Population And Community Health Nursing 6 Ed By Mary JO Clark-Test Bank

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Population And Community Health Nursing 6 Ed By Mary JO Clark-Test Bank

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Population And Community Health Nursing 6 Ed By Mary JO Clark-Test Bank

Population and Community Health Nursing, 6e (Clark)

Chapter 2   Population Health Nursing: Yesterday, Today, and Tomorrow

 

1) The population health nurse is reviewing the recommendations within the Report of the Massachusetts Sanitary Commission drafted by Lemuel Shattuck. What should the nurse identify as being the most important effect of this document?

  1. Establishing state boards of health.
  2. Establishing workhouses for the sick poor.
  3. Mobilizing social reform to sanitary engineering.
  4. Refuting that poverty was the result of deficiencies in moral character.

Answer:  1

Explanation:  1. The Massachusetts Sanitary Commission was established in response to concern over the effects of crowded living conditions, poverty, and poor sanitation on health. In 1850, Lemuel Shattuck drafted the commissions findings. The Report of the Massachusetts Sanitary Commission included recommendations for establishing state and local health departments, systematic collection of vital statistics, and sanitation inspections, and for instituting programs for school health and control of mental illness, alcohol abuse, and tuberculosis. Other recommendations included public education regarding sanitation, control of nuisances, periodic physical examinations, supervision of the health of immigrants, and construction of model tenements. In addition, the report recommended improved education for nurses and the inclusion of content on preventive medicine and sanitation in medical school curricula. Until the late 19th century, it was held that poverty was the result of ones moral character. Workhouses for the poor had been in place since the late 18th century. Chadwicks Inquiry into the Sanitary Conditions of the Labouring Population of Great Britain shifted the view from social reform to sanitary engineering.

Nursing/Int.Conc:  Nursing Process: Assessment

Client Need:  Health Promotion and Maintenance

Cognitive Level:  Application

Learning Outcome:  2-1

 

2) The nurse is reviewing the evolution of national health care systems in countries throughout Europe and the United States for a school project. In which century should the nurse emphasize that national health insurance in the United States was first proposed?

  1. Late 20th century.
  2. Mid-20th century.
  3. Early 20th century.
  4. Mid-19th century.

Answer:  3

Explanation:  3. National health insurance was proposed as early as 1912 as an element of Theodore Roosevelts 1912 election platform. Germany initiated a national health program in the 1860s, as did Great Britain, though the latter was unsuccessful. While efforts to address national health insurance in the United States had been proposed in the mid- and late 20th century, its earliest origin was at the turn of the century.

Nursing/Int.Conc:  Nursing Process: Assessment

Client Need:  Health Promotion and Maintenance

Cognitive Level:  Application

Learning Outcome:  2-3

3) In preparation for a health fair the nurse wants to explain the role of ancient civilizations on water purification. Which civilizations should the nurse highlight as being advocates for clean water supplies? (Select all that apply.)

  1. Aztecs.
  2. Greeks.
  3. Romans.
  4. Germans.
  5. Egyptians.

Answer:  1, 3, 5

Explanation:  1. The Egyptians, Romans, and Aztecs were all known to emphasize the importance of clean water supplies. Other civilizations developed some measures to protect their water supplies but not quite to the extent of the Egyptians, Romans, and Aztecs.

  1. The Egyptians, Romans, and Aztecs were all known to emphasize the importance of clean water supplies. Other civilizations developed some measures to protect their water supplies but not quite to the extent of the Egyptians, Romans, and Aztecs.
  2. The Egyptians, Romans, and Aztecs were all known to emphasize the importance of clean water supplies. Other civilizations developed some measures to protect their water supplies but not quite to the extent of the Egyptians, Romans, and Aztecs.

Nursing/Int.Conc:  Nursing Process: Implementation

Client Need:  Health Promotion and Maintenance

Cognitive Level:  Application

Learning Outcome:  2-1

 

4) The population health nurse is discussing the first organized approach to home nursing of the sick that was established in 1813 by the Ladies Benevolent Society of Charleston, SC, in response to a yellow fever epidemic. What important aspect of the care provided by this organization should the nurse emphasize?

  1. Restricted to women and children.
  2. Directed to those residing in the Jewish community.
  3. Restricted to those who were able to pay for services.
  4. Nondenominational and nondiscriminatory in an era of racial discrimination.

Answer:  4

Explanation:  4. Though the care was given by upper class women to those who needed nursing care, the Ladies Benevolent Society of Charleston was notable in that its services were nondenominational and nondiscriminatory in a region and time where racial discrimination was the prevailing behavior. Payment for services was not a hallmark of the Ladies Benevolent Society. Services to the Jewish Community were organized in Philadelphia in 1819 by Rebecca Gratz. There were no restrictions to the people whom the Ladies Benevolent Society provided nursing care.

Nursing/Int.Conc:  Nursing Process: Implementation

Client Need:  Health Promotion and Maintenance

Cognitive Level:  Application

Learning Outcome:  2-3

 

5) The population health nurse is researching the activities of Margaret Sanger for a school paper. The nurse should explain the actions of Ms. Sanger as combining social activism with nursing to her clients by:

  1. Advocating for better care for the mentally ill.
  2. Reducing rural childbirth morbidity and mortality rates.
  3. Providing information about contraceptive services to women.
  4. Providing education regarding improved nutrition for families.

Answer:  3

Explanation:  3. Margaret Sanger combined social activism with nursing by providing contraceptive information to poor women. Among population health nursing care, education was always a component in the early efforts of activists like Sanger. Reducing rural childbirth mortality and morbidity rates was done by Mary Breckenridge in the Frontier Nursing Service. Dorothea Dix was an early activist for advocating for the mentally ill.

Nursing/Int.Conc:  Nursing Process: Implementation

Client Need:  Health Promotion and Maintenance

Cognitive Level:  Application

Learning Outcome:  2-2

 

6) Prior to providing care to a family the population health nurse reflects on the achievements of historical nurses who influenced approaches used today to provide care. Which historical figure should the nurse attribute to the combination of political activism with health promotion and disease prevention to improve individual and societal conditions affecting health?

