Community Health Nursing and Health Disparities, Exams of Community Health

Download Community Health Nursing and Health Disparities and more Exams Community Health in PDF only on Docsity! COMM 442 community Final exam Verified Questions and Answers Latest 2024 MULTIPLE CHOICE 1. Which best describes the primary reason that Americans are concerned about health care? a. Politicians are discussing how to improve health care. b. The media has provided mixed messages about the health care system. c. Our national health care costs keep increasing. d. The new health care system offers free services to Americans. ANS: C The primary reason for the focus on health care is the constantly increasing costs, which cannot be sustained. The costs of caring for the sick accounted for the majority of escalating health care dollars, which increased from 5.7% of the gross domestic product in 1965 to 17.8% in 2015. Politicians and the media both influence Americans’ perceptions about health care; however, they are not the primary reason why Americans are concerned. The new health care system will change the health care access and availability, but will not necessarily be offering any free services to Americans. DIF: Cognitive Level: Understand (Comprehension) 2. A nurse has begun to lobby with politicians for changes to the health care system. Why is this involvement important? a. Nurses, as central characters in several popular TV series, are currently very visible in American media. b. Nurses are primarily responsible for managing the various units in our health care system. c. Nurses are the largest segment of health care providers. d. Nurses are the only group that is employed both inside and outside of hospitals. ANS: C As the largest segment of health care providers, nurses are informed about the current health care system and all the problems that result from people not seeking care until they are desperately ill. Nurses, as the American Nurses Association (ANA) emphasize, usually believe that health care is a right, not a privilege. Therefore, nurses, whose work is central to our current health care delivery system, can also be instrumental in working politically to create a health care delivery system that will meet health needs. While nurses are in several current TV series and are employed both inside and outside of hospitals, physicians and other health care providers are as well. Nurses are often managers, but managers often have other backgrounds, such as business administration. DIF: Cognitive Level: Understand (Comprehension) 3. What conclusion can be drawn from examining where nurses are employed? a. There is a trend toward consolidation of health care into large central medical centers. b. There is an increased emphasis on community-based health care. c. There is an obvious need to decrease health care costs by cutting positions. d. Managed care organizations (MCOs) are employing nurses to improve customer Individual behavior choices are responsible for about 50% of health outcomes. Individual choices are affected through interaction with other individuals, and their mutual social and physical environments. The number of health care providers has not played a major role in the health outcomes in the community in comparison to individual health behaviors. The quality of public safety officers and number of public health officials have not been identified as major contributors to the determinants of health. DIF: Cognitive Level: Apply (Application) 10. What change could most effectively lead to a longer life span in Americans? a. Parenting and sexual behavior classes in all public school systems b. Legislation restricting alcohol and drug use c. Notably reducing speed limits on all state and federal highways, and changing the age limit for driving to 21 years of age d. The belief that smoking is shameful and disgusting, as well as expensive, becoming the social norm ANS: D Smoking is responsible for almost 20% of all deaths in the United States. Although smoking is an individual’s choice, all people are affected by social norms. Parenting and sexual behavior classes and legislative changes may influence health, but may not necessarily lead to a longer lifespan. Community health nurses should recognize that health is influenced by a web of factors, some that can be changed and some that cannot. Influencing social norms may better promote change among Americans. DIF: Cognitive Level: Apply (Application) 11. What is the health issue causing the most concern in the United States today? a. Diabetes epidemic b. Increase in cardiac disease c. Increase in obesity d. Rise in cancer rates ANS: C The widespread increase in incidence of overweight and obesity has led to calls for population-based measures to address this issue. The overarching problem of obesity has led to an increase in diabetes as well as cardiac disease. If this health issue was controlled, there should be in a decrease in the other health issues. DIF: Cognitive Level: Understand (Comprehension) 12. What factors are most responsible for the increasing length of life of Americans over the past 100 years? a. Better nutrition and family planning options b. Education concerning the need to reduce salt and fat in the diet c. Improved medical care, including exciting new technologies d. More efficient cancer screenings and early intervention ANS: A Average increased life span over the past 100 years can be largely attributed to higher standards of living, better nutrition, a healthier environment, and having fewer children. Public health efforts such as immunization and medical care have also contributed. DIF: Cognitive Level: Understand (Comprehension) 13. Why would a public health nurse want to know about morbidity and mortality statistics on the local, state, and national level? a. To be able to share current trends in health problems with the community b. To be able to observe the community’s statistics over time and compare the community with other communities c. To justify local budgets and the need for increased income from citizens d. To publicize current health issues and suggest appropriate actions to citizens ANS: B Although being informed and being able to educate the public is always preferred and nurses often do have to justify budgets, data are needed to compare the local community with itself over time and with other communities so that problems may be recognized and action taken to confront health issues. The first step is always to recognize problems as they develop. DIF: Cognitive Level: Apply (Application) 14. How do public health efforts differ from medical efforts in improving the health of our citizens? a. Medical care providers autonomously choose appropriate interventions, whereas public health care providers must engage in whatever actions legislation requires. b. Medical care providers are self-employed or agency employed, whereas public health care providers are employed by and paid through the government. c. Medical care providers focus only on individuals, whereas public health care providers focus only on aggregates. d. Medical care providers focus on disease diagnosis and management, whereas public health care providers focus on health promotion and disease prevention. ANS: D Medical care providers are restricted by insurance and government regulations. Providers may also be employed in government facilities, such as Veterans Administration facilities. However, medical care providers primarily focus on diagnosis and treatment of disease, whereas public health care providers try to promote health and prevent disease. Although medical care providers primarily focus on individuals and public health care providers primarily focus on aggregates, their practice is not limited to only individuals or only aggregates. DIF: Cognitive Level: Apply (Application) 15. Which primary prevention would the school nurse choose to address the school’s number of unwed pregnancies? a. Create a class on parenting for both the moms-to-be and the dads-to-be. b. Convince the school board to allow sex education classes to include birth control measures. c. Employ the moms-to-be as 1-hour-a-day employees in the school daycare center for children born to school students. d. Establish a class where all the unwed moms-to-be can learn infant care. ANS: B Primary prevention relates to activities directed at preventing a problem before it occurs by altering susceptibility or reducing exposure for susceptible individuals. Primary prevention consists of two elements: general health promotion and specific protection. Health promotion efforts enhance resiliency and protective factors and target essentially well populations. Specific protection efforts reduce or eliminate risk factors. Although all choices would be appropriate actions in a school, only education regarding sexuality and birth control would help prevent future pregnancies. DIF: Cognitive Level: Apply (Application) 16. What would be the proper term for the action of the school health nurse arranging for all the students in the elementary school to receive H1N1 immunizations? a. Health education b. Secondary prevention c. Specific protection d. Tertiary prevention ANS: C Immunizations are a specific protection effort as part of primary prevention. Primary prevention relates to activities directed at preventing a problem before it occurs by altering susceptibility or reducing exposure for susceptible individuals. Primary prevention consists of two elements: general health promotion and specific protection. Health promotion efforts enhance resiliency and protective factors and target essentially well populations. Specific protection efforts reduce or eliminate risk factors. Secondary prevention refers to early detection and prompt intervention during the period of early disease pathogenesis. Tertiary prevention targets populations that have experienced disease or injury and focuses on limitation of disability and rehabilitation. Health education would relate to educating the students about the immunization not making the arrangements for the immunization to be given. DIF: Cognitive Level: Understand (Comprehension) 17. Which action would probably result in the largest change in health care outcomes for Americans? a. Establish large numbers of scholarships for education of nurses, physicians, and other health care providers. b. Fund a one-time extremely large stimulus to allow all health care providers and agencies to create and integrate computer network systems for client health care records. c. Increase funding for hospitals and medical centers to expand their neighborhood clinics. d. Redirect a large portion of federal funding from acute care to health promotion activities. ANS: D Populations are not all the same. The needs of subpopulations must be assessed. The high-risk and vulnerable subpopulations must be identified early. Those individuals who do not receive service early become very expensive high-cost users later. DIF: Cognitive Level: Understand (Comprehension) 24. A nurse works hard to develop alliances among various community organizations toward improving health in the community. What are actions such as this called? a. Building coalitions b. Collaboration c. Communication d. Community cooperation ANS: A By definition, the nurse’s actions are coalition building. Although collaboration has a very similar meaning, Table 1.4 stresses that collaboration is focused more on enhancing the capacity of an individual or a group. The nurse is establishing cooperative alliances, but not yet working with them toward a goal. DIF: Cognitive Level: Understand (Comprehension) 25. After completing a master’s degree, a nurse took a course in marketing. Should the agency reimburse the nurse’s tuition costs? a. No, courses taken for personal enjoyment are not eligible. b. No, courses taken outside the professional’s responsibilities are not eligible. c. Yes, the nurse is demonstrating professional commitment by continuing education. d. Yes, the nurse could use such information in social marketing for the agency. ANS: D Social marketing tools using marketing principles and technologies are designed to influence the knowledge, attitudes, values, beliefs, and behaviors of populations. Such information would be extremely helpful for agency personnel in improving community health and lifestyle choices. DIF: Cognitive Level: Apply (Application) 26. Which factor is most responsible for differences in an individual’s health? a. Culture of the majority of the community’s citizens b. Individual’s education and income c. Number of physicians and other health care providers in the community d. Quality of the community health agency and hospital in the community ANS: B Factors that contribute to wide variations in health disparities are education, income, and occupation. This is best addressed by looking at an individual’s education and income. The culture, number of physicians, and quality of agencies in the community do not play as important of a role in individual health. DIF: Cognitive Level: Understand (Comprehension) MULTIPLE RESPONSE 1. What are the leading health indicators found in Healthy People 2020? (Select all that apply.) a. Financial issues b. Health system issues c. Individual behaviors d. Issues related to legal and illegal immigration e. Legislative issues f. Physical and social environmental factors ANS: B, C, F Ten leading health indicators are identified in Healthy People 2020, including individual behaviors, physical and social environmental factors, and health systems issues. Financial issues, issues related to legal and illegal immigration, and legislative issues are not found in Healthy People 2020. DIF: Cognitive Level: Understand (Comprehension) 2. What historically have been public health nurses’ two most important priorities? (Select all that apply.) a. Establishing school nursing to improve care of children b. Engaging in political activity to improve living conditions c. Giving superb clinical bedside care in the home d. Increasing funding to public health efforts e. Teaching family members how to care for their family f. Working with the community to confront health issues and poverty ANS: B, F Neither administering bedside clinical nursing nor teaching family members to deliver care in the home has adequately addressed the true determinants of health and disease. The early public health nurses resolved that collective political activity should focus on improving social and environmental conditions such as poverty. DIF: Cognitive Level: Understand (Comprehension) 3. Based on Healthy People 2010, what are the two primary goals of Healthy People 2020? (Select all that apply.) a. Eliminate health disparities. b. Expand health promotion activities in every community. c. Improve funding, including diverting funds from other priorities to health care. d. Improve health outcomes measures to be more consistent with other developed nations’ outcomes. e. Increase quality and years of healthy life. f. Reduce mortality and morbidity figures nationwide. ANS: A, E As published, the two goals are to increase quality and years of healthy life and eliminate health disparities. Expanding health promotion activities in every community, improving funding and improving health outcomes, and reducing mortality and morbidity are not the primary goals of Healthy People 2020. DIF: Cognitive Level: Understand (Comprehension) Chapter 03: Thinking Upstream: Nursing Theories and Population-Focused Nursing Practice Nies: Community/Public Health Nursing, 7th Edition MULTIPLE CHOICE 1. Which statement best summarizes Lillian Wald’s achievements? a. She suggested new nursing specialties. b. She demonstrated how to improve health in communities. c. She gave expert clinical nursing care to her clients. d. She was appointed a national nursing leader. ANS: B Lillian Wald improved health in a community by using diplomacy and neighborhood power. She was elected president of a national nursing organization and created new nursing specialties such as school nursing. However, she is primarily known for her creation of Henry Street House (see Chapter 2 of text), which led to the Visiting Nurses Association and notably improved health in many communities. DIF: Cognitive Level: Understand (Comprehension) 2. Which statement best describes “thinking upstream”? a. Modifying economic, political, and environmental factors b. Preparing for nursing career long-term goals by planning now c. Seeking causes of water and air pollution “upstream” from cities d. Trying to understand how or why someone got ill ANS: A Upstream thinking actions focus on modifying economic, political, and environmental factors that are the precursors of poor health throughout the world. DIF: Cognitive Level: Understand (Comprehension) 3. Which statement best describes a weakness of early nursing theories? a. Many nurses did not know or understand the theoretical basis of nursing practice. b. Most nursing theories focused on microscopic individual concerns. c. The theories did not reflect the actual world of nursing practice. d. The theories had global applicability to nursing practice. ANS: B Most nursing theories have an extremely narrow focus on individual nurse–patient care situations. This microscopic focus ignores the broader global social macroscopic perspective. DIF: Cognitive Level: Understand (Comprehension) 4. Which best describes the primary purpose of nursing theory? a. To improve nursing practice b. To demonstrate that nursing is a profession c. To organize nursing knowledge d. To serve as a basis for ongoing nursing research As the model focuses on sociopolitical and environmental constraints to a client’s free choice, it also encourages assessment of such constraints, as well as suggesting alternative