Test Bank For Population And Community Health Nursing 6th Edition By Clark

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Test Bank For Population And Community Health Nursing 6th Edition By Clark

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WITH ANSWERS

 

Population And Community Health Nursing 6th Edition By Clark

 

Population and Community Health Nursing, 6e (Clark)

Chapter 1   Population Health and Nursing

 

1) The nurse is designing a program for pregnant adolescents in the community. The program will focus on fetal development, appropriate nutrition, developing social support systems, and screening for potential abuse by partners or others. This is an example of:

  1. Community-driven care.
  2. Community-focused care.
  3. Community-based nursing.
  4. Population health nursing.

Answer:  4

Explanation:  4. Population health nursing is the practice of promoting and protecting the health of populations using knowledge from nursing, social, and public health sciences. The population will benefit from the program because the adolescents will be healthier and deliver healthier infants, thus saving on health care costs. Community-based nursing is nurses providing sick care in community settings. Community-focused care is bringing nursing knowledge and expertise to the community, but it does not have a population focus. Community-driven care focuses on the needs of the community as a whole and emphasizes community participation in determining those needs. It can limit the focus of practice to health needs identified by the population group, and could thus exclude pregnant adolescents.

Nursing/Int.Conc:  Nursing Process: Planning

Client Need:  Health Promotion and Maintenance

Cognitive Level:  Application

Learning Outcome:  1-1

 

2) The nurse meets with members of the community in open forums to help determine ways to improve health. The nurse identifies health problems in the community based on the community input and the nurses community assessment. In this situation, the nurse is practicing:

  1. Public-health nursing.
  2. Community-driven care.
  3. Community-focused care.
  4. Community-oriented care.

Answer:  3

Explanation:  3. Community-focused care brings nursing knowledge and expertise to the community. Public health nursing has a perceived focus of environmental sanitation and controlling communicable diseases. Community-driven care focuses on the needs of the community as a whole, but can be limited to only addressing needs identified by community members. Community-oriented care is limited and focuses program development on small aggregates while potentially ignoring health issues affecting larger population groups.

Nursing/Int.Conc:  Nursing Process: Implementation

Client Need:  Health Promotion and Maintenance

Cognitive Level:  Application

Learning Outcome:  1-1

 

3) The nurse holds community forums to gain input in determining the health needs for the community. Issues raised the forum focus on the need for nutrition education, but the nurse notices that many community members are outside smoking before entering the building. The nurse acknowledges the importance of nutrition education, but addresses the incorporation of smoking cessation education as part of a total lifestyle choice program. Which type of nursing is the nurse implementing?

  1. Public health nursing.
  2. Community-driven nursing.
  3. Population-focused nursing.
  4. Community-focused nursing.

Answer:  3

Explanation:  3. The nurse gained input from the community as to their concerns, but also noted that a health concern was smoking. This is population-focused in that it incorporates other population health issues based on the nurses assessment and are not focused solely on the communitys concerns. Community-driven care focuses on the needs of the community as a whole and emphasizes community participation in determining those needs. Community-focused nursing is defined as the bringing of nursing knowledge and expertise to the community but such care may not have a population focus. Public health nursing is indicative of governmental or official agency oversight and jurisdiction with a focus on control of communicable diseases and environmental sanitation.

Nursing/Int.Conc:  Nursing Process: Implementation

Client Need:  Health Promotion and Maintenance

Cognitive Level:  Application

Learning Outcome:  1-1

 

 

4) The population health nurse reviews the standards for population-focused care prior to meeting with a group of patients. On which standards should the nurse focus to determine this populations risk for developing health problems related to obesity? (Select all that apply.)

  1. Standard 1: Assessment.
  2. Standard 2: Diagnosis.
  3. Standard 8: Competency.
  4. Standard 12: Ethics.
  5. Standard 13: Evidence-based practice.

Answer:  1, 2, 5

Explanation:  1. The first standard addresses assessment where the population health nurse collects data needed to assess the health status of the population and to identify factors contributing to health and illness in the population. Under Standard 2, the nurse analyzes health assessment data to derive population health diagnoses, which are then prioritized to promote effective action. Standard 13 is the integration of research findings into evidence-based practice. This is important for this population because of the disease process and related health problems. Standard 8 focuses on attaining knowledge and maintaining competency in nursing and public health practice. There is no specific evidence to suggest that the nurse needs to attain additional knowledge. Standard 12 emphasizes the need for ethical behavior on the part of the population health nurse. There is no specific evidence to suggest that extra emphasis is needed on ethic for this patient population.

  1. The first standard addresses assessment where the population health nurse collects data needed to assess the health status of the population and to identify factors contributing to health and illness in the population. Under Standard 2, the nurse analyzes health assessment data to derive population health diagnoses, which are then prioritized to promote effective action. Standard 13 is the integration of research findings into evidence-based practice. This is important for this population because of the disease process and related health problems. Standard 8 focuses on attaining knowledge and maintaining competency in nursing and public health practice. There is no specific evidence to suggest that the nurse needs to attain additional knowledge. Standard 12 emphasizes the need for ethical behavior on the part of the population health nurse. There is no specific evidence to suggest that extra emphasis is needed on ethic for this patient population.
  2. The first standard addresses assessment where the population health nurse collects data needed to assess the health status of the population and to identify factors contributing to health and illness in the population. Under Standard 2, the nurse analyzes health assessment data to derive population health diagnoses, which are then prioritized to promote effective action. Standard 13 is the integration of research findings into evidence-based practice. This is important for this population because of the disease process and related health problems. Standard 8 focuses on attaining knowledge and maintaining competency in nursing and public health practice. There is no specific evidence to suggest that the nurse needs to attain additional knowledge. Standard 12 emphasizes the need for ethical behavior on the part of the population health nurse. There is no specific evidence to suggest that extra emphasis is needed on ethic for this patient population.

