:
	Mental health is a leading health indicator. Other leading health indicators include physical activity, overweight and obesity, tobacco use, substance use, responsible sexual behavior, injury and violence, environmental quality, immunization, and access to health care.

10.	Which of the following statements about health promotion and disease prevention is the most accurate?
	A)	Health promotion and disease prevention include all efforts that seek to move people closer to optimal well-being or higher levels of wellness.
	B)	Disease prevention differs from health promotion in that disease prevention is targeted toward a specific disease or diseases.
	C)	Health promotion can be described in terms of primary, secondary, and tertiary prevention.
	D)	The goal of disease prevention is to raise levels of wellness for individuals, families, populations, and communities.
	Ans:	B
	Feedback:
	Health promotion includes all efforts that seek to move people closer to optimal well-being or higher levels of wellness. The goal of health promotion is to raise levels of wellness for individuals, families, populations, and communities. Disease prevention is targeted toward a specific disease or diseases and consists of primary, secondary, and tertiary prevention.

11.	A group of community health nursing students design a health education program for a group of pregnant teens that includes teaching nutrition during pregnancy, demonstrating helpful exercises, and discussing their concerns. This is an example of which of the following?
	A)	Health promotion
	B)	Treatment of disorders
	C)	Rehabilitation
	D)	Evaluation
	Ans:	A
	Feedback:
	The student nurses are engaging in health promotion activities. Health promotion incorporates all efforts that seek to move people closer to optimal well-being or to higher levels of wellness. Treatment of disorders would include direct care for issues involving the group, such as complications that might arise in this population. Rehabilitation would involve activities to minimize disability or restore or preserve function. Evaluation would involve an analysis of the effectiveness of these activities.

12.	The community health nurse is developing a plan of primary prevention activities. Which of the following might the nurse include? Select all that apply.
	A)	Teaching about safe-sex practices to high school students
	B)	Encouraging older adults to install safety devices in the bathroom
	C)	Providing regular immunization programs for communicable diseases
	D)	Participating in cholesterol screening programs at health fairs
	E)	Providing skin testing for tuberculosis for children over 1 year of age
	F)	Working with a group testing water samples for contamination
	Ans:	A, B, C
	Feedback:
	Primary prevention activities are those taken to keep illness or injuries from occurring. These include teaching about safe-sex practices, encouraging older adults to use safety devices in the bathroom, and providing regular immunization programs for communicable diseases. Cholesterol screening programs, skin tests for tuberculosis, and working with a group testing water samples for contamination are examples of secondary prevention activities.

13.	A community health nurse is preparing a presentation for a group of nursing students about community health nursing. Which of the following descriptions about community health nursing would the nurse most likely include in the presentation?
	A)	Focusing on addressing continuous needs
	B)	Working with the client as an equal partner
	C)	Engaging in tertiary prevention as the priority
	D)	Encouraging clients to reach out to the nurse
	Ans:	B
	Feedback:
	The community health nurse works with the client as an equal partner, encouraging autonomy. At any time, the nurse deals with continuous and episodic needs simultaneously. Primary prevention is the priority for community health nurses. The community health nurse engages in primary prevention as the priority, having the obligation to actively reach out to all who might benefit from a specific activity or service.

14.	A community health nurse is working with other members of a team that will be implementing a citywide immunization program. The nurse is coordinating the services and addressing the needs of the population groups to ensure which of the following?
	A)	Involvement of the community
	B)	Client participation
	C)	Continuity of service
	D)	Plan for follow-up
	Ans:	C
	Feedback:
	Working in cooperation with other team members and coordinating services and addressing the needs of population groups are essential to interprofessional collaboration. In doing so, the community health nurse is preventing fragmentation and gaps thereby ensuring continuity of service. Involvement of the community and client participation are important but these help to ensure that the clients are viewed as equal partners of the health care team. A plan for follow-up may or may not be appropriate. In addition, it is the only aspect that may be addressed with the program.

15.	A community health nurse works to ensure the greatest good for the greatest number of people by applying which of the following?
	A)	Secondary prevention activities
	B)	Autonomy
	C)	Justice
	D)	Utilitarianism
	Ans:	D
	Feedback:
	The ethical theory of utilitarianism promotes the greatest good for the greatest number. Primary prevention activities, not secondary prevention, are the priority. Autonomy refers to the freedom of choice. Justice involves treating people fairly.

16.	When working in the community, the community health nurse adopts the teaching plan to ensure that the population understands the basic information provided to address which of the following?
	A)	Self-care
	B)	Health disparities
	C)	Health literacy
	D)	Episodic needs
	Ans:	C
	Feedback:
	Consumers are often intimated by health professionals and are uninformed about health and health care affecting the quality of care. Adopting a teaching plan to ensure that the population understands the basic information addresses health literacy, the ability to read, understand, and use health care information appropriately. Doing so helps to ensure that the teaching plan will be effective. Self-care refers to the process of taking responsibility for developing one’s own health potential by actively participating in promoting one’s own health. Health disparities reflect differences in all aspects of health care related to vulnerable populations. Episodic needs are one-time specific negative health events that arise and are not an expected part of life.

17.	Which of the following would be crucial for the community health nurse to address as the priority when dealing with policy makers about the development of community health programs?
	A)	Research-based best practices
	B)	Population’s make up
	C)	Amount of services to be provided
	D)	Scarcity of the available resources
	Ans:	A
	Feedback:
	Decisions for programs or services are often made on the basis of cost-effectiveness or cost–benefit. Therefore, community health nurses must provide policy makers with information about best practices, grounded in research. Although population make up, amount of services to be provided, and scarcity of resources are factors that may need to be considered, the community health nurse must demonstrate evidence-based practice.

18.	After a class that described the differences between acute care nursing and community health nursing, which statement by the class about community health nurses indicates successful teaching?
	A)	Use a reactive approach.
	B)	Seek out potential health problems.
	C)	Concentrate on the illness end of the continuum.
	D)	Emphasize curative care.
	Ans:	B
	Feedback:
	Community health nurses, in contrast to acute care nurses, seek out potential health problems, identifying high-risk groups and instituting preventive programs; use a proactive approach; concentrate on the wellness end of the health continuum; and put less emphasis on curative care.

19.	Which of the following activities would be associated with a community health nurse? Select all that apply.
	A)	Examining infants in a city well-baby clinic
	B)	Caring for elderly stroke victims in their homes
	C)	Providing emergency care in an acute care facility
	D)	Carrying out epidemiologic research
	E)	Participating in health policy analysis
	Ans:	A, B, D, E
	Feedback:
	Community health nurses work in every conceivable kind of community agency, from a state public health department to a community-based advocacy group. Their duties rang from examining infants in a well-baby clinic or teaching elderly stroke victims in their homes to carrying out epidemiologic research or engaging in health policy analysis and decision making. Providing care in an acute care facility would not be an activity associated with a community health nurse.

20.	The term health can be described in many different ways. A community health nurse would view health as which of the following?
	A)	The absence of disease
	B)	The potential to lead a productive life
	C)	An environment free of toxins
	D)	A holistic state of well-being
	Ans:	D
	Feedback:
	Community health nurses view health as a holistic state of well-being, which includes soundness of mind, body, and spirit. Along with this foundational view is the emphasis on wellness, which includes the definition of health as well as the capacity to develop a person’s potential to lead a fulfilling and productive life. Health is more than just the absence of disease or an environment free of toxins.

21.	While interviewing a client, which of the following statements would a nurse identify as reflecting an objective dimension of health?
	A)	“I’m feeling better since I started taking that medication.”
	B)	“Life is pretty good right now, except for an occasional upset stomach.”
	C)	“I’m able to wash myself in the mornings with just a bit of help.”
	D)	“Sometimes when I wake up, I don’t even want to face the day.”
	Ans:	C
	Feedback:
	The objective dimension of health involves one’s ability to function in daily activities. The statement about being able to care for one’s self is an example. The statements of feeling better with medication, life being pretty good, and not wanting to face the day are examples of the subjective dimension of health, which involves how people feel.

22.	When employing a population-oriented focus, the community health nurse would do which of the following?
	A)	Assess the groups’ relationships looking for a common need.
	B)	Consider the members individually for similarities.
	C)	Focus on the geographical area of the population.
	D)	Promote the groups’ dependency for improving health.
	Ans:	A
	Feedback:
	A population-oriented focus requires the assessment of relationships, considering the groups or communities in relationship to the rest of the community to discover common needs or risks for a common health problem. The nurse does not consider the groups or communities separately but rather in context. The population may or may not be delineated by the geographical area. The community health nurse encourages individuals’ participation to promote their autonomy rather than permitting dependency.

23.	A community health nurse is involved in a project to evaluate the health of a city. Which of the following findings would suggest that the city would most likely need additional programs?
	A)	Citizens are actively involved in the city’s department of recreation and after-school programs.
	B)	The construction of affordable organized housing developments and communities is nearing completion.
	C)	Approximately one third of the people are recently unemployed due to closure of the automotive factory.
	D)	Several new recreational facilities for adults and children have been created at several locations.
	Ans:	C
	Feedback:
	A healthy city is one in which there is continual creation and improvement the physical and social environments with expansion of community resources so that people can mutually support one another. It is characterized by the meeting of basic needs for all of the city’s people. This would include food, water, shelter, income, safety, and work. Loss of employment of one third of the city’s workforce would be a threat to the health of the city and necessitate intervention. Active involvement in the city’s functioning, affordable housing, and recreational facilities are suggestive of a healthy city.

1.	Which of the following statements about competent communities are accurate? Select all that apply.
	A)	A competent community is able to collaborate effectively identifying community needs and problems.
	B)	A competent community is able to achieve a working consensus on goals and priorities.
	C)	A competent community is able to agree on ways and means to implement the agreed-upon goals.
	D)	A competent community has no problems.
	E)	A competent community is able to collaborate effectively to take the required actions.
	Ans:	A, B, C, E
	Feedback:
	A competent community is able to collaborate effectively identifying community needs and problems. A competent community is able to achieve a working consensus on goals and priorities. A competent community is able to agree on ways and means to implement the agreed-upon goals. A competent community is able to collaborate effectively to take the required actions. All communities have problems.