avenues to helping the patient obtain needed care. Milio encourages the practice of nursing from a broad understanding of health and illness. DIF: Cognitive Level: Apply (Application) 11. Which health-related variable is examined by the critical theoretical perspective? a. Cultural beliefs b. Effect of history and tradition c. Ethnic and racial differences d. Social inequalities ANS: D Critical theoretical perspective examines social inequalities within the broader political, economic, and social systems of society that keep people from reaching their full potential. Cultural beliefs, the effect of history and tradition, and ethnic and racial differences are not examined by the critical theoretical perspective. DIF: Cognitive Level: Understand (Comprehension) 12. A nurse is using the critical theoretical perspective in daily nursing practice. Which activity would the nurse most likely complete? a. Criticize health insurance programs as a barrier to health care. b. Expose social values underlying the health care system. c. Promote individual freedom and decision-making. d. Exert control over the client’s environment. ANS: B Improvements can only be made if societal and personal values are made explicit. Once these values are recognized, they are more easily confronted. Change may be sought toward a more just society. Society must change for health and medical care to improve. Inequities of health care are connected to historically located social arrangements and cultural values of society. DIF: Cognitive Level: Apply (Application) 13. A nurse is using Healthy People 2020 as a guide to improve the health and well-being of the community. Which strategy would the nurse most likely implement? a. Address the root causes of health problems. b. Choose one of the 28 focal areas for emphasis in funding and media attention. c. Concentrate on the goals of improving the quality of life. d. Continue funding expansion of the health care system. e. Expand efforts to put all medical records on electronic media. ANS: A The chapter emphasizes the need to go beyond individual lifestyle behaviors to the social, economic, political, and value-laden processes of daily life that affect health (social determinants of health). Based on Healthy People 2020, advances are needed in these areas in order to improve health. DIF: Cognitive Level: Apply (Application) 14. Which is most closely associated with morbidity and mortality outcomes? a. Number of physicians per capita b. Insurance status c. Crime rate d. Personality traits ANS: B Tremendous disparities for access exist between insured and uninsured people in the United States. Access to care is associated with economic, social, and political factors, and depending on individual and population needs, it can be a primary determinant of health status and survival. Structural variables such as race-ethnicity, educational status, gender, and income are highly predictive of health status. DIF: Cognitive Level: Understand (Comprehension) 15. A nurse has accepted a new position in a public health department. Which characteristic is crucial to the nurse’s success? a. Advanced educational preparation b. Being knowledgeable about the community’s needs c. Listening and showing respect d. Caring and empathetic personality ANS: C Rather than nursing to the community, the nurse must work with the community to be successful. Listening, being patient, providing accurate information, and respecting the experiences of community members are essential for success. DIF: Cognitive Level: Apply (Application) 16. A nurse is using a macroscopic approach when providing care. Which would the nurse most likely demonstrate? a. Emphasizing behaviors that will help in healing b. Examining the family’s responses to illness c. Explaining how these actions will help in healing d. Providing testimony to legislators concerning proposed legislation ANS: D All the choices focus on individual client care (microscopic) except for the nurse who is politically involved as demonstrated by providing testimony relevant to proposed legislation (macroscopic). DIF: Cognitive Level: Apply (Application) 17. A nurse is using Milio’s framework to promote healthy eating choices among members of the community. Which intervention would the nurse most likely implement? a. Provide community education about healthy food choices. b. Promote legislation to increase taxation on unhealthy food choices. c. Lobby for health insurance providers to pay for participation in health promotion programs. d. Encourage community members to be responsible for making healthy choices. ANS: B One of the propositions of Milio’s framework is that alteration in patterns of behavior resulting from decision-making of a significant number of people in a population can result in social change. Some behaviors, such as tobacco use, have become difficult to maintain in many settings or situations in response to organizational and public policy mandates. Increasing taxation on unhealthy food choices may make it more difficult for community members to make these unhealthy choices. DIF: Cognitive Level: Apply (Application) MULTIPLE RESPONSE 1. A nurse has a broad, aggregate focus when providing care to clients. Which best describes how this approach will help improve client outcomes? (Select all that apply.) a. Ensures that collaborative efforts of many professionals will be used b. Confirms the individual’s responsibility for resolving the health problem c. Empowers decision-making based on both individual and community goals, needs, and priorities d. Enables the nurse to ask for assistance from other community professionals e. Encourages allocation of time for population-focused preventive efforts f. Upholds professional nursing standards of care ANS: C, E Having a broader focus will help both nurse and patient make appropriate decisions. Unfortunately, it cannot ensure that others will help. Ideally, it will help both parties recognize that health problems are not just an individual’s responsibility but often a result of environmental, sociopolitical, and economic factors as well. Encouraging the nurse to allocate time for population-focused health promotion efforts will also help the nurse’s individual clients over the long term. DIF: Cognitive Level: Apply (Application) 2. A community health nurse is using the Health Belief Model (HBM) as a basis for providing client care. Which best describes the problems associated with using the HBM? (Select all that apply.) a. It ignores the need to reduce health system barriers to action. b. It is extremely difficult to change the client’s belief system. c. It is the nurse’s responsibility to persuade clients to engage in the appropriate behavior. d. Clients do not have the knowledge to correctly analyze the seriousness of the disease or their susceptibility to it. e. Clients expect health professionals to take preventive actions for them. f. The choice and the burden for acting are entirely with the client. ANS: A, F 4. A nurse was becoming frustrated. She had given her client extensive information on his health problem, but the client continued to be noncompliant in making needed changes. Which principle had the nurse forgotten? a. A person may have a higher priority than improving his or her health. b. Information, while necessary, will not motivate people to change. c. People need repetition over time to be able to absorb information. d. Physicians, not nurses, are perceived as experts in health. ANS: B Information alone is rarely enough to motivate a person to act. Information is necessary to know what to do and how to do it before the person chooses to act, but other factors are primarily responsible for motivating people to change their behavior. Although other priorities may result in delay of change, the fact that the client has returned to the nurse demonstrates interest in changing. Repetition may be helpful, but apparently the nurse has given information on more than one occasion because she believes extensive information has been given. DIF: Cognitive Level: Apply (Application) 5. The nurse working with a client to change behavior to maximize health asked the client to bring his family to the next visit. Which best describes why the nurse wants the family to come with the client? a. To analyze the family’s beliefs about health b. To determine the family’s support of the client c. To establish the family’s communication patterns d. To evaluate the family’s approval of the proposed changes ANS: D Under the Theory of Reasoned Action, it is assumed that all behavior is determined by intentions, which are determined by attitude toward the behavior and the norms associated with the behavior. That in turn is determined by whether or not important persons approve or disapprove of the behavior. The family’s beliefs about health, support of the client, and communication patterns are irrelevant if the family does not approve of the changes that have been proposed. DIF: Cognitive Level: Apply (Application) 6. A nurse is using the theory of reasoned action when working with a client to exercise on a regular basis. Which would be the easiest way for the nurse to determine if the client will engage in this activity? a. The client’s intention to exercise regularly b. The client’s perception of the threat of illness if he doesn’t exercise regularly c. Society’s emphasis on the importance of regular exercise d. The pros and cons of regular exercise ANS: A The theory of reasoned action attempts to predict a person’s intention to perform or not perform a certain behavior based on the assumption that all behavior is determined by one’s behavioral intention. The client’s perception of the threat of illness, the opinion of society, and benefits of regular exercise are not major factors discussed using the theory of reasoned action. DIF: Cognitive Level: Apply (Application) 7. A nurse is using the theory of planned behavior when working with a client to change her behavior and improve her health. Which consideration should be made by the nurse? a. If environmental limitations may prevent the person from acting b. The availability of needed environmental supports for the client c. The client’s belief about factors that may facilitate or impede the behavior d. If the suggested behavior is actually the most effective approach ANS: C The theory of planned behavior stresses that perceived control is a major factor in whether or not the client performs the behavior. Thus, the nurse needs to understand the client’s beliefs about factors that may facilitate or impede the behaviors. Using this theory, the environment is not considered as a major factor in client change, nor is the analysis as to if the behavior is the most effective approach. DIF: Cognitive Level: Apply (Application) 8. Some people believe that the air within their workplace makes them ill. Which premises support this belief? a. They consistently feel worse on workdays and weeks without holidays. b. There has been media coverage of “sick buildings” where there is very little air exchange with fresh air outside. c. Research has demonstrated that some buildings emit poisonous vapors that make anyone who works there ill. d. When a small group of persons begins to believe something, the others in the larger group begin to believe it as well. ANS: A As the question discusses risk, the textbook states that the risk factor must precede the problem and that the problem would increase with exposure. Feeling ill only on workdays would imply that some factor in the workplace is responsible. The media coverage, research related to poisonous vapors, and “group think” responses do not address the fact that the repeated exposure to the risk factor may be what is making them ill. DIF: Cognitive Level: Apply (Application) 9. It is rumored that there is something in the workplace that is causing persons employed there to feel ill. Which action would be most appropriate for the nurse to take? a. Ask researchers to set up a study to confirm the health hazard in the environment. b. Assess the risk, including identifying any toxic substance. c. Confirm the extent to which the illness resulted from intergroup agreement on the illness and cause. d. Insist that the media not further spread stories of possible sick buildings until the truth of the situation can be studied. ANS: B The media report news; they do not create it without any basis. Researchers are not asked to confirm a preconceived conclusion but to seek what factors are active in a situation. “Group think” is a well-known phenomenon, but one would have to ask what led the communication leaders to believe originally that there was a hazard in the environment. Risk assessment in a questionable situation begins with identifying a possible hazard and describing the risk. DIF: Cognitive Level: Analyze (Analysis) 10. Which risk factors are least subject to modification? a. Choice of lifestyle behaviors b. Environmental exposure c. Nutritional options d. Recreational activities ANS: B An individual may choose to control lifestyle behaviors, nutrition choices, and recreational options. An individual cannot alone control his or her neighborhood, employment setting, or other environmental exposures. DIF: Cognitive Level: Understand (Comprehension) 11. Which best describes why risk reduction is of such importance in the United States today? a. Families suffer when family members die from avoidable causes. b. Risk reduction activities will decrease insurance costs to individuals and their employers. c. The leading causes of death are all related to lifestyle choices. d. Risk reduction can decrease the ongoing rise in national health care expenditures. ANS: C Approximately 50% of annual U.S. deaths occur as a result of modifiable lifestyle factors. The leading causes of death with the highest mortality are all related to lifestyle factors. A change in these factors will also reduce health care expenditures and insurance costs for those persons with insurance. However, unnecessary deaths are even more important. DIF: Cognitive Level: Apply (Application) 12. Which is the cause of most preventable deaths in the United States? a. Alcohol b. Drug addictions c. Sexually transmitted diseases d. Tobacco ANS: D Smoking is the leading cause of preventable deaths, accounting for about one out of every five deaths. DIF: Cognitive Level: Understand (Comprehension) 13. A nurse is completing a health history with a client. Which question would be most important to include? a. How many alcoholic drinks do you have in a day? b. How many sexual partners have you had in the past month? f. What one’s family and peers believe should be done ANS: A, B, D, F Fear and threat are not aspects of Pender’s model. Although fear may cause an initial attempt at change, fear is not a long-term motivator for ongoing action. Pender does include perceived benefits, perceived self-efficacy, interpersonal influences, and available situational (environmental) options as factors that motivate persons to engage in health actions. DIF: Cognitive Level: Apply (Application) 3. A nurse is using the Health Belief Model to help a client improve lifestyle choices. Which interventions would the nurse most likely implement? (Select all that apply.) a. Conduct an ongoing public information campaign to motivate people to take action. b. Emphasize how important it is to change behavior immediately. c. Examine the individual’s perceptions of his or her health in relation to current lifestyle behavior choices. d. Review how lifestyle changes can reduce risk and improve the client’s life. e. Share statistics regarding the probability of health problems and their seriousness if action is not taken. f. Use communication channels to send reminders of action currently needed. ANS: C, D, E, F An effective way to evoke action begins with examining the individual’s perceptions of his or her health and current lifestyle choices so education to change perceptions can occur. Sharing information regarding the probability of illness or perceived susceptibility and using communication channels to serve as cues to action may both be motivating. Similarly, reviewing how lifestyle changes can reduce risk and improve life may change the person’s perception of the benefits of acting. Unfortunately, although people have to know what to do and how to do it before they can take action, information alone will not motivate people to act. Continued harassment, as in emphasizing how important it is for people to act, also is not motivating. DIF: Cognitive Level: Analyze (Analysis) 4. A nurse was becoming frustrated. It had been 2 weeks, and although the client had verbalized that the best time of day to take a 15-minute walk was early in the morning, the client had not begun to exercise. Which principles of the Transtheoretical Model had the nurse forgotten? (Select all that apply.) a. A decision to act always occurs before action begins. b. Behavior change is difficult and takes time. c. Continuing to stress to the client how important exercise is will help the client decide to exercise. d. Discussing with the client why he or she is not yet exercising may help the client recognize his or her own resistance. e. The nurse should offer some reward if the person exercises for at least a week. f. Verbalizing compassion for how difficult it is to change is a crucial intervention. ANS: A, B The Transtheoretical Model is based on the assumption that behavior change takes place over time, progressing through a sequence of stages. The fact that the person had stated the best time to exercise demonstrates the client has moved through precontemplation and contemplation and is preparing to act. The nurse is being rather optimistic in thinking change will occur within 2 weeks. Although