  1. Lillian Wald.
  2. Lavinia Dock.
  3. Lina Struthers.
  4. Mary Brewster.

Answer:  1

Explanation:  1. Lillian Wald is the person most closely aligned with population health nursing and coined the term public health nurse. She accomplished many reforms to improve the health of New York and was politically active in lobbying for these improvements in addition to providing nursing care to the immigrant population served by the Henry St. Settlement. All the other nurses worked with Wald at the Henry St. Settlement but branched out to other aspects of nursing and political activism.

Nursing/Int.Conc:  Nursing Process: Implementation

Client Need:  Health Promotion and Maintenance

Cognitive Level:  Application

Learning Outcome:  2-2

 

7) The nurse is preparing a seminar on population health for a group of staff nurses in a community health clinic. Which events that demonstrated the effectiveness of population health nursing in the United States should the nurse emphasize? (Select all that apply.)

  1. Formation of the Red Cross.
  2. School nursing program in New York City.
  3. Improvement of sanitary conditions in slum areas.
  4. Formation of benevolent societies to care for the sick poor.
  5. Visiting nurse services of Metropolitan Life Insurance Company.

Answer:  2, 5

Explanation:  2. Use of a single school nurse in New York City and the impact of reducing absenteeism resulted in the establishment of school nurses throughout the city. The visiting nurse services of Metropolitan Life Insurance Company were an overwhelming success in decreasing insurance costs for the company. These services were provided on a three-month pilot, and because of its success, the Metropolitan Life Insurance Company extended this program until the 1950s. The formation of the Red Cross had no bearing on population health, but was organized primarily to help people in times of war and disaster. While improving sanitary conditions improved overall health, this was an ongoing process and not a discrete event. Benevolent societies preceded the formal development of population health nursing.

  1. Use of a single school nurse in New York City and the impact of reducing absenteeism resulted in the establishment of school nurses throughout the city. The visiting nurse services of Metropolitan Life Insurance Company were an overwhelming success in decreasing insurance costs for the company. These services were provided on a three-month pilot, and because of its success, the Metropolitan Life Insurance Company extended this program until the 1950s. The formation of the Red Cross had no bearing on population health, but was organized primarily to help people in times of war and disaster. While improving sanitary conditions improved overall health, this was an ongoing process and not a discrete event. Benevolent societies preceded the formal development of population health nursing.

Nursing/Int.Conc:  Nursing Process: Implementation

Client Need:  Health Promotion and Maintenance

Cognitive Level:  Application

Learning Outcome:  2-3

 

8) While conducting a training class for hospice nurses, the nurse explains the actions taken by William Rathbone, a Quaker philanthropist who implemented nursing care at home for the sick in England. Mr. Rathbone enlisted Florence Nightingales assistance to develop a concept of nursing care, which he later adopted in the United States after witnessing its benefits to his dying wife. Which aspect of care should the nurse attribute to Mr. Rathbone?

  1. Home nursing.
  2. Parish nursing.
  3. District nursing.
  4. Community nursing.

Answer:  3

Explanation:  3. After seeing the effectiveness of the nursing care to his wife, Rathbone conceived of district nursing to improve the overall health of set populations in local districts. Early efforts were not successful, however, until Rathbone solicited Nightingales help. She made this concept successful. Although district nursing evolved into population nursing and later parish nursing, the original idea was for district nursing as conceived by Rathbone. Home nursing was already done by either trained nurses or by family members.

Nursing/Int.Conc:  Nursing Process: Implementation

Client Need:  Health Promotion and Maintenance

Cognitive Level:  Application

Learning Outcome:  2-1

 

 

9) The clinical trainer for a group of population health nurses is planning to present the historical events that shaped and formed the development of population nursing in the United States. Which events should the trainer include? (Select all that apply.)

  1. Creation of district nursing.
  2. Settlement house movement.
  3. Passage of immigration limiting legislation.
  4. Standardization of community nursing practice.
  5. Passage of legislation specific to community nursing.

Answer:  2, 4, 5

Explanation:  2. The settlement house movement was started in answer to the rise of immigration to the United States to help the immigrants assimilate to U.S. culture and mores. The immigrant population in the United States drew Lillian Wald and her followers to provide nursing care to this group and thus improve their overall health, which then translated to the overall population. Standardization of practice resulted in the formation of the National Organization of Public Health Nurses in 1912. Wald and other nurses then advocated for legislation specific to the population health, most notably with the Sheppard-Towner Act in 1921. District nursing was a movement primarily located in Great Britain.

  1. The settlement house movement was started in answer to the rise of immigration to the United States to help the immigrants assimilate to U.S. culture and mores. The immigrant population in the United States drew Lillian Wald and her followers to provide nursing care to this group and thus improve their overall health, which then translated to the overall population. Standardization of practice resulted in the formation of the National Organization of Public Health Nurses in 1912. Wald and other nurses then advocated for legislation specific to the population health, most notably with the Sheppard-Towner Act in 1921. District nursing was a movement primarily located in Great Britain.
  2. The settlement house movement was started in answer to the rise of immigration to the United States to help the immigrants assimilate to U.S. culture and mores. The immigrant population in the United States drew Lillian Wald and her followers to provide nursing care to this group and thus improve their overall health, which then translated to the overall population. Standardization of practice resulted in the formation of the National Organization of Public Health Nurses in 1912. Wald and other nurses then advocated for legislation specific to the population health, most notably with the Sheppard-Towner Act in 1921. District nursing was a movement primarily located in Great Britain.

Nursing/Int.Conc:  Nursing Process: Implementation

Client Need:  Health Promotion and Maintenance

Cognitive Level:  Application

Learning Outcome:  2-3

 

 

10) A group of nursing students are researching governmental efforts to address health promotion-focused public health. Which legislation should the students identify as starting this change in providing care?

  1. Hill-Burton Act.
  2. Child Health Act.
  3. Social Security Act.
  4. Sheppard-Towner Act.

Answer:  4

Explanation:  4. The Sheppard-Towner Act represented the first federal legislation that specifically targeted an aspect of population health, most notably maternal-child health. The Child Health Act was not passed until 1967 and recommended the use of nurses in extended roles. The Social Security Act did not originally focus on health promotion efforts. The Hill-Burton Act, passed after World War II, focused on the building of hospitals rather than population health.

