Test Bank for Foundations for Population Health in Community/Public Health Nursing, 6th Edition (Chapters 1-32)

Name: Test Bank for Foundations for Population Health in Community/Public Health Nursing, 6th Edition (Chapters 1-32)
Brand: Academic Documents Platform
Price: 16.99 USD
Availability: InStock
Author: Olivia Parker

Test Bank for Foundations for Population Health in Community/Public Health Nursing, 6th Edition (Chapters 1-32) gives you instant access to a variety of exam-focused practice questions.

Olivia Parker

Contributor

4.4

about 2 months ago

Preview (31 of 156)

Chapter 01: Public Health Nursing and Population Health
Stanhope: Foundations for Population Health in Community/Public Health Nursing, 6th Edition
MULTIPLE CHOICE
1. Which statement best describes community-based nursing?
a. A practice in which care is provided for individuals and families.
b. Providing care with a focus on the group’s needs.
c. Giving care with a focus on the aggregate’s needs.
d. A value system in which all clients receive optimal care.
ANS: A
By definition, community-based nursing is a setting-specific practice in which care is provided for “sick” individuals and families
where they live, work, and attend school. The emphasis is on acute and chronic care and the provision of comprehensive,
coordinated, and continuous care. These nurses may be generalists or specialists in maternal–infant, pediatric, adult, or psychiatric
mental health nursing. Community-based nursing emphasizes acute and chronic care to individuals and families, rather than
focusing on groups, aggregates, or systems.
2. Which statement best describes the goal of community-oriented nursing?
a. Providing care to individuals and families
b. Providing care to manage acute or chronic conditions
c. Giving direct care to ill individuals within their family setting
d. To preserve, protect, promote, or maintain health and prevent disease
ANS: D
By definition, community-oriented nursing has the goal of preserving, protecting, or maintaining health and preventing disease to
promote the quality of life. All nurses may focus on individuals and families, give direct care to ill persons within their family
setting, and help manage acute or chronic conditions. These definitions are not specific to community-oriented nursing.
3. Which of the following is the primary focus of public health nursing?
a. Families and groups
b. Illness-oriented care
c. Individuals within the family unit
d. Health care of communities and populations
ANS: D
In public health nursing, the primary focus is on the health care of communities and populations rather than on individuals, groups,
and families. The goal is to prevent disease and preserve, promote, restore, and protect health for the community and the population
within it. Community-based nurses deal primarily with illness-oriented care of individuals and families across the life span. The
aim is to manage acute and chronic health conditions in the community, and the focus of practice is on individual or
family-centered illness care.
4. Which of the following is responsible for the dramatic increase in life expectancy during the 20th century?
a. Technology increases in the field of medical laboratory research
b. Advances in surgical techniques and procedures
c. Sanitation and other population-based prevention programs
d. Use of antibiotics to fight infections
ANS: C
There has to be indisputable evidence collected over time that public health policies and programs were primarily responsible for
increasing the average life span from 47 in 1900 to 78.6 years in 2017, an increase of approximately 60% in just over a century plus
through improvements in (1) sanitation, (2) clean water supplies, (3) making workplaces safer, (4) improving food and drug safety,
(5) immunizing children, and (6) improving nutrition, hygiene, and housing. Although people are excited when a new drug is
discovered that cures a disease or when a new way to transplant organs is perfected, it is important to know about the significant
gains in the health of populations that have come largely from public health accomplishments.
5. A nurse is developing a plan to decrease the number of premature deaths in the community. Which of the following interventions
would most likely be implemented by the nurse?
a. Provide free health care to all citizens
b. To increase the number of individuals with access to effective health care benefits
c. Lower the cost of health care to the American population
d. To lessen the governmental burden of providing health care to Americans
ANS: B
The central feature in the Patient Protection and Affordable Care Act (ACA) of 2010 are the mechanisms to increase the number of
people with health insurance. The care provided is not necessarily free. While the cost of health care and the burden it places on the
American government are serious concerns, they are not the primary focus of ACA.
lOMoARcPSD|13778330