being compassionate is helpful, it is not a crucial step in the beginning of the process. Personal resistance to change is probably obvious and does not need further discussion as the patient has moved beyond the stage of analyzing pros and cons to the change. DIF: Cognitive Level: Apply (Application) 5. Which actions have been effective in reducing problems related to alcohol use? (Select all that apply.) a. Abstinence education programs in elementary schools b. Enforcement of ban on sales of alcohol to minors c. Increased taxes on alcoholic beverages d. Media campaigns that show unpleasant behaviors such as vomiting after drinking e. Stringent laws on accurate labeling of alcoholic content in beverages f. Suggesting children be taught appropriate use of alcohol in the home ANS: B, C The prevalence of underage drinking declined significantly when states enacted the minimum legal drinking age of 21 years. The states with more stringent drinking laws have a lower prevalence of binge drinking. Enforcement of the legal drinking age, as well as enforcement of bans on sales of alcohol to minors, helps prevent underage drinking, as have increased excise taxes on alcoholic beverages. DIF: Cognitive Level: Understand (Comprehension) 6. A nurse asks a client how she has been sleeping. Which best describes the rationale behind this question? (Select all that apply.) a. Accidents and injury may occur with the sleep-deprived client at fault. b. Interventions for sleep problems are primarily common sense. c. Many adults report sleep problems or occasional lack of sleep. d. Many important functions occur during sleep. e. Nurses can determine whether the patient has a sleep disorder. f. A sleep assessment is easy and inexpensive to complete. ANS: C, D Almost three-fourths of all adults report having a sleep problem at least once a week, yet sleep is an essential component of chronic disease prevention and health promotion. Many important functions occur while we sleep, such as release of hormones, memory consolidation, and decrease in blood pressure. DIF: Cognitive Level: Apply (Application) Chapter 05: Epidemiology Nies: Community/Public Health Nursing, 7th Edition MULTIPLE CHOICE 1. An epidemiologist has written a summary of a food poisoning outbreak, including its cause and ways to prevent it from occurring in the future. Which best describes what has been done? a. Analytic epidemiology b. Descriptive epidemiology c. Prospective cohort study d. Retrospective cross-sectional survey ANS: B There are two principal types of epidemiology: (1) analytic epidemiology and (2) descriptive epidemiology. Descriptive epidemiology describes the amount and distribution of disease, which may suggest possible causes. These causes can then be confirmed or corrected through more ad- vanced methods of research. Analytic epidemiology investigates the causes of disease by deter- mining why a disease rate is lower in one population group than another. A prospective cohort study monitors a group of disease-free individuals to determine whether and when disease occurs. Retrospective studies compare individuals with a particular condition or disease and those who do not have the disease. DIF: Cognitive Level: Apply (Application) 2. Two brothers played with their cousin. One brother later became quite ill, whereas the other did not. Which provides the best explanation for this occurrence? a. Difference in length of time exposed b. Difference in how actively the children played c. Difference in genetic inheritance between the two brothers d. Difference in lifestyle between the two brothers ANS: C Assuming the two brothers lived in the same household, the environment and the agent or infec- tious organisms are the same. The only difference could be between the two brothers themselves and their genetic inheritance. DIF: Cognitive Level: Apply (Application) 3. In which circumstance would it be more helpful to use the wheel model of epidemiology than the epidemiological triangle model? a. When factors outside the triangle model are involved b. When there are multiple causes for a chronic disease c. When research has not yet determined the d. How many had died so far in local hospi- tals and care facilities ANS: A As only new cases were being reported to the health department, the media could only report the ongoing incidence rate, that is, the number of new cases reported each day. The prevalence rate is the number of all cases of a specific disease or condition in a population at a given point in time which would not assist in knowing the number of new cases. Those infected with the flu may or may not be hospitalized or have died from the flu. DIF: Cognitive Level: Apply (Application) 9. When trying to determine whether the swine flu outbreak was getting worse, which rate should be carefully observed? a. The crude death rate b. The age-specific death rate c. The swine flu incidence rate d. The swine flu prevalence rate ANS: C The incidence rate of new cases would be most useful for detecting short-term acute disease changes, because the swine flu duration is usually relatively short. The prevalence rate is the number of all cases of a specific disease or condition in a population at a given point in time. Crude death rates summarize the occurrence of mortality. An age-specific death rate characterizes the death rates of a particular age group in the population. DIF: Cognitive Level: Apply (Application) 10. A newspaper published an article stating that the athletic banquet at the local high school had approximately 1000 family members in attendance. Exactly 650 persons became ill within 24 hours, complaining of severe diarrhea, vomiting, and cramping. Which best describes the attack rate? a. 650 persons b. 1000 persons c. 650:1000 d. 6.5% ANS: C Rates are calculated by the number of people with the problem over the number exposed to the problem. In this case, 650 persons out of the 1000 at the banquet complained of illness. Although this rate could be presented as an attack rate of 65%, 6.5% is incorrect. DIF: Cognitive Level: Apply (Application) 11. In a particular community, the rate of new cases of diabetes and the rate of new cases of flu during the month of January were precisely the same. Which disease would have the higher pre- valence rate? a. As an acute condition, flu would have the higher prevalence rate. b. As a chronic condition, diabetes would have the higher prevalence rate. c. Flu would have the higher prevalence rate because people can get flu several times in one season. d. Flu would have the higher prevalence rate because it is so contagious. ANS: B Diabetes would have the higher prevalence rate because it is a long-term chronic condition that typically does not decrease. Although flu might have a higher incidence rate of new cases, be- cause flu is typically of short duration, the prevalence rate would remain low. Flu is contagious, which could increase the incidence rate but not the prevalence rate. DIF: Cognitive Level: Apply (Application) 12. Which statement best describes why the incidence and prevalence of gonorrhea is unknown? a. Gonorrhea is not a reportable condition. b. Gonorrhea can vary in how long the in- fection remains in the body. c. Gonorrhea can be cured with antibiotics, so people do not remain infected. d. People are ashamed to admit they have gonorrhea. ANS: A Morbidity rates (incidence and prevalence rates) are not available for many conditions because surveillance of many chronic diseases is not widely conducted. Furthermore, morbidity rates may be subject to underreporting when they are available. In other words, there is no responsibility to report cases of most diseases, including gonorrhea. Information is only available related to condi- tions where care providers are required to report that specific condition or where those affected die and mortality data are available. DIF: Cognitive Level: Analyze (Analysis) 13. Which group should be used to determine the community’s pregnancy rate? a. All persons between 15 and 45 years old in the community b. The total population of the community c. The total population of women in the community d. Women between 15 and 45 years old in the community ANS: D Although pregnancy is not specifically addressed, the text stresses that only those susceptible to a particular condition should be considered in the denominator. In the case of pregnancy, only women of childbearing age are susceptible. DIF: Cognitive Level: Apply (Application) 14. Which research study would determine the attributable risk of a sedentary lifestyle in cardiac disease? a. Measuring all cases of cardiac problems in a specific community b. Comparing the number of persons with cardiac disease among athletes with the number among nonathletes in a commu- nity c. Subtracting the rate of cardiac disease among athletes from the rate of cardiac disease among nonathletes d. Calculating the relative risk and then sub- tracting the attack rate to determine the attributable risk ANS: C Attributable risk is determined by subtracting the rate of disease among nonexposed individuals (such as athletes) from the rate of disease among those exposed (the individuals with a sedentary lifestyle). DIF: Cognitive Level: Apply (Application) 15. A nurse conducted a study of two skin lotions: (1) an inexpensive one and (2) an expensive one. The nurse found that there was a relative risk of 0.7 for skin sores using the inexpensive one and a relative risk of 1.2 using the expensive one. Which skin lotion should the nurse use? a. Impossible to tell from the data given b. It made no difference which lotion was used c. The expensive lotion d. The inexpensive lotion ANS: D A risk factor of less than one means the factor is actually protective, so the inexpensive lotion is helpful in preventing skin sores. A risk factor of more than one means the factor increases risk, so using the expensive lotion increases the probability of getting a skin lesion. DIF: Cognitive Level: Apply (Application) 16. Which best describes a model that demonstrates the progression of disease from prepathogenesis through disease outcome? a. Epidemiological model b. Ecosocial model c. Natural history model d. Wheel model ANS: C The natural history of disease model explains disease from prepathogenesis through resolution of information with the federal government ANS: B Effectiveness of Healthy People 2020 depends on the availability of reliable baseline and conti- nuing data to characterize health problems and evaluate goal achievement. Surveillance is crucial. Without surveillance data, there is no relatable data available. Increased financing will not assist in determining if the health of Americans is improving. Although it is important for individuals to be willing to share health information so that data collection can be completed, individual health information alone will not be an effective determinant of the health of Americans. DIF: Cognitive Level: Understand (Comprehension) 22. A researcher is examining potential risk factors in comparison with disease at a specific time through collecting data regarding current exercise, sleep patterns, and current health status among 12-year-olds. Which research study would be most appropriate? a. Cross-sectional study b. Prospective study c. Retrospective study d. True experiment ANS: A By definition, a cross-sectional study examines relationships between potential causal factors and disease at a specific time. A prospective study monitors a group of disease-free individuals to determine if and when disease occurs. A retrospective study compares individuals with a particu- lar condition or disease with those who do not have the disease. A true experiment involves both an experimental group who receives an intervention and a control group who does not receive an intervention. DIF: Cognitive Level: Apply (Application) 23. A researcher, interested in the onset of early menses, compared the life experiences and history of 1000 14-year-old girls, half of whom had monthly periods and half of whom did not, to determi- ne what variables might be observed. Which would be the most appropriate categorization of this study? a. Cross-sectional study b. Prospective study c. Retrospective study d. True experiment ANS: C When a study looks at individuals with a particular condition in comparison with those who do not have the disease, based on their exposures to various life situations, it is a retrospective study; that is, the study requires participants to look back at previous experiences. A cross-sectional study examines relationships between potential causal factors and disease at a specific time. A prospective study monitors a group of disease-free individuals to determine if and when disease occurs. A true experiment involves both an experimental group who receives an intervention and a control group who does not receive an intervention. DIF: Cognitive Level: Apply (Application) 24. One famous study followed a cohort of nurses over their lives, collecting data and health histories as they aged. Which would be the most appropriate categorization of this study? a. Cross-sectional study b. Prospective study c. Retrospective study d. True experiment ANS: B Prospective studies monitor a group of individuals to determine if and when disease occurs. A cross-sectional study examines relationships between potential causal factors and disease at a specific time. A retrospective study compares individuals with a particular condition or disease with those who do not have the disease. A true experiment involves both an experimental group who receives an intervention and a control group who does not receive an intervention. DIF: Cognitive Level: Apply (Application) 25. A researcher wanted to engage in the best possible research design to obtain reliable information about the possible cause(s) of a disease. Which design would the researcher choose? a. Cross-sectional study b. Descriptive study c. Prospective study d. Retrospective study ANS: C The most advantageous research design, because it obtains more reliable information and can more easily establish a stronger temporal relationship between presumed causal factors and their effects, is a longitudinal cohort prospective study. A cross-sectional study examines relationships between potential causal factors and disease at a specific time. A descriptive study focuses on the amount and distribution of health and health problems within a population. A prospective study monitors a group of disease-free individuals to determine if and when disease occurs. A retro- spective study compares individuals with a particular condition or disease with those who do not have the disease. DIF: Cognitive Level: Apply (Application) 26. A researcher has limited time and funds. Which research design would be most appropriate? a. Cohort study b. Incidence study c. Longitudinal study d. Retrospective study ANS: D Because longitudinal, cohort, or incidence studies are costly in terms of resources and staff and often lose subjects over time, a retrospective study may be used because it is faster and less de- manding of resources. DIF: Cognitive Level: Apply (Application) 27. On the basis of findings related to elevated blood levels of cholesterol, a researcher wanted to determine whether a new drug would notably lower the blood levels of cholesterol in otherwise healthy persons. Which study would the researcher most likely use? a. Cross-sectional study b. Experimental study c. Prospective study d. Retrospective study ANS: B Experimental design is used to test treatment and prevention strategies. Subjects are randomly assigned to the experimental group to obtain the new drug while the control group receives a placebo or alternative. The changes in blood cholesterol level would then be measured. A cross-sectional study examines relationships between potential causal factors and disease at a specific time. A prospective study monitors a group of disease-free individuals to determine if and when disease occurs. A retrospective study compares individuals with a particular condition or disease with those who do not have the disease. DIF: Cognitive Level: Apply (Application) 28. A client has developed pellagra because of a lack of certain B vitamins. Which best describes the classification of the nutritional deficiency? a. Relative risk factor b. Agent factor c. Environment factor d. Host factor ANS: B Nutritional deficiencies are included under agent factors. Although too much of an agent can cause disease (such as obesity related to diabetes), so can too little of an agent. Relative risk in- dicates the extent of excess risk incurred by exposure relative to nonexposure. Host factors are intrinsic factors and describe one’s susceptibility or response influence to the exposure to the agent, such as genetics, age, sex, ethnicity, and human behavior. Environment factors are extrinsic factors and they influence the existence of the agent, exposure, or susceptibility to the agent such as physical environment, biological environment, and socioeconomic environment. DIF: Cognitive Level: Apply (Application) 29. Which best describes the Tuskegee Syphilis Study? a. It provided excellence in research design. b. It used an extensive subject base leading to confirmed conclusions. c. It developed information about the causes and treatment of syphilis. d. It implemented unethical and racist treat- ment of uninformed subjects. ANS: D As treatment was knowingly withheld over many years resulting in incredible harm to the sub- jects and their families, public outrage over unethical, racist, and discriminatory behavior of the DIF: Cognitive Level: Understand (Comprehension) 5. A nurse wanted a screening test that was very sensitive in determining who might have a particular