2.	Which of the following are overarching goals for the health of the nation presented in Healthy People 2020? Select all that apply.
	A)	To attain high-quality, longer lives free of preventable disease, disability, injury, and premature death
	B)	To achieve health equity, eliminate disparities, and improve the health of all groups
	C)	To create social and physical environments that promote good health for all
	D)	To promote quality of life, healthy development, and healthy behaviors across all life stages
	E)	Healthy People 2020 does not address the health of the nation but does address the health of individuals.
	Ans:	A, B, C, D
	Feedback:
	The four overarching goals for the health of the nation are the following: To attain high-quality, longer lives free of preventable disease, disability, injury, and premature death To achieve health equity, eliminate disparities, and improve the health of all groups To create social and physical environments that promote good health for all To promote quality of life, healthy development, and healthy behaviors across all life stages

3.	When the nursing student identifies the three dimensions of the health of a community, the nurse educator is aware that the student has grasped which of the following concepts?
	A)	Status/people, structure, and process
	B)	Assessment, policy development, and assurance
	C)	Primary, secondary, and tertiary
	D)	Function, structure, and process
	Ans:	A
	Feedback:
	The three dimensions of the health of the community are status/people, structure, and process. Assessment, policy development, and assurance are the three core public health functions. Primary, secondary, and tertiary are the levels of prevention. Function, structure, and process are the descriptions of Human Anatomy and Physiology.

4.	A community health nurse is working as part of a health planning team to determine the needs of pregnant teenagers in the community. Which of the following population variables would be important to assess? Select all that apply.
	A)	Rate of growth or decline among those in need
	B)	Health needs and practices of subculture groups
	C)	Geographic placement of proposed health services
	D)	Functions of community organizations
	E)	Social class of the community
	F)	Level of agreement on community goals
	Ans:	A, B, E
	Feedback:
	Population variables include size, density, composition, rate of growth or decline, cultural characteristics, social class structure, and mobility. Pregnant teens are a subculture of teenagers. Cultural differences are population variables along with the numbers, social class, and mobility. Health needs vary among subculture and ethnic populations. Geographic placement reflects location. Functions of community organizations and social class reflect the social system.

5.	A community health nurse avoids focusing care on illness and health problems, considering clients as which of the following?
	A)	Aggregate
	B)	Agent
	C)	Community
	D)	Total system
	Ans:	D
	Feedback:
	It was proposed by Mundinger and Jauron that the use of nursing diagnoses in the community could be formulated by substituting the terms, client, family, group, or aggregate for the word patient. Community health nurses look for evidence of all kinds of needs that relate to or influence a client’s levels of wellness. Needs cover the whole span of the health–illness continuum and the total person, family, group, aggregate, population, or community—the total system. Not all clients are communities. They may be individuals or families. Not all clients are in the category of groups, aggregates, or populations. A client can be an individual or a family. When using the epidemiological triad, there are three components: host, agent, and environment. A client would be considered the host. An agent is a factor that causes or contributes to a health problem or condition.

6.	When the nursing student identifies the concept of community as client as which of the following the instructor knows that the student has grasped this concept?
	A)	The community is comprised of individual clients.
	B)	The community is comprised of families.
	C)	The community is a group or population of people as the focus of nursing service.
	D)	The community cannot be a client. Persons who are hospitalized are patients.
	Ans:	C
	Feedback:
	The concept of community as client refers to a group or population of people as the focus of nursing service.

7.	Which of the following statements about the structural dimension of the community as client are accurate? Select all that apply.
	A)	Structure of a community refers to its services and resources.
	B)	Community associations, groups, and organizations provide a means for accessing needed services.
	C)	Adequacy and appropriateness of health services can be determined by examining patterns of use, number and types of health and social services, and quality measures.
	D)	Demographic data, such as socioeconomic and racial distribution, age, gender, and educational level, are important indicators of community structure.
	E)	Structure is the most common measure of the health of a community.
	Ans:	A, B, C, D
	Feedback:
	Structure of a community refers to its services and resources. Community associations, groups, and organizations provide a means for accessing needed services. Adequacy and appropriateness of health services can be determined by examining patterns of use, number and types of health and social services, and quality measures. Demographic data, such as socioeconomic and racial distribution, age, gender, and educational level, are important indicators of community structure. Status/people is the most common measure of the health of a community.

8.	The community health nurse is determining the health of a community by examining status. Which of the following would the nurse examine?
	A)	Leading causes of death and illness
	B)	Adequacy of health services
	C)	Socioeconomic distributions
	D)	Strengths of the community
	Ans:	A
	Feedback:
	Status typically comprises morbidity and mortality data identifying the physical, emotional, and social determinants of health. Physical and social indices include vital statistics, leading causes of death and illness, suicide rates, and rates of drug and alcohol addiction. Social determinants can be identified by crime rates and functional ability level, or by high school dropout rates or average income levels. Adequacy of health services and socioeconomic distributions reflect structure. Strengths of the community involve process.

9.	The community health nurse is assessing the health of a community by reviewing the dimension of process. Which of the following is true of this dimension?
	A)	Process of a community refers to its services and resources.
	B)	Process reflects the community’s ability to function effectively.
	C)	It usually consists of morbidity and mortality data.
	D)	It refers to the physical, emotional and social determinants of health.
	Ans:	B
	Feedback:
	Process reflects the community’s ability to function effectively. Structure of a community refers to its services and resources. Status/people dimension usually refers to the morbidity and mortality data and the physical, emotional, and social determinants of health.

10.	As part of an orientation for a group of newly hired nurses for a community agency, a community health nurse emphasizes which of the following as crucial?
	A)	Cyclic nature
	B)	Client focus
	C)	Interaction
	D)	Flexibility
	Ans:	C
	Feedback:
	Although the nursing process is cyclical, deliberative, flexible (adaptable), client focused, and need oriented, interaction is an essential first consideration for community health nursing. All steps of the nursing process depend on interaction.

11.	When building a coalition, which of the following would the community health nurse do first?
	A)	Conduct a community assessment
	B)	Identify key players
	C)	Identify potential members
	D)	Define goals and objectives
	Ans:	D
	Feedback:
	Steps to coalition building include defining goals and objectives, conducting a community assessment, identifying key players or leaders, and identifying potential coalition members.

12.	When assessing a community’s needs, which of the following would the nurse most likely complete first?
	A)	Familiarization assessment
	B)	Problem-oriented assessment
	C)	Community subsystem assessment
	D)	Comprehensive assessment
	Ans:	A
	Feedback:
	A familiarization assessment is a common starting place in evaluation of a community. It involves studying data already available on a community and then gathering a certain amount of firsthand data in order to gain a working knowledge of the community. A problem-oriented assessment begins with a single problem and assesses the community in terms of that problem. It is commonly used when familiarization is not sufficient and a comprehensive assessment is too expensive. A community subsystem assessment focuses on one dimension of community life. It is a useful way for a team to conduct a more thorough community assessment. A comprehensive assessment seeks to discover all relevant community health information.

13.	When completing a community assets assessment, the community health nurse would gather information about which of the following?
	A)	Key informants
	B)	Strengths of the community
	C)	Specific problem of the community
	D)	Overall life of the community
	Ans:	B
	Feedback:
	An assets assessment focuses on the strengths and capacities of a community rather than its problems. Key informants are important sources of information with a comprehensive assessment. Information about a specific health problem is gathered during a problem-oriented assessment. Information about an overall view of the community and its life is gathered with a familiarization or windshield survey.

14.	Nursing students in a community health nursing course identified toxic waste disposal to be a major problem in their community. The most cost-effective type of community assessment to determine the extent of the problem and the resources available to handle it would be a
	A)	familiarization assessment.
	B)	community subsystem assessment.
	C)	problem-oriented assessment.
	D)	comprehensive community assessment.
	Ans:	C
	Feedback:
	The problem-oriented assessment is commonly used when familiarization is not sufficient and a comprehensive assessment is too expensive and not needed and a subsystem assessment is too narrow to determine the extent of the problem.

15.	A community health nurse involved in assessing community health needs is planning to get a group of approximately 10 similar individuals together to obtain information about opinions on first pregnancies. The nurse is using which assessment method?
	A)	Survey
	B)	Community forum
	C)	Focus group
	D)	Descriptive epidemiology
	Ans:	C
	Feedback:
	The nurse is using a focus group, similar to the community forum or town hall meeting in that it is designed to obtain grassroots opinion. Focus groups usually have only a small group of participants, usually 5 to 15 people and the members chosen for the group are homogeneous with respect to specific demographic variables. A survey involves a series of questions, often to provide a broad range of data. Community forum is a qualitative method to obtain community opinions; the members typically represent all segments of the community involved with the issue. Descriptive epidemiologic studies examine the amount and distribution of a disease or health condition in a population by person, place, and time.

16.	A community health nurse obtains data about the community from primary sources, including which of the following?
	A)	World Health Organization
	B)	Community members
	C)	State health department
	D)	Other community health nurses
	Ans:	B
	Feedback:
	Primary sources of information include community members, including formal leaders, informal leaders, and community members, and can frequently offer the most accurate insights and comprehensive information. Information gathered by talking to people provides primary data, because the data are obtained directly from the community. The World Health Organization is an international source of information. State health department is a state source of data. Other community health nurses as well as health team members, client records, community health (vital) statistics, census bureau data, reference books, and research reports are secondary sources of information.

17.	When developing community diagnoses, which of the following would the community health nurse do?
	A)	Focus primarily on deficits of the community
	B)	Use broad statements to guide a range of interventions
	C)	Employ a revised nursing diagnosis format
	D)	Substitute the terms client, family, group, or aggregate for the word patient
	Ans:	D
	Feedback:
	Community diagnoses should include statements about the strengths of the community and possible sources for community solutions, as well as the community’s weaknesses or problem areas. In addition, they should portray a community focus, include the community response, and identify any related factors that have potential for change through community health nursing. These may also include wellness diagnoses, which indicate maintenance or potential change responses (due to growth and development), when no deficit is present. Diagnoses statements should be narrow enough to guide interventions and use the standard nursing diagnosis format.

18.	During which stage of the health planning process would the community health nurse create a plan?
	A)	Assessment
	B)	Analysis and design
	C)	Implementation
	D)	Evaluation
	Ans:	B
	Feedback:
	During the health planning process, a community health nurse creates a plan during the analysis and design stage, which correlates to the planning phase of the nursing process. Assessment involves data collection, interpretation, and goal setting. Implementation involves how to operationalize the plan and a design for monitoring progress. Evaluation involves examining the costs and benefits, judging the potential outcomes, modifying the plan, presenting the plan to the sponsoring group or agency, and obtaining acceptance.