Nursing/Int.Conc:  Nursing Process: Implementation

Client Need:  Health Promotion and Maintenance

Cognitive Level:  Analysis

Learning Outcome:  2-5

11) While reviewing the history of health care services as part of an education program the nurse learns that the passage of the amended Social Security Act created Medicare and Medicaid, which increased demands for health care services. How did The National Health Planning and Resources Development Act of 1974 attempt to address the demand for health care services?

  1. Increasing funds to improve the health status of the indigent poor.
  2. Recognizing that increased hospitals improved the public health status.
  3. Increasing funds for more health services to improve public health status.
  4. Recognizing the contribution of health practitioners to the public health status.

Answer:  4

Explanation:  4. The 1974 Act recognized health practitioner efforts to improve public health status, which was an early legislative shift to recognize health promotion as an effective effort to improve public health status. Increasing funds to improve indigent health status was not addressed in the 1974 Act, though it was for the 1965 amended Social Security Act. Increased hospital building was not a public policy shift of recognizing an emphasis on health promotion. Increasing funding for health services was not the goal of the 1974 act.

Nursing/Int.Conc:  Nursing Process: Assessment

Client Need:  Health Promotion and Maintenance

Cognitive Level:  Analysis

Learning Outcome:  2-5

 

 

12) The nurse case manager is explaining to a group of health care providers how insurance expenditures for health spending led to the development of diagnosis-related groups (DRGs) in efforts to control spending. What should the case manager emphasize as the driving force for directing health efforts with DRGs?

  1. Organize services to be more cost-effective.
  2. Decreasing length of stays for hospitalizations.
  3. Placing the emphasis on the community to improve population health status.
  4. Emphasizing health promotion to decrease hospitalizations and medical costs.

Answer:  4

Explanation:  4. The effect of DRGs has shifted emphasis to health promotion of populations rather than medical care for conditions preventable by health promotion efforts. DRGs have not been proven to make services more cost-effective, though that has been one of its objectives. DRGs pay a flat fee in advance for client diagnosis, which may not benefit the client health status during hospitalizations. DRGs have not emphasized the community as a whole to improve a populations health status. That is achieved through a variety of methods, not solely DRGs.

Nursing/Int.Conc:  Nursing Process: Implementation

Client Need:  Health Promotion and Maintenance

Cognitive Level:  Application

Learning Outcome:  2-4

13) As part of a school assignment the graduate nursing student is reviewing documents that address population health nursing practice in the United States. Which document should the student emphasize as being the most current policy promulgated by the U.S. Department of Health and Human Services?

  1. Lalonde Report.
  2. Healthy People 2010.
  3. Future of Public Health.
  4. Declaration of Alma Alta.

Answer:  2

Explanation:  2. Healthy People is the most current policy of the U.S. government to address improving the population health and targets population health nursing practice. The Lalonde Report addressed Canadian population health. The Future of Public Health is a document of the Institute of Medicine, which impacts population health but is not the national health policy. The Declaration of Alma Alta is an international document addressing primary health care.

Nursing/Int.Conc:  Nursing Process: Implementation

Client Need:  Health Promotion and Maintenance

Cognitive Level:  Application

Learning Outcome:  2-5

 

 

14) The population health nurse is reviewing the concept of health-for-all with a group of new nurses. What should the nurse explain as the significance of the Ottawa Charter for Health Promotion to population health nursing practice?

  1. Created specific mechanisms to categorize nursing services.
  2. Provided a mechanism for prospective payment for hospital services.
  3. Identified assessment, policy formation, and assurance as key indicators for global health.
  4. Focused on social, economic, and political reforms as strategies to improve global health.

Answer:  4

Explanation:  4. The health-for-all concept was further developed in the World Health Organizations (WHO) Global Strategies for Health for All by the Year 2000, published in 1981, and the Ottawa Charter for Health Promotion, developed at the First International Conference on Health Promotion in 1986. Both focused on social, economic, and political reform and empowerment as strategies for improving the health of the worlds populations. The Nursing Interventions Classification (NIC) created a mechanism to categorize nursing services. Prospective payment of services was the feature of DRGs. The Future of Public Health by the Institute of Medicine (IOM) focused on assessment, policy formation, and assurance as key indicators.

Nursing/Int.Conc:  Nursing Process: Implementation

Client Need:  Health Promotion and Maintenance

Cognitive Level:  Application

Learning Outcome:  2-4

15) The nurse is identifying events that can shape the future of population health nursing practice for a group of nursing students. Which event should the nurse emphasize?

  1. International effort to eradicate smallpox.
  2. Prospective payment for nursing services.
  3. Surveillance of the CDC on population health.
  4. Threat of terrorism to harm the publics health.

Answer:  4

Explanation:  4. Terrorist threats and governmental focus on terrorism may serve to detract attention to overall population health. Population health nursing efforts will be focused on maintaining a balance between terrorist threats and safeguarding population health. Smallpox was eradicated in 1977, so international efforts are not geared toward this aspect of global health. DRGs emphasize prospective payment. Surveillance of the CDC focuses on diseases that affect population health, not population health nursing practice.

Nursing/Int.Conc:  Nursing Process: Implementation

Client Need:  Health Promotion and Maintenance

Cognitive Level:  Application

Learning Outcome:  2-5

 

 

16) The mental health nurse is seeing patients recovering from post-traumatic stress disorder in an out-patient health clinic. Which historical figure should the nurse recognize as being instrumental in improving the care provided to patients with mental disabilities?

  1. Clara Barton.
  2. Dorothea Dix.
  3. Harriet Tubman.
  4. Sojourner Truth.

Answer:  2

Explanation:  2. Dorothea Dix was a social reformer who did much to improve the conditions of people with mental illness in institutions throughout the nation. Clara Barton was instrumental in the establishment of the Red Cross of the United States of America. Harriet Tubman, a former slave who functioned as a nurse during the Civil War, is probably best known for her activities with the Underground Railroad in bringing approximately 300 former slaves to freedom in the north. Sojourner Truth was an African American who served during the Civil War and then for the Freedmans Relief Association during reconstruction.