Nursing/Int.Conc:  Nursing Process: Implementation

Client Need:  Health Promotion and Maintenance

Cognitive Level:  Application

Learning Outcome:  1-4

 

 

5) While working with a local community on an immunization program, the nurse is developing an evaluation tool that incorporates the standards of care for population health nursing practice. What standards should the nurse include in this tool? (Select all that apply.)

  1. Advocacy.
  2. Research.
  3. Collegiality.
  4. Autonomy.
  5. Leadership.

Answer:  1, 2, 3, 5

Explanation:  1. The standards of care for population health nursing practice have been developed within the framework of the nursing process and the core functions of public health. They relate to the areas of assessment, diagnosis, outcomes identification, planning, implementation, and evaluation. Additional standards address expected levels of professional performance and deal with quality of practice, education, professional practice evaluation, collegiality, ethics, collaboration, research, resource utilization, leadership, and advocacy.

  1. The standards of care for population health nursing practice have been developed within the framework of the nursing process and the core functions of public health. They relate to the areas of assessment, diagnosis, outcomes identification, planning, implementation, and evaluation. Additional standards address expected levels of professional performance and deal with quality of practice, education, professional practice evaluation, collegiality, ethics, collaboration, research, resource utilization, leadership, and advocacy.
  2. The standards of care for population health nursing practice have been developed within the framework of the nursing process and the core functions of public health. They relate to the areas of assessment, diagnosis, outcomes identification, planning, implementation, and evaluation. Additional standards address expected levels of professional performance and deal with quality of practice, education, professional practice evaluation, collegiality, ethics, collaboration, research, resource utilization, leadership, and advocacy.
  3. The standards of care for population health nursing practice have been developed within the framework of the nursing process and the core functions of public health. They relate to the areas of assessment, diagnosis, outcomes identification, planning, implementation, and evaluation. Additional standards address expected levels of professional performance and deal with quality of practice, education, professional practice evaluation, collegiality, ethics, collaboration, research, resource utilization, leadership, and advocacy.

Nursing/Int.Conc:  Nursing Process: Planning

Client Need:  Safe and Effective Care Environment

Cognitive Level:  Application

Learning Outcome:  1-4

 

6) The nurse is reviewing the eight domains of competencies for population health nursing before structuring a program to address an identified health problem. What should the nurse keep in mind when reviewing these competencies?

  1. They reflect the practice of the experienced population health nurse at only the specialist level and include cultural competence.
  2. They reflect the practice of the experienced population health nurse at the generalist level and exclude communication.
  3. They include expectations, which range from awareness through knowledge to proficiency and include financial planning.
  4. They must all be incorporated into any population health nursing position and include advanced public health practice.

Answer:  3

Explanation:  3. The competencies address eight domains of practice: (a) analytic assessment, (b) policy development and program planning, (c) communication, (d) cultural competence, (e) community dimensions of practice, (f) basic public health science, (g) financial planning and management, and (h) leadership and systems thinking. The competencies were intended to reflect the practice of experienced community health nurses at both generalist and specialist levels, not novices, and expectations ranged from awareness through knowledge to proficiency on any given item. The competencies were revised to address three tiers of practice. Tier 1 competencies are skills to be possessed by public health nurses who engaged in day-to-day care in official state and local public health agencies. Tier 2 competencies address the practice of program managers or supervisors. Tier 3 competencies are intended for public health nurses in senior management and leadership positions with responsibility for major programs and strategy development. Any particular population health nursing position may incorporate components from some or all domains.

Nursing/Int.Conc:  Nursing Process: Assessment

Client Need:  Safe and Effective Care Environment

Cognitive Level:  Application

Learning Outcome:  1-5

 

7) The population health nurse is helping a client identify alternative solutions for a health problem. In which focus and role is the nurse functioning in this situation?

  1. Client-oriented and educator.
  2. Delivery-oriented and case manager.
  3. Client-oriented and counselor.
  4. Population-oriented and counselor.

Answer:  3

Explanation:  3. This is an example of client-oriented community health nursing and of a counselor role. The role of counselor includes helping the client identify alternative solutions. This is an example of a client-oriented focus but not of an educator role. The role of educator is to assess the need for education, develop the education plan, present health education, and evaluate outcome of the health education. This is not an example of a delivery-oriented focus, which are roles designed to enhance the operation of the health care delivery system itself; and the role of case manager does not include identification of alternative solutions. This is not an example of a population-oriented focus, which is directed toward promoting, maintaining, and restoring the health of the population. The counselor role is not population-oriented.

Nursing/Int.Conc:  Nursing Process: Implementation

Client Need:  Health Promotion and Maintenance

Cognitive Level:  Analysis

Learning Outcome:  1-6

 

8) The population health nurse is demonstrating behavior to be learned by a client and the family. In which focus and role is the nurse providing care?

  1. Client-oriented and role model.
  2. Delivery-oriented and educator.
  3. Client-oriented and referral resource.
  4. Population-oriented and collaborator.

Answer:  1

Explanation:  1. The focus of nursing care in this situation is the client and the behavior is role modeling. Delivery-oriented nursing involves the operation or the health care delivery system, and role model is a better description of this behavior than educator. The focus of nursing care is the client but this is not a referral resource. Population-oriented care involves promotion, maintenance, and restoration of the population. The behavior that the nurse is demonstrating is not collaboration.

Nursing/Int.Conc:  Nursing Process: Implementation

Client Need:  Safe and Effective Care Environment

Cognitive Level:  Analysis

Learning Outcome:  1-6

 

9) The nurse is functioning as a liaison within a local clinic. What action is the nurse performing in this role?

  1. Serving as initial point of contact between client and agency.
  2. Coordinating and directing the use of health care services.
  3. Organizing and integrating services.
  4. Creating alliances of individuals or groups to achieve a specific purpose.

Answer:  1

Explanation:  1. The liaison role is one of serving as the initial point of contact between the client and agency. The case manager role is one of coordinating and directing the selection and use of health care services. As a coordinator the nurse organizes and integrates services to best meet client needs in the most efficient manner possible. Coalition building is the creation of temporary or permanent alliances of individuals or groups to achieve a specific purpose.