illness. What might be a problem with using such a sensitive test? (Select all that apply.) a. Many persons have true negative test re- sults. b. Persons who test negative are able to ce- lebrate their healthy state. c. Persons who do not have the illness are told that they might, which leads to anxiety, as well as time and cost of follow-up diagnostic tests. d. Such a test may have lower specificity, so some persons with the disease are told they are disease free and hence do not receive care. e. There is no problem; it is best to use the most sensitive screening test available. f. Persons who have the disease are notified and receive treatment. ANS: C, D The problem with very sensitive tests is that the test picks up almost all people with the disease but also many others who do not have the disease. These “false positives” result in persons nee- ding follow-up diagnostic tests. Additional time, effort, and expense, as well as worry, result until the negative test results are obtained. There is no problem with persons receiving true negative test results and celebrating that knowledge or with persons having their condition correctly diag- nosed and treated. DIF: Cognitive Level: Apply (Application) Chapter 06: Community Assessment Nies: Community/Public Health Nursing, 7th Edition MULTIPLE CHOICE 1. Which best describes how care can be appropriately given in a community? a. Provide individualized care to unique individuals as much as resources allow. b. Consider the community itself as the “client.” c. Administer care according to the priorities of the local health department. d. Prioritize care for the sickest populations first. ANS: B As it is clearly impossible and impractical to give service to each person in a community, the best approach considers the community itself to be the unit of service. The nurse partners with community members to identify community problems and develop solutions to ultimately improve the community’s health. The community health nurse does not administer care according to the priorities of the health department or care for the sickest populations first. DIF: Cognitive Level: Understand (Comprehension) 2. Which provides the most accurate way to explain community health nursing? a. Being employed outside a medical center, such as in a physician’s office b. Focusing care on the community as a whole c. Providing care within the community, rather than a hospital or extended-care facility d. Working for a public health department ANS: B Not only is community a context or place where a community health nurse gives care, but the community as a whole is the focus of the nurse’s efforts. Being employed outside a medical center, providing care within the community, and working for a public health department all describe settings where a community health nurse may be employed, but do not demonstrate the emphasis on providing population-focused care. DIF: Cognitive Level: Understand (Comprehension) 3. Which activity would be most helpful to a person in whom a serious chronic illness has been diagnosed? a. Discuss it with a religious leader on a confidential, do-not-tell basis. b. Join a support group of others with the same illness. c. Share the diagnosis with coworkers and neighbors to gain sympathy and support. d. Tell extended family because many diseases have a genetic component. ANS: B Although a person might choose to do any of these, the most helpful action over the long term is to join a support group with persons having the same diagnosis for mutual learning, sharing of resources, and support. Religious leaders could also be helpful, but many people do not have a religious leader. DIF: Cognitive Level: Apply (Application) 4. Which is a major factor in determining which people or groups are most likely to be helpful to a particular individual? a. Anyone who has time to be available b. Environmental proximity c. Same employment responsibilities d. Similar religious faith ANS: B Although it is certainly more common to have friends who are similar to ourselves in many ways, those most likely to be called on and respond are those in close environmental proximity. Proximity facilitates the recognition of commonality and the development of cohesion among members. DIF: Cognitive Level: Understand (Comprehension) 5. Which best describes how people typically respond when asked of what community are they a member? a. Geographic community (neighborhood or city) b. House of worship participants or members c. Occupational or professional group d. Those who are devoted to a particular craft or hobby ANS: A Although individuals might well respond in terms of any of the possible responses, the most common response is in terms of geographic location of one’s home or place of residence. Traditionally, a community is an entity delineated by geopolitical boundaries; this view best exemplifies the dimension of location. DIF: Cognitive Level: Understand (Comprehension) 6. Which best describes what community members receive from each other? a. Safe environment to live and work b. Entertainment and recreational opportunities c. Socialization and role fulfillment d. Useful services such as physicians and medical centers ANS: C A major feature of a community is the relationships that community members form with one another. These functions provide socialization, role fulfillment, goal achievement, and member support. Not all communities are safe environments, have medical centers, or offer recreational opportunities. DIF: Cognitive Level: Understand (Comprehension) 7. An individual lives in a healthy community. Which characteristic would this community most likely display? a. Ability to adapt and respond to changes b. Lack of environmental pollution c. Low unemployment rate d. Ongoing growth in population DIF: Cognitive Level: Understand (Comprehension) 14. All of the needed objective data on a specific health problem are available for the community health nurse. Which best describes why the nurse would also interview community residents about the health problem? a. To confirm the accuracy of the previously collected data b. To emphasize to residents the importance of the health problem c. To obtain the residents’ personal insights and beliefs about the problem d. To update the previously collected data ANS: C The nurse must understand the community’s perspective on health status, the services used or required, and their concerns. Official data do not capture this type of information. Data collected directly from an aggregate may be more insightful and accurate. DIF: Cognitive Level: Apply (Application) 15. A nurse begins to collect information about a particular health problem from community residents. Which potential problem would most likely arise? a. Residents might become suspicious about why the nurse needs this information. b. Residents might believe the nurse is becoming intrusive in their personal lives. c. Residents might wonder why they are being asked about the problem when previous surveys may also have asked about the same problem. d. Residents might begin to expect service to be given to address the problem. ANS: D Although the process of needs assessment can indicate strengths and weaknesses, it can also raise expectations for new services to address problems. It is also possible that this data collection may cause residents to become suspicious and wonder why this data collection is necessary. However, in most cases, this is not problematic. The problem will arise if residents expect that services will be provided when they may not. DIF: Cognitive Level: Apply (Application) 16. The nurse is interviewing community members as part of a community assessment. Which group of people would the community health nurse most likely want to interview? a. Bankers who could share economic data on the community b. Long-time residents who were informal leaders in the community c. Pastors and other religious leaders who share the faith of the community d. Realtors who could share housing and living conditions in the community ANS: B The nurse needs to interview key informants in the community to gather data about the health of the community. Although each group could share some information, the long-time informal leaders would be most knowledgeable about the overall strengths and concerns of the community. DIF: Cognitive Level: Apply (Application) 17. A nurse was debating about which approach to use to both obtain data about community needs and encourage community participation in their resolution. Which approach would be most effective in meeting both goals? a. A community forum, open to all interested residents of the community b. A community survey mailed to all residents c. Establishing focus groups with selected participants d. Conducting in-depth interviews with select community residents ANS: C All of the responses would be helpful in obtaining information about the community. However, only focus groups promote group interaction and encourage further participation in planning solutions to identified problems. DIF: Cognitive Level: Apply (Application) 18. A community health nurse has completed a community assessment and is now writing a community diagnosis for the problem. Which component of the diagnosis will be used to summarize the assessment data of the problem? a. Identification of the health risk b. Evidence supporting the choice of priority c. The aggregate that needs the intervention d. The cause of the identified health problem ANS: A The identification of the health problem or risk represents a synthesis of all assessment data. The evidence can suggest the magnitude of the problem. The aggregate states who will be the beneficiary of the nurse’s action plan. The cause of the health problem directs the focus of the intervention. DIF: Cognitive Level: Apply (Application) 19. A community health nurse is trying to determine the success of a planned intervention. Which would the community health nurse most likely examine? a. Changes in funding made available to the agency to continue their efforts b. An increase or decrease in the number of persons asking for assistance c. Current problem data to compare with original baseline data d. Feedback from community residents ANS: C By comparing baseline data, the nurse can construct benchmarks to gauge the achievement of program objectives. Such epidemiological data are also important for documentation of a program’s long-term effectiveness. The planned intervention would most likely cause some type of a change in funding, change in service use, and allow the residents to provide feedback; however, these things would not provide the best information about success of the program. DIF: Cognitive Level: Apply (Application) 20. A community health nurse found a very small number of families in the community who were desperately in need of basic preventive health services. Which ethical approach supports expending agency resources on these few, but needy, families? a. Beneficence suggests focusing on the most needy, so resources should be expended on these families. b. Deontological ethics suggest that the nurse must give priority to the intervention that would have the broadest impact. c. Utilitarianism (the most good for the largest number) would suggest continuing to focus on broader community needs. d. Virtue ethics would suggest focusing on these families to support the nurse’s own character development. ANS: A Each response is an accurate portrayal of a branch of ethics. Beneficence and social justice would give moral advantage to the most vulnerable. By caring for these families, the demands of utilitarianism (the most good for the largest number) would also be met as caring for the weakest supports the whole community. DIF: Cognitive Level: Apply (Application) MULTIPLE RESPONSE 1. Which best describes the aspects central to the definition of community? (Select all that apply.) a. Geographic boundaries at a point in time b. Whatever is most convenient for the nurse c. Patterns of disease found d. Persons who share common goals and interests e. Persons who band together to address a shared problem f. The name the people have given themselves ANS: A, E, F The person-place-time model suggests epidemiologists examine demographic characteristics of the community (person characteristics), geographic or environmental factors (place), and a point in time (i.e., the present in comparison with the past and hope for future). Therefore, using the model, any item related to geographic boundaries, persons with shared goals, or a particular time would be correct. DIF: Cognitive Level: Understand (Comprehension) 2. Which is a central function unique to community health nursing? (Select all that apply.) a. Being willing to travel to give care in an appropriate setting b. Collaborating and cooperating with other health care team members c. Gathering appropriate comprehensive assessment data on the community d. Incorporating epidemiological approaches throughout the nursing process e. Keeping accurate and detailed medical records on care given f. Being willing to contribute to health policy development ANS: C, D, F Although all nurses ideally arrange transportation to their employment site, keep accurate records, and collaborate with health care team members, only community health nurses are expected to engage in comprehensive community assessment, incorporate epidemiology, and contribute to health policy development. equal number of services. d. The nurse must choose which health care need should have first priority. ANS: B The nurse decides which aggregate to focus on and then carefully defines that aggregate. Whether caring for an individual, a family, or an aggregate, the nurse must know the demographics of the client and choose which health need has first priority. In caring for aggregates, each participant does not receive an equal number of services, but only those services that each participant needs. DIF: Cognitive Level: Understand (Comprehension) 4. A nurse is using a systems framework when caring for individuals, families, and aggregates in the community. Which best describes an aspect that would be more challenging when caring for an aggregate as opposed to caring for an individual? a. Ability to communicate clearly with the client b. Analyzing power and decision-making within the system c. Defining the system’s structure and functions d. Recognizing the system’s goals ANS: B Although all aspects can be challenging, it is probably more challenging to recognize the interacting aspects of a large aggregate system in its power distribution, consensus activities, accommodation, and authority within the decision-making process. DIF: Cognitive Level: Apply (Application) 5. A nurse is caring for an aggregate as his or her client. Which task would the nurse complete first? a. Determine the setting of the aggregate. b. Gain access into the aggregate. c. Identify the nurse’s own strengths and preferences. d. Review the resources available to use in the community. ANS: C A nurse should also consider personal interests and strengths in selecting an aggregate for intervention. For example, the nurse should consider whether he or she has an interest in teaching health promotion and preventive health or in planning for organizational change, whether his or her communication skills are better suited to large or small groups, and whether he or she has a preference for working with the elderly or with children. Thoughtful consideration of these and other variables will facilitate assessment and planning. After self-reflection, the nurse will need to determine the setting of the aggregate, consider how to gain access, and identify the community resources available. DIF: Cognitive Level: Apply (Application) 6. A nurse decided that a high-risk aggregate most needed education about diabetes. Which would be the best approach when teaching the group? a. Involve participants in small group activities applying the information. b. Organize the information into a visual presentation such as a PowerPoint presentation. c. Share the nurse’s expertise directly with the group at a meeting for that purpose. d. Use handouts and pamphlets with pictures consistent with the local cultural groups throughout. ANS: A Most persons do not enjoy lectures, so the nurse must initiate small group involvement and participation. Those with less educational experience are more comfortable in informal learning settings. Visual only presentations, such as power point presentations and handouts are not the best approach to use with adult learners. Sharing of the nurse’s expertise is an important part of the teaching process but will not be effective if the participants are not actively involved in the learning process. DIF: Cognitive Level: Apply (Application) 7. A community health nurse has determined that the number one priority is to help families in which one member has diabetes. Which action would be most appropriate to maximize services to persons with diabetes? a. Ask friends with diabetes about what services they want improved. b. Duplicate the diabetic organization’s services, because not all patients with diabetes have yet received services. c. Meet with the diabetic organization to see how the public health department can augment what it is offering. d. Submit a request for funding so that the public health department can also offer services to patients with diabetes. ANS: C The nurse should augment existing resources or create a new service rather than duplicate what is already available to the aggregate. It is assumed that if the nurse has concluded that diabetic issues are the number one priority, there is no pressing need to ask specific questions of friends with diabetes. DIF: Cognitive Level: Apply (Application) 8. A nurse is determining