Nursing/Int.Conc:  Nursing Process: Assessment

Client Need:  Health Promotion and Maintenance

Cognitive Level:  Analysis

Learning Outcome:  2-2

17) A graduate nurse has scheduled an appointment with the director of the Center for Nursing Research within the National Institutes of Health. What types of research should the graduate nurse prepare to discuss during this meeting?

  1. Medication compliance.
  2. Reduction in sentinel events.
  3. Health promotion and illness prevention.
  4. Elimination of hospital-acquired infections.

Answer:  3

Explanation:  3. Growing evidence indicates a shift to greater emphasis on health promotion and illness prevention in national and international health policy. Evidence of this shift is the 1988 creation of the Center for Nursing Research within the National Institutes of Health (NIH). One reason given in Senate testimony favoring the center was the health promotion and illness prevention focus in much of nursing research. Medication compliance, reduction in sentinel events, and elimination of hospital-acquired infections might be topics for future nursing research; however, these topics do not explain the type of research being conducted within the Center for Nursing research.

Nursing/Int.Conc:  Nursing Process: Planning

Client Need:  Health Promotion and Maintenance

Cognitive Level:  Application

Learning Outcome:  2-4

Population and Community Health Nursing, 6e (Clark)

Chapter 12   Case Management

 

1) The population health nurse is reviewing the goals for managing the care of a client. Which goal should the nurse identify as being client-centered?

  1. Cost containment and cost-efficiency.
  2. Improved quality of life.
  3. Decreased paperwork.
  4. Financial viability.

Answer:  2

Explanation:  2. Improved quality of life is a client-centered goal or benefit of case management. Cost containment and cost-efficiency, decreased paperwork, and financial viability are system-centered goals or benefits of case management.

Nursing/Int.Conc:  Nursing Process: Planning

Client Need:  Safe and Effective Care Environment

Cognitive Level:  Application

Learning Outcome:  12-1

 

2) The population nurse is reviewing goals with a newly hired case manager. Which goal should the nurse identify as being system-centered?

  1. Reduced duplication of services.
  2. Better coordination of care.
  3. Access to affordable services.
  4. Ability to function independently.

Answer:  1

Explanation:  1. A system-centered goal for case management is reducing the duplication and fragmentation of services. Better coordination of care, access to affordable services, and ability to function independently are client-centered goals or benefits of case management.

Nursing/Int.Conc:  Nursing Process: Implementation

Client Need:  Safe and Effective Care Environment

Cognitive Level:  Application

Learning Outcome:  12-1

 

3) The local health department has been criticized for not providing effective communicable disease control programs. What ethical problem should the population health nurse identify that the health department is committing?

  1. Negligence at the population level.
  2. Breach of contract at the population level.
  3. Abandonment at the individual level.
  4. Variance of care at the individual level.

Answer:  1

Explanation:  1. Negligence is the failure to act in a situation as a reasonably prudent nurse would if faced with the same situation. Failure of a local health department to provide effective communicable disease control programs could be considered an example of negligence at the population level. Breach of contract occurs when a managed care organization drops a client from the plan without adequate justification or when the system fails to pay for care that should be covered by the plan. Abandonment occurs when the case manager terminates services to a client with continuing needs without notifying the client or arranging for services from another provider. Variances are deviations from the typical path, which is not the best description of this situation.

Nursing/Int.Conc:  Nursing Process: Evaluation

Client Need:  Safe and Effective Care Environment

Cognitive Level:  Analysis

Learning Outcome:  12-4

 

4) The population health nurse case manager is determining a clients need for case management. Which indicators should the nurse identify as being social? (Select all that apply.)

  1. History of drug abuse.
  2. Homelessness.
  3. Lack of insurance.
  4. History of family violence.
  5. Single parenthood.

Answer:  2, 3, 4, 5

Explanation:  2. Social indicators that show a need for case management include homelessness or an unhealthy home environment, being uninsured, evidence of family violence, and single parenthood. History of drug abuse is a personal indicator, not a social indicator.

  1. Social indicators that show a need for case management include homelessness or an unhealthy home environment, being uninsured, evidence of family violence, and single parenthood. History of drug abuse is a personal indicator, not a social indicator.
  2. Social indicators that show a need for case management include homelessness or an unhealthy home environment, being uninsured, evidence of family violence, and single parenthood. History of drug abuse is a personal indicator, not a social indicator.
  3. Social indicators that show a need for case management include homelessness or an unhealthy home environment, being uninsured, evidence of family violence, and single parenthood. History of drug abuse is a personal indicator, not a social indicator.

Nursing/Int.Conc:  Nursing Process: Assessment

Client Need:  Health Promotion and Maintenance

Cognitive Level:  Application

Learning Outcome:  12-5

5) A client who has asthma is being assisted by the case manager to achieve control of the disease. Which type of care is the case manager providing to the client?

  1. Case management.
  2. Disease management.
  3. Multidisciplinary care.
  4. Risk management.

Answer:  2

Explanation:  2. Disease management is the process of intensively managing a particular disease across different care settings. Case management is assisting the same client to meet a wide variety of health and social needs. Multidisciplinary care is a team of health care professionals with a designated coordinator. Although the disease management plan might include assessment of risk factors that trigger asthma attacks, this is only one aspect of control of the disease.

Nursing/Int.Conc:  Nursing Process: Implementation

Client Need:  Health Promotion and Maintenance

Cognitive Level:  Analysis

Learning Outcome:  12-6

 

6) The population nurse case manager is preparing a case management plan for a client. What should the nurse remember about this type of plan when creating it for the client?

  1. It is generic.
  2. It is static.
  3. It is time-limited.
  4. It is outcomes-based.

Answer:  4

Explanation:  4. A case management plan is a series of expected outcomes of care and related activities that address the contribution of each discipline involved in the care of a particular patient or population. Effective case management plans are interdisciplinary and flexible and address clients needs in a comprehensive fashion. The plans are not generic, static, or time-limited.

Nursing/Int.Conc:  Nursing Process: Planning

Client Need:  Safe and Effective Care Environment

Cognitive Level:  Application

Learning Outcome:  12-7

 

7) A client being case managed has become unstable. What should the nurse case manager do?

  1. Delegate the care to assistive personnel.
  2. Refuse to continue care.
  3. Retain care of the client.
  4. Make an automatic referral.