19.	A community health nurse is engaged in evaluation of a health plan using a formative evaluation. The nurse would focus on which of the following?
	A)	Process during the actual intervention
	B)	Outcomes of the interventions
	C)	Development of performance standards
	D)	Impact on the clients’ health
	Ans:	A
	Feedback:
	The focus of formative evaluation is on process during the actual interventions. It uses performance standards that are developed to determine what is working and not working. Summative evaluation focuses on the outcome of the interventions and examines the programs’ impact on clients’ health.

20.	When applying community development theory, which of the following would most likely be considered the agent of change?
	A)	Clients
	B)	Nurse
	C)	Families
	D)	Community leaders
	Ans:	B
	Feedback:
	When applying community development theory, the agent of change is most often the community health nurse who is considered a partner rather than an authority figure responsible for the community’s health. Clients, families, and community leaders would be the care recipients.

1.	Which of the following would be most appropriate for the community health nurse to do first when planning an initial home visit to a family?
	A)	Obtain the basic supplies that will be needed
	B)	Gather appropriate educational materials
	C)	Contact the family via telephone
	D)	Review the referral information
	Ans:	D
	Feedback:
	The first step is to obtain the referral and review it to gather information about the possible needs of the family and the reason for the visit. Once this is done, then the nurse would obtain the basic supplies and education materials that might be needed and contact the family to arrange the visit.

2.	When planning for a home visit, which of the following would be most helpful to ensure a successful home visit?
	A)	Documentation in a timely manner
	B)	Summarizing the main visit points
	C)	Providing incidental teaching
	D)	Scheduling an appropriate visit time
	Ans:	D
	Feedback:
	As part of planning the community health nurse would contact the family to set up an appropriate time for the visit. Documenting in a timely manner ensures successful evaluation. Providing incidental teaching and summarizing the main visit points help to ensure successful implementation.

3.	A community health nurse arrives at a family’s home. Which of the following would behaviors by the nurse would be nontherapeutic?
	A)	Maintaining eye contact with the family members
	B)	Paging through paperwork for information
	C)	Sitting on the furniture near the family members
	D)	Placing car keys in the nurse’s carryall bag
	Ans:	B
	Feedback:
	Community health nurses, like all nurses, need to be aware of their own body language. Fidgeting with car keys during the entire visit, noisily chewing gum, giving minimal eye contact, continuously looking at or paging through paperwork, appearing rushed, and refusing to sit on any of the furniture are behaviors that tell the family a great deal about the nurse, including how he or she feels about being in their home. These actions are nontherapeutic. Sitting on the furniture near family members demonstrates interest in the family. Placing car keys in the carryall bags prevents inadvertent distractions.

4.	A community health nurse is about to make the first home visit to a family based on a referral from the hospital where the high-risk infant was born to an adolescent mother about 6 days ago. The nurse plans to assess the family and home environment and provide anticipatory guidance. On arrival, the mother sleepily answers the door after the nurse rings the bell and knocks several times. The mother lets the nurse in but is not happy to see the nurse. She gets the infant and places him in the nurse’s arms, then sits across the room and turns on the TV. Which response by the nurse would be most appropriate?
	A)	“You must be very tired caring for a newborn baby.”
	B)	“I wasn’t planning to hold the baby. You should hold him, you are the mother.”
	C)	“I need to talk to you, so please turn off the TV.”
	D)	“How do you feel being a mother at 17?”
	Ans:	A
	Feedback:
	It is always best to acknowledge a client’s feelings, and from the scenario, observations and referral information, being fatigued 6 days after having a baby is very possible. The option about holding the baby is not the best way to respond to the mother or the first comment to make, but holding the baby gives the nurse an opportunity to role model infant interaction and caring and assess his or her cleanliness and clothing appropriateness. However, the nurse may want to say that he or she would like to wash his or her hands before holding the baby. This gives the nurse an additional opportunity to teach and assess another room when washing hands. Asking to turn off the TV might be appropriate after a few moments of introductory conversation. It would be best to ask the mother to turn the TV down because of difficulty hearing her. The nurse will win the mother’s favor with this approach better than by asking her to turn off the TV. Asking how she feels being a mother at 17 might be information to gather, but asking it directly as a first comment sounds like a put-down. There are better ways to obtain this information a bit later in the visit.

5.	While making a family health visit, an older relative who is visiting has been drinking and becomes verbally abusive and increasingly loud. Which action by the community health nurse would be best?
	A)	Continue the visit with caution
	B)	Suggest the relative go in another room and take a nap
	C)	Ask the sober family members to take the visitor home
	D)	Terminate the visit, making plans for another visit
	Ans:	D
	Feedback:
	Terminating the visit is the best choice. It appears the problem is escalating, and the nurse’s safety should always come first. Continuing the visit puts the nurse and possibly the other family members at risk. Making a suggestion to go into another room and take a nap may agitate the relative and make a deteriorating situation worse. Making a suggestion for a family member to take the visitor home may agitate the relative and make a deteriorating situation worse. Additionally, this is the client’s home and the suggestion should be the client’s.

6.	Which of the following things does a nurse who is traveling by automobile to make a home visit need? Select all that apply.
	A)	A full gas tank and well-operating vehicle
	B)	A map that includes the geographic location where the home visit will be made
	C)	A cellular telephone
	D)	A bus schedule
	E)	Exact change
	Ans:	A, B, C
	Feedback:
	A nurse who is traveling by automobile to make a home visit needs the following: a full gas tank and well-operating vehicle, a map that includes the geographic location where the home visit will be made, and a cellular telephone. If the nurse is not using public transportation, the nurse does not need exact change for each bus trip or a bus schedule.

7.	Which of the following are specific safety measures the nurse should apply when making a home visit? Select all that apply.
	A)	Plan to reschedule the visit if you find a large group of people assembled between you and the client’s door.
	B)	Immediately leave the home when family members begin to physically fight with one another.
	C)	Enter the residence before you determine that the family you are intending to visit does live there and is home.
	D)	Travel only in pairs for all home visits.
	E)	If someone approaches you and indicates that they want your nursing bag, throw your bag away from where you are and run in the opposite direction.
	F)	Leave an itinerary of your planned travels, the telephone numbers of families you will attempt to visit and your cellular phone number at your base of operation.
	Ans:	A, B, E, F
	Feedback:
	It is most important to leave an itinerary of your planned travels, the telephone numbers of families you will attempt to visit, and your cellular phone number at your base of operation. Specific safety measures the nurse should apply when making a home visit include planning to reschedule the visit if you find a large group of people assembled between you and the client’s door; immediately leaving the home when family members begin to physically fight with one another; and if someone approaches you and indicates that they want your nursing bag, throw your bag away from where you are and run in the opposite direction. It is not appropriate for the nurse to enter the residence before determining that the family that is to be visited does live there and is home. It is not necessary to travel only in pairs for all home visits.

8.	Which one of the following has a negative influence on family health and individual health?
	A)	The level at which a family functions significantly affects the individual’s level of health.
	B)	A healthy family fosters individual growth and sustains members during times of crisis.
	C)	Family patterns dictate whether members participate in their own health care.
	D)	Individuals can obstruct the family’s health and families can obstruct individual family members’ health.
	Ans:	D
	Feedback:
	A negative influence on family health and individual health is that individuals can obstruct the family’s health and families can obstruct individual family members’ health. The level at which a family functions significantly affects the individual’s level of health; that a healthy family fosters individual growth and sustains members during times of crisis; and the influence of families that dictate whether members participate in their own health care are all positive influences.

9.	When assessing a family, which of the following would lead the nurse to question the health of a family?
	A)	Role relationships are inflexible.
	B)	Coping is actively attempted.
	C)	Family members communicate regularly.
	D)	The family lacks regular links with the broader community.
	Ans:	D
	Feedback:
	In a healthy family, role relationships are structured effectively so that they can change with changing family needs. Active coping, regular family communication, and regular links with the broader community reflect a healthy family.

10.	During a home visit, a client asks the community health nurse to take his or her shopping to purchase some of the food items he or she needs for his or her diet. Which response by the nurse would be most appropriate?
	A)	“I can’t, I’m going in a totally different direction.”
	B)	“You need to find some other way to get to the store.”
	C)	“I’ll help you find a way to get to the store.”
	D)	“Use the foods you have in the house and shop next week.”
	Ans:	C
	Feedback:
	The nurse needs to empower the client and helping the client find a way to get to the store promotes the skill of planning so that the client can begin to manage her own needs effectively. Telling the client that the nurse is going in a different direction, telling him or her to find some other way to get to the store, and telling him or her to use the foods in the house are neither therapeutic nor do they promote empowerment.

11.	A community health nurse, visits an 81-year-old newly diagnosed insulin-dependent diabetic who lives alone. The nurse has visited the family three previous times and is visiting early in the morning to observe his client’s insulin administration technique. The nurse finds the client depressed over his or her situation one morning. The nurse suggests that together they list positive points about his or her situation and discuss his or her feelings. This is an example of which of the following?
	A)	Strengthening
	B)	Data collection
	C)	Goal-directed questioning
	D)	Measuring family functioning
	Ans:	A
	Feedback:
	The nurse is demonstrating a communication technique called strengthening which is used to assist the family in becoming independent of the nurse’s services. Data collection, goal-directed questioning, and measurement of family function are methods used for assessment.

12.	Which one of the following is a principle that guides and enhances family nursing practice?
	A)	The nurse should expect that the family will be normal and will not change.
	B)	The nurse should start where the family is at the present time and not the ideal level of functioning.
	C)	The nurse should focus on each family member individually.
	D)	The nurse should evaluate the family based on consistency with traditional family patterns.
	Ans:	B
	Feedback:
	When working with families, community health nurses begin at the present, not the ideal level of functioning. This is accomplished after the nurse views the family collectively, not individually. The nurse should expect that what is normal for one family is not necessarily normal for another and that families are constantly changing. The nurse should recognize the validity of family structure variations.

13.	A community health nurse is attempting to empower a family to become independent. Which of the following would be most appropriate?
	A)	Focus attention on the problem areas
	B)	Do for the family what they cannot
	C)	Emphasize the family’s strengths
	D)	Reinforce positive traits
	Ans:	C
	Feedback:
	To help empower families, the community health nurse needs to emphasize the family’s strengths. It is the nurse’s job to recognize the strengths in families and to help families recognize them as well. Focusing on problem areas portrays a negative view and can undermine the nurse’s efforts. Doing for the family what they cannot fosters dependency. Reinforcing positive traits may be appropriate if those positive traits are strengths. Not all positive traits are strengths.