6. What is the basic assumption stated by Healthy People 2010 as it relates to public health efforts?
a. Health disparities among any groups are morally and legally wrong.
b. Health care is the most important priority in government planning and funding.
c. The health of individuals cannot be separated from the health of the community.
d. The government is responsible for lengthening the life span of Americans.
ANS: C
The major premise of Healthy People 2010 was that the health of the individual cannot be entirely separate from the health of the
larger community. Public health practice focuses on the community as a whole, and the effect of the community’s health status
(resources) on the health of individuals, families, and groups. The goal is to prevent disease and disability and promote and protect
the health of the community as a whole. Public health can be described as what society collectively does to ensure that conditions
exist in which people can be healthy. The basic assumptions of public health do not judge the morality of health disparities. The
focus is on prevention of illness not on spending more on illness care. Additionally, individual responsibility for making healthy
choices is the directive for lengthening life span not the role of the government.
7. Which of the following actions would most likely be performed by a public health nurse?
a. Asking community leaders what interventions should be chosen
b. Assessing the community and deciding on appropriate interventions
c. Using data from the main health care institutions in the community to determine
needed health services
d. Working with community groups to create policies to improve the environment
ANS: D
Although the public health nurse might engage in any of the tasks listed, he or she works primarily with members of the community
to carry out core public health functions, including assessment of the population as a whole and engaging in promoting health and
improving the environment. The interventions of asking community leaders which interventions should be chosen, assessing the
community and deciding on appropriate interventions, and using data from health care institutions do not demonstrate the
engagement of the community when making decisions about what the community actually wants and needs.
8. Which public health nurse most clearly fulfills the responsibilities of this role?
a. The nurse who met with several groups to discuss community recreation issues
b. The nurse who spent the day attending meetings of various health agencies
c. The nurse who talked to several people about their particular health concerns
d. The nurse who watched the city council meeting on local cable television
ANS: B
Any of these descriptions might represent a nurse communicating, cooperating, or collaborating with community residents or
groups about health concerns. A major challenge for the future is the need for public health nursing specialists to be more
aggressive in working collaboratively with various groups in the community as well as professional colleagues in institutional
settings to deal with barriers to health. However, the nurse who spent the day attending meetings of various health agencies is the
most representative, because in public health, concerns are addressed from a broader perspective. In public health, broad concerns
of the community should be addressed. Concerns are broader than recreation, individual concerns are not as important as aggregate
priorities, and watching television (a one-way form of communication) is less effective than interacting with others.
9. Which of the following best defines aggregate?
a. A large group of persons
b. A collection of individuals and families
c. A collection of people who share one or more characteristics
d. Another name for demographic group
ANS: C
An aggregate is defined a collection of people who share one or more personal or environmental characteristics. Members of a
community can be defined in terms of either geography (e.g., a county, a group of counties, or a state) or a special interest (e.g.,
children attending a particular school). These members make up a population. The term population may be used interchangeably
with the term aggregate. A large group of persons, a collection of individuals and families, and another name for demographic
group are not accurate definitions of the term aggregate.
10. Which question asked by a novice nurse would be the most reflective of an understanding of the role of a public health nurse?
a. “Which groups are at the greatest risk for problems?”
b. “Which patients should I see first as I begin my day?”
c. “With which physicians will I be most closely collaborating?”
d. “With which nursing assistants will I partner the most?”
ANS: A
Asking which groups are at greatest risk reflects a community-oriented perspective. The incorrect responses reflect a focus on
individuals rather than a community-oriented perspective.
11. Making sure that essential community-oriented health services are available defines which of the core public health functions?
a. Policy development
b. Assessment
c. Assurance
d. Scientific knowledge-based care
ANS: C
Assurance includes making sure that essential community-oriented health services are available in the community. The definition
does not fit the terms assessment, policy development. Scientific knowledge-based care is not a core function of public health.
Assessment is systematic data collection on the population, monitoring the population’s health status, and making information
available about the health of the community. Policy development refers to efforts to develop policies that support the health of the
population, including using a scientific knowledge base to make policy decisions.
lOMoARcPSD|13778330