Nursing/Int.Conc:  Nursing Process: Implementation

Client Need:  Safe and Effective Care Environment

Cognitive Level:  Analysis

Learning Outcome:  1-6

 

10) The nurse is caring for a specific population within a community. Which nursing action should the nurse use to exemplify the population health nurses case finding role?

  1. Assess a clients need for education.
  2. Advocate for a mother who is being seen in a clinic.
  3. Carry out an investigation of meningitis cases.
  4. Develop an educational plan for a group of adolescents.

Answer:  3

Explanation:  3. Case finding has been described as basic to population health nursing. Case finding involves identifying individual cases or occurrences of specific diseases or other health-related conditions requiring services. In the educator role, the population health nurse provides clients and others with information and insights that allow them to make informed decisions on health matters. As an advocate, the population health nurse engages in a number of activities or functions including determining the need for advocacy, determining the point at which advocacy will be most effective, collecting facts related to the problem, and presenting the case to the appropriate decision makers.

Nursing/Int.Conc:  Nursing Process: Implementation

Client Need:  Safe and Effective Care Environment

Cognitive Level:  Analysis

Learning Outcome:  1-6

 

11) The nurse is creating a program to address cigarette smoking by community members. Which Healthy People 2020 topical areas are relevant to this program? (Select all that apply.)

  1. Tobacco.
  2. Oral health.
  3. Substance abuse.
  4. Environmental quality.
  5. Clinical preventive services.

Answer:  1, 4

Explanation:  1. For the topical area of Tobacco, objectives include reducing tobacco use by adults and adolescents.

  1. For the topical area of Environmental Quality, a leading health indicator objective is to reduce tobacco use by adults. Tobacco is not a leading health indicator objective for the topical area of Oral Health. Tobacco is not a leading health indicator objective for the topical area of Substance Abuse. Tobacco is not a leading health indicator objective for the topical area of Clinical Preventive Services.

Nursing/Int.Conc:  Nursing Process: Planning

Client Need:  Health Promotion and Maintenance

Cognitive Level:  Application

Learning Outcome:  1-2

 

12) After completing a community assessment the nurse is preparing a plan to address behavioral determinants of health. Which topics should the nurse include in this plan? (Select all that apply.)

  1. Use of park and bicycle trails.
  2. Intake of fresh fruits and vegetables.
  3. Ease of obtaining marijuana and cocaine.
  4. Hours that the community health clinic is open.
  5. Use of protective gear when bicycling.

Answer:  1, 2, 3, 5

Explanation:  1. Behavioral determinants involve personal behaviors that either promote or impair health. Behavioral factors are often those most amenable to change in efforts to prevent disease and promote health. Health-related behaviors include recreation and exercise, dietary patterns, substance use and abuse, and use of protective measures. Hours that the community health clinic is open is considered a health system determinant.

  1. Behavioral determinants involve personal behaviors that either promote or impair health. Behavioral factors are often those most amenable to change in efforts to prevent disease and promote health. Health-related behaviors include recreation and exercise, dietary patterns, substance use and abuse, and use of protective measures. Hours that the community health clinic is open is considered a health system determinant.
  2. Behavioral determinants involve personal behaviors that either promote or impair health. Behavioral factors are often those most amenable to change in efforts to prevent disease and promote health. Health-related behaviors include recreation and exercise, dietary patterns, substance use and abuse, and use of protective measures. Hours that the community health clinic is open is considered a health system determinant.
  3. Behavioral determinants involve personal behaviors that either promote or impair health. Behavioral factors are often those most amenable to change in efforts to prevent disease and promote health. Health-related behaviors include recreation and exercise, dietary patterns, substance use and abuse, and use of protective measures. Hours that the community health clinic is open is considered a health system determinant.

Nursing/Int.Conc:  Nursing Process: Planning

Client Need:  Health Promotion and Maintenance

Cognitive Level:  Application

Learning Outcome:  1-2

 

13) The population nurse becomes aware of a treatment plant that is depositing waste materials into the drinking water. Efforts to have this plant change its behavior have failed and the nurse has been asked by community members to intervene. Which action should the nurse perform when advocating for the community members?

  1. Provide a list of community members who are employees of the treatment plant.
  2. Analyze other community approaches used to address similar water treatment issues.
  3. Collect information about the waste materials being introduced into the water supply.
  4. Examine community members for health problems believed to be caused by the contaminated water.

Answer:  3

Explanation:  3. As an advocate, the population health nurse engages in four activities or functions. The first function is determining the need for advocacy and factors that prevent clients from acting on their own behalf. A second function involves determining the point at which advocacy will be most effective. Collecting facts related to the problem is the third advocacy-related function and the fourth function is presenting the case to the appropriate decision makers. Collecting information about the waste materials being introduced into the water supply exemplifies advocacy for this community issue. Providing a list of community members who are employees of the treatment plan demonstrates advocacy for the treatment plant and not the community. Analyzing other community approaches used to address similar water treatment issues does not advocate for the community members in any way. Examining community members for health problems believed to be caused by the contaminated water suggests that the nurse does not believe that the treatment plant is causing health problems and does not advocate for the community members.

Nursing/Int.Conc:  Nursing Process: Assessment

Client Need:  Safe and Effective Care Environment

Cognitive Level:  Application

Learning Outcome:  1-3

 

14) The population health nurse is meeting with school district administrators to discuss strategies to promote healthy behaviors in the students who attend schools in the district. Which strategy should the community nurse emphasize as being important for the schools to implement?

  1. Provide fresh fruit for morning and afternoon snacks.
  2. Schedule scoliosis screening for all female students aged 12 through 16.
  3. Examine the quality of repairs made to the school pool after a recent landslide.
  4. Ensure safety equipment is available for all student use during sports activities.