14.	A community health nurse is applying an interactional framework to assess a family’s health. Which of the following would the nurse do?
	A)	View them in terms of the family’s internal relationships
	B)	Look at them from a life-cycle perspective
	C)	Evaluate the members’ changing roles and tasks
	D)	Assess them as a social system relating to other social systems
	Ans:	A
	Feedback:
	An interactional framework describes the family as a unit of interacting personalities and emphasizes communication, roles, conflict, coping patterns, and decision-making processes. A developmental framework studies the family from a life-cycle perspective by examining the members’ changing roles and tasks in each progressive stage. A structural–functional framework describes the family as a social system relating to other social systems in the environment.

15.	A community health nurse constructs an eco-map for a family based on the understanding that this tool is useful for which reason?
	A)	Family relationships over three or more generations are depicted.
	B)	The ecological system of a family’s neighborhood is charted.
	C)	It was originally devised to depict the complexity of the client’s story.
	D)	Directions for gathering data about neighborhoods are provided.
	Ans:	C
	Feedback:
	An eco-map depicts the complexity of the client’s story. Lines are drawn to indicate connections to other systems with arrows signifying the direction of energy or flow of resources, and the absence of lines indicates a lack of connections. The family’s neighborhood is one component, but not the central focus of the eco-map. A genogram displays family information about complex family patterns such as family relationships over three or more generations, arrows signify the direction of energy or flow of resources, and absence of lines indicates a lack of connections.

16.	A community health nurse is collecting data about the family’s demographics. Which of the following would the nurse include? Select all that apply.
	A)	Dietary patterns
	B)	Housing
	C)	Climate
	D)	Socioeconomic status
	E)	Education of members
	F)	Ethnicity
	Ans:	D, E, F
	Feedback:
	Family demographics refer to such descriptive variables as a family’s composition, its socioeconomic status, and the ages, education, occupation, ethnicity, and religious affiliations of members. Dietary patterns, housing, and climate are variables assessed with the physical environment.

17.	When a community health nurse is conducting a family assessment on an assigned family, which of the following would be most appropriate?
	A)	Use quantitative data only to maintain and preserve objectivity
	B)	Interview one family member to avoid confusion and repeated information
	C)	Use a checklist format, completing the tool in the family’s presence
	D)	Make several visits and accumulate data from all family members
	Ans:	D
	Feedback:
	Completing a family assessment takes time. It is better to keep notes from several visits with the family and observe the family as a group during some family activity. The nurse should not use obtrusive questionnaire techniques or take notes in the family’s presence. Quantitative data will give a one-sided view of family data. It is best to interview all family members over time. The nurse should collect both quantitative and qualitative data, which will provide a rich family assessment.

18.	During a home visit and assessment of an infant and new mother, the nurse determines that the infant looks healthy. The mother asks several questions and listens attentively. One question she asks is whether the nurse is going to visit her again. Which response would be most appropriate?
	A)	“Your baby looks healthy. You should not have any further questions.”
	B)	“The agency limits the number of visits I can make; I will let you know.”
	C)	“I plan to visit again. What would you like to accomplish at the next visit.”
	D)	“I can come weekly for the next 16 weeks, and then a staff nurse will visit.”
	Ans:	C
	Feedback:
	The response about what the client wants to accomplish together represents a mutual approach, giving power to the client and hints at accomplishing things together on subsequent visits. Noting that the infant looks good and that the mother should not have further questions is closed-ended and nurse-focused and does not promote open communication between the client and the nurse. The option about limiting visits is inaccurate; the nurse has more control over the number of visits than this response implies, unless the visit is part of a special and very limited program. Even then it would not be phrased this way. The final option about 16 weekly visits followed by a staff nurse sounds overwhelming and unrealistic. Very few clients receive this much service from public health agencies.

19.	A community health nurse determines that it is time for teaching a family about health promotion activities when they say which of the following?
	A)	“Is there a place we can go for the medicine?”
	B)	“It’s time we do something about eating right.”
	C)	“When are you coming back to visit?”
	D)	“Our grandchildren visit every summer.”
	Ans:	B
	Feedback:
	Teaching health promotion activities should begin only after family members express an interest and recognize a need, such as the statement about eating right. Asking about where to get medicine and when the nurse is coming back do not reflect an interest or need. The statement about grandchildren reflects information about the family structure and demographics.

20.	Which of the following would a community health nurse use when conducting an outcome evaluation?
	A)	Organization
	B)	Family progress
	C)	Timing
	D)	Performance
	Ans:	B
	Feedback:
	Outcome evaluation involves determining the change in the family’s health status or progress. Organization and timing are components of the structure–process evaluation. Performance is part of self-evaluation.

21.	The nurse educator knows that the nursing student has grasped the concept of self-evaluation when the nursing student makes which one of the following statements?
	A)	It is important for the family to evaluate itself.
	B)	It is important for the nurse’s growth and effectiveness as a community health nurse.
	C)	Evaluations by others are not helpful.
	D)	Individuals can always see their own strengths or flaws.
	Ans:	B
	Feedback:
	Self-evaluation is important for the nurse’s growth and effectiveness as a community health nurse. Self-evaluation is referring to the nurse’s growth and not the family’s. Sometimes, we cannot see our own strengths or flaws, and evaluations by others are helpful.

1.	Critical population health indicators that affect childbearing women, infant, toddler, and preschool populations globally and in the United States include which of the following? Select all that apply.
	A)	Maternal mortality rate
	B)	Infant mortality rate
	C)	HIV/AIDS
	D)	Crude mortality rate
	E)	Fetal alcohol syndrome
	Ans:	A, B, C, E
	Feedback:
	Critical population health indicators that affect childbearing women, infant, toddler, and preschool populations globally and in the United States include maternal mortality rate, infant mortality rate, HIV/AIDS, and fetal alcohol syndrome. Crude mortality rate does not apply specifically to childbearing women, infant, toddler, and preschool populations.

2.	Which one of the following statements about low-birth-weight and very-low-birth-weight babies is most accurate?
	A)	Low-birth-weight is more common in Whites and Hispanics than African Americans.
	B)	Birth weight is one of the most important predictors of infant mortality.
	C)	The incidence of low-birth-weight in the United States is decreasing in relation to the increase in multiple births.
	D)	Recent trends in very-low-birth-weight babies show that they continue to have morbidity with significant increases in survival.
	Ans:	B
	Feedback:
	Birth weight is one of the most important predictors of infant mortality. Low birth weight is more common in African Americans than in Whites and Hispanics. The overall incidence of low-birth-weight is increasing slightly, which can be explained by increased multiple births. Recent trends in very-low-birth-weight babies show that they continue to have morbidity with no significant increases in survival.

3.	A community health nurse is developing a program that would encourage mothers to use breast-feeding exclusively for their babies’ nutrition for the first 6 months. The nurse bases this program on the understanding about which of the following?
	A)	Exclusive breast-feeding promotes better growth and development.
	B)	Its lower cost provides more money for other needed items.
	C)	Infant mortality would significantly decrease.
	D)	It would aid in decreasing maternal mortality rates.
	Ans:	C
	Feedback:
	Approximately 1.3 million infants would survive annually if mothers were able to exclusively breast-feed their infants for 6 months. The lack of breast-feeding is related to decreased survival and increased morbidity from infections, lower intelligence test scores, increased cardiac risk factors, and inadequate nutrition. The superiority of breast milk and lower costs would not be factors for developing a community health program for breast-feeding. Exclusive breast-feeding is not associated with decreasing maternal mortality rates.

4.	A community health nurse is integrating the Healthy People 2010 goals into suggested programs for a local community. Which of the following goals would the nurse identify as having been met?
	A)	Reduction in low-birth-weight infants
	B)	Reduction in total preterm births
	C)	Increase in the number of infants put to sleep on their backs
	D)	Increased proportion of mothers breast-feeding at 6 months
	Ans:	C
	Feedback:
	After years of working toward improving maternal–child health, the United States has made limited progress. One objective, however, has been met: 70% of infants are now being put to sleep on their backs (up from 35% baseline), largely due to public health educational efforts and reminders. Objectives for LBW, VLBW, and preterm births all moved away from their Healthy People 2010 targets. Breast-feeding is beneficial to both mother and infant, and in 2005, almost 73% of infants were breast-fed for some period of time. However, the goal has not been met.

5.	Which Healthy People 2020 goal that has been established has been met?
	A)	The number of infants being put to sleep on their backs and the rate for sudden infant death syndrome
	B)	Improving the proportion of infants who are breast-fed
	C)	Reduce the rate of fetal and infant deaths
	D)	Reduce the occurrence of fetal alcohol syndrome
	Ans:	A
	Feedback:
	After years of working toward improving maternal–child health, the United States has made limited progress. One objective, however, has been met; 70% of infants are now being put to sleep on their backs, up from a 35% baseline. The rate for sudden infant death syndrome (SIDS) had dropped by over 50% since 1994. The proportion of infants who are breast-fed and reducing the rate of fetal and infant deaths and occurrence of fetal alcohol syndrome have not been met.

6.	A community health nurse is providing a class for pregnant women about the dangers of alcohol consumption during pregnancy. Which of the following would the nurse include as an effect on the newborn? Select all that apply.
	A)	Intellectual impairment
	B)	Low-birth-weight
	C)	Leukemia
	D)	Respiratory distress
	E)	Altered growth and development
	F)	Childhood cancers
	Ans:	A, B, E
	Feedback:
	The health of infants can be dramatically affected by maternal consumption of alcohol. The pregnancy itself can be threatened. However, the most devastating consequence of alcohol consumption during pregnancy is fetal alcohol spectrum disorders (FASD) and fetal alcohol syndrome (FAS), both of which compromise the intellectual functioning, birth weight, and altered growth and development of the infant or child. Respiratory distress, leukemia, and other childhood cancers are not associated with maternal alcohol consumption.

7.	A community health nurse is working with a group of pregnant women in the community to reduce lifestyle risk factors associated with low-birth-weight newborns and infant mortality. Which of the following would the nurse address?
	A)	Multiparity
	B)	College level education
	C)	Environmental toxins
	D)	Single gestation pregnancy
	Ans:	C
	Feedback:
	Environmental toxins are lifestyle risk factors associated with low-birth-weight newborns and infant mortality. Other risk factors include primiparity, low educational level, and multiple gestation among others.