12. When talking to a women’s group at the senior citizens’ center, the nurse reminded them that the only way the center would be able
to afford to provide transportation services for them would be for them to continue to write letters to their local city council
representatives requesting funding for such a service. What was the nurse trying to accomplish through this action?
a. Ensure that the women did not expect the nurse to solve their problem.
b. Demonstrate that the nurse understood the women’s concerns and needs.
c. Express empathy, support, and concern.
d. Help the women engage in political action.
ANS: D
Public health nurses engage themselves and others in policy development and encourage and assist persons to communicate their
needs to those with the power to take action. The nurse is demonstrating the role of advocate through this action, it goes beyond
merely understanding the women’s concern, and instead mobilizes them to take action. This action does not demonstrate the nurse
showing empathy rather the nurse is empowering these women.
13. The public health nurse has a clear vision of what needs to be done and where to begin to improve the health of the community.
Why would the nurse spend time meeting with community groups to discuss the most important task to be addressed first?
a. To increase the group’s self-esteem
b. To maintain communication links with the groups
c. To make the groups feel good about their contribution
d. To work with the groups, not for the groups
ANS: D
Historically, health care providers have been accused of providing care for or to people without actually involving the recipients in
the decisions. Public health nursing is a “with the people”—not a “to the people” or “for the people”—approach to planning. There
is an imperative to work with members of the community to carry out core public health functions. The purpose of meeting with
community groups is not to increase their self-esteem or make them feel good about their contribution, rather it is to allow them to
act for themselves to solve the problems they are facing. The first task of working with the group should occur before addressing
maintaining communication links.
14. The nurse often has to make resource allocation decisions. Which of the following best describes the criterion the nurse should use
in such cases?
a. The specific moral or ethical principle related to the situation
b. The cheapest, most economical approach
c. The most rational probable outcome
d. The needs of the aggregate rather than a few individuals
ANS: D
The dominant needs of the population outweigh the expressed needs of one or a few people. All of the choices represent
components of a decision that the nurse might consider in determining the needs of the aggregate.
15. Which of the following actions best represents public health nursing?
a. Assessing the effectiveness of the high school health clinic
b. Caring for clients in their home following their outpatient surgeries
c. Providing care to children and their families at the school clinic
d. Administering follow-up care for pediatric clients at an outpatient clinic
ANS: A
A public health or population-focused approach would look at the entire group of children being served to determine whether
available services are effective in achieving the goal of improving the health of the school population. Caring for clients and their
families focuses on individuals and families and not on the entire population. Public health focuses on care of populations.
16. Two nurses plan to walk under a huge downtown bridge where various homeless persons live. Why would the nurses go to such an
unsafe area?
a. To assess the needs of the homeless who live there
b. To demonstrate their courage and commitment
c. To distribute some of their own surplus clothes to those who can use them
d. To share with various churches and other charities what is needed
ANS: A
In most nursing practices, the client seeks out and requests assistance. In public health nursing, the nurse often reaches out to those
who might benefit from a service or intervention, beginning with assessment of needs. The other answers reflect responses where
the nurse is trying to give assistance to this population that may or may not be helpful or welcomed.
MULTIPLE RESPONSE
1. Which of the following variables have led to a stronger commitment to population-focused services? (Select all that apply.)
a. Economic turmoil and demand for high-technology care
b. Emergence of new or drug-resistant infectious diseases
c. Emphasis on overall health care needs rather than only on acute care treatment
d. Threat of bioterrorism
ANS: B, C, D
As overall health needs become the focus of care in the United States, a stronger commitment to population-focused services is
emerging. Threats of bioterrorism, anthrax scares, and the emergence of modern-day epidemics have drawn attention to
population-focused safety and services. Economic turmoil and demand for high-technology care have not contributed to a stronger
commitment to population-focused services, rather it has occurred as overall health needs have become the focus of care.
lOMoARcPSD|13778330

Loading page 4...

2. Which of the following actions demonstrate effective public health nursing practice in the community? (Select all that apply.)
a. Epidemiologic investigations examine the environment for health hazards.
b. New services are organized where particular vulnerable populations live.
c. Partnerships are established with community coalitions.
d. Staff members at the public health agency continue to increase in number.
e. Staffing walk in clinics for low income families
ANS: A, B, C
Evidence that public health nurses are practicing effectively in the community would include organizing services where people
live, work, play, and learn; working in partnerships and with coalitions; and participating in epidemiologic studies. Neither
increasing the number of staff nor acting as staff in the delivery of acute and/or chronic care has a relationship to the effectiveness
of public health nursing practice.
3. Why are nurses increasingly providing care in clients’ homes rather than in hospitals? (Select all that apply.)
a. Home care is less expensive.
b. It is much more efficient to give care in the home.
c. Nurses prefer to give home care with individual attention.
d. People prefer to receive care in their homes rather than in hospitals.
ANS: A, D
An increasing number of clients are receiving care in the home because it is less expensive and clients prefer to receive care in
familiar and comfortable settings. It is not more efficient nor more convenient, since travel time has to be considered. Nurses differ
as to their preferred employment setting.
lOMoARcPSD|13778330

Loading page 5...