the needs of a selected aggregate. Eight percent of the aggregate has diabetes. Which best describes the action that should be taken next to determine if this should be a priority? a. Ask the American Diabetes Association if 8% is a worrisome rate. b. Discuss the findings with the head of the public health department. c. Review the literature to determine the national and state diabetic rate. d. Determine what the aggregate’s diabetic rate has been in the past. ANS: C A rate by itself is meaningless unless compared with previous trends (although the instructor or the head of the local public health department may or may not know that particular piece of information) or with state or national norms. The easiest way to find those norms would be to check the literature to determine the typical incidence in a similar environment or community. The literature review could include research reports and statistics that will help determine whether this finding represents a priority for this aggregate. DIF: Cognitive Level: Apply (Application) 9. A nurse has assessed an aggregate, determined the priority health needs, and decided on what intervention to offer. Which will best determine if the intervention will be successful? a. Accuracy of the nurse’s assessment b. Careful planning and implementation of the intervention c. Determination of the aggregate’s perspective of the need for the intervention d. Selection of appropriate evaluation measures both in process and on completion ANS: C Interventions are seldom successful unless the aggregate has input into determination of need, its priority, and appropriateness of the intervention. DIF: Cognitive Level: Apply (Application) 10. Which action must a nurse take to be successful in addition to the typical assessment, diagnosing, and planning directly related to the intervention project? a. Advocate for community empowerment throughout the process. b. Choose superb people to implement the plan. c. Confirm administrative support throughout the project. d. Continue to assess both barriers and resources throughout the project. ANS: A An essential component is to have a strong level of community involvement. The nurse is responsible for advocating for client empowerment throughout the process. Attention to community involvement and empowerment helps ensure that the outcomes reflect the community’s needs and will be accepted. DIF: Cognitive Level: Understand (Comprehension) 11. A nurse found that several professionals resented time spent interacting with and teaching clients. Which describes the most likely underlying motivation for resisting client involvement? a. Believing that people could change their lives if they really wanted to do so. b. Empowering others shifts power from the experts to the community. c. It is more efficient to plan appropriate care without listening to client ideas. d. Longtime experience with community members has led to disillusionment. ANS: B Successful programs rely on empowering citizens to make decisions about their care. Empowering citizens causes power to shift from health providers to community members. Many prefer to remain in positions of power rather than sharing. Client ideas must be included in the planning process in order to get them involved. Empowerment will lead the clients to change their lives. DIF: Cognitive Level: Apply (Application) 12. A nurse assessed carefully and created a comprehensive intervention plan including primary, secondary, and tertiary care for individuals and families. Which factor may the nurse have overlooked? a. Are other staff members interested in such a project? b. Are there adequate resources for such a project? c. Is there support from the administration for the project? Its purpose was to make the latest technology for the diagnosis and treatment of heart disease, cancer, stroke, and related diseases available to community health care providers through the establishment of regional cooperative arrangements. The National Health Planning and Resources Development Act attempted to reduce overall health care costs and to increase acceptability, accessibility, continuity, and quality of health care services. State government developed and implemented the requirement for hospitals to obtain approval for certain projects by requiring a certificate of need. DIF: Cognitive Level: Understand (Comprehension) 19. Which best describes a flaw of many of the health care bills passed during the last four decades? a. They avoided interfering with the current health care approach and did not improve problems of access or duplication of efforts. b. They encouraged each state to do what was best for its residents without consideration of what was best for the nation as a whole. c. They created new layers of bureaucracy in health care administration. d. They did not include financing to pay for the suggested changes. ANS: A Although each bill attempted to meet some problem in health care planning and delivery, none really improved quality, access, and cost issues. Current health care providers and institutions heavily influenced outcomes. DIF: Cognitive Level: Understand (Comprehension) 20. Which describes why the National Health Planning and Resources Development Act of 1974 was unsuccessful in its efforts to increase accessibility and acceptability, improve quality, and constrain rising costs? a. A new president forced the legislation’s repeal. b. No federal financing was included to implement the law. c. The federal government made no effort to enforce the law. d. The law did not affect the current health care delivery system. ANS: D The 1974 Act was unsuccessful because it grandfathered in the entire health care system. In other words, nothing had to change. DIF: Cognitive Level: Understand (Comprehension) 21. Which best describes the first efforts at improving community health? a. Environmental planning of water and sewer systems b. Mass community immunizations c. Passing laws requiring quarantine of infected persons d. Segregation of ships from harbors until the harbormaster checked the sailors ANS: A The first communitywide efforts toward improving health were environmental planning for water and sewer systems. Mass community immunizations, laws regarding quarantine, and segregation of ships were not among the first efforts to improve community health. DIF: Cognitive Level: Understand (Comprehension) 22. Which is the most important component of the Planning Approach to Community Health (PATCH) model? a. Use of data to develop strategies b. Community participation throughout the process c. Intensive planning by all professionals involved d. Selection of professional outcome measures ANS: B An essential element of the PATCH model is community participation. The idea is that health promotion is a process that enables the population to have more control of its own health. Selection of professional outcome measures and intensive planning by all professionals are not a part of the PATCH model. Use of data to develop comprehensive health strategies is part of the PATCH model, but is not the most important component. DIF: Cognitive Level: Understand (Comprehension) 23. Which best describes the purpose of the Assessment Protocol for Excellence in Public Health (APEX-PH)? a. To improve the functioning of public agencies by peer evaluation b. To provide intensive planning for all professionals involved in public health c. An evaluation process involving both community and public organizations d. A self-evaluation by all the groups involved in public health planning ANS: C The APEX-PH program is a true self-assessment and is intended to be more of a public endeavor involving the community, as well as public organizations. DIF: Cognitive Level: Understand (Comprehension) 24. Which is the most important phase of the Mobilizing for Action through Planning and Partnership (MAPP) model? a. Conduct assessments identifying strengths and current health status b. Evaluate current local health care systems and forces for change c. Guide the community toward long-range visioning d. Mobilize the community to become involved ANS: D The MAPP model is a planning model that is based on first mobilizing the community; guiding the community toward a shared vision for long-range planning; and, finally, conducting assessments of community strengths, forces of change, health status, and the local health system. Without completion of the first phase, the model is unable to be implemented. DIF: Cognitive Level: Understand (Comprehension) 25. Which best describes why states will increasingly monitor and report on quality and cost of health care? a. Citizens are increasingly complaining of high medical costs in a depressed economy. b. Congress has been unsuccessful in reducing health care costs. c. Taxation has decreased, resulting in fewer funds available for health care. d. Hospitals and nursing homes are demanding increased funding. ANS: B When Congress rejected President Clinton’s plan for health care in 1994, the federal government withdrew from active health planning. Most states have become very involved in various aspects of health care planning as state funding from the federal government decreased and state budgets are not increasing. States are forced to determine priorities for the resources available. Even though citizens do complain about high medical costs, this is not the reason why states are becoming more involved with health care reporting and monitoring. Although hospitals and nursing homes may want increased funding, much of this control comes from federal legislation, which is not impacted by the states. Taxation has not decreased. DIF: Cognitive Level: Understand (Comprehension) 26. Which approach has been suggested to improve the functioning of local and national health planning? a. Increase nursing involvement. b. Invite citizen participation in health care provision. c. Invite more health professionals to be involved in health planning. d. Increase community involvement among hospitals. ANS: A The textbook suggests increased nursing involvement as one method of strengthening local and national health planning. Nurses can assess aggregates, identify health needs, and perform planning, intervention, and evaluation. Health would improve if nurses reemphasized the larger aggregate and shared their insights with planning groups. DIF: Cognitive Level: Understand (Comprehension) MULTIPLE RESPONSE 1. Which best describes the provisions of the Affordable Care Act (ACA) of 2010? (Select all that apply.) a. It provided free health insurance to all U.S. citizens. b. It required all U.S. citizens to be covered by health insurance. c. It prohibited insurance companies from denying coverage because of pre-existing medical conditions. d. It gradually decreased the number of health insurance options available to Americans. e. It reduced expenses for families by capping out-of-pocket expenses. f. It required all school-age children to have access to health care services. ANS: B, C, E Chapter 08: Community Health Education Nies: Community/Public Health Nursing, 7th Edition MULTIPLE CHOICE 1. A nurse has instructed a client several times what he needs to do to get better, but the client has not followed these instructions. Which offers the best explanation for this behavior? a. Barriers prevent action. b. The client does not understand. c. The client does not really care. d. Barriers prevent desire to change. ANS: A Often the patient is blamed and labeled as being noncompliant. It is more helpful to wonder what barriers interfered with the patient’s ability to engage in appropriate action. It is unlikely that the client doesn’t understand or doesn’t care, rather the barriers are preventing action from being taken. Barriers may prevent the change, but not necessarily the desire to change. DIF: Cognitive Level: Apply (Application) 2. Which best describes one of the most fundamental nursing principles suggested by Nightingale? a. Be open to the patient’s preferences and priorities. b. Engage in health teaching. c. Keep the focus on individualized care for each person. d. Meet physical needs, such as air, food, and water, first. ANS: B Although Nightingale would probably agree with each of the listed suggestions, she emphasized that health teaching is one of the most fundamental nursing principles. DIF: Cognitive Level: Understand (Comprehension) 3. Which best describes why health education in the community is more effective than health education in a hospital or clinic? a. Being in the patient’s home emphasizes the importance of the teaching. b. It is easier to focus on the nurse’s words and demonstrations outside of health settings. c. The setting is familiar and comfortable to participants. d. There are too many interruptions in hospitals and clinics. ANS: C There can be interruptions and distractions anywhere, including in a patient’s home. In the community, the setting is familiar and comfortable. DIF: Cognitive Level: Understand (Comprehension) 4. A nurse is implementing a comprehensive and entertaining educational program. Which action must the nurse complete first? a. Be sure all the electronics (such as the computer showing the PowerPoint slides) are working. b. Develop an open and trusting relationship with participants. c. Distribute evaluation materials to participants. d. Greet each participant and welcome him or her to the event. ANS: B At the core of health education is the development of trusting relationships based on nurturing interactions; thus, this action must be completed before completing any other action. DIF: Cognitive Level: Apply (Application) 5. Which best describes why community health education programs are important? a. It provides a way to reinforce voluntary behavior changes. b. Health education is an area that has desperately needed improvement. c. Health education prevents the occurrence of disease. d. It is the most cost-effective way of improving health. ANS: A Health education is designed to predispose, enable, and reinforce voluntary behavior conducive to health. Health education is unable to prevent disease from occurring, and it is not the most cost-effective way to improve health. DIF: Cognitive Level: Understand (Comprehension) 6. Which is most likely to determine if a health education program will create change? a. Amount of input and participation by learners b. Funds available for obtaining educational resources c. Participant attendance at the entire program d. Quality of the instructors involved in the program ANS: A The lasting effect of cognitive and behavioral changes is determined by learner participation. Funding, attendance, and quality of instructors are not important if learners are not encouraged to participate in the program. DIF: Cognitive Level: Understand (Comprehension) 7. A nurse is selecting goals for an educational program. Which method should be used? a. Ask the formal leadership of a community what the learning needs are. b. Interview informal leaders about the learning needs of the community. c. Use the expertise of professional nurses skilled at assessing needs. d. The target audience must determine their needs and priorities. ANS: D Learners must be involved in determining their own health education needs and priorities. Both the formal and informal leadership would have useful information to share, but the crucial component is input from the target group. DIF: Cognitive Level: Apply (Application) 8. A nurse is planning a health education program in the community. Which consideration must be made by the nurse? a. The listed priorities of Healthy People 2020 b. The skills and abilities of the nurse educator c. The sociopolitical cultural context of the community’s environment d. What learning materials have already been created and are available for use ANS: C Community health education with the community as client is based on practical, useful, and scientifically sound methods and widely accessible technology. An effective program relates economic, political, and epidemiological factors to internal behavioral and communication factors. Thus the program activities are viewed within a sociopolitical structure especially within the local environmental settings. DIF: Cognitive Level: Apply (Application) 9. Which is the best way to assess if learning has occurred? a. There is an appreciation for the new knowledge and skills learned. b. Participants passed an examination designed to measure learning. c. Participants stayed attentive throughout the program. d. There is a long-term change in knowledge and behavior. ANS: D By definition, learning is an enduring change involving modification of insights, behaviors, perceptions, or motivations. An appreciation for the new knowledge, passing an examination, and staying attentive does not address the entire scope of the learning process. DIF: Cognitive Level: Understand (Comprehension) 10. Which led to the creation of the Health Belief Model (HBM)? a. Attempting to explain why individuals engage in health actions b. Attempting to identify health behaviors of military spouses c. Attempting to understand why people chose unhealthy and high-risk behaviors d. Attempting to understand why people did not flock to free health care ANS: D The HBM was created to explain why people did or did not participate in health education programs to prevent or detect disease, even when the programs were free. The HBM addresses factors that provide health-enhancing behaviors. Pender’s Health Promotion Model (HPM) aims to explain why individuals engage in health actions. HPM has been used in studies identifying factors that enhance health-promoting behaviors of military spouses. DIF: Cognitive Level: Understand (Comprehension) 11. Which needs to be considered when using the Health Belief Model (HBM)? a. Prior