8.	A community health nurse visits a local women’s health center to provide teaching about the effects of smoking during pregnancy. After teaching the class, the nurse determines that the women have understood the teaching when they identify which of the following as a possible maternal or infant effect?
	A)	Low-birth-weight newborns
	B)	Newborn feeding problems
	C)	Genetic malformations
	D)	Developmental delays
	Ans:	A
	Feedback:
	One of the strongest predictors of both LBW and preterm birth is maternal smoking. Other studies have shown that there is a greater incidence of stillbirths, spontaneous abortions, and perinatal mortality in pregnancies in which women smoke. Smoking during pregnancy is not associated with genetic malformations, developmental delays, or feeding problems.

9.	A local community health center is providing classes to childbearing families about the effects of alcohol use during pregnancy. During one of the classes, a community health nurse describes fetal alcohol spectrum disorder (FASD). Which of the following would the nurse include as a common finding in the newborn?
	A)	Large for gestational age
	B)	Facial abnormalities
	C)	Hypoactive behavior
	D)	Enhanced intellectual development
	Ans:	B
	Feedback:
	A newborn with FASD typically exhibits facial abnormalities, is small for gestational age, demonstrates hyperactivity and intellectual impairment.

10.	While providing preconception counseling to a group of women, the community health nurse emphasizes the need for adequate weight gain during pregnancy based on the understanding of which of the following?
	A)	Maternal nutritional habits do not affect later life.
	B)	Inadequate weight gain increases the woman’s risk for cesarean birth.
	C)	Prolonged labor can occur with too little or too much weight gain.
	D)	Adequate weight gain is positively correlated with normal birth weight.
	Ans:	D
	Feedback:
	Research has demonstrated a positive correlation between weight gain during pregnancy and normal birth weight in babies. Inadequate weight gain is related to LBW, premature births, and perinatal mortality. Gaining large amounts of weight can also cause problems at birth, including increased numbers of cesarean deliveries, large-for-gestational-age babies, along with the mother’s retention of excessive weight. Maternal nutritional habits set gene switches that affect later life.

11.	After teaching a group of pregnant women about the need for proper oral health during pregnancy, which of the following statements by the group indicates the need for additional teaching?
	A)	“We should continue seeing the dentist like we always do.”
	B)	“Chewing sugar-free gum is okay even with the pregnancy.”
	C)	“If we need dental work, we can postpone it until after the birth.”
	D)	“Flossing and brushing are just as important now as before.”
	Ans:	C
	Feedback:
	Postponing dental work is inappropriate. Dental health procedures have generally been found to be effective and safe for pregnant women, especially during the second trimester. Statements about the importance of regular dental health checkups and proper dental hygiene, along with referrals for dental treatment when needed, indicate effective teaching. Sugar-free gums that contain xylitol and chlorhexidine may be helpful in reducing the maternal–child transmission of caries-causing bacteria.

12.	What are the roles that public and community health nurses need to enact in order to maximize the outcome for pregnant adolescents? Select all that apply.
	A)	Clinician
	B)	Educator
	C)	Counselor
	D)	Provider of referrals
	E)	Friend
	Ans:	A, B, C, D
	Feedback:
	Roles that public and community health nurses need to enact in order to maximize the outcome for pregnant adolescents include clinician, educator, counselor, and provider of referrals. It is not appropriate for the nurse to enact the role of friend with pregnant adolescent clients or any other client.

13.	A pregnant woman with hypertensive disease comes to the community health center for follow up. Which of the following would be appropriate to include when teaching the woman about controlling her blood pressure at this time?
	A)	Ensuring rest periods with legs elevated
	B)	Limiting her daily intake of fluid
	C)	Restricting intake of fresh fruits
	D)	Encouraging additional weight gain
	Ans:	A
	Feedback:
	Various methods are employed to attempt to prevent and control hypertension during pregnancy, namely, a diet rich in fresh fruits and vegetables, adequate fluid intake, weight gain limitations, rest, and regular exercise. These remain the most common preventive suggestions that community health nurses, in collaboration with the clients’ primary health care providers, can give to their pregnant clients. A calm environment, along with periods of rest with the pregnant woman either elevating her feet or reclining in a left side-lying position, is also recommended.

14.	During a home postpartum visit, a community health nurse suspects that the woman is experiencing depression. Which of the following responses would be most appropriate?
	A)	“You should try drinking more caffeine to help you be less tired.”
	B)	“Don’t worry. Good mothers don’t hurt their babies.”
	C)	“Try napping when the baby is napping.”
	D)	“You should be able to achieve perfection with housekeeping tasks while you are still on maternity leave.”
	Ans:	C
	Feedback:
	Getting adequate sleep is important, because sleep deprivation exacerbates psychiatric symptoms. Napping when the baby naps, resting when possible throughout the day, and going to bed early (albeit with the knowledge that sleep may be interrupted two or more times to feed the infant) will provide more hours of rest and sleep. Caffeine can lead to sleep disturbance, and alcohol is a depressant that has been implicated in depression. The elimination of both is a simple yet helpful suggestion. The statement about telling the woman not worry discounts her feelings. In addition, it also may increase her anxiety because she may be worried about hurting the baby. The statement about ability to achieve perfection with housekeeping tasks while on maternity leave is counterproductive as it has been recently identified perfectionism increases the risk for postpartum depression.

15.	After teaching a group of students about various community nutritional programs, the instructor determines that the teaching has been successful when the students identify which of the following as a result of the WIC program?
	A)	Increased expenditures for health care
	B)	Decreased rates of large for gestational age babies
	C)	Reduced rates of infant iron deficiency anemia
	D)	Drop in breast-feeding rates
	Ans:	C
	Feedback:
	In addition to supporting women and young children with nutritious foods and achieving the initial goals of decreasing the rates of preterm and LBW babies, increasing the length of pregnancy, and reducing the incidence of infant and child iron deficiency anemia, WIC also increases breast-feeding rates and improves pregnant women’s nutritional status.

16.	A group of nursing students are studying for a test on child health statistics. The students demonstrate that they are prepared for the test when they identify which of the following as a major cause of death in the 1- to 4-year-old population.
	A)	Pneumonia
	B)	Poverty
	C)	Unintentional injuries and homicide
	D)	Heart disease
	Ans:	C
	Feedback:
	Unintentional injuries and homicide cause most of the deaths for the 1- to 4-year-old population: motor vehicle crashes, falls, drowning, fires, and burns. Pneumonia is not a major cause of death among children. Poverty contributes to morbidity and mortality but is not a cause of death in and of itself. Heart disease is the fourth leading cause of death among young children.

17.	A community health nurse is developing a plan to address the nutritional needs of infants, toddlers, and preschoolers. Which of the following would the nurse need to incorporate as a major issue associated with nutritional problems?
	A)	Life in the culture of poverty
	B)	Overfeeding of an infant
	C)	Cultural food preferences
	D)	Rapid growth spurts
	Ans:	B
	Feedback:
	Overfeeding an infant can lead to childhood obesity and becomes a risk factor for heart disease, hypertension, and diabetes. Many parents overfeed infants and toddlers and allow preschool-aged children to make inappropriate food choices, which can lead to a lifetime of nutritional problems. Poverty may limit food choices and selection of inappropriate foods; however, poverty itself does not cause nutritional problems. Although there are major differences in food preferences and eating practices among different cultural groups, they do not account for nutritional problems. Growth spurts in young children often are marked by changes in appetite, but it is the quality of the food that can cause the nutritional problems rather than the changes in quantity.

18.	A community health nurse implements a teaching program for new parents about ways to reduce infant mortality. Which suggestion would the nurse include as most important?
	A)	“Never leave the infant alone on a dressing table or couch.”
	B)	“Check the temperature of the bath water before bathing.”
	C)	“Stay within an arm’s length when the baby is in the tub.”
	D)	“Put the infant to sleep on his or her back.”
	Ans:	D
	Feedback:
	Suffocation is the leading cause of death in infants. Therefore, the suggestion to put the baby to sleep on the back is a major preventive measure and the most important. Never leaving the infant alone would reduce the risk for falls, a leading case of nonfatal injuries for infants. Checking bath water temperature is appropriate to prevent burns. Staying within an arm’s length while bathing is a suggestion to prevent drowning.

19.	A community health nurse is involved in a screening program for lead exposure. The nurse would target this program primarily to which age group?
	A)	Birth to -year-olds
	B)	– to 3-year-olds
	C)	3- to 5-year-olds
	D)	5- to 7-year-olds
	Ans:	B
	Feedback:
	The critical age of lead exposure (or peak level) is thought to be between 18 and 36 months. Levels generally begin to decline after age 3.

20.	Which of the following issues motivated the increased doses of certain vaccines and reformulated vaccines at the start of the 21st century? Select all that apply.
	A)	Increased virulence of the vaccine-preventable disease causative organisms
	B)	Pertussis immunity was found to wane with age so the vaccine was reformulated to cocoon infants by immunizing the adults around them to prevent exposure of infants.
	C)	Varicella vaccine given in two doses has been found to increase immunity.
	D)	Measles outbreaks were identified in populations where parents had refused MMR vaccination for their children and received personal belief exemptions.
	Ans:	B, C, D
	Feedback:
	The following issues motivated the increased doses of certain vaccines and reformulated vaccines at the start of the 21st century. Pertussis immunity was found to wane with age so the vaccine was reformulated to cocoon infants by immunizing the adults around them to prevent exposure of infants; varicella vaccine given in two doses has been found to increase immunity and measles outbreaks were identified in populations where parents had refused MMR vaccination for their children and received personal belief exemptions. There is no evidence that the vaccine preventable disease causative organisms have increased virulence.

21.	A community health nurse is making a family home visit. The family consists of the mother, father, 1-year-old, and 4-year-old. The mother states that the 4-year-old who is in preschool had a cold last week and now the 1-year-old has it. She asks the nurse if she can use the over-the-counter cold medication that she gave to the 4-year-old for the 1-year-old. Which response would be most appropriate?
	A)	“It shouldn’t be a problem if you use that same medication for the 1-year-old.”
	B)	“I don’t know if the medicine will work, but you can try it and see.”
	C)	“That type of medicine should not be used in children under age 2.”
	D)	“You should use a smaller dose but watch if it makes him irritable.”
	Ans:	C
	Feedback:
	Community health nurses need to emphasize that over-the-counter cough and cold medications should not be used for children under age 2. The Food and Drug Administration (FDA) deemed them unsafe and ineffective and most manufacturers took them off the market in fall of 2007 in response to emergency room visits and deaths linked to their toxic effects. Therefore, the nurse would tell the mother not to use the medicine since the child is only a 1-year-old.