Chapter 02: The History of Public Health and Public and Community Health Nursing
Stanhope: Foundations for Population Health in Community/Public Health Nursing, 6th Edition
MULTIPLE CHOICE
1. A nurse is considering applying for a position as a public health nurse. Which of the following would be a reason this position
would be appealing?
a. Its autonomy and independence
b. Its focus on acute care and immediately visible outcomes
c. Its collaboration with other health care professionals
d. Its flexibility and higher wages
ANS: A
Public health nursing is known for its autonomy and independence. In many instances, there are limited other health care
professionals and staff with whom to interact. In-patient acute care nurses focus on acute care with outcomes known fairly quickly.
Acute care nurses collaborate frequently with other health care professionals. Depending on the position there may be more
flexibility, but typically public health nurses do not receive higher wages.
2. The Elizabethan Poor Law of 1601 is similar to which current law?
a. Welfare
b. Food stamps
c. Medicaid
d. Medicare
ANS: C
The Elizabethan Poor Law guaranteed medical care for poor, blind, and “lame” individuals. This minimal care was generally
provided in almshouses supported by local government similar to Medicaid assistance. Welfare and food stamps do not provide for
medical care. Medicare provides medical care to primarily the elderly population.
3. How did the Industrial Revolution result in previous caregiving approaches, such as care by families, friends, and neighbors,
becoming inadequate?
a. Economic and political wars resulted in frequent death and injuries.
b. Incredible plagues consistently and constantly swept the European continent.
c. Migration and urbanization resulted in increased demand for care.
d. Caregivers could easily find other employment, so they demanded to be paid.
ANS: C
Care became inadequate because of the social changes in Europe, with great advances in transportation, communication, and other
technologies. The increased mobility led to migration and urbanization, which in turn led to increased need for care. The Industrial
Revolution was a time of great advances in technology, transportation, and communication, not a time of economic and political
unrest or a time where incredible plagues occurred in Europe. Caregivers during this time period were typically poorly educated
and untrained, so there was not an issue related to wages or employment.
4. A colonist is working in the public health sector in early colonial America. Which of the following activities would have likely
been completed?
a. Establishing schools of nursing
b. Developing vaccines to administer to large numbers of people
c. Collecting vital statistics and improving sanitation
d. Developing public housing and almshouses
ANS: C
Collecting vital statistics and improving sanitation are examples of activities from the early colonial America. Establishing schools
of nursing, developing vaccines to administer to large numbers of people, and developing public housing and almshouses all
happened after the colonial period.
5. Why did American citizens become interested in establishing government-sponsored boards of health?
a. They were afraid of infectious diseases such as yellow fever.
b. The government could force the poverty-stricken to accept care.
c. Such boards could tax and thereby ensure adequate funds to pay for care.
d. Such a system would allow for accurate records of births and deaths.
ANS: A
Threat of disease, especially yellow fever, led to public interest in establishing government-sponsored, or official, boards of health.
The threat of disease was the impetus for creation of the boards of establishing boards of health. The primary interest of the boards
of health was to provide public health services for the entire population and not only those who were poverty-stricken. The primary
purpose of the boards of health was not to collect accurate vital statistics or receive tax dollars rather its purpose was to ensure the
health of the population.
lOMoARcPSD|13778330

Loading page 6...

6. A nurse was employed by the Marine Hospital Service in 1800. Which of the following interventions would the nurse most likely
have implemented?
a. Setting policy on quarantine legislation for immigrants
b. Establishing hospital-based programs to care for the sick at home
c. Identifying and improving environmental conditions
d. Providing health care for merchant seamen
ANS: D
Providing health care to seamen was an early effort by the federal government to improve public health. The purpose of the Marine
Hospital Service was to secure its maritime trade and seacoast cities. Quarantine legislation was enacted by legislation during this
time period, but the nurse would not have been responsible for setting these policies. Nursing care for clients in the home began in
the first half of the 1800s through a variety of agencies including the Ladies’ Benevolent Society of Charleston South Carolina.
Identifying and improving environmental conditions was a focus of the public boards of health, not necessarily specifically a role
of the nurse.
7. What was the outcome of the Shattuck Report?
a. Efforts to control alcohol and drug abuse, as well as tobacco use, were initiated.
b. Environmental sanitation efforts became an immediate priority.
c. Guidelines for modern public health organizations were eventually developed.
d. Local and state governments established boards of health after its publication.
ANS: C
It took 19 years for the first of Shattuck’s recommendations to be implemented, but his report was the first effort to create a modern
public health organization. This report called for broad changes to improve the public’s health to take place; however, these
changes did not happen immediately after publication. They took 19 years to be implemented in the first state of Massachusetts.
The report included establishment of a state health department and local health boards in every town, sanitary surveys, and food,
drug, and communicable disease control, but none of these changes happened quickly.
8. Which nurse is famous for creating public health nursing in the United States?
a. Florence Nightingale
b. Frances Root
c. Lillian Wald
d. Mrs. Solomon Loeb
ANS: C
Lillian Wald established the Henry Street Settlement and later emerged as the established leader of public health nursing during its
early decades. Mrs. Solomon Loeb was a wealthy layperson who assisted Mary Brewster in the establishment of the Henry Street
Nurses Settlement. Francis Root was the first trained nurse in the United States who was salaried as a visiting nurse. Florence
Nightingale had many accomplishments, but none of these occurred in the United States.
9. Which of the following would have been the focus of a school nurse in the early 20th century?
a. Investigating causes of absenteeism
b. Teaching school as well as being a nurse
c. Promoting nursing as an autonomous practice
d. Providing medical treatment to enable children to return to school
ANS: A
Early school nursing focused on investigating causes of absenteeism. Providing medical treatment was the responsibility of
physicians. School nurses did not teach in the schools nor were they part of an autonomous practice during this time period.
10. A nurse is reviewing the original work of the National Organization for Public Health Nursing. Which accomplishments of today
were started within this organization?
a. Requiring that public health nurses have a baccalaureate degree in nursing
b. Standardizing public health nursing education
c. Developing public health nursing competencies
d. Opening the Henry Street Settlement
ANS: B
The National Organization for Public Health Nursing sought to improve the educational and services standards of public health
nursing. The Henry Street Settlement was already in existence and was opened by Lillian Wald and Mary Brewster. The
baccalaureate degree in nursing was not developed yet. Public health nursing competencies were developed by the Quad Council.
11. Why were nurses so unprepared for public health nursing in the early 20th century?
a. Public health nursing had not yet been created as a field.
b. No one would teach the nurses how to engage in public health activities.
c. Nightingale’s textbook did not include content on public health nursing.
d. Nurses were educated in diploma schools, which emphasized care of hospital
clients.
ANS: D
Nursing school courses taught in diploma schools of nursing emphasized hospital care of patients; thus, nurses were unprepared for
home visiting. The specialty of public health nursing practice was developed in the early 1800s. There was not a lack of teachers
for this activity, rather the focus of nursing care was in the acute care setting and not in the community. Nightingale did not have a
published textbook.
lOMoARcPSD|13778330