behaviors b. Perceived benefits c. Health promoting behaviors d. Personal benefits ANS: B One of the underlying premises of community health is to “start where the people are.” Therefore, the nurse must spend a great deal of time and effort in the community interacting with community members and must be where the people are. Writing reports in the car, avoiding paperwork, and simply stating one is being paid to be in the community do not demonstrate the nurse’s connection to the community. DIF: Cognitive Level: Apply (Application) 19. A very busy day is planned at a community health fair, and a nurse spends time greeting and meeting each person who walks in. Which best describes the rationale for this action? a. To distribute evaluation forms immediately so the participants can fill in the appropriate answers after each interaction with a professional b. To immediately establish a friendly relationship and a level of trust c. To make sure everyone knew who was sponsoring this free event d. To most efficiently send the person to the area consistent with his or her apparent health need ANS: B The core of health education is the therapeutic and healing relationship between the nurse and clients. Inclusion and trust must be established before creating change. The nurse enhances inclusion by greeting clients on arrival in a warm fashion. Distribution of evaluation forms, informing participants of program sponsorship, and sending clients to the appropriate area of the health fair are not as important as the need for establishing a relationship. DIF: Cognitive Level: Apply (Application) 20. A nurse is trying to improve on providing culturally effective care in the community. Which behavior would be most effective to meet this goal? a. Being willing to change communication patterns to increase client comfort b. Demonstrating expertise in recognizing physiological differences caused by ethnicity c. Exhibiting sensitivity to individual differences resulting from culture and experiences d. Expressing the importance of valuing diversity and differences ANS: C Unfortunately, voicing the need for valuing diversity is not always consistent with behavior. It is often useful to change communication patterns to increase client comfort, although the nurse must sometimes refuse to fulfill client demands. However, it is always crucial to exhibit sensitivity to individual concerns, cultural background, or previous life experiences. DIF: Cognitive Level: Apply (Application) 21. A nurse is using the Framework for Developing Health Communications to create a health program in the community. Which is the first step the nurse would take? a. Determine factors related to the health problems, such as low socioeconomic status or educational level b. Assess health resources available (e.g., money, staff, materials) c. Establish goals and objectives that are prioritized and time specific d. Target the program to meet the audience’s learning needs as they perceive them ANS: D Understanding the intended audience’s learning needs and targeting the program or message to the audience is key to activating effective health education. After understanding the audience’s needs, it will be important to determine the factors related to health problems, assess health resources available, and establish goals and objectives. DIF: Cognitive Level: Understand (Comprehension) 22. A nurse wants to make sure that the teaching materials and the communication channels being planned for use during an educational program will be effective. Which action should the nurse take? a. Create materials based on the goals of the program, assuming a low literacy level b. Determine the reading level of the audience and the materials to be distributed c. Only use materials that have been professionally developed by a commercial group d. Pretest the materials with members of the target group to obtain feedback ANS: D Pretest the materials to obtain feedback about the understandability and acceptability of the materials with this particular audience. Learning in advance what works and what does not saves time and effort later. The best way to determine literacy level and congruency of available resources with the target group’s needs is by pretesting the materials. DIF: Cognitive Level: Apply (Application) 23. Which best describes the operational definition of “health literacy” in the United States? a. Being able to read and write at the fifth-grade level b. Being able to accurately complete a health self-assessment questionnaire c. Knowing how to access and use information to make health decisions d. Knowing one’s right to obtain health care services ANS: C Literacy as a whole is typically defined as being able to read and write at the fifth-grade level. Health literacy, however, is defined as being able to access, understand, and use information to make health decisions. Only the latter type of literacy empowers clients to best act on their own behalf. DIF: Cognitive Level: Understand (Comprehension) 24. When handed the consent form to sign before treatment could be given, a client looked at the nurse and said, “I’m sorry; I forgot my glasses today.” Which action should be taken by the nurse? a. Ask if the client can use a magnifying glass to better see the form b. Suggest the client bring his glasses or someone else with him to assist with the forms c. Tell the patient why the form was necessary and point to where the patient should sign d. Wonder if the patient might have difficulty with reading and therefore summarize the content of the form for the client ANS: D The Institute of Medicine report related that millions of U.S. adults are unable to read and act on health instructions and messages. Among the recommendations is a need for clear communication with clients. Because the underlying issue may be reading, the other responses are not appropriate suggestions for this nurse–client interaction. DIF: Cognitive Level: Apply (Application) 25. A nurse is trying to determine a client’s reading level. Which action should be taken by the nurse? a. Ask the client how he or she would rate his or her ability to read. b. Ask the client to assess his or her own health literacy and give examples. c. Determine the number of years of formal education the client completed. d. Use a literacy assessment tool, many of which are in the literature. ANS: A Any of the responses might be effective at assessing literacy, but the single question asking how often help might be needed is the fastest and easiest. Nurses are limited in the time available for assessment. One question is easier for a client than a complete assessment tool. Asking about years of education can be dismaying to someone who did not complete many years of formal schooling. Clients may not understand the question when asked to assess their own health literacy. DIF: Cognitive Level: Apply (Application) 26. During a health education program, a nurse continues to ask questions and encourages attendees to contribute examples from their own lives relevant to the discussion. Which best describes the rationale for the nurse’s action? a. To avoid having to prepare more material related to the topic b. To let the participants feel appreciated and knowledgeable c. To allow the participants to learn by doing through active participation d. To apply Freire’s principles of learning ANS: C One of the key concepts of community organizing practice is the principle of participation, which essentially means that active participation—or learning by doing—results in a greater likelihood of change in behavior and attitude. DIF: Cognitive Level: Apply (Application) 27. A nurse is helping clients to change their behavior. Which would be most effective? a. Counseling through the Ask, Advise, Assess, Assist, and Arrange approach b. Encouraging them to interact with others who also need to change their behavior c. Showing them how the inappropriate behavior is hurting their friends and family d. Using subtle rewards when small steps are taken toward the appropriate behavior ANS: A Ask, Advise, Assess, Assist, and Arrange is the five As approach to counseling as seen, for example, in smoking cessation programs. The other responses are not as comprehensive as the five A approach to counseling. DIF: Cognitive Level: Apply (Application) The nurse must determine what the client wants to know, not what the nurse believes the client needs to know. The nurse should not go into excess detail but focus on a few concepts or key points, that is, stick with the essentials; use clear and concise language while avoiding technical terms; encourage participants by use of questions related to their life experiences; use demonstrations and real-life examples to illustrate major points and summarize the key points to help the audience retain the material. DIF: Cognitive Level: Apply (Application) Chapter 10: Policy, Politics, Legislation, and Community Health Nursing Nies: Community/Public Health Nursing, 7th Edition MULTIPLE CHOICE 1. Which nurse fought to have American nursing controlled by nurses rather than physicians? a. Clara Barton b. Florence Nightingale c. Lavinia Dock d. Lillian Wald ANS: C Lavinia Dock was a political activist who waged a campaign for legislation to allow nurses to control the nursing profession. Florence Nightingale was the first nurse to exert political pressure on a government. Clara Barton was responsible for organizing relief efforts during the U.S. Civil War. Lillian Wald was the driving force behind the federal government’s development of the Children’s Bureau in 1912. DIF: Cognitive Level: Remember (Knowledge) 2. Which nurse used political expertise to influence the federal government to develop a Children’s Bureau? a. Clara Barton b. Florence Nightingale c. Lavinia Dock d. Lillian Wald ANS: D Lillian Wald recognized the connection between social conditions and health. She was a driving force behind the federal government’s development of the Children’s Bureau in 1912. Lavinia Dock was a political activist who waged a campaign for legislation to allow nurses to control the nursing profession. Florence Nightingale was the first nurse to exert political pressure on a government. Clara Barton was responsible for organizing relief efforts during the U.S. Civil War. DIF: Cognitive Level: Remember (Knowledge) 3. Which best describes the most important factor in legislation? a. The amount of financing and lobbying behind each choice b. The beliefs, attitudes, and values of the policy c. The preferences of the majority of American voters d. The president’s ongoing encouragement for one particular choice ANS: B Public policy encompasses the choices made regarding goals, priorities, and how resources are allocated. Policy choices reflect the values, beliefs, and attitudes of those designing the policy. The influence of the president, preferences of Americans, and amount of financing related to the legislation are not as important as the beliefs, attitudes, and values of the policy. DIF: Cognitive Level: Understand (Comprehension) 4. Which is accomplished through the use of public policy? a. Solutions to problems of public concern are developed. b. A rational, logical problem-solving decision-making process is implemented. c. Public safety nets for vulnerable populations are created. d. Economic and business management principles are applied. ANS: A The field of public policy involves the study of specific policy problems and governmental responses to them. Political scientists involved in the study of public policy attempt to devise solutions for problems of public concern. The use of public policy may not involve the implementation of a logical problem-solving, decision-making process. Public policy addresses more than safety nets for vulnerable populations. Additional principles besides economics and business management are applied through the use of public policy. DIF: Cognitive Level: Understand (Comprehension) 5. Which best describes why it is so difficult to change the paradigm of health care from disease orientation to promoting health orientation? a. The belief exists that those without insurance could obtain insurance if they worked hard enough. b. People find it difficult to agree on what the ideal paradigm should be. c. People realize the media have exaggerated the problems that result from lack of insurance. d. Serious reallocation of resources would have to occur. ANS: D A shift in the paradigm would necessitate a substantial reallocation of resources because the vast majority of health spending is currently directed to medical care and biomedical research and reflects a viewpoint of health care as a commodity. The allocation of resources has the most influence on creating a paradigm shift. Individual opinions and the use of media do not play as great of role as where resources are spent. DIF: Cognitive Level: Understand (Comprehension) 6. Which best describes how the government controls conditions that individuals cannot? a. Appeals to the common sense and good nature of the citizens b. Establishes social mores that enable groups to control individuals’ behaviors c. Passes and enforces law d. Uses fear reinforced by police power ANS: C Government regulates conditions that individuals cannot control and provides individual protection through a population-wide focus. These tasks are accomplished through passage and enforcement of laws. These laws control individuals’ behaviors, which may lead to the establishment of social mores and common sense related to the laws that have been established. DIF: Cognitive Level: Understand (Comprehension) 14. Which statement best describes what happened to the hospitals built or expanded by Hill-Burton Act funds? a. Many such hospitals have consolidated or closed. b. Not needing to expand, hospitals have used the funds to upgrade their facilities. c. They have continued to use such funds to expand. d. When funding ceased, so did hospital expansion. ANS: A The Hill-Burton Act authorized federal assistance in construction of hospitals, making hospitals more accessible. However, with the high cost of health care and the decreasing lengths of stay and increasing use of primary care, many hospitals are closing. Because hospitals have closed, they are not further expanding or upgrading facilities. DIF: Cognitive Level: Understand (Comprehension) 15. An individual has been terminated from his job and has lost his health insurance. Which federal law allows him to continue his insurance benefits for a specified period of time? a. Health Insurance Portability and Accountability Act of 1996 (HIPAA) b. Family Support Act of 1988 c. Health Maintenance Organization Act of 1973 (HMO) d. Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) ANS: D An important requirement of COBRA focuses on the problem of the loss of insurance when a person loses his or her job. With the growing number of unemployed, COBRA is even more important. Employers who terminate an employee must continue benefits for the employee and dependents for a specified period of time if the employee had health benefits before the termination. HIPPA offers protections for patient privacy and confidentiality. The Family Support Act expanded coverage for poor women and children and required states to extend Medicaid coverage for 12 months to families who have increased earnings but are no longer receiving cash assistance. The HMO Act provides grants for HMO development. DIF: Cognitive Level: Apply (Application) 16. Which statement best describes an effect of the Welfare Reform Act of 1996? a. Individuals who were required to obtain employment lost their health coverage. b. Many were happy to be off the government dole and self-supporting. c. Persons sought and obtained employment that often included insurance benefits. d. The food stamp program decreased in size. ANS: A The law decreased the number of people on welfare and forced many individuals to take low-paying jobs, many of which did not offer health insurance. Many individuals, particularly women and children, subsequently lost Medicaid coverage. DIF: Cognitive Level: Understand (Comprehension) 17. Which best describes the history of the State Child Health Improvement Act (SCHIP) of 1997? a. The law included goals and programs but no funding to achieve them. b. The law received extensive support by both Republicans and Democrats. c. The law was extended, not renewed by the Bush administration, and then renewed by the Obama administration. d. The law was passed by the majority of states but not by the federal government. ANS: C The law was extended several times, and then it was not renewed by the Bush administration. The program was renewed again by the Obama administration in the Children’s Health Insurance Reauthorization Act of 2009. DIF: Cognitive Level: Understand (Comprehension) 18. Which best describes what happened after the Medicare Modernization Act of 2003 was enacted? a. Additional restrictions in coverage were imposed. b. Experimental treatments were approved for reimbursement. c. Reimbursement procedures became more efficient. d. A prescription drug benefit was added. ANS: D The Medicare Modernization Act of 2003 provides seniors and people living with disabilities some prescription drug benefit coverage, as well as more choices and better benefits. The act did not impose additional restrictions to coverage, approve experimental treatments, or provide efficiency with reimbursement procedures. DIF: Cognitive Level: Understand (Comprehension) 19. A nurse is employed by the state public health department. Which activity would she most likely complete? a. Set up a flu shot clinic at a neighborhood church. b. Lobby for health care reform to cover more preventive services. c. Monitor the incidence of influenza in the