Answer:  1

Explanation:  1. Health promotion entails activities designed to foster a healthy lifestyle and develop a state of good health in the population. This includes advocacy for access to healthy foods, designed to foster good nutrition as a health promoting strategy. The resolution level of health care is eliminating an existing health problem. At this level, a health problem has already occurred and population health nursing interventions are directed toward its solution and preventing further serious consequences. An example of this would be screening for scoliosis. Restoration, or rehabilitation, involves activities designed to assist the clients or populations return to a prior state of good health and functional ability. Rebuilding damaged buildings and highways would constitute restoration. An example of this would be examining the quality of pool repairs made after a recent landslide. Prevention involves strategies aimed at preventing the occurrence of specific health problems such as safety equipment for sports activities.

Nursing/Int.Conc:  Nursing Process: Implementation

Client Need:  Health Promotion and Maintenance

Cognitive Level:  Application

Learning Outcome:  1-7

 

15) A group of community members committed to increasing physical activity asks the nurse for help in implementing bicycle lanes on community roads. Which approach would the nurse use that demonstrates social marketing of this community goal?

  1. Determine the number of community members who use bicycles for transportation.
  2. Conduct a telephone survey of community members asking for their support for a bicycle lane.
  3. Approach elected officials and ask if the bicycle lane can be discussed during the next council meeting.
  4. Create a display explaining the advantages of a bicycle lane to be posted during the upcoming community health fair.

Answer:  4

Explanation:  4. Social marketing is a population health nursing intervention that applies commercial marketing technologies to the analysis, planning, execution, and evaluation of programs designed to influence the voluntary behavior of target audiences to improve their personal welfare or that of their society. Social marketing is consumer focused in that it is tailored to the needs and characteristics of a specific target population and is designed to address societal problems at the population level. The best approach would be for the nurse to create a display to be posted during the community health fair which explains the benefits of having a bicycle lane. Determining the number of community members who use bicycles for transportation does not support the goal of increasing physical activity by community members. Conducting a telephone survey of community members asking for support of a bicycle lane does not identify barriers or identify perceived benefits. Approaching elected officials to discuss a bicycle lane during the next meeting does not gain the communitys support for the change.

Nursing/Int.Conc:  Nursing Process: Planning

Client Need:  Health Promotion and Maintenance

Cognitive Level:  Application

Learning Outcome:  1-7

Population and Community Health Nursing, 6e (Clark)

Chapter 3   Epidemiology and Population Health Nursing

 

1) After being diagnosed with cancer the patient tells the population health nurse that the disease is punishment from God. Which theory of disease causation is this patient using to explain the illness?

  1. Environment.
  2. Physical forces.
  3. Specific organism.
  4. Divine intervention.

Answer:  4

Explanation:  4. Theories about the cause of disease and ill health have evolved over time. The first recognized attempt to attribute a cause to illness occurred during the religious era. During this period, disease was thought to be caused directly or indirectly by divine intervention, possibly as punishment for sins or as a trial of faith. During Hippocrates time, the primary belief of disease was from harmful substances in the environment. Before the religious era, disease was often attributed to physical forces such as miasmas or mists. The belief that disease was caused by a specific organism was introduced in the late 1870s with the bacteriologic era.

Nursing/Int.Conc:  Nursing Process: Assessment

Client Need:  Physiological Integrity

Cognitive Level:  Analysis

Learning Outcome:  3-1

 

2) A patient diagnosed with a terminal illness asks why the disease developed when others who have less healthy lifestyle habits enjoy good health. Which theory of disease causation should the nurse use when responding to this patients enquiry?

  1. Environment.
  2. Divine intervention.
  3. Single cause theory.
  4. Multiple cause theory.

Answer:  4

Explanation:  4. The discovery of specific agents responsible for particular diseases did not explain why some people exposed to an agent developed the disease, while others did not. The result of this explanatory failure was the movement into the current era of multiple causation or the ecosocial perspective. The era of multiple causation is characterized by the recognition that multiple factors interact in the development of health or illness in a given person or population and that there is seldom one single cause. During Hippocrates time, the primary belief of disease was from harmful substances in the environment. During the religious era disease was thought to be caused directly or indirectly by divine intervention, possibly as punishment for sins or as a trial of faith. During the bacteriologic era specific organisms were identified as causative agents for specific diseases.

Nursing/Int.Conc:  Nursing Process: Implementation

Client Need:  Health Promotion and Maintenance

Cognitive Level:  Application

Learning Outcome:  3-1

 

3) The population health nurse is visiting the home of a family whose youngest child developed chickenpox after being exposed to a classmate with the same disease. Of which criterion for establishing a causal relationship is this situation an example?

  1. Frequency.
  2. Consistency.
  3. Absolute risk.
  4. Susceptibility.

Answer:  2

Explanation:  2. Consistency is the first criterion for establishing a causal relationship. This consistency must be between the supposed causal factor and its presumed effect. The condition in question must occur when the factor is present, not when it is absent. Frequency is not a criterion for establishing a causal relationship. Absolute risk is the probability that anyone in a given population will develop a particular condition. Susceptibility is the ability to be affected by factors contributing to a particular health condition.

Nursing/Int.Conc:  Nursing Process: Assessment

Client Need:  Physiological Integrity

Cognitive Level:  Analysis

Learning Outcome:  3-2

 

4) The population health nurse is trying to identify the causative relationship for a group of school students who developed viral meningitis. Which criterion must the nurse identify to prove causation for the development of the disease in these students?

  1. Coherence.
  2. Specificity.
  3. Consistency.
  4. Temporal relationship.

Answer:  4

Explanation:  4. Only the criterion of a correct temporal relationship is absolutely required for attributing causation. Temporal relationship is the time between the factor and the result condition. The factor thought to be causative should occur before the condition occurs. Coherence is the idea that one condition that causes another must be logical and should be congruent with other known facts. Specificity is present when the factor in question results in one specific condition. Consistency is when the condition in question occurs when the factor is present and not when it is absent.