Loading page 7...

12. A nurse is considering joining the American Public Health Association (APHA). What information about this organization should
be considered when making this decision?
a. APHA focuses on the public health concerns of the medical profession.
b. APHA represents concerns of nursing specialty practices.
c. APHA provides a national forum for nurses to discuss their public health
concerns.
d. APHA focuses on providing health promotion education to the public.
ANS: C
APHA was formed to facilitate interprofessional efforts and promote the “practical application of public hygiene.” The Public
Health Nursing Section within APHA provides nurses with a national forum to discuss their concerns and strategies within the
larger context of the major public health organization. It also serves as a focus of leadership and policy development for
community/public health nursing. The focus of public health concerns of the APHA is broader than only the medical profession.
The APHA focuses on concerns of public health nurses, not all nursing specialty practice. The APHA focuses on practical
application of public hygiene, which is broader than only health promotion education.
13. Why did the Metropolitan Life Insurance Company establish and retain for several years the first community nursing health
program for policyholders?
a. Creating such a service was the morally correct thing to do
b. Employing nurses directly was less expensive than paying taxes to the city for the
same purpose
c. Having the company’s nurses make home visits increased worker morale
d. Public health nurses visits led to fewer policyholder deaths and lowers company
costs
ANS: D
Metropolitan Life saw an average decline of 7% in the mortality rate of policyholders and almost a 20% decline in the deaths of
children under the age of 3 years. The insurance company attributed this improvement and the associated reduced costs to the work
of visiting nurses. There was limited funding in the early 20th century to extending nursing services in the community; thus, home
visiting was a very expensive service to provide. Although Metropolitan Life Insurance Company may have increased worker
morale that was not the primary reason for continuation of the program.
14. Which client would have been most likely to receive care from the Frontier Nursing Service?
a. An injured soldier
b. A homebound, elderly male
c. A woman in labor
d. A child with a broken femur
ANS: C
The Frontier Nursing Service nurses were trained in nursing, public health, and midwifery and provided care to rural and
inaccessible areas, which led to reduced mortality. Care for soldiers, elderly, and children was not the focus of the care provided by
the Frontier Nursing Service.
15. A public health nurse is determining what type of programming should be developed for the community. Which of the following is
the most crucial factor that will influence program development?
a. Comprehensive assessment and planning done in the community
b. Documented needs of the local community
c. Federal funding for priority diseases or groups
d. Nursing staff’s expertise and skills
ANS: C
Programs are designed to fit funding priorities; thus, the areas supported by Congress determine the categories in which most effort
is focused locally. A need in the community may be identified through community assessment, planning, and looking at needs in
the community; however, without funding there will not be a way to create necessary programming. The expertise of the staff
should not be the determining factor when deciding on programming in the community.
16. A nursing student during World War II would likely join which group?
a. The US Public Health Service
b. The Marine Nurse Corps
c. The Frontier Nursing Service
d. The Cadet Nurse Corps
ANS: D
The Bolton Act of 1943 established the Cadet Nurse Corps during World War II, which increased enrollment in schools of nursing
at undergraduate and graduate levels. The U.S. Public Health Service began to use nurses during World War I to establish a public
health nursing program for military outposts. The Marine Hospital Service was established well before World War II in 1798. The
Frontier Nursing Service was established by Mary Breckinridge in 1925 and provided health care to the rural and often inaccessible
populations in the Appalachian region of southeastern Kentucky.
17. A public health nurse is compiling information about how to promote early detection of breast cancer in women. Which document
would most likely provide useful information about this topic?
a. The Future of Public Health
b. Healthy People 2020
c. Patient Protection and Affordable Care Act
d. Scope and Standards of Public Health Nursing Practice
ANS: B
The Healthy People 2020 documents propose a national strategy to significantly improve the health of Americans by preventing or
delaying the onset of major chronic illnesses, injuries, and infectious diseases. The disarray resulting from reduced political
support, financing, and effectiveness is described in The Future of Public Health. The Scope and Standards of Public Health
Nursing Practice describes the processes of assessment, analysis, and planning that are carried out by the public health nurse. The
Patient Protection and Affordable Care Act improved access to health insurance for Americans.
lOMoARcPSD|13778330

Loading page 8...