state. d. Serve as a volunteer for a state legislator’s campaign. ANS: C One of the state health care functions is assessment of health needs based on statewide data collection. This could be done by monitoring the incidence of influenza in the state. Setting up a flu shot clinic would most likely be done at the local level, while lobbying for health care reform would most likely be done at the federal level. Serving as a volunteer for a campaign may be something a nurse would do, but would not be specifically related to employment by the state public health department. DIF: Cognitive Level: Apply (Application) 20. It has been proposed that a new, better approach to health care be tested with a small group to evaluate its effectiveness. Which best describes why this cannot be done? a. Any employment in the project would be only temporary, so it would be difficult to find professionals to staff the program. b. It is challenging to find appropriate sites located in the target area from which to offer the pilot project service. c. No one wants to accept free services if they include being a guinea pig in a research project. d. Offering a service establishes a precedent and a sense of entitlement, so it is difficult to discontinue the program. ANS: D Once a direct health care service is offered, it is difficult to discontinue it. Existing programs create tradition by establishing vested interest and a sense of entitlement. DIF: Cognitive Level: Apply (Application) 21. Which best describes the most crucial step in policy formation? a. Convincing both political parties and independents to support the proposed policy b. Defining the issue and placing it on the agenda for possible action c. Determining who has vested interest in what aspects of the policy d. Trying to simplify the proposed legislation so the public will support it ANS: B How an issue is defined determines what the possible approaches to resolution might be. With all the demands on legislators’ time, it is difficult for an issue to be seen as important enough to have action taken. Defining the issue as crucially important and worthy of a place on the agenda for possible action is the most critical step. DIF: Cognitive Level: Understand (Comprehension) 22. A nurse suggests to the students that they attend the local district nurses’ association meeting, where the nurse is an officer. Which provides the best rationale for this action? a. Meeting outside the clinical area allows for more effective informal learning based on discussion and interaction. b. Role models are typically the major influence on nurses choosing to become politically active. c. Students are often given extra credit from their instructor for such community involvement. d. Such groups want students to attend their meetings to encourage them to join and to accept a committee responsibility. ANS: B Professional groups do not usually accept students into membership (especially since many students may want a different specialty practice). Nurses most often identify positive role models as the major influence that assisted them to become politically active. Therefore, mentorship at the student level up to the expert level is important. Providing extra credit should not be the motivator for students to learn from these role models. The learning that occurs is a formal learning process related to learning more about political advocacy and something that is difficult to demonstrate in a classroom environment. DIF: Cognitive Level: Apply (Application) 23. Which statement best describes why nurses are not more effective in creating political change? a. Nurses are not listened to by politicians. b. Nurses are not perceived as leaders in the health care field. c. Nurses do not act or do not agree on what changes are needed. Because PACs are a reality of political life, nurses need to recognize their power and support those that are committed to electing candidates sympathetic to health care issues. The contribution of money will support the current nursing practice initiatives which will change as nursing practice changes. These contributions will most likely not have any relationship to a future political appointment. Legislative votes are influenced by a variety of factors and are not limited only to money. DIF: Cognitive Level: Understand (Comprehension) 30. Which best describes one of the strategic plan priorities for the Center of Disease Control’s (CDC) Strategic Framework? a. Eliminate waste of health care resources b. Eliminate health disparities c. Improve health care access d. Improve health security at home ANS: D The three strategic plan priorities for the Center of Disease Control Strategic Framework are: improve health security at home and around the world; better prevent the leading causes of illness, injury, disability, and death; and strengthen public health and health care collaboration. Improvement of health care access, elimination of wasting health care resources, and eliminating health care disparities are not part of the strategic plan for the CDC. DIF: Cognitive Level: Understand (Comprehension) 31. A nurse would like to influence an internal private health policy. Which action should the nurse take? a. Build or join a private entrepreneurial practice to provide lower cost services to underserved groups b. Participate in public discussions regarding quality and managed care c. Support nursing research done that demonstrates positive clinical and economic outcomes d. Write managed care organizations to request that nurses receive reimbursement for health services to clients ANS: C Internal nursing action is from within the agency, such as holding an important management position. Nurses can support and use nursing research that demonstrates positive clinical and economic outcomes. Such action also serves to validate the importance of nursing within the health system. External strategies can include participation in discussions regarding aspects of care or seeking employment in entrepreneurial practices. DIF: Cognitive Level: Apply (Application) 32. What was the poverty guideline for a family of four in mainland United States in 2013? a. Below $24,600 b. Below $16,240 c. Below $37,140 d. Below $41,320 ANS: A A four-person household must make less than $24,600 to be considered under the poverty guideline according to the U.S. Department of Health and Human Services. DIF: Cognitive Level: Understand (Comprehension) MULTIPLE RESPONSE 1. Which best describes the purposes of professional societies such as the American Nurses Association (ANA)? (Select all that apply.) a. Providing control and oversight of the occupation b. Creating licensing laws to control entry into the profession c. Determining appropriate requirements for education into the profession d. Establishing standards for practice e. Protecting the interests of the practitioners f. Safeguarding the public trust ANS: A, D, E, F Professional societies seek to further a particular profession, the interests of persons engaged in that profession, and the public interest. Their roles are to maintain control and oversight of the occupation—such as by writing standards for practice—as well as safeguarding the public trust. Licensure and educational standards are responsibilities of individual states. DIF: Cognitive Level: Understand (Comprehension) 2. Which is one legally required to obey? (Select all that apply.) a. Directions to a destination provided by a police officer b. Court decisions related to legislative law c. Delegation of responsibility for a task by a physician d. Executive decisions, such as your employer requirements e. Laws passed by your state or the federal government f. Rules and regulations from agencies, such as the state board of nursing ANS: B, E, F Laws that all must obey include legislative law, regulatory agency rules and regulations, and judiciary rulings regarding the law. Although physicians may delegate a task, a physician cannot delegate responsibility. DIF: Cognitive Level: Understand (Comprehension) 3. Which current issues are leading the World Health Organization (WHO) to reconsider its initial definition of health? (Select all that apply.) a. Environmental issues such as industrial toxins or carcinogenic commercial products b. Global, not local, problems such as spread of antibiotic-resistant bacteria c. Need to move from containment and treatment to social intervention d. Pressure from industrialized nations to emphasize chronic diseases rather than infectious diseases e. Realization that government actions influence the basic human right of health f. Worldwide pandemics such as human immunodeficiency virus (HIV) and swine flu, which require a different approach ANS: A, B, C, E, F WHO is refocusing as it attempts to deal with environmental issues of nuclear contamination and industrial toxins, and the exploration of carcinogenic commercial products (such as tobacco). Globally, WHO is trying to eliminate antibiotic-resistant bacteria and the HIV pandemic. HIV has changed the paradigm from traditional containment and treatment to a more comprehensive approach of social intervention. There is a realization that health is a basic human right and health problems are linked to government action and affect human rights. The WHO is not emphasizing the chronic diseases faced by industrialized nations. DIF: Cognitive Level: Understand (Comprehension) 4. Which best describes the new national health goals as seen in Healthy People 2020? (Select all that apply.) a. Achieve a plan for universal basic health care for citizens b. Create social and physical environments that promote good health c. Eliminate health disparities d. Eliminate preventable disease, disability, injury, and premature death e. Achieve health equity f. Promote healthy behaviors at every stage of life ANS: B, D, F Building on previous iterations, the updated 2020 version has four “over-arching goals” for 2020: (1) attain high quality, longer lives free of preventable disease, disability, injury, and premature death; (2) achieve health equity, eliminate disparities, and improve the health of all age groups; (3) create social and physical environments that promote good health for all; and (4) promote quality of life, health development, and health behaviors across all life stages. Achieving a plan for universal basic health care for citizens, eliminating health care disparities, and achieving health equity are not seen as national health goals in Healthy People 2020. DIF: Cognitive Level: Understand (Comprehension) 5. Which statements best describe a notable change of the Omnibus Budget Reconciliation Act? (Select all that apply.) a. Legislated a funding increase for RN staffing b. Changed from process evaluation to outcome evaluation when evaluating care c. Established guidelines for the use of restraints d. Created health maintenance organizations nationwide e. Added prescription drug benefits for Medicaid recipients f. Required all states to review certificates of need before agencies could expand ANS: B, C, E The Budget Reconciliation Act influenced funding and set up guidelines and regulations about several issues including a move from process to outcome evaluation, use of restraints, and prescription drugs for Medicaid recipients. The Health Maintenance Organization Act of 1973 established health maintenance organizations. The National Health Planning and Resources Act of 1974 required health care facilities to obtain prior approval from the state for expansion in the form of a certificate of need. The Nurse Training Act in 1964 provided funds for nursing school construction and loans and scholarships for full-time study. Chapter 11: The Health Care System Nies: Community/Public Health Nursing, 7th Edition MULTIPLE CHOICE 1. Which best describes the principal factor behind ongoing legislation on the federal level related to health care? a. Change is needed to reflect differences in health needs today. b. Efforts must be put in place to control constantly increasing costs. c. There is a need to focus on the population as a whole. d. Technological breakthroughs should be expanded. ANS: B With the rapid growth of technology and increased demands on the private and public health care subsystems, health care costs have become prohibitive. Cost-effectiveness and cost containment have become critical driving forces as health care delivery system changes are made; however, cost-effectiveness often conflicts with the provision of quality care. DIF: Cognitive Level: Understand (Comprehension) 2. Which best describes the most common organization for receiving personal health care in the United States today? a. A group of physicians all in a particular specialty group who share an office b. Community health center that includes educational and social services c. Fee for service by a physician in practice by himself or herself d. Managed care organization with capitated payments to providers, both professionals and organizations ANS: D Managed care has become a dominant paradigm in health care. This model has replaced fee for service by a physician in independent practice or physicians in a group practice, and care in a community health center. DIF: Cognitive Level: Understand (Comprehension) 3. Which best describes how voluntary health agencies fit into the overall health care system? a. They fill in the gaps between services offered by private and public health systems. b. They primarily serve as sources of financial aid for the underserved. c. They supplement the effort of the public health care system. d. They support research, education, and services for particular groups of patients. ANS: D Voluntary health agencies are committed to specific diseases, organ or body structures, health and welfare of special groups, or particular phases of health. Philanthropic groups support research and programs. These organizations provide major sources of help in preventing disease, promoting health, treating illness, consumer education, and advocacy and research. Unfortunately, there continue to be overlaps among private, voluntary, and public agencies, but without voluntary agencies, fewer services would be available. DIF: Cognitive Level: Understand (Comprehension) 4. Which level of government primarily establishes regulations and provides funding for health care? a. Federal government b. Local health departments c. Regional health districts d. State health departments ANS: A The federal government has been assuming a larger role in the protection of the population through regulation and funding. Local health departments establish local health codes, fund public hospitals, and provide services to populations at risk who often lack health insurance. State health departments are highly dependent on the federal level of resources and guidance. Regional health districts are not used as a level of government in the United States. DIF: Cognitive Level: Remember (Knowledge) 5. Which federal agency is responsible for administering most of the federal health-related activities? a. Centers for Disease Control and Prevention (CDC) b. Department of Health and Human Services (HHS) c. Health Resources and Services Administration (HRSA) d. National Institutes of Health (NIH) ANS: B Most health-related activities at the federal level are implemented and administered by the HHS. The responsibility of the CDC is to keep the public safe and healthy. The responsibility of the HRSA is to improve access to health care services for vulnerable groups in the population. The main responsibility of the NIH is biomedical and health-related research. DIF: Cognitive Level: Remember (Knowledge) 6. Which federal agency is responsible for the Women, Infants, and Children (WIC) program, food stamps, and school-based nutrition programs? a. Aid to Dependent Children Department b. Department of Agriculture c. Department of Education d. Department of Health and Human Services ANS: B The Department of Agriculture administers the inspection of meat and milk and provides funds for the WIC program (supplemental nutrition), the food stamp program, and the school-based nutrition program. The Aid to Dependent Children is a program, not a department, that provided financial assistance to families with limited financial resources. The Department of Education administers and coordinates resources related to education. The Department of Health and Human Services is responsible for protecting the health of all Americans. DIF: Cognitive Level: Remember (Knowledge) 7. Which best describes the approach to health care used by states? a. Federal funding encourages experimentation in creating new programs. b. Insurance regulations concerning reimbursement cross state lines. c. Information about successful programs is known to legislators. d. States frequently develop new programs as federal funds become available to pay for them. ANS: D Many state and local government programs were developed on the basis of availability of federal funds. Funds are accompanied by regulations, which apply to all recipients. These have served to standardize health policy. Federal funding is limited, thus there is limited opportunity for experimentation. Legislators must be involved in ongoing education in order to keep up to date on what is happening with programs that have been implemented. Insurance regulations are monitored by individual states, so reimbursement concerns are unable to cross state lines. DIF: Cognitive Level: Understand (Comprehension) 8. Which has led to the more recent focus on cooperation between the state and the federal level in relation to public health? a. The emphasis of Healthy People 2020 b. The ongoing continued restriction of financial resources c. The new presidential administration’s goals d. The threat of bioterrorism ANS: D Cooperation between the state and federal levels has been brought to the forefront with efforts to plan for bioterrorism, an event that would necessitate cooperation and sharing. In addition, the state is highly dependent on the federal level for resources and guidance. The administrative goals of the president, emphasis of Healthy People 2020, and restriction of available financial resources have not been the main factor that has led to an increase in cooperation related to public health. DIF: Cognitive Level: Understand (Comprehension) 9. Which health care provider organization is seeing an increase in the demand for their services? a. Physician practice b. Hospice service c. Hospitals d. Long-term care facilities ANS: D Hospital stays have shortened and patients who are admitted are more acutely ill and require more intensive care. Consequently, decreased hospital stays result in more home care admissions and more discharges to long-term care facilities for short-term recovery and rehabilitation. Hospice services and physician practices have not been as impacted as greatly by this shift in where care is provided. DIF: Cognitive Level: Understand (Comprehension) 10. Which advanced nurse does not have advanced education in a clinical specialty? The Agency for Healthcare Research and Quality (AHRQ) is the main federal organization that works to improve the safety and quality of the health care system. This was largely through funding research to make care safer and to improve quality by publishing materials to educate health care systems and professionals to put research into practice and through generation of measures and data to be used by providers and policymakers (AHRQ, 2017). AHRQ support efforts for clinicians and providers includes clinical guidelines and recommendations. AHRQ publishes research and reports specifically related to health care disparities, quality, and evidence-based practice but does not implement strategies. DIF: Cognitive Level: Understand (Comprehension) 17. Which report states that nurses should practice to the full extent of their education and training? a. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care b. Keeping Patients Safe: Transforming the Work Environment c. Priority Areas for National Action d. The Future of Nursing ANS: D The Future of Nursing report contains four key messages. One of the key messages is that nurses should practice to the full extent of their education and training. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care addresses potential causes of disparities in health care. Keeping Patients Safe: Transforming the Work Environment addresses critical quality and safety issues with a particular focus on nursing care and nurses, and examines these issues from the perspective of the work environment. Priority Areas for National Action identified 19 priority areas that should be addressed to improve quality. DIF: Cognitive Level: Remember (Knowledge) 18. Which best describes a health disparity that exists in the United States? a. Caucasians have higher rates of mortality than minority groups. b. Caucasians have increased access to see specialist physicians. c. Minority groups have increased access to government insurance options. d. Minority groups have a higher prevalence of chronic conditions than Caucasians. ANS: D Health disparities refer to observable or quantifiable differences in the presence of disease, health outcomes, or access to health care among different groups or populations. In the United States, health disparities have long been recognized as particularly problematic among ethnic minorities, including blacks, Native Americans, and Hispanics. Research indicates that often these groups have a higher prevalence of chronic conditions and higher rates of mortality and poorer health outcomes when compared with the white population. DIF: Cognitive Level: Understand (Comprehension) MULTIPLE RESPONSE 1. Which functions are responsibilities of the states? (Select all that apply.) a. Delegating power to localities and holding them accountable for results b. Creating managed health organizations to decrease state health care costs c. Establishing and managing local health departments d. Licensure of professional health care providers e. Overseeing all insurance programs f. Providing access to necessary health services ANS: A, D, E, F State governments focus particularly on financing and delivery of services and oversight of insurance. The state is responsible for addressing the mission of public health—assessment, policy development, and assurance—throughout the state. Tasks include assessment of health needs based on statewide data collection; establishment of statewide health objectives; and delegating power to localities as appropriate and holding them accountable. States license health professionals as part of the statewide effort to develop and maintain essential personnel. Creating managed health organizations and establishing and managing local health departments are not a main responsibility of the state. DIF: Cognitive Level: Understand (Comprehension) 2. Which activities would be a responsibility of local health departments? (Select all that apply.) a. Ensuring quality of nursing education programs b. Determining the safety of residents’ wells c. Establishing requirements for professionals to maintain their licensure d. Providing free health screenings e. Providing health education programs on proper nutrition f. Inspecting restaurants ANS: B, D, E, F Local health departments are responsible for the health needs of their constituents. Community health services include surveillance and immunizations, as well as health education programs. Environmental health services on the local level include inspection of food-processing plants and restaurants and control of waste, air, noise, and water pollution. Local health departments protect the environment through such activities as inspecting wells and public swimming pools. Ensuring quality of nursing education programs and continuing competence of health professions are both state functions. DIF: Cognitive Level: Understand (Comprehension) 3. Which best describes how complementary and alternative therapies differ from traditional health care? (Select all that apply.) a. Alternative therapies have been documented as ineffective. b. Complementary medicine is expanding because of paid media coverage. c. Nurses rarely are involved in complementary or alternative therapies. d. Providers vary in training and licensure. e. Reimbursement is often unavailable. f. Alternative therapies lack any research related to their effectiveness. ANS: D, E Alternative or complementary therapies are expanding because of consumer demand although reimbursement for these services is lagging. The National Center for Complementary and Alternative Medicine is currently researching their effects on health and disease. Training and licensure requirements vary widely. Many nurses have incorporated alternative therapies into their practice and seek more continuing education on such care. DIF: Cognitive Level: Understand (Comprehension) 4. Which would be offered as part of the community health services of a local health department? (Select all that apply.) a. Immunization programs b. Food inspection programs c. Health promotion education d. School-based clinics e. Maternal-child programs f. Community-based mental health programs ANS: A, C, E The local health department is responsible for monitoring the health status and meeting the health needs of their constituents. This includes identifying unmet needs and taking actions to meet these needs. Most services to groups and individuals are provided at the local level. These services fall into the following four major categories: Community health services include control of communicable disease such as surveillance and immunizations, maternal-child health programs, nutrition services, and education; environmental health services include food hygiene such as inspection of food-producing and food-processing plants and restaurants; protection from hazardous substances; control of waste, air, noise, and water pollution; and occupational health; personal health services provide care to individuals and families in clinics, schools, and correctional institutions; mental health services are provided through community-based mental health care. DIF: Cognitive Level: Understand (Comprehension) 5. Which would most likely be found in a patients’ bill of rights? gave? (Select all that apply.) a. A statement about guaranteeing confidentiality b. A statement about how to create a living will c. A statement about who has access to the client’s medical information d. A statement about completing the patient satisfaction survey e. A statement about who will be the payer of the services provided f. A statement about patient autonomy when making decisions ANS: A, C, F Health care facilities often have a “patients’ bill of rights.” Typically, a patients’ bill of rights is a list of guarantees or promises for those receiving care at that facility or by providers. Generally included are guarantees of confidentiality, promises of access to information, fair treatment, informed consent, and autonomy over decisions, among other rights. Other patients’ rights issues that are vitally important that continue to be discussed and debated are information disclosure, physician and provider choice, direct access to specialists, reimbursement for emergency care, and reimbursement denial. DIF: Cognitive Level: Understand (Comprehension) 6. Which describes why a health care agency would want to achieve accreditation? (Select all that apply.) a. Accreditation assesses the quality of services and care of the organization. b. Accreditation requires achievement of certain minimum standards. c. Accreditation instills public confidence in the health care agency. b. Society was focused on not having to pay for doctor visits and other needed health benefits. c. Teachers were role models for unions to demand insurance as a benefit. d. To obtain and retain the limited number of persons available to work when government rules prohibited raising wages, insurance was offered. ANS: D The idea of paying a small fee for guaranteed health care to have sickness cured was very popular. Health care providers liked knowing they would receive payment for their services. During World War II, faced with a limited workforce and governmental restrictions on wages, employers began to see health insurance as a means of supplying workers’ benefits without granting a wage increase. Teachers were not demanding insurance as a benefit. Hospitals and physicians continued to provide charity care as they were able. Society understood that they needed to pay for health services; however, businesses realized that providing insurance was a way to keep their needed workforce. DIF: Cognitive Level: Understand (Comprehension) 5. Which best describes a flaw of indemnity plans? a. Blue Cross and Blue Shield had a great idea, but they went bankrupt. b. Cost sharing was expected of Blue Cross and Blue Shield enrollees. c. Enrollees could not choose their provider or manage their own care. d. Plans lacked any incentives to contain costs. ANS: D Indemnity plans paid all the costs of covered services provided to the enrollee. The enrollee enjoyed free choice of provider and services. They preserve the enrollee’s right of choice and allow the person to manage his or her own health care. These plans became very costly because there were no incentives for cost containment. Today, cost-sharing efforts (e.g., copayments, deductibles) help contain costs. Blue Cross and Blue Shield continue to be a provider of health insurance. DIF: Cognitive Level: Understand (Comprehension) 6. Which best describes the first government step in trying to stop constantly rising costs? a. Insurance companies were told to cease adding new members to their plan. b. Payment reimbursement was based on diagnosis and client characteristics rather than on treatment given. c. Physicians were limited to a maximum amount that would be paid for any particular service. d. Reimbursement was based on prospective payment, that is, in advance of admittance for care. ANS: B The first efforts to control costs were made by the federal government when Medicare hospital reimbursement was based on a prospective payment system. Payment would be based on a classification system that identified costs according to diagnosis and client characteristics. Restricting insurance companies to add new members to their plan was not part of the first steps to try to stop constantly rising costs. DIF: Cognitive Level: Understand (Comprehension) 7. Which statement best describes the message that public health leaders are trying to emphasize to the public? a. Assume responsibility for your own health by choosing healthy behaviors b. Have a primary physician and get yearly checkups c. Obtain immunizations and screenings when they are offered d. Support legislative efforts to improve our medical care system ANS: A Although there are many public health messages in the media, from quitting smoking to getting a checkup, the primary message currently being emphasized by public health, as well as all the media coverage of the constantly increasing cost for health care, is for each person to take responsibility for his or her own health through choosing healthy lifestyle behaviors. Supporting legislative efforts is not as important as the need for individuals to take responsibility for their own health. DIF: Cognitive Level: Understand (Comprehension) 8. Which action would be the least expensive approach to treating chronic diseases? a. Choose healthy lifestyle behaviors to retain health b. Continue media campaigns encouraging early detection and treatment c. Encourage patients to seek care at a local neighborhood health clinic d. Suggest self-therapies that have been demonstrated to be effective ANS: A The five leading causes of death and illness can be positively affected by changes in lifestyle. Healthy lifestyles can modify or even prevent most chronic illnesses. Seeking care at a neighborhood health clinic, producing media campaigns, and engaging in self-therapies are all more expensive approaches to treating chronic diseases than choosing healthy lifestyle behaviors. DIF: Cognitive Level: Understand (Comprehension) 9. Which best describes how having health insurance has affected lifestyle behaviors? a. Health promotion disease prevention programs are attended because they are reimbursable. b. Health education is widespread because insurance companies promote such education. c. Medications and medical treatment are relied on for cure. d. Screening is widespread because of insurance sponsorship. ANS: C Funding for behavioral changes is limited, inadequate, or unavailable. Weight loss programs or smoking cessation programs are not reimbursable treatment regimens although more expensive pharmaceutical interventions are reimbursable. Therefore, it is financially wise not to worry until illness strikes because illness care is reimbursable, whereas preventive health care is not. DIF: Cognitive Level: Understand (Comprehension) 10. Which best describes why so many Americans continue to engage in unhealthy behaviors? a. Americans are not knowledgeable on how to change their behavior. b. Americans believe that most illnesses can be cured with insurance footing the bill. c. Health is not a concern to most Americans. d. Most Americans do not know which behaviors are unhealthy. ANS: B Society sees insurance as an economic shield protecting against all disease and illness. The belief in cure rather than prevention, combined with this financial safety net, encourages society to become a passive participant in health care. The pervasive societal thought is “I don’t have to worry; I have insurance.” Americans are aware of which behaviors are unhealthy, have knowledge on how to change their behavior, and are concerned about health, but insurance has allowed them to take a passive approach to health. DIF: Cognitive Level: Understand (Comprehension) 11. Which conclusion can be drawn from reviewing how health care costs are spread over a person’s lifetime? a. Health care expenditures increase with age. b. Premature newborns incur more costs than other children from birth through adulthood. c. The majority of cost is incurred during middle age when chronic diseases strike. d. Persons aged 85 years and above spend the most money on health care. ANS: A Health care expenditures increase with age, dramatically so at older ages. DIF: Cognitive Level: Understand (Comprehension) 12. Which was a major change after Medicare began a prescription drug benefit? a. Number of prescriptions ordered by physicians decreased b. Medications increased without affecting patient care outcomes c. U.S. expenditures on drugs approached the same level as that of other industrialized nations d. Use of drugs and their cost immediately increased ANS: D As with other health care services, once a funding source has been established, usage and costs increase. Thus, the number of prescriptions ordered increased. For 2016, the U.S. expenditure for pharmaceuticals was about 10% of health care expenditures, and these expenditures continue to rise. DIF: Cognitive Level: Understand (Comprehension) 13. Which best describes a current trend related to health care services? a. Nonprofit organizations are assuming responsibilities for service from for-profit organizations. b. Health care organizations are offering services low in cost and higher in reimbursement. c. Ways to minimize reimbursement using current procedural terminology (CPT) codes have been created. d. Postponing computerized medical record programs increases profitability.