22.	A community health nurse is working with a group of parents who have infants and toddlers. Which of the following would the nurse include in a teaching plan for this group about reducing dental caries?
	A)	Serving sugary foods at mealtimes and not snacks
	B)	Providing juice in a sippy cup between meals
	C)	Allowing the older infant to fall asleep with a bottle
	D)	Permitting snacking throughout the day
	Ans:	A
	Feedback:
	It is recommended that sugary foods be eaten at mealtimes and not as snacks, and that regular snack times be established. Between-meal drinks should consist of water or milk. Juice should be given only with meals. Allowing infants to fall asleep with a bottle can lead to baby bottle tooth decay or nursing caries.

23.	Which of the following would be appropriate as secondary prevention level activities focusing on child abuse and neglect?
	A)	Prenatal parent preparation classes
	B)	Public service announcements for positive parenting
	C)	Education to improve family functioning skills
	D)	Respite care for families with special needs children
	Ans:	D
	Feedback:
	Providing respite care for families with special needs children is an example of a secondary prevention action. Prenatal parent preparation classes, public service announcements, and education to improve family functioning skills are examples of primary prevention level activities.

24.	As one aspect of ensuring adequate brain development in a child, a community health nurse would encourage the intake of which during the first 2 years of life?
	A)	Vitamins
	B)	Fats
	C)	Protein
	D)	Carbohydrates
	Ans:	B
	Feedback:
	During the first 2 years, when rapid myelination is taking place, 50% of total calories should come from fat, but after age 2, the choice of 1% or 2% milk—should be the norm. A well-balanced diet including an adequate intake of vitamins, protein, and carbohydrates is needed for overall growth and development.

1.	A community health nurse is working with other professionals to develop preventive programs to address the leading cause of death in men and women. Which of the following would be appropriate?
	A)	Risk reduction for heart disease
	B)	Cancer screening
	C)	Safety education
	D)	Flu vaccine immunization
	Ans:	A
	Feedback:
	The leading cause of death for men and women is heart disease. Therefore, risk reduction for heart disease would be most appropriate. Cancer screening, safety education, and flu vaccine immunization would be appropriate for cancer, the second leading cause of death; unintentional injuries, the third leading cause of death in men; and influenza and pneumonia, the eighth leading cause of death in men and women respectively.

2.	When developing teaching programs for a community of adult men and women, which of the following would the community health nurse identify as a key aspect for this community’s ability to follow through with the teaching?
	A)	Life expectancy
	B)	Health disparity
	C)	Health literacy
	D)	Financial ability
	Ans:	C
	Feedback:
	Health literacy is a critical aspect of managing health problems and a key to being able to read and understand health information so that individuals can follow through and make appropriate health decisions. Low health literacy also contributes to health disparities, a difference in health status due to sex, race, or ethnicity. Life expectancy is the average number of years an individual member is projected to live. It is a standard measurement unrelated to the ability to follow through with teaching. Financial ability may impact a person’s ability to obtain needed services, but it is not a key aspect.

3.	When assessing a population for health disparities, which of the following would the nurse least likely evaluate?
	A)	Race
	B)	Education
	C)	Age
	D)	Sexual orientation
	Ans:	C
	Feedback:
	A health disparity is defined as a difference in health status that occurs by sex, race or ethnicity, education or income, disability, geographic location, or sexual orientation. Age would not be used to assess health disparity.

4.	Which one of the following statements about life expectancy is most accurate?
	A)	The life expectancy for White women is 4 years greater than for Black women.
	B)	The life expectancy for Black men is 6 years greater than for White men.
	C)	In the United States, life expectancy continues to decline.
	D)	There is a gap in life expectancy between women and men of more than 6 years.
	Ans:	A
	Feedback:
	The life expectancy for White women is 4 years greater than for Black women. The life expectancy for White men is 6 years greater than for Black men. In the United States, life expectancy continues to increase consistently over time. The gap in life expectancy between women and men was 5.0 years in 2007.

5.	A community health nurse is working with a grant funded project to address stroke prevention nationwide. After reviewing statistics related to stroke, which would the nurse identify as having the greatest need for this type of program?
	A)	North central
	B)	Southeast
	C)	Southwest
	D)	Pacific northwest
	Ans:	B
	Feedback:
	The nurse would identify the southeast as the area of greatest need because here. Known as the stroke belt, stroke death rates for both Blacks and Whites are higher than in any other part of the country.

6.	The nurse educator is aware that the nursing student has a grasp of the major health problems of adults when the nursing student makes which one of the following statements?
	A)	“Morbidity and mortality among adults does not vary much by age, gender, and race/ethnicity.”
	B)	“The six leading causes of death in adults include suicide, Alzheimer’s disease, and homicide.”
	C)	“Diseases of the heart and cerebrovascular diseases are the first and third causes of death in adults.”
	D)	“Malignant neoplasms, chronic lower respiratory diseases, unintentional injuries, and diabetes mellitus are not among the six leading causes of death in adults.”
	Ans:	C
	Feedback:
	The following statement is true: “Diseases of the heart and cerebrovascular diseases are the first and third causes of death in adults.” Morbidity and mortality among adults varies substantially by age, gender, and race/ethnicity. Malignant neoplasms, chronic lower respiratory diseases, unintentional injuries, and diabetes mellitus are among the six leading causes of death in adults. Causes of death in adults that are not among the six leading causes of death include suicide, Alzheimer’s disease, and homicide.

7.	The following is a list of the top five causes of unintentional injuries accounting for the majority of adults deaths due to injury. Order these in their proper sequence from first to fifth. A) Fire arms B) Suffocation C) Motor vehicle crashes D) Poisoning E) Falls
	Ans:	C, A, D, E, B
	Feedback:
	The top five causes of unintentional injuries include motor vehicle crashes, fire arms, poisoning, falls, and suffocation. Together, these causes account for approximately 80% of all injury deaths.

8.	A community health nurse is preparing a presentation about drug use and abuse for a group of adults. Which of the following would the nurse include as the one of the fastest growing forms of drug abuse?
	A)	Cocaine
	B)	Alcohol
	C)	Prescription drugs
	D)	Heroin
	Ans:	C
	Feedback:
	Illegal use of prescription drugs is one of the fastest growing forms of drug abuse, and it is becoming a major public health concern. The primary illicit drugs used in the United States, such as cocaine and heroin, have and continue to be a public health problem. Alcohol abuse also is a public health problem and is considered the third leading lifestyle-related cause of death for people living in the United States.

9.	After teaching a group of students about the major types of cancer affecting men and women, the instructor determines that the teaching was successful when the students identify which of the following as the number one cause of cancer deaths among adults?
	A)	Colon
	B)	Pancreatic
	C)	Esophageal
	D)	Lung
	Ans:	D
	Feedback:
	Lung and bronchus cancers are the number one cause of cancer deaths among adults. Colon and rectal cancers are the third most common cancers in adults. Pancreatic and esophageal cancers are less common causes of cancer death.

10.	A patient comes to the community health clinic with complaints of changes in urination. Which of the following would lead the community health nurse to suspect that the patient has benign prostatic hypertrophy (BPH)?
	A)	Nighttime frequency
	B)	Dysuria
	C)	Hematuria
	D)	Flank pain
	Ans:	A
	Feedback:
	The symptoms of BPH vary, but the most common ones involve changes or problems with urination, such as hesitant, interrupted, or weak urinary stream; urgency or leaking of urine; and more frequent urination, especially at night. Dysuria may indicate a urinary tract infection. Hematuria could suggest a variety of problems, such as infection calculi, or cancer. Flank pain may indicate conditions such as pyelonephritis or renal calculi.

11.	When developing community health programs target to adult men, which of the following would the nurse need to integrate into the plan?
	A)	Improved quality of education programs available for men
	B)	Increased access of health services by men as compared to women
	C)	Limited male-gender specific research
	D)	Increased awareness of men’s health issues
	Ans:	C
	Feedback:
	The current state of men’s health involves a lack of quality health education programs for men, health care services that are only accessed half as much by men when compared to women, and a lack of male gender-specific research. In addition, awareness of men’s health issues is lacking. Currently, there is no Office on Men’s Health in the U.S. Department of Health and Human Services; legislation to establish such an office has been introduced; however, the bill did not progress out of the congressional subcommittee on health and has not been reintroduced.

12.	A community health nurse is reviewing research related to women’s health. Which of the following would the nurse use to obtain information about postmenopausal women’s health?
	A)	The Women’s Health Study
	B)	The Women’s Health Initiative
	C)	The Nurses’ Health Study I
	D)	The Nurses’ Health Study II
	Ans:	B
	Feedback:
	The nurse would use The Women’s Health Initiative. This study was a major 15-year research program addressing the most common causes of death, disability, and poor quality of life in postmenopausal women—CVD, cancer, and osteoporosis. The Women’s Health Study evaluated the effects of vitamin E and low-dose aspirin therapy in primary prevention of CVD and cancer in apparently healthy women. The Nurses’ Health Study I investigated the potential long-term consequences of the use of oral contraceptives. The Nurses’ Health Study II studied oral contraceptives, diet, and lifestyle risk factors in a population younger than the original Nurses’ Health Study cohort.

13.	While working in a community health clinic, a community health nurse interviews a 24-year-old client. Which of the following would lead the nurse to suspect that the client is binge eating?
	A)	Significant weight loss from dieting last year
	B)	Participation in excessive exercise
	C)	Exaggerated concern about body shape
	D)	Severe emaciation
	Ans:	A
	Feedback:
	Binge eating is an eating disorder that is characterized by repeated episodes of uncontrolled eating. It usually starts following significant weight loss from dieting. Typically, individuals with this disorder eat quickly, eat until they are uncomfortably full, eat when they are not hungry, eat large amounts of food alone, have difficulty expressing their feelings, have difficulty controlling impulses and stress, and feel depressed about overeating. Participation in excessive exercise and an exaggerated concern about body shape is usually associated with bulimia. Severe emaciation is associated with anorexia.