18. A public health nurse is involved in health care reform. Which of the following best explains why the nurse is involved in these
efforts?
a. To promote the nursing profession
b. To increase funding for public health nursing
c. To address the concerns of nurses
d. To help improve health care access
ANS: D
Public health nurses have been involved in health care reform for several years. An emphasis of reform is that health promotion and
disease prevention appear to yield reduction in costs and illness/injury incidence while increasing years of healthy life. Health care
reform has a larger scope than only the profession of nursing and public health nursing. It addresses the concerns of nurses as well
as many other health care professions.
MULTIPLE RESPONSE
1. How did Florence Nightingale help bring about community health nursing? (Select all that apply.)
a. She convinced socially prominent wealthy women to volunteer to give care.
b. She focused on all soldiers and their environment.
c. She interacted with each individual person, assessing his or her needs and acting
to meet those needs.
d. She kept careful records on what was done and what were the results.
ANS: B, D
Nightingale progressively improved the soldiers’ health using a population-based approach that improved both environmental
conditions and nursing care. Using simple epidemiology measures, she documented a decreased mortality rate to demonstrate the
outcomes. While Nightingale was part of a wealthy family, the role of nurses during this time period was typically fulfilled by poor
women. The focus of Nightingale’s care was to identify health care needs and interventions that influenced the health of the entire
population, not individuals.
2. A nurse working with Mary Breckinridge would have likely assisted in what activity? (Select all that apply.)
a. Establishing the Henry Street Settlement
b. Developing health programs geared toward improving the health care of the rural
populations
c. Blazing a nursing trail through the Rockies, providing nursing care to miners and
their families
d. Ensuring positive outcomes for pregnancies among women in the Appalachian
region
ANS: B, D
Mary Breckinridge developed health programs geared toward improving the health care of the rural and often inaccessible
populations in the Appalachian regions of the Southern Kentucky. Breckinridge introduced the first nurse-midwives into the United
States when she deployed FNS nurses trained in nursing, public health, and midwifery. Their efforts led to reduced pregnancy
complications and maternal mortality, and to one-third fewer stillbirths and infant deaths in an area of 700 square miles. Lillian
Wald established the Henry Street Settlement. Mary Breckinridge developed health programs geared toward improving the health
care of the rural and often inaccessible populations in the Appalachian regions of southern Kentucky, not the Rockies.
3. How did nursing education change in the 1950s? (Select all that apply.)
a. Baccalaureate nursing programs typically included public health nursing
concepts.
b. Diploma schools of nursing continued to expand their student numbers.
c. Junior and community colleges began offering nursing programs.
d. Nurses were strongly encouraged to have a scientific basis for their practice.
e. Post diploma training was initiated nationwide.
ANS: A, C
In the 1950s, public health nursing became a required part of most baccalaureate nursing education programs. In 1952, nursing
education programs began in junior and community colleges. Associate degree programs began to expand their enrollments, not
diploma schools. The need for evidence-based practice continues to grow but was not a change in the 1950s. In 1914 Mary
Adelaide Nutting, working with the Henry Street Settlement, began the first course for post-diploma school training in public
health nursing at Teachers College in New York City.
4. How did health care and its delivery change during the 1980s? (Select all that apply.)
a. Funding to public health increased as funding for acute hospital care decreased.
b. Laws began to be passed that discouraged the use of alcohol, drugs, and tobacco.
c. Nurse practitioners were increasingly used to provide care.
d. Public health programs suffered reduced political support, financing, and
effectiveness.
ANS: B, C, D
During the 1980s funding began to shift to meet the costs of acute hospital care, medical procedures, and institutional long-term
care. The use of health maintenance organizations was encouraged, and the use of nurse practitioners increased. Consumer and
professional advocacy groups urged the passage of laws to prohibit unhealthy practices such as smoking and driving under the
influence of alcohol. By the late 1980s, public health had declined in political support, financing, and effectiveness.
lOMoARcPSD|13778330

Loading page 9...