Answer:  3

Explanation:  3. Care of unstable clients should not be delegated to unlicensed assistive personnel or automatically referred but should be retained by the case manager or other qualified personnel. After assessment the client might be referred to the primary care provider.

Nursing/Int.Conc:  Nursing Process: Implementation

Client Need:  Safe and Effective Care Environment

Cognitive Level:  Application

Learning Outcome:  12-8

8) The nurse is deciding tasks to delegate to other caregivers. What should the nurse use to help making these delegation decisions?

  1. Age.
  2. Education.
  3. Ability for self-care.
  4. Ability to pay for services.

Answer:  3

Explanation:  3. The nurse manager is guided by the following decisions when making delegation decisions: stability of the client, competence of the person to whom the task is being delegated, level of decision making and problem solving required, ability of the client for self-care, and the predictability of the outcome of the task. Age, education, and ability for self-care will not help the manager make delegation decisions.

Nursing/Int.Conc:  Nursing Process: Planning

Client Need:  Safe and Effective Care Environment

Cognitive Level:  Application

Learning Outcome:  12-8

 

9) The nurse is making a referral for the client. What should be the nurses first consideration for this referral?

  1. Factors that might prevent the client from following through with the referral.
  2. Clients eligibility for the service.
  3. Cost of the referral services.
  4. Acceptability of the referral to the client.

Answer:  4

Explanation:  4. The first consideration in making a referral is the acceptability of the referral to the client. The second consideration is the clients eligibility for the service provided. The presence of situational constraints or factors in the clients situation that would prevent him or her from following through with the referral is the third consideration. The cost of the service is not a consideration when making referrals.

Nursing/Int.Conc:  Nursing Process: Implementation

Client Need:  Safe and Effective Care Environment

Cognitive Level:  Analysis

Learning Outcome:  12-6

 

10) The case manager arranges for the transfer of the clients records from the primary care provider to the home health agency. In which role is the case manager functioning?

  1. Clinical expert.
  2. Consultant.
  3. Coordinator of care.
  4. Change agent.

Answer:  3

Explanation:  3. The coordinator of care arranges seamless care across systems and agencies to meet client needs. An example of the coordinator of cares role function is arranging for transfer of client records from the primary care provider to the home health agency. The consultant provides assistance to clients and other health care professionals regarding client needs and available services. The clinical expert is knowledgeable regarding clinical conditions and best, evidence-based practice. The change agent promotes change in client behaviors and/or health care delivery systems.

Nursing/Int.Conc:  Nursing Process: Implementation

Client Need:  Safe and Effective Care Environment

Cognitive Level:  Application

Learning Outcome:  12-6

 

11) The population health nurse is evaluating outcomes for a group of clients based upon the best possible achievable outcome. Which action is the nurse completing?

  1. Assessing.
  2. Screening.
  3. Delegation.
  4. Benchmarking.

Answer:  4

Explanation:  4. A benchmark is a standard of performance against which the performance of a given system can be judged. Clinical benchmarking reflects the best outcome actually achieved for a group of clients or a diagnosis, as well the best possible achievable outcome. Assessment involves identification of the need for case management services. Screening involves risk identification. Delegation involves transferring authority to a competent individual.

Nursing/Int.Conc:  Nursing Process: Implementation

Client Need:  Health Promotion and Maintenance

Cognitive Level:  Analysis

Learning Outcome:  12-9

 

12) The diabetes nurse education is telephoning clients to assess current Hgb A1c rates and the results of their last ophthalmologic examinations. Which case management model is the nurse using to provide care?

  1. Linked.
  2. Intensive.
  3. Supportive.
  4. Disease-specific.

Answer:  4

Explanation:  4. Disease-specific case management is often provided by a nurse with expertise in a particular area who provides both direct care related to management of the disease as well as education, advice, and referral for other needed services. In a linked model, the case manager makes referrals for services to independent services and networks. In intensive case management models, the majority of services needed by clients are offered by a single organization, often the organization that provides the case management services. Supportive case management addresses immediate discrete service needs and involves short-term service provision.

Nursing/Int.Conc:  Nursing Process: Implementation

Client Need:  Health Promotion and Maintenance

Cognitive Level:  Analysis

Learning Outcome:  12-2

 

13) The nurse is managing the care of a client with end-stage renal failure, anemia, and chronic pain from osteoarthritis. Within the case management system, which tier should be used to guide this clients care?

  1. Tier oneself-care support.
  2. Tier twohigh-risk disease management.
  3. Tier threecomplex needs to be addressed.
  4. Tier fourrehabilitation and ancillary service needs.

Answer:  3

Explanation:  3. A tiered case management system comprised of three levels. The first level is designed to provide self-care support for the bulk of the population needing services. The second level of case management involves high-risk disease management and might be appropriate for brittle diabetics or women with high-risk pregnancies who require more intense services and more frequent monitoring. The third level addresses care of clients with complex needs who require a broad array of services such as the client with renal failure, anemia, and chronic pain from osteoarthritis. There is no fourth tier in the tiered case management system.

Nursing/Int.Conc:  Nursing Process: Planning

Client Need:  Health Promotion and Maintenance

Cognitive Level:  Application

Learning Outcome:  12-2

 

14) The population health nurse case manager is assisting a client identify the closest facility to have a required diagnostic test completed. Which principle of case management is the nurse performing with the client?

  1. Incorporating client advocacy.
  2. Promoting optimal client safety.
  3. Navigating the health care system.
  4. Linking with community resources.

Answer:  3

Explanation:  3. Assisting a client to identify the closest facility to have a required diagnostic test is an example of navigating the health care system. Assisting the client is not an example of client advocacy, client safety, or linking with community resources.

Nursing/Int.Conc:  Nursing Process: Implementation

Client Need:  Health Promotion and Maintenance

Cognitive Level:  Application

Learning Outcome:  12-3

 

 

15) The population health nurse case manager addresses the clients holistic needs when managing the care of the client. What actions should the nurse expect to perform when adhering to this case management principle? (Select all that apply.)

  1. Discuss ways to eliminate smoking.
  2. Encourage to schedule an appointment for a mammogram.
  3. Review the current medication regimen for type 2 diabetes mellitus.
  4. Strategize ways to overcome feelings of inadequacy with unemployment.
  5. Methodically review the steps to take to improve compliance with a low-fat diet.