14.	Which of the following statements by a women’s group indicates that they have understood the teaching about heart disease and women?
	A)	“More women die of breast cancer than heart disease.”
	B)	“Women experience similar symptoms as men.”
	C)	“Hormone replacement therapy protects the heart.”
	D)	“Heart disease is the number one killer of women.”
	Ans:	D
	Feedback:
	Heart disease is the number one killer of women. One in 2.6 female deaths is from cardiovascular disease, compared to 1 in 30 from breast cancer. Women have atypical symptoms or less acute chest pain than men, often leading them to delay care. Hormone therapy does not reduce coronary events.

15.	Which one of the following statements about coronary heart disease and stroke are most accurate?
	A)	Cardiovascular disease kills more women than men.
	B)	Stroke kills more men than women.
	C)	White persons are more likely to have their first stroke earlier than Black persons.
	D)	Risk factors for cardiovascular disease are not known.
	Ans:	A
	Feedback:
	Cardiovascular disease kills more women than men. Stroke kills more women than men. Black persons are more likely to have their first stroke earlier than White persons. Risk factors for cardiovascular disease are known. Some are controllable such as lifestyle, and some are uncontrollable such as heredity.

16.	A community health nurse working in a local women’s health clinic is planning a teaching session for a group of women about menopause. Which of the following would the nurse include in the session?
	A)	Menopause involves very noticeable and characteristic symptoms.
	B)	The symptoms are usually temporary lasting for a month or two.
	C)	It can occur as early as age 30 but more commonly ages 45 to 55 years.
	D)	Going 6 months without a period signals menopause.
	Ans:	C
	Feedback:
	Menopause is a time that marks the permanent cessation of menstrual activity. It usually occurs between the ages of 45 and 55 years. However, it can occur as early as age 30. Symptoms of menopause vary among women and last from months to years. They range from hardly noticeable in some women to very severe in others. Natural menopause is when a woman has not had a period in 12 months (no other apparent causes).

17.	During a home visit to a family, a community health nurse encourages the mother, aged 42, and grandmother, aged 67, to have a clinical breast exam at which frequency?
	A)	Monthly
	B)	Yearly
	C)	Every 2 years
	D)	Every 3 years
	Ans:	B
	Feedback:
	Clinical breast exams, performed by a health care provider should be done every year for each of these women. They should also perform breast self-exam every month. The mother at her current age should have a physical examination every 2 years. Both the mother and grandmother should have a pelvic exam and Pap smear done every 3 years after three consecutive negative Pap smears.

18.	As part of a health screening program, a community health nurse determines that a client is infected with the human papilloma virus (HPV). The community health nurse encourages the client to do which of the following?
	A)	Get a mammogram immediately
	B)	Have her blood glucose level checked
	C)	Undergo testing for a breast cancer gene
	D)	Have a pelvic examination and Pap smear
	Ans:	D
	Feedback:
	Infection with certain types of human papilloma virus is associated with an increase risk for developing cervical cancer. Pap smears have improved early detection and prevention of cervical cancer dramatically. HPV infection is not associated with breast cancer, so there is no need for a mammography or testing for a breast cancer gene. HPV is not associated with diabetes so blood glucose testing is not indicated.

19.	A nurse is instructing the adult male members of a family on how to perform testicular self examination. Which of the following would the nurse include?
	A)	Performing the examination every 3 months
	B)	Completing the exam right after a hot shower
	C)	Examining both testicles at the same time
	D)	Reporting a slight difference in size of one testicle
	Ans:	B
	Feedback:
	A testicular self-examination should be performed monthly right after a hot shower or bath. One testicle is examined at a time. One testicle, usually the right one, is normally slightly larger than the other.

20.	Which one of the following statements best describes the role of the community health nurse in promoting the health of adult men 35 to 65 years of age?
	A)	Anticipatory guidance to men approaching each stage and help them with ways to manage life more effectively.
	B)	Men of this age do not need to enhance their self-care skills.
	C)	A positive attitude toward aging is not helpful to men at this time in their lives.
	D)	Men of this age should exercise sporadically.
	Ans:	C
	Feedback:
	The community health nurse can provide anticipatory guidance to men approaching this stage and help them with ways to manage life more successfully. Successful navigating this stage of life can be fulfilling but may require a man to enhance his self-care skills. This includes having a positive attitude toward aging, one that examines the benefits of maturity, finds a balance between work and home, and maintains a healthy lifestyle by eating balanced meals and obtaining regular exercise.

21.	When developing a plan of care for a group of male patients experiencing erectile dysfunction, which of the following would the nurse expect to institute first?
	A)	Lifestyle changes
	B)	Adjustments to current medications
	C)	Psychotherapy
	D)	Behavior modification
	Ans:	A
	Feedback:
	Treatment for ED usually proceeds from least to most invasive. For some men, making a few healthy lifestyle changes may solve the problem. Smoking cessation, weight loss, and increased physical activity may help some men regain sexual function. Cutting back on any drugs with harmful side effects is considered next. For example, drugs for high blood pressure work in different ways. If a particular drug is causing problems with erection, a different class of blood pressure medicine might work just as well. Medications, psychotherapy and behavior modifications would follow.

22.	Which of the following would a community health nurse recommend adult men and women over the age of 50 receive yearly?
	A)	Electrocardiogram
	B)	Tetanus booster
	C)	Flexible endoscopy
	D)	Hemoccult stool testing
	Ans:	D
	Feedback:
	Men and women over the age of 50 should receive yearly physical exams and hemoccult stool testing, electrocardiograms every 3 years, tetanus booster every 10 years, and flexible endoscopy every 3 to 4 years.

23.	A community health nurse, who is working with a program to foster early detection of prostate cancer, recommends prostate-specific antigen testing and a digital rectal exam for men with average risk starting at which age?
	A)	40 years
	B)	45 years
	C)	50 years
	D)	55 years
	Ans:	C
	Feedback:
	The American Cancer Society recommends that screening of men who are at average risk should begin at age 50 years and should include a blood test to assess PSA levels and a digital rectal examination.

1.	When describing the term “frontier area,” which of the following would the nurse include as the most common description?
	A)	A population density of fewer than 1,000 people per square mile
	B)	Population density of 1,000 people or more per square mile
	C)	Fewer than 10,000 residents in the community
	D)	Fewer than six people per square mile
	Ans:	D
	Feedback:
	Fewer than six people per square mile is one of the most common descriptions of a “frontier area.” Fewer than 10,000 residents or population density of less than 1,000 people per square mile is the definition of “rural.” A population density of 1,000 or more people per square mile refers to an urbanized area or urban cluster.

2.	The nurse educator is aware that the nursing student needs further instruction on the terminology related to rural, frontier, migrant, and urban issues when the nursing students identifies which of the following?
	A)	A rural area has six or fewer persons per square mile.
	B)	There are many factors that are considered when determining if a community is rural or frontier other than population density.
	C)	Urban areas are much more densely populated than urban areas.
	D)	An urban area consists of at least 2,500 people per square mile with at least 1,500 of those who reside outside institutional group quarters.
	Ans:	A
	Feedback:
	If a nursing student would identify that a rural area has six or fewer persons per square mile, the student would need further instruction as it is a frontier area that has six or fewer persons per square mile. There are many factors that are considered when determining if a community is rural or frontier other than population density. Urban areas are much more densely populated than rural areas. Urban areas consist of at least 2,500 people per square mile with at least 1,500 of them living outside institutional group quarters.

3.	When attempting to describe the characteristics of a typical rural population to a group of community health nurses, which of the following would the nurse include?
	A)	Older, White, with a lower income and less formal education
	B)	Young minorities with a lower income and less formal education
	C)	Wealthier, more highly educated, older White Americans
	D)	A reflection of the population as a whole
	Ans:	A
	Feedback:
	Population characteristics include older adults as the largest segment of the population, majority as White, with lower educational attainment, and, on the average, a lower income.

4.	Which of the following reasons is most likely to force a rural hospital to close?
	A)	Rural hospitals have a high risk for financial problems and closures.
	B)	Rural hospitals do not have access to high tech equipment and services.
	C)	Rural hospitals are able to attract many specialty physicians.
	D)	Many rural residents depend heavily on public health department services.
	Ans:	A
	Feedback:
	Rural hospitals have a high risk for financial problems and closures. Rural hospitals usually have less high-tech health care equipment and services, but this does not directly influence closure of the hospital. Rural hospitals are usually not able to attract many specialty physicians, and indeed physician and nurse and pharmacist shortages in rural areas make it difficult to operate a hospital. Many rural residents depend heavily on public health department services, but this is more likely an effect of lack of access to acute care services than a cause of lack of access to acute care services.

5.	Which of the following are barriers to access to health care that may be experienced by rural clients? Select all that apply.
	A)	Adequate numbers and types of providers
	B)	Unpredictable and hazardous weather conditions
	C)	Lack of transportation
	D)	Physical distance between the residence and the location of health care services
	E)	Less high-tech health care equipment and services available
	Ans:	B, C, D, E
	Feedback:
	The barriers to access to health care that may be experienced by rural clients include unpredictable and hazardous weather conditions, lack of transportation, physical distance between the residence and the location of health care services, and less high-tech health care equipment and services available. There are often not adequate numbers and types of providers of health care in rural areas.

6.	Which one of the following statements about migrant workers and their families most accurately describes their lifestyle?
	A)	They are usually paid fairly and treated justly by their employers.
	B)	Often the men are the only ones who perform the migrant work.
	C)	They often work 6 days a week from sunrise to sunset.
	D)	Their earning power is dependent only upon their skill level.
	Ans:	C
	Feedback:
	Migrant workers often work 6 days a week from sunrise to sunset. They are often paid unfairly and treated unjustly. The entire family is often involved in performing the migrant work. Their earning power is variable depending on the variables of weather and crop conditions.

7.	When assessing a group of migrant farmworkers, the community health nurse notes that the group leaves their home base for part of the year to travel to the same place along a route during the agricultural season, usually returning on yearly basis. The community health nurse identifies this as which of the following?
	A)	Restricted circuit migration
	B)	Point-to-point migration
	C)	Nomadic migration
	D)	Migrant stream migration
	Ans:	B
	Feedback:
	Point-to-point migration entails leaving a home base for part of the year to travel to the same place or series of places along a route during the agricultural season, usually returning on a yearly basis. In a restricted circuit, many people travel throughout a season within a small geographic area, following the crops. Nomadic migration involves traveling away from home for several years, working from farm to farm and crop to crop, relying on word of mouth about job opportunities. Migrant stream migration involves following the harvest seasons of agricultural crops, moving from place to place, usually along predetermined routes (migrant streams).