Nursing/Int.Conc:  Nursing Process: Diagnosis

Client Need:  Physiological Integrity

Cognitive Level:  Application

Learning Outcome:  3-2

 

5) The population health nurse notes that the number of cases of diabetes in a community remained stable during the last year. However in January, ten new diagnoses of diabetes were confirmed. What type of data is the nurse analyzing?

  1. Incidence.
  2. Morbidity.
  3. Prevalence.
  4. Case fatality rate.

Answer:  1

Explanation:  1. Incidence reflects the number of new cases of a particular condition identified during a specified period of time. Morbidity is the ratio of the number of cases of a disease or condition to the number of people in the population. Prevalence is the total number of people affected by a particular condition at a specified point in time. Case fatality rate is the percentage of persons who develop a health problem and who die as a result of it.

Nursing/Int.Conc:  Nursing Process: Assessment

Client Need:  Health Promotion and Maintenance

Cognitive Level:  Application

Learning Outcome:  3-4

 

6) The population health nurse is compiling childhood illness statistics and finds that the morbidity for chickenpox is higher for one neighborhood in comparison to the local county. What does this information mean to the nurse?

  1. There are new cases of chickenpox in the neighborhood.
  2. There are a larger percentage of children with chickenpox in the neighborhood.
  3. A large group of children have been affected by chickenpox in the neighborhood.
  4. There has been a rise in the number of children with chickenpox during a specified period of time in the neighborhood.

Answer:  4

Explanation:  4. Morbidity is the ratio of the number of cases of a disease or condition to the number of people in the population. The morbidity for chickenpox indicates the total number and new cases identified during and at a specified period of time. Incidence is the number of new cases alone. The percentage with chickenpox represents case rate. Prevalence is the group affected by chickenpox.

Nursing/Int.Conc:  Nursing Process: Assessment

Client Need:  Health Promotion and Maintenance

Cognitive Level:  Analysis

Learning Outcome:  3-4

 

7) The population health nurse is compiling statistics about lung cancer in one neighborhood that has experienced an average of 15 years from diagnosis to death. Which concept of epidemiology is the nurse analyzing?

  1. Mortality rate.
  2. Survival time.
  3. Morbidity rate.
  4. Survival rate.

Answer:  2

Explanation:  2. The average length of time from diagnosis to death is survival time. Mortality rate is the ratio of the numbers of deaths from a specific condition. Morbidity rate reflects the incidence and prevalence of a specific condition. Survival rate is the proportion of people with a given condition who remain alive after a specific period.

Nursing/Int.Conc:  Nursing Process: Assessment

Client Need:  Health Promotion and Maintenance

Cognitive Level:  Analysis

Learning Outcome:  3-4

 

8) The population health nurse is explaining the epidemiologic triad to a group of nursing students. What should the nurse use as an example of this triad?

  1. Sun, beach, and sunburn.
  2. Rural Mississippi, deer, and Lyme disease.
  3. Potato salad, outdoor picnic, and food poisoning.
  4. Standing water, mosquitoes, and warm weather.

Answer:  3

Explanation:  3. The epidemiologic triad consists of agent, host, and environment. Potato salad is the agent, the host is food poisoning, and the environment is the outdoor picnic. Sun, beach, and sunburn does not exemplify the epidemiologic triad. Rural Mississippi, deer, and Lyme disease does not exemplify the epidemiologic triad. Standing water, mosquitoes, and warm weather does not exemplify the epidemiologic triad.

Nursing/Int.Conc:  Nursing Process: Implementation

Client Need:  Health Promotion and Maintenance

Cognitive Level:  Application

Learning Outcome:  3-6

 

9) The population health nurse is planning to use a web of causation to explain the development of a health problem in a group of patients. What should the nurse use as an example of the web of causation?

  1. Oil refinery, flare emissions, and asthma.
  2. Mosquitoes, West Nile virus, and decreased mosquito spraying.
  3. Adolescent pregnancy rate, lower socioeconomic status and education, and close friends with infants.
  4. Access to alcohol, decreased enforcement of minors, and attractive media portrayal of alcohol that contributes to adolescent alcohol usage.

Answer:  4

Explanation:  4. Web of causation explores the influence of multiple factors on a specific health condition. The factors of access to alcohol, decreased enforcement of age checking, and the attractive portrayal of alcohol in the media contributes to adolescent alcohol usage. The other examples are of the epidemiologic triad.

Nursing/Int.Conc:  Nursing Process: Planning

Client Need:  Health Promotion and Maintenance

Cognitive Level:  Application

Learning Outcome:  3-6

 

 

10) The population health nurse is identifying determinants of health to address the development of cancer in a small rural neighborhood. Which determinants should the nurse identify? (Select all that apply.)

  1. Availability of health facilities.
  2. Mean age of the male population.
  3. Prevailing diet high in unprocessed foods and low fat.
  4. High percentage of tobacco use among the male population.
  5. Proximity of the community to chemical plants that have a poor history of regulating emissions.

Answer:  3, 4, 5

Explanation:  3. Determinants of health are broad categories of factors that influence health and illness. Determinants of health to address the development of cancer in a community would be the proximity to chemical plants with emissions, tobacco usage, and diet. Availability of health facilities has no bearing on the development of cancer. Mean age of a population has no bearing on cancer development.

  1. Determinants of health are broad categories of factors that influence health and illness. Determinants of health to address the development of cancer in a community would be the proximity to chemical plants with emissions, tobacco usage, and diet. Availability of health facilities has no bearing on the development of cancer. Mean age of a population has no bearing on cancer development.
  2. Determinants of health are broad categories of factors that influence health and illness. Determinants of health to address the development of cancer in a community would be the proximity to chemical plants with emissions, tobacco usage, and diet. Availability of health facilities has no bearing on the development of cancer. Mean age of a population has no bearing on cancer development.