Answer:  1, 2, 3, 4

Explanation:  1. One principle of case management is that it is comprehensive and holistic, incorporating health promotion, illness prevention, and risk mitigation as well as care for existing health and psychosocial problems. When adhering to this principle the nurse case manager would help with smoking cessation, encourage to schedule appointments for routine diagnostic tests, review medication regimens, and strategize ways to help the client with self-esteem. Reviewing steps to adhere to an eating plan is implementing behavior change with the client.

  1. One principle of case management is that it is comprehensive and holistic, incorporating health promotion, illness prevention, and risk mitigation as well as care for existing health and psychosocial problems. When adhering to this principle the nurse case manager would help with smoking cessation, encourage to schedule appointments for routine diagnostic tests, review medication regimens, and strategize ways to help the client with self-esteem. Reviewing steps to adhere to an eating plan is implementing behavior change with the client.
  2. One principle of case management is that it is comprehensive and holistic, incorporating health promotion, illness prevention, and risk mitigation as well as care for existing health and psychosocial problems. When adhering to this principle the nurse case manager would help with smoking cessation, encourage to schedule appointments for routine diagnostic tests, review medication regimens, and strategize ways to help the client with self-esteem. Reviewing steps to adhere to an eating plan is implementing behavior change with the client.
  3. One principle of case management is that it is comprehensive and holistic, incorporating health promotion, illness prevention, and risk mitigation as well as care for existing health and psychosocial problems. When adhering to this principle the nurse case manager would help with smoking cessation, encourage to schedule appointments for routine diagnostic tests, review medication regimens, and strategize ways to help the client with self-esteem. Reviewing steps to adhere to an eating plan is implementing behavior change with the client.

Nursing/Int.Conc:  Nursing Process: Planning

Client Need:  Health Promotion and Maintenance

Cognitive Level:  Application

Learning Outcome:  12-3

Population and Community Health Nursing, 6e (Clark)

Chapter 20   Care of the GLBT Population

 

1) An adolescent shares with the nurse that he is gay and that he is going to tell his parents. The nurse knows that parental response to the disclosure of homosexuality is strongly influenced by the: (Select all that apply.)

  1. Strength of traditional gender role conceptions.
  2. Perceptions of the probable attitudes of significant others in the familys network.
  3. Parental age.
  4. Parental education.
  5. Parental race.

Answer:  1, 2, 3, 4

Explanation:  1. The parental response to the disclosure of homosexuality is strongly influenced by a variety of factors, which include: the strength of traditional gender role conceptions, perceptions of the probable attitudes of significant others in the familys social network, and parental age and education level. The younger and better educated parents tend to be more accepting. Race is not an influencing factor.

  1. The parental response to the disclosure of homosexuality is strongly influenced by a variety of factors, which include: the strength of traditional gender role conceptions, perceptions of the probable attitudes of significant others in the familys social network, and parental age and education level. The younger and better educated parents tend to be more accepting. Race is not an influencing factor.
  2. The parental response to the disclosure of homosexuality is strongly influenced by a variety of factors, which include: the strength of traditional gender role conceptions, perceptions of the probable attitudes of significant others in the familys social network, and parental age and education level. The younger and better educated parents tend to be more accepting. Race is not an influencing factor.
  3. The parental response to the disclosure of homosexuality is strongly influenced by a variety of factors, which include: the strength of traditional gender role conceptions, perceptions of the probable attitudes of significant others in the familys social network, and parental age and education level. The younger and better educated parents tend to be more accepting. Race is not an influencing factor.

Nursing/Int.Conc:  Nursing Process: Planning

Client Need:  Health Promotion and Maintenance

Cognitive Level:  Analysis

Learning Outcome:  20-2

 

2) A therapist who works primarily with gay and lesbian couples is aware that the same kinds of stress that affect heterosexual relationships also affect gay and lesbian relationships. But the therapist knows that the stress is different with respect to:

  1. Extended family involvement.
  2. Inequalities of power.
  3. Disparity in income.
  4. Coming out.

Answer:  4

Explanation:  4. With the exception of the stage of coming out, most issues that affect the stability or relationships among heterosexual and nonheterosexual couples are the same. Extended family involvement, inequalities of power, and disparity in income tend to have the same effect on gay and lesbian relationships.

Nursing/Int.Conc:  Nursing Process: Assessment

Client Need:  Health Promotion and Maintenance

Cognitive Level:  Analysis

Learning Outcome:  20-2

 

3) The population health nurse is interviewing a client who states that she is a lesbian. What statement by the client indicates the need for more education?

  1. Since I only have sex with females I am at a lower risk for some sexually transmitted diseases.
  2. I have less risk factors for breast cancer than a heterosexual.
  3. I do need to have routine Pap smears.
  4. I have an increased risk of heart disease.

Answer:  2

Explanation:  2. There is a higher prevalence of certain risk factors for breast cancer among lesbian women. Women who engage in sexual activity exclusively with other women seem to be at lower risk for some sexually transmitted diseases. Routine Pap smears are as important for lesbians as for heterosexuals. There is an increased risk for heart disease among lesbians perhaps because lesbians smoke more than their heterosexual sisters and tend to have a higher body mass index.

Nursing/Int.Conc:  Nursing Process: Evaluation

Client Need:  Health Promotion and Maintenance

Cognitive Level:  Analysis

Learning Outcome:  20-4

 

 

4) The most accurate description the population health nurse could give a colleague about homophobia is that it:

  1. Prohibits homosexuals from serving as foster parents.
  2. Encompasses a belief system that is used to justify discrimination against lesbians.
  3. Is an intolerance of all homosexuals or of homosexual feelings within oneself.
  4. Has led to homosexual activity being criminalized in all states.

Answer:  3

Explanation:  3. Homophobia is an irrational fear and intolerance of people who are homosexual or of homosexual feelings within oneself. Homophobia is not a law. Homophobia is not used to justify discrimination against lesbians. Homosexual activity is not criminalized in all states.