8.	A community health nurse is working to improve the health children of migrant families. Which of the following issues would be of least importance for the nurse to address?
	A)	Adolescent substance abuse
	B)	Exposure to domestic violence
	C)	Mental health problems
	D)	Participation in chores
	Ans:	D
	Feedback:
	Many migrant children are called upon by their families to stay home from school to work, care for younger children, or attend to other household chores, thus affecting the child’s academic performance. However, chores and helping the family are necessary to the family’s survival and as such would be something the nurse would focus on at a later time. Issues such as adolescent substance abuse, domestic violence, and mental health problems are common and would need to be addressed early on.

9.	Which of the following have a direct and negative influence on the vulnerability of migrant workers? Select all that apply.
	A)	Many are undocumented aliens and live in fear of deportation.
	B)	They are often deprived of safe working conditions.
	C)	Their children are deprived of a quality education.
	D)	They often lack adequate sanitation and housing.
	E)	They often have poor nutrition because of poverty.
	Ans:	A, B, D, E
	Feedback:
	Factors that have a direct and negative influence on the vulnerability of migrant workers include many are undocumented aliens and live in fear of deportation; lack of safe working conditions; lack of adequate sanitation and housing; and poor nutrition because of poverty. That their children are deprived of a quality education is also significant, but it is not a direct influence on the vulnerability to health concerns of the migrant workers themselves.

10.	A community health nurse is working to develop programs to address the health status of migrant families. Which of the following would the nurse need to keep in mind when planning these programs? Select all that apply.
	A)	A greater mortality from injuries, TB, respiratory diseases, and cerebrovascular diseases
	B)	A dramatic increase in use of immunizations for migrant children
	C)	An infant mortality rate that is 25% to 30% higher than for other infants in the United States
	D)	Health needs compromised by limited access to health care and high mobility
	E)	A much lower life expectancy than that of the general population
	Ans:	A, C, D, E
	Feedback:
	The life expectancy of a migrant worker is much lower than the general population, with proportionally increased mortality from “injuries, tuberculosis, mental disorders, cerebrovascular disease, respiratory diseases, ulcers, hypertension, and cirrhosis.” The migrant infant mortality rate is 25% to 30% higher than the national average. Migrant children are delayed for immunizations. Migrant families have numerous health needs, but they often face many obstacles to accessing health care including their frequent movement from place to place.

11.	A local community has a significant population of migrant workers. In response, a community health nurse plans to prevent a program to the local community about this population. As part of the program the nurse plans to include information about Cesar Chavez, describing him as which of the following?
	A)	A Mexican president who worked to keep people from crossing the border illegally
	B)	A well-known actor who advocates for increasing the number of Latinos in Hollywood
	C)	The senator who wrote the Children’s Health Insurance Program (CHIP) bill
	D)	Founder of the United Farm Workers who spent his life fighting for social justice
	Ans:	D
	Feedback:
	Cesar Chavez founded the United Farm Workers (UFW), the first union in agricultural labor history that successfully organized migrant farmworkers. Chavez fought for social justice and is an example of a migrant hero. He was not a senator, well-known actor, or Mexican president.

12.	When providing care for migrant workers, which of the following would be most appropriate for the community health nurse to do?
	A)	Maintain existing services
	B)	Use standard methods of health care delivery
	C)	Employ information tracking systems
	D)	Use professionals for community outreach
	Ans:	C
	Feedback:
	Employing information tracking systems is necessary due to the mobility of this population and the need for continuity of care. The nurse should improve the existing services, use unique methods of health care delivery to reach this population, and use lay personnel for community outreach.

13.	A community health nurse works to offer increased health care services to meet the needs of a local migrant population. Which of the following ideas will work well for this population? Select all that apply.
	A)	Providing a mobile van clinic that comes to the farms during the day
	B)	Offering a clinic at the migrant camp from 7 to 10 PM
	C)	Asking local doctors to stay open until 6 PM during the summer
	D)	Offering school-based health services for the children
	E)	Providing a breakfast program for the children at school
	Ans:	A, B, D, E
	Feedback:
	The van at the work site, services for children in school including a breakfast program, a late evening clinic at the camp would help the greatest number of migrant family members. Migrant workers are in the fields until dark. In the summer that may be 9 PM; thus, a physician who stays open until 6 PM will not help.

14.	When dealing with urban populations, which of the following issues would a community health nurse most likely face? Select all that apply.
	A)	Health disparities in the population
	B)	Lower levels of homelessness
	C)	Increased cases of asthma
	D)	High levels of poverty
	E)	Major transportation issues
	Ans:	A, C, D
	Feedback:
	Health disparities are very evident in the populated urban setting. There are increased levels of asthma and higher levels of poverty. Homelessness is more evident, yet transportation issues are not as great as in suburban or rural areas.

15.	After teaching a group of community health nursing students about urban sprawl and its effects, the instructor determines that additional teaching is needed when the students identify which of the following as an effect?
	A)	Water pollution
	B)	Heat islands
	C)	Less exposure to pesticides
	D)	Decreased air quality
	Ans:	C
	Feedback:
	Encroachment of housing areas into natural habitats or farmlands can lead to wider human exposure to pesticides, herbicides, and other things such as mosquito-borne illnesses. Urban encroachment into agricultural areas creates problems with air and water pollution, access to health care, and heat islands.

16.	Which of the following are livability principles that have been identified by the Partnership for Sustainability Communities? Select all that apply.
	A)	Diminish economic competitiveness
	B)	Disassemble existing communities
	C)	Coordinate and leverage federal policies and investment
	D)	Provide more transportation choices
	E)	Promote equitable, affordable housing
	Ans:	C, D, E
	Feedback:
	The six livability principles include (1) provide more transportation choices, (2) promote equitable, affordable housing, (3) enhance economic competitiveness, (4) support existing communities, (5) coordinate and leverage federal policies and investment, and (6) value communities and neighborhoods.

17.	After teaching a group of students about the concept of social justice, which of the following if stated by the group as a component indicates effective teaching?
	A)	Decreased burden borne by all
	B)	Increased benefits obtained for all
	C)	Narrow isolated view of health
	D)	Diversity viewed as a strength
	Ans:	D
	Feedback:
	Social justice occurs when a society provides for the health needs and health care issues of all people by treating people fairly, regardless of where they live or who they are. It deals with concepts of inclusion, participation, empowerment, and the recognition that diversity is a strength. Social justice involves an equal bearing of the burdens and equal reaping of the benefits. Community health nurses who practice social justice have broad and holistic views of health.

18.	A community health nurse working with urban populations integrates the concept of social justice into practice by demonstrating which of the following?
	A)	Impartiality
	B)	Paternalism
	C)	Self-interest
	D)	Inflexibility
	Ans:	A
	Feedback:
	Social justice requires impartiality, that is, ensuring that interventions are just and the outcome is fair when viewed by an uninvolved outsider. Paternalism reflects an individual focus rather than the population focus of social justice. Self-interest and inflexibility would interfere with impartiality and, subsequently, social justice.

19.	A rural community health nurse is a guest speaker at a nearby nursing school. The nurse is describing how rural community health nursing compares with community health nursing in urban and suburban areas. Which of the following would the nurse include about rural community health nurses?
	A)	Salaries comparable with the other two areas
	B)	More difficulty in initiating planned change
	C)	Nurses viewed as active, highly respected community members
	D)	Less physical isolation from professional opportunities
	Ans:	C
	Feedback:
	Rural community health nurses are active members of their community and are highly respected professionals. Salaries typically are lower than that of urban nurses in comparable positions. However, because the system of health care is smaller, it can be easier to understand the system and initiate planned change. Rural community health nurses may experience the challenge of physical isolation from personal and professional opportunities associated with urban areas. Traveling to cities for basic and continuing education can be a barrier. In addition, rural nurses may feel isolated in clinical practice because of the scarcity of professional colleagues.

20.	A community health nurse implements the use of promotoras to promote health in migrant communities. Which of the following best describes a promotora?
	A)	Nonprofessional community outreach worker
	B)	Trained childbirth assistant
	C)	Retired nurses knowledgeable of the area
	D)	Language translators
	Ans:	A
	Feedback:
	The use of promotoras—lay community outreach workers—or doulas—usually trained childbirth assistants—have promoted health in migrant communities. Promotoras are not retired nurses or language translators.

21.	Which of the following activities best exemplifies a community health nurse forging a relationship?
	A)	Dealing with sensitive subjects
	B)	Introducing one’s self as a community health nurse
	C)	Listening to more than just what is said
	D)	Being aware of the long term commitment to the client
	Ans:	B
	Feedback:
	In forging a relationship, CHNs begin with creating a “perception of presence” by identifying themselves as a public health nurse and passing out their card with the instruction to the client to call upon them when needed. Acting as a resource involves dealing with “sensitive subjects” and requires “honesty, asking direct questions, and ignoring rude behavior.” Detecting and asking the next question “means listening to more than what is said.” When a client is truly heard and all information is on the table, making an informed judgment is then possible. Sense of time includes the awareness of the long-term commitment of the community health nurse to the client and the belief that results can occur, despite the lack of progress or even regression on the part of some clients.

22.	After teaching a class on urban health to a group of community health nursing, the instructor determines that the teaching was successful when the students describe it as which of the following?
	A)	Providing care to those individuals who are living in ghettos
	B)	Addressing the needs of immigrants living in large cities
	C)	Considering effects of environment on the health of large cities
	D)	Ensuring the appropriate planning of attractive and equitable places
	Ans:	C
	Feedback:
	Urban health considers those characteristics of the environment as they relate to the health of the population living within large cities. Individuals living in ghettos and immigrants living in large cities are but two segments of the urban population. Urban planning works to improve the welfare of individuals and communities by creating more healthful, efficient, attractive, and equitable places.

23.	A rural community health nurse is acting in the role of a mentor. Which of the following activities would the nurse most likely be doing?
	A)	Providing childbirth classes
	B)	Contacting a specialist for a client
	C)	Collecting immunization data for program development
	D)	Orienting a new rural health nurse to the community
	Ans:	D
	Feedback:
	In the role of a mentor, the rural community health nurse would engage in guiding new community health nurses, nursing students, and other nurses new to the rural community. Childbirth classes would be characteristic of the educator role. Contacting a specialist for a client reflects the nurse’s role as a referral agent. Collecting immunization data for program development reflects the nurse’s role as a change agent/researcher.