Nursing/Int.Conc:  Nursing Process: Assessment

Client Need:  Health Promotion and Maintenance

Cognitive Level:  Application

Learning Outcome:  3-6

11) The population health nurse is concerned that a group of lifeguards who refuse to use sunscreen might develop skin cancer. On what is the nurse focusing this concern?

  1. Risk.
  2. Cases.
  3. Mortality.
  4. Morbidity.

Answer:  1

Explanation:  1. Risk is the probability that a given individual will develop a specific condition. Cases are the number of a particular event. Mortality is the ratio of the number of deaths in various categories to the number of people in a given population. Morbidity is the ratio of the number of cases of a disease or condition to the number of people in the population.

Nursing/Int.Conc:  Nursing Process: Assessment

Client Need:  Health Promotion and Maintenance

Cognitive Level:  Analysis

Learning Outcome:  3-3

 

 

12) After reviewing data collected during a community health fair the population health nurse is concerned that 500 people have an absolute risk of developing peripheral vascular disease. How should the nurse explain this risk to the community leaders?

  1. Probability that any of the 500 people will develop peripheral vascular disease.
  2. Probability that one of the 500 people will develop peripheral vascular disease when compared to the rest of the population.
  3. The ability that the 500 people will be affected by factors that contribute to the development of peripheral vascular disease.
  4. The likelihood that the 500 people will be exposed to factors that contribute to the development of peripheral vascular disease.

Answer:  1

Explanation:  1. Absolute risk is the probability that anyone in a given population will develop a particular condition. Relative risk is the probability that someone in a group of people with a particular characteristic will develop the condition when compared to people without that characteristic. Susceptibility is the ability to be affected by factors contributing to a particular health condition. Exposure potential is the likelihood of encountering or being exposed to factors that contribute to a condition.

Nursing/Int.Conc:  Nursing Process: Implementation

Client Need:  Health Promotion and Maintenance

Cognitive Level:  Application

Learning Outcome:  3-3

13) The population health nurse is reviewing data collected on a group of patients to determine which patients are experiencing the same health problem. In which step of the epidemiologic process is the nurse functioning?

  1. Defining the condition.
  2. Developing control strategies.
  3. Identifying strategic points of control.
  4. Determining the natural history of the condition.

Answer:  1

Explanation:  1. The nurse is working within the first step of the process or defining the condition. The nurse is working to clearly define what is, and what is not, an instance of the problem. Developing control strategies is the fourth step of the process and occurs after the condition is defined, the natural history of the condition is determined, and strategic points of control have been identified. When identifying strategic points of control the nurse identifies strategic points at which the development or course of the condition might be controlled. Determining the natural history of the condition is a description of the events that precede its development and occur during its course, as well as its typical outcomes. This step occurs after the condition is defined.

Nursing/Int.Conc:  Nursing Process: Assessment

Client Need:  Health Promotion and Maintenance

Cognitive Level:  Application

Learning Outcome:  3-5

 

14) After collecting information from patients about a health problem the population health nurse is analyzing the information to determine the natural history of the condition. What elements of the natural history should the nurse identify? (Select all that apply.)

  1. Signs and symptoms of the health problem.
  2. The effects that the health problem has on the body.
  3. Length of time the health problem will affect the body.
  4. Factors that contribute to the development of the health problem.
  5. Outcomes and factors that affect the outcomes of the health problem.

Answer:  1, 2, 4, 5

Explanation:  1. Determining a conditions natural history involves identifying factors that contribute to its development, typical signs and symptoms of the condition, its effects on the human system, and its typical outcomes and factors that may affect those outcomes. The length of time the health problem will affect the body is not a factor when determining a conditions natural history.

  1. Determining a conditions natural history involves identifying factors that contribute to its development, typical signs and symptoms of the condition, its effects on the human system, and its typical outcomes and factors that may affect those outcomes. The length of time the health problem will affect the body is not a factor when determining a conditions natural history.
  2. Determining a conditions natural history involves identifying factors that contribute to its development, typical signs and symptoms of the condition, its effects on the human system, and its typical outcomes and factors that may affect those outcomes. The length of time the health problem will affect the body is not a factor when determining a conditions natural history.
  3. Determining a conditions natural history involves identifying factors that contribute to its development, typical signs and symptoms of the condition, its effects on the human system, and its typical outcomes and factors that may affect those outcomes. The length of time the health problem will affect the body is not a factor when determining a conditions natural history.

Nursing/Int.Conc:  Nursing Process: Diagnosis

Client Need:  Health Promotion and Maintenance

Cognitive Level:  Analysis

Learning Outcome:  3-5

 

15) A patient comes into the clinic with manifestations of an acute respiratory infection. When analyzing the natural history of the condition, the population health nurse identifies that this patient is in which stage?

  1. Clinical.
  2. Preclinical.
  3. Resolution.
  4. Susceptibility.

Answer:  1

Explanation:  1. The natural history of a condition is often divided into four stages: susceptibility, preclinical, clinical, and resolution. In the susceptibility stage, factors contributing to development of the condition are present and the person is at-risk for its development. When exposure to causative factors has occurred, but no symptoms have appeared, the condition is in the preclinical stage. The clinical stage begins with the onset of signs and symptoms characteristic of the disease or condition. In the resolution stage, the condition culminates in a return to health, death, or continuation in a chronic state.

Nursing/Int.Conc:  Nursing Process: Assessment

Client Need:  Physiological Integrity

Cognitive Level:  Analysis

Learning Outcome:  3-5

Population and Community Health Nursing, 6e (Clark)

Chapter 13   Home Visits as a Population Health Nursing Strategy

 

1) The population health nurse visits a new mother and infant at home. During the visit, the nurse and mother discuss how the postpartal course is going and how the infant is doing with feeding and sleeping. The nurse provides information and answers any questions the mother may have and performs teaching as needed. In what role is the nurse functioning?

  1. Case finding and referral.
  2. Care of the sick.
  3. Health promotion and illness prevention.
  4. Home health nursing.