Nursing/Int.Conc:  Nursing Process: Implementation

Client Need:  Health Promotion and Maintenance

Cognitive Level:  Application

Learning Outcome:  20-2

5) The nurse is working with a group of lesbian, bisexual, and transgender women. What statements should the nurse be most concerned about regarding psychological considerations in working this group of clients? (Select all that apply.)

  1. I do not live my life openly, but I never fear someone will find out I am a lesbian.
  2. I constantly monitor everything I say and do for fear my mother will find out I am a lesbian.
  3. I constantly feel negative feelings about my sexual preference.
  4. I am coming out and sometimes I have contradictory feelings of excitement and relief.
  5. The excitement of coming out is overwhelming.

Answer:  1, 2

Explanation:  1. The lesbian, bisexual, or transgender woman who does not live her identity openly must deal with the fear that someone will discover who she really is. Although these women grieve the loss of hiding who they are, the grief is not sanctioned by society and is another source of hidden stress. Lesbians or bisexual women may internalize negative social attitudes to their sexual identities, leading to greater risk of suicide. Coming out causes contradictory feelings of excitement and relief.

  1. The lesbian, bisexual, or transgender woman who does not live her identity openly must deal with the fear that someone will discover who she really is. Although these women grieve the loss of hiding who they are, the grief is not sanctioned by society and is another source of hidden stress. Lesbians or bisexual women may internalize negative social attitudes to their sexual identities, leading to greater risk of suicide. Coming out causes contradictory feelings of excitement and relief.

Nursing/Int.Conc:  Nursing Process: Assessment

Client Need:  Health Promotion and Maintenance

Cognitive Level:  Analysis

Learning Outcome:  20-2

 

6) The population health nurse is assessing a community member who identifies with the GLBT community. When discussing sexual orientation the nurse knows that three aspects are being assessed which are: (Select all that apply.)

  1. Identity.
  2. Behavior.
  3. Attraction.
  4. Acceptance.
  5. Coming out.

Answer:  1, 2, 3

Explanation:  1. Sexual orientation refers to ones preferred choice of sexual or romantic partners or the gender(s) of people to whom one is attracted. Sexual orientation comprises three aspects: attraction, behavior, and identity. Acceptance and coming out are not aspects of sexual orientation.

  1. Sexual orientation refers to ones preferred choice of sexual or romantic partners or the gender(s) of people to whom one is attracted. Sexual orientation comprises three aspects: attraction, behavior, and identity. Acceptance and coming out are not aspects of sexual orientation.
  2. Sexual orientation refers to ones preferred choice of sexual or romantic partners or the gender(s) of people to whom one is attracted. Sexual orientation comprises three aspects: attraction, behavior, and identity. Acceptance and coming out are not aspects of sexual orientation.

Nursing/Int.Conc:  Nursing Process: Assessment

Client Need:  Health Promotion and Maintenance

Cognitive Level:  Application

Learning Outcome:  20-1

 

7) A client who identifies with the GLBT community tells the nurse that the only thing that makes him a male is having a penis and testosterone in the bloodstream. The population health nurse realizes that this client is using which perspectives to describe gender? (Select all that apply.)

  1. Hormonal.
  2. Behavioral.
  3. Anatomical.
  4. Chromosomal.
  5. Psychological.

Answer:  1, 3

Explanation:  1. There are four perspectives on sex or gender: anatomical, chromosomal, hormonal, and psychological. In the hormonal perspective, ones sex is defined by the balance of male and female hormones. The anatomical perspective relies on sex-specific internal and external organs such as a penis. The chromosomal perspective is based on the number of X and Y chromosomes one possesses. The final perspective involves ones felt identity or gender identity. Behavioral is not a perspective on sex or gender.

  1. There are four perspectives on sex or gender: anatomical, chromosomal, hormonal, and psychological. In the hormonal perspective, ones sex is defined by the balance of male and female hormones. The anatomical perspective relies on sex-specific internal and external organs such as a penis. The chromosomal perspective is based on the number of X and Y chromosomes one possesses. The final perspective involves ones felt identity or gender identity. Behavioral is not a perspective on sex or gender.

Nursing/Int.Conc:  Nursing Process: Evaluation

Client Need:  Health Promotion and Maintenance

Cognitive Level:  Analysis

Learning Outcome:  20-1

 

8) During an assessment the population health nurse believes that a client who identifies with the GLBT community is a gender nonconforming individual. What did the nurse assess to make this clinical determination?

  1. Prefers to have sexual relations with both sexes.
  2. Does not confirm to societal gender expectations.
  3. Client states being a woman trapped in a mans body.
  4. Self-perceived gender is congruent with assigned birth gender.

Answer:  2

Explanation:  2. A gender-nonconforming individual is one who by nature or choice does not conform to societal gender expectations A person who prefers to have sexual relations with both sexes would be considered bisexual. Transsexuals are persons who believe they were born into the wrong body and are actually members of the opposite gender. Cisgender refers to an individual whose self-perceived gender is congruent with his or her assigned birth gender.

Nursing/Int.Conc:  Nursing Process: Assessment

Client Need:  Health Promotion and Maintenance

Cognitive Level:  Analysis

Learning Outcome:  20-1

 

9) The population health nurse is concerned that members of a community are demonstrating heterosexism. Because of this, for which potential issues should the nurse be aware of occurring within the GLBT population? (Select all that apply.)

  1. Violence.
  2. Oppression.
  3. Stigmatization.
  4. Discrimination.
  5. Family rejection.

Answer:  1, 2, 3, 4

Explanation:  1. Heterosexism is the assumption that all people are heterosexual and belief that heterosexuality is normal and superior to other sexual orientations. Heterosexism results in oppression, stigmatization, discrimination, and violence against members of GLBT populations. Family rejection is a response to disclosure of a family members homosexuality. This is not an outcome of heterosexism.

  1. Heterosexism is the assumption that all people are heterosexual and belief that heterosexuality is normal and superior to other sexual orientations. Heterosexism results in oppression, stigmatization, discrimination, and violence against members of GLBT populations. Family rejection is a response to disclosure of a family members homosexuality. This is not an outcome of heterosexism.
  2. Heterosexism is the assumption that all people are heterosexual and belief that heterosexuality is normal and superior to other sexual orientations. Heterosexism results in oppression, stigmatization, discrimination, and violence against members of GLBT populations. Family rejection is a response to disclosure of a family members homosexuality. This is not an outcome of heterosexism.
  3. Heterosexism is the assumption that all people are heterosexual and belief that heterosexuality is normal and superior to other sexual orientations. Heterosexism results in oppression, stigmatization, discrimination, and violence against members of GLBT populations. Family rejection is a response to disclosure of a family members homosexuality. This is not an outcome of heterosexism.