Chapter 03: US and Global Health Care
Stanhope: Foundations for Population Health in Community/Public Health Nursing, 6th Edition
MULTIPLE CHOICE
1. A public health agency is planning to implement the electronic health record. (Which is a benefit of this choice?
a. Facilitation of interprofessional care
b. Improved client compliance with medical regimens
c. Cost savings to the agency
d. Compliance with JCAHO standards
ANS: A
The electronic medical record facilitates interprofessional care in chronic disease management and coordination of referrals;
24-hour availability of records with downloaded laboratory results and up-to-date assessments; incorporation of protocol reminders
for prevention, screening, and management of chronic disease; improvement of quality measurement and monitoring; increased
client safety; and decline in medication errors. There is no evidence that an electronic health record improves client compliance
with medical regimens. Electronic health records can increase costs to an agency. JCAHO does not accredit public health agencies.
2. Which statement best describes the cost of health care in the United States?
a. Health care costs are kept low, and the indicators of health are among the best
worldwide.
b. Health care costs are low which has resulted in poor health outcomes.
c. Health care costs are the highest in the world, but the indicators of health are not
the best worldwide.
d. Health care costs and indicators of health are the highest in the world.
ANS: C
Health care costs in the United States are the highest in the world and comprise the greatest percentage of the gross domestic
product, the indicators of what constitutes good health do not document that Americans are really getting their money’s worth.
Health care costs are not low in comparison to the rest of the world. The health outcomes in the United States are poor in
comparison to other countries who spend less money on health care.
3. A nurse is explaining the health care system in the United States to a group of health care providers visiting from South America.
How would the nurse best describe the current health care system?
a. “It is a logical, rational approach to meeting expressed needs while still trying to
control costs.”
b. “It is a centralized system that provides care in hospitals.”
c. “It is divided primarily into two components: private health care and public health
care.”
d. “It is the best in the world with outstanding research and high-technology care
available to all.”
ANS: C
Health care in the United States consists of a private or personal care system and a public health system, with overlap between the
two. The United States health care system is one of the most expensive systems in the world that does not do a good job at
controlling costs. Care is provided through an enormous range of facilities and providers, including hospitals, physicians’ and
dentists’ offices, nursing homes, mental health facilities, ambulatory care centers, and freestanding clinics. Although there is great
research and high-technology care in the United States, the health care outcomes of the country do not reflect this. Health care
disparities exist among multiple populations making this system not available to all.
4. Which statement best describes ideal primary health care?
a. Based on a multidisciplinary group of health care providers that work as a team
b. Essential care available to all community members, which encourages
self-management
c. Focused on health promotion and disease prevention for everyone enrolled in the
health center
d. Local efforts to meet the Declaration of Alma Ata principles
ANS: B
Primary health care is generally defined as essential care made universally accessible to individuals, families, and the community.
Health care is made available to them with their full participation and is provided at a cost that the community and country can
afford. Public health is described as organized and multidisciplinary efforts aimed at preventing disease and promoting health, not
primary care. Primary care provides for the integration of health promotion, disease prevention, with curative and rehabilitative
services. The Declaration of Alma Ata was aimed at a world-wide, not local goal, to attain a level of health that permitted all
citizens of the world to live socially and economically productive lives.
lOMoARcPSD|13778330

Loading page 10...

5. How does managed care (MC) attempt to control costs of care?
a. By encouraging families to use the point of service list of individual practice
associates
b. By requiring families to choose a care provider from the MC network and not
allowing access to other services without their provider’s permission
c. By moving Medicaid-eligible families onto state Medicare enrollment
d. By refusing permission for families to use urgent care or emergency department
services
ANS: B
Managed care is a system in which care is delivered by a specific network of providers. Each provider serves as a gatekeeper who
controls access to other providers and services. Cost is reduced because members cannot use specialists or seek hospital or other
care without permission from their primary-care providers. Thus, those enrolled in Medicaid managed care have restrictions that
help keep costs down for government (and for taxpayers). Managed care provides care through a specific network of providers who
agree to comply with the care approaches established through a case management approach, not through a point of service list of
individual practice associates. Medicaid and Medicare programs are not interchangeable, these programs serve different
populations. Managed care does not refuse permission for certain services such as urgent care or emergency department, rather a
case management approach is used to control costs.
6. An 80-year-old woman comes to the community health care facility with a large bag of medications. She tells the nurse she can no
longer afford these medications because her only income is Social Security. Which statement is the best response by the nurse?
a. “Let’s go through these medications and see which ones we can delete.”
b. “You can get these medicines at this clinic for free.”
c. “Let’s see if we can get some help from Medicare to help you pay for these
medications.”
d. “These medications are important. Do your best to pay for them.”
ANS: C
This elderly patient probably is eligible for benefits through Medicare Part D. Medicare Part D has been added to Medicare to help
cover the cost of prescriptions. The role of the nurse would not be to delete medications for the patient or to tell the patient to figure
it out on her own. Because of the age of the patient, the nurse should see if options exist under the Medicare system before looking
into receiving the medications for free as there may be other barriers which limit the abilities to get these medications at a
discounted cost.
7. A nurse is determining which health care services must be offered at a local public health clinic. Which factor is most important for
the nurse to consider?
a. Data available from the most recent community assessment
b. Suggestions from community members about what is needed
c. Recommendations from Healthy People 2020
d. Services mandated by the state government
ANS: D
At the local level, health departments provide care that is mandated by state and federal regulations. Data available from the most
recent community assessment, suggestions from community members about need, and recommendations from Healthy People 2020
could all be used. However, funding for these types of programs may not be available. The services that are mandated by the state
government will be funded and allow the clinic to be able to provide these services.
8. A public health nurse is working with a low-income population in Massachusetts. Which of the following assumptions can the
nurse make about this population?
a. They have difficulty accessing health care due to a shortage of primary-care
providers.
b. They most likely receive health insurance through Medicare.
c. They are unable to access health care due to the implementation of the Affordable
Care Act.
d. They have access to affordable health care insurance.
ANS: D
Massachusetts began an experiment in health reform in 2006. Two years after health reform legislation became effective, only
2.6% were uninsured, the lowest percentage ever recorded in any state. The shortage of primary care providers is not significantly
different in Massachusetts than in other areas of the country. Low-income populations are eligible for Medicaid services, not
Medicare. The program in Massachusetts became a model for the Affordable Care Act.
9. A public health nurse is working with a client who does not have health insurance. Where will the nurse most likely direct the
client to in order to receive care?
a. Managed care
b. Community health center
c. Emergency department
d. Physician office
ANS: B
There is a safety net for the uninsured or underinsured. These are the federally funded community health centers which provide a
broad range of health and social services, using nurse practitioners and RNs, physician assistants, physicians, social workers, and
dentists. Community health centers serve primarily in medically underserved areas which can be rural or urban as well as people of
all ages, races, and ethnicities, with or without health insurance. Managed care is a system in which care is delivered by a specific
network of providers who agree to comply with the care approach, not a place to refer a client without health insurance. Emergency
departments and physician offices are not the best place for an individual without health insurance to receive care. Both are
expensive and do not provide the necessary resources for the individual to possibly receive health insurance.
lOMoARcPSD|13778330