Answer:  3

Explanation:  3. Promoting maternal and child health is health promotion. The nurse visits the postpartal mother to answer questions, assess how the mother is recuperating, and how the infant is progressing. The nurse performs teaching as needed, which is health promotion and illness prevention. It is not case finding and referral, or care of the sick. Home health nursing is a specific type of home nursing that addresses an illness event.

Nursing/Int.Conc:  Nursing Process: Evaluation

Client Need:  Health Promotion and Maintenance

Cognitive Level:  Analysis

Learning Outcome:  13-5

 

 

2) The nurse receives a referral to visit a client who neighbors fear is being abused by a spouse. The client allows the nurse inside but is obviously reluctant to have the nurse in the home. The nurse could best address the clients concerns by: (Select all that apply.)

  1. Tactfully communicating the reason for the visit.
  2. Establishing appropriate expectations for the visit for the client and nurse.
  3. Starting to establish a rapport with the client.
  4. Stating that the neighbors made the referral.
  5. Informing the client that her name has been given to a local womens shelter.

Answer:  1, 2, 3

Explanation:  1. Initiating a home visit can present challenges to the nurse and create uncertainty and fear in the client. It is important for the nurse to state the reason for the visit and establish expectations from both perspectives. This allows the start of building a relationship with the client and establishes rapport. Revealing that the neighbors made the referral could be negative, and the nurse needs to respect this as a confidential source. Informing the client that her name has been given to a local womens shelter could irreparably damage any relationship the nurse has with the client and halt any progress the nurse may have made in making the client feel sufficiently at ease to speak of any potential abuse.

  1. Initiating a home visit can present challenges to the nurse and create uncertainty and fear in the client. It is important for the nurse to state the reason for the visit and establish expectations from both perspectives. This allows the start of building a relationship with the client and establishes rapport. Revealing that the neighbors made the referral could be negative, and the nurse needs to respect this as a confidential source. Informing the client that her name has been given to a local womens shelter could irreparably damage any relationship the nurse has with the client and halt any progress the nurse may have made in making the client feel sufficiently at ease to speak of any potential abuse.
  2. Initiating a home visit can present challenges to the nurse and create uncertainty and fear in the client. It is important for the nurse to state the reason for the visit and establish expectations from both perspectives. This allows the start of building a relationship with the client and establishes rapport. Revealing that the neighbors made the referral could be negative, and the nurse needs to respect this as a confidential source. Informing the client that her name has been given to a local womens shelter could irreparably damage any relationship the nurse has with the client and halt any progress the nurse may have made in making the client feel sufficiently at ease to speak of any potential abuse.

Nursing/Int.Conc:  Nursing Process: Implementation

Client Need:  Safe and Effective Care Environment

Cognitive Level:  Application

Learning Outcome:  13-2

 

 

3) The population health care is planning to make a visit to the home of a new community member who is recovering from major surgery. What observations should the nurse identify as advantages to making this home visit? (Select all that apply.)

  1. Clients home is neat, clean, and cheerful.
  2. Client and spouse sit together in the living room.
  3. Client ambulates safely with the use of a walker.
  4. Client requests no further visits because the neighbors will know.
  5. Client states that no care is needed because insurance wont cover it.

Answer:  1, 2, 3

Explanation:  1. Advantages of home visits include obtaining a complete picture of the client situation, identification of environmental influences on health, the ability to view relationships among family members and with the larger community, opportunity to see actual performance of activities of daily living, and better evaluation of intervention effects. The client requesting no further visits because of the neighbors and the concern about payment for services are disadvantages to making home visits.

  1. Advantages of home visits include obtaining a complete picture of the client situation, identification of environmental influences on health, the ability to view relationships among family members and with the larger community, opportunity to see actual performance of activities of daily living, and better evaluation of intervention effects. The client requesting no further visits because of the neighbors and the concern about payment for services are disadvantages to making home visits.
  2. Advantages of home visits include obtaining a complete picture of the client situation, identification of environmental influences on health, the ability to view relationships among family members and with the larger community, opportunity to see actual performance of activities of daily living, and better evaluation of intervention effects. The client requesting no further visits because of the neighbors and the concern about payment for services are disadvantages to making home visits.

Nursing/Int.Conc:  Nursing Process: Assessment

Client Need:  Health Promotion and Maintenance

Cognitive Level:  Analysis

Learning Outcome:  13-1

 

4) The community has a large number of immigrants. The nurse organizes a home visiting program to this community area to address family health concerns and provide health information. This is considered:

  1. Care of the sick.
  2. Case finding and referral.
  3. Health promotion and illness prevention.
  4. Health protection.

Answer:  3

Explanation:  3. Visiting the homes of this population to address health concerns is an aspect of health promotion and illness prevention. The client is in a familiar environment and is more comfortable, which makes teaching easier for the nurse. The population is not indicated as sick. Case finding and referral would apply if the nurse was seeking something specific among this population. Health protection is part of health promotion, but is more of a broad-scale activity done to maintain health.

Nursing/Int.Conc:  Nursing Process: Implementation

Client Need:  Health Promotion and Maintenance

Cognitive Level:  Analysis

Learning Outcome:  13-3

 

 

5) The population nurse is planning to make a home visit. What should the nurse take into consideration for this visit? (Select all that apply.)

  1. Reason for the visit and age of the client.
  2. Surrounding neighborhood.
  3. Support systems employed by the client.
  4. Clients ability to pay for services.
  5. Preliminary client treatment goals.

Answer:  1, 2, 3, 5

Explanation:  1. The reason for the visit, age of the client, neighborhood, and clients support systems are all considerations in planning a home visit. The reason for the visit sets the tone for the home visit, and the age of the client allows the nurse to perform any health teaching and intervention at an appropriate level. Knowing the surrounding neighborhood for safety allows the nurse to plan an appropriate time for the home visit. In the planning phase, the nurse needs to have some preliminary treatment goals in mind for the client based on the information received prior to the visit but remain aware that these may be modified or amended when the assessment is completed. The ability of the client to pay for services is important but is not a necessary step for planning the visit.