Nursing/Int.Conc:  Nursing Process: Planning

Client Need:  Health Promotion and Maintenance

Cognitive Level:  Analysis

Learning Outcome:  20-2

 

 

10) The population health nurse is asked by a member of the GLBT community for information on how to prevent the onset of illnesses. What should the nurse recommend to this client? (Select all that apply.)

  1. Recommend hormone therapy.
  2. Strengthen partner relationships.
  3. Practice safe sex to prevent HIV.
  4. Attend smoking cessation classes.
  5. Receive hepatitis A and B immunizations.

Answer:  2, 3, 4, 5

Explanation:  2. Effective illness and injury prevention strategies for the GLBT population include measures to prevent HIV infection and immunization for illnesses such as hepatitis A and B for those at risk of infection. Population health nurses can promote strengthening partner relationships. Other illness and injury prevention strategies would be similar to those for the general population and include eliminating risk behaviors such as smoking. Recommending hormone therapy would be appropriate to resolve an existing health problem.

  1. Effective illness and injury prevention strategies for the GLBT population include measures to prevent HIV infection and immunization for illnesses such as hepatitis A and B for those at risk of infection. Population health nurses can promote strengthening partner relationships. Other illness and injury prevention strategies would be similar to those for the general population and include eliminating risk behaviors such as smoking. Recommending hormone therapy would be appropriate to resolve an existing health problem.
  2. Effective illness and injury prevention strategies for the GLBT population include measures to prevent HIV infection and immunization for illnesses such as hepatitis A and B for those at risk of infection. Population health nurses can promote strengthening partner relationships. Other illness and injury prevention strategies would be similar to those for the general population and include eliminating risk behaviors such as smoking. Recommending hormone therapy would be appropriate to resolve an existing health problem.
  3. Effective illness and injury prevention strategies for the GLBT population include measures to prevent HIV infection and immunization for illnesses such as hepatitis A and B for those at risk of infection. Population health nurses can promote strengthening partner relationships. Other illness and injury prevention strategies would be similar to those for the general population and include eliminating risk behaviors such as smoking. Recommending hormone therapy would be appropriate to resolve an existing health problem.

Nursing/Int.Conc:  Nursing Process: Implementation

Client Need:  Health Promotion and Maintenance

Cognitive Level:  Application

Learning Outcome:  20-3

 

11) A member of the GLBT community admits that anal intercourse is often conducted unprotected. What should the population health nurse recommend to reduce this clients risk of illness?

  1. Always use a condom.
  2. Have monthly HIV testing.
  3. Alter the type of intercourse.
  4. Consider a monogamous relationship.

Answer:  1

Explanation:  1. The one strategy to help prevent disease from unprotected anal intercourse is the use of a condom. Having monthly HIV testing is an inappropriate suggestion. Altering the type of intercourse does not meet the clients need. Considering a monogamous relationship does not reduce the threat of illness from unprotected anal intercourse.

Nursing/Int.Conc:  Nursing Process: Implementation

Client Need:  Health Promotion and Maintenance

Cognitive Level:  Application

Learning Outcome:  20-3

 

12) A client who is awaiting FTM gender assignment surgery is scheduled for a routine health examination at the community clinic. What screenings should the client receive?

(Select all that apply.)

  1. Pap smear.
  2. Mammogram.
  3. Throat culture.
  4. Prostate exam.
  5. Tuberculosis test.

Answer:  1, 2

Explanation:  1. Most FTM transgender individuals continue to need regular cervical cancer screening and screening for breast cancer. The client is genetically female so a prostate gland is not a part of the clients anatomy. Throat cultures and tuberculosis tests are not considered routine screenings.

  1. Most FTM transgender individuals continue to need regular cervical cancer screening and screening for breast cancer. The client is genetically female so a prostate gland is not a part of the clients anatomy. Throat cultures and tuberculosis tests are not considered routine screenings.

Nursing/Int.Conc:  Nursing Process: Planning

Client Need:  Health Promotion and Maintenance

Cognitive Level:  Application

Learning Outcome:  20-4

 

13) A client who is a MTG transgender is considering feminizing genitoplasty. Which surgical procedures should the population health nurse include when instructing this client? (Select all that apply.)

  1. Penectomy.
  2. Vovoplasty.
  3. Orchiectomy.
  4. Vaginoplasty.
  5. Reduction mammoplasty.

Answer:  1, 2, 3, 4

Explanation:  1. Feminizing genitoplasty for MTF transgenders usually includes orchiectomy, penectomy, vaginoplasty, and volvoplasty. Surgery for FTM transgender individuals often includes chest reconstruction or reduction mammoplasty.

  1. Feminizing genitoplasty for MTF transgenders usually includes orchiectomy, penectomy, vaginoplasty, and volvoplasty. Surgery for FTM transgender individuals often includes chest reconstruction or reduction mammoplasty.
  2. Feminizing genitoplasty for MTF transgenders usually includes orchiectomy, penectomy, vaginoplasty, and volvoplasty. Surgery for FTM transgender individuals often includes chest reconstruction or reduction mammoplasty.
  3. Feminizing genitoplasty for MTF transgenders usually includes orchiectomy, penectomy, vaginoplasty, and volvoplasty. Surgery for FTM transgender individuals often includes chest reconstruction or reduction mammoplasty.

Nursing/Int.Conc:  Nursing Process: Implementation

Client Need:  Physiological Integrity

Cognitive Level:  Application

Learning Outcome:  20-4

 

 

14) A client is recovering from MTF sexual reassignment surgery. What health teaching should the population health nurse provide to this client as a part of health restoration strategies?

(Select all that apply.)

  1. Having routine PSA levels drawn.
  2. Actions to prevent the development of a stroke.
  3. Explaining the risk of heart disease from hormo

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