  1. The reason for the visit, age of the client, neighborhood, and clients support systems are all considerations in planning a home visit. The reason for the visit sets the tone for the home visit, and the age of the client allows the nurse to perform any health teaching and intervention at an appropriate level. Knowing the surrounding neighborhood for safety allows the nurse to plan an appropriate time for the home visit. In the planning phase, the nurse needs to have some preliminary treatment goals in mind for the client based on the information received prior to the visit but remain aware that these may be modified or amended when the assessment is completed. The ability of the client to pay for services is important but is not a necessary step for planning the visit.
  2. The reason for the visit, age of the client, neighborhood, and clients support systems are all considerations in planning a home visit. The reason for the visit sets the tone for the home visit, and the age of the client allows the nurse to perform any health teaching and intervention at an appropriate level. Knowing the surrounding neighborhood for safety allows the nurse to plan an appropriate time for the home visit. In the planning phase, the nurse needs to have some preliminary treatment goals in mind for the client based on the information received prior to the visit but remain aware that these may be modified or amended when the assessment is completed. The ability of the client to pay for services is important but is not a necessary step for planning the visit.
  3. The reason for the visit, age of the client, neighborhood, and clients support systems are all considerations in planning a home visit. The reason for the visit sets the tone for the home visit, and the age of the client allows the nurse to perform any health teaching and intervention at an appropriate level. Knowing the surrounding neighborhood for safety allows the nurse to plan an appropriate time for the home visit. In the planning phase, the nurse needs to have some preliminary treatment goals in mind for the client based on the information received prior to the visit but remain aware that these may be modified or amended when the assessment is completed. The ability of the client to pay for services is important but is not a necessary step for planning the visit.

Nursing/Int.Conc:  Nursing Process: Planning

Client Need:  Health Promotion and Maintenance

Cognitive Level:  Application

Learning Outcome:  13-4

 

6) A client receiving telephonic care visits with a population health nurse asks why a home visit is needed after hospitalization. What should the population health nurse explain to the client?

  1. Home care is a subspecialty of population health care.
  2. The home care nurse reports to the population health nurse.
  3. A home visit is the only way that the population health nurse will be paid.
  4. The client is extremely ill and the population health nurse needs someone to make an assessment.

Answer:  1

Explanation:  1. Home health is actually a subspecialty within population health nursing in which the primary, but not sole, focus is on resolution of existing health problems and health restoration. Effective home health nurses, who provide holistic nursing care, employ principles of population health nursing within the segment of the population that is ill. The home care nurse does not report to the population health nurse. A home visit is not being done so that the population health nurse can be paid. There is no evidence to support that the client is extremely ill or that the population nurse needs someone to assess the patient at home.

Nursing/Int.Conc:  Nursing Process: Implementation

Client Need:  Health Promotion and Maintenance

Cognitive Level:  Application

Learning Outcome:  13-8

7) After several home visits, the nurse and the client have agreed to improve the clients overall nutritional status. In order to achieve this outcome, the nurse should:

  1. Assess the clients food preferences and methods of food preparation.
  2. Plan menus for the client to prepare.
  3. Accompany the client when food shopping.
  4. Refer the client to a Meals-on-Wheels program.

Answer:  1

Explanation:  1. In implementing a home visit, goals are agreed upon for the overall health of the client. In this instance, the improvement of the clients overall nutritional status cannot be achieved unless the nurse assesses the clients food preferences and methods of food preparation. Otherwise, if the nurse plans meals without these considerations, the outcome will not be achieved. Accompanying the client when food shopping will not necessarily guarantee this outcome, nor will a referral to a Meals-on-Wheels program.

Nursing/Int.Conc:  Nursing Process: Implementation

Client Need:  Health Promotion and Maintenance

Cognitive Level:  Application

Learning Outcome:  13-5

 

 

8) The population nurse is conducting a home visit. Which action should the nurse take during this visit?

  1. Continue to validate the accuracy of the assessment and resulting diagnosis.
  2. Focus on the plan of care as it is written.
  3. Concentrate on the already-identified needs.
  4. Plan to write an evaluation.

Answer:  1

Explanation:  1. The validity and accuracy of the assessment and resulting diagnosis should always be a factor in the home visit implementation. Additional needs can be added to modify the plan of care, so focusing solely on the plan of care as it is written may not meet the clients needs. Concentrating only on the identified needs may ignore other issues that arise in subsequent home visits. The evaluation is part of every visit and is not something that is done at another time.

Nursing/Int.Conc:  Nursing Process: Implementation

Client Need:  Health Promotion and Maintenance

Cognitive Level:  Application

Learning Outcome:  13-5

9) The nurse is making a home visit to a new client. The client is very friendly and welcomes the nurse into the home; however, the nurse sees that the client has a gun on the coffee table. The nurse hurriedly goes through the visit and leaves. What should the nurse do prior to the next visit?

  1. Call the police prior to making the visit.
  2. Call the client prior to the visit and state that there cannot be a visible firearm present during the visit.
  3. Cancel future visits to this client.
  4. Refer the client to another agency for visitation.

Answer:  2

Explanation:  2. The distraction the nurse encountered was both environmental and behavioral. Presence of a firearm is an environmental concern, and the nurses reaction of hurrying through the visit indicates a level of discomfort with the presence of the firearm. Notifying the client prior to the next visit about the presence of the firearm addresses the nurses concern and lets the client know that this is not acceptable. There is nothing to indicate that the client is creating a distraction. Calling the police is not a necessary step prior to the next visit. Canceling future visits could impair the clients overall health. Referring the client to another agency is not solving this concern.

Nursing/Int.Conc:  Nursing Process: Implementation

Client Need:  Safe and Effective Care Environment

Cognitive Level:  Application

Learning Outcome:  13-6

 

 

10) During a visit to the home of

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