Loading page 11...

10. Which of the following best describes why local, state, and federal governmental agencies have started to cooperate and collaborate
more closely in the last few years?
a. Increased administrative pressures to demonstrate outcomes
b. Increased focus on emergency preparedness and response
c. Increased taxpayers’ complaints and general unhappiness
d. Increased pressure to decrease overlap in services
ANS: B
Since the tragedy of September 11, 2001, health departments have increasingly focused on emergency preparedness and response.
In case of an emergency event, state and local health departments in the affected area will be expected to collect data and accurately
report the situation, to respond appropriately to any type of emergency, and to ensure the safety of the residents of the immediate
area, while protecting those just outside the danger zone. This goal—to enable public health agencies to anticipate, prepare for,
recognize, and respond to terrorist threats or natural disasters—has required an unprecedented level of interstate and federal-local
planning and cooperation among these agencies. Demonstrating outcomes and decreasing overlap of services are both important
factors to consider; however, this is not the reason why increased collaboration has occurred. There has not been an increase in
taxpayer complaints or unhappiness that has caused these changes to occur.
11. Minority nurses represented about 30.1 percent of the RN population. What is this an example of?
a. Projection
b. Disparity
c. Racism
d. A sentinel event
ANS: B
Disparities are racial or ethnic differences in the quality of health care or representation of a faction of the population, not based on
access or clinical needs, preferences, or appropriateness of an intervention. Projection is an estimate or forecast of a future situation
based on current trends. Racism is a prejudice that exists against someone of a different race based on the belief that one’s own race
is superior. A sentinel event is an unanticipated event in health care that results in death or serious injury to the pa tient.
MULTIPLE RESPONSE
1. A public health agency is in the process of obtaining accreditation. Which of the following best describes why the agency would
want to achieve accreditation? (Select all that apply.)
a. To improve health programming and services
b. To improve community relationships
c. To improve performance and quality
d. To improve management
e. To decrease cost of health care
ANS: B, C, D
The purpose of accreditation for public health departments is to assist and identify quality health department performance and
quality, and it develops leadership, improve management, and improve community relationships. Neither the improvement of
health care programming and services nor minimizing health care costs is a reason why a public health agency would want to
achieve accreditation.
2. What do demographic figures suggest about the ways in which the population of the United States is changing? (Select all that
apply.)
a. Foreign-born immigrant population is increasing.
b. Hispanics are the largest minority group population.
c. Leading causes of death are from infectious diseases.
d. Mortality for both genders in all age groups declined.
e. Unintentional injuries are among the top 10 causes of death.
ANS: A, B, D, E
The nation’s foreign-born population is growing, and it is projected that from now until 2050 the largest population growth will be
due to immigrants and their children. Although African Americans used to be the largest minority group, Hispanics now have that
distinction. The population of the United States continues to increase, and mortality for both genders from all age groups has
declined. The leading causes of death have changed from infectious diseases to chronic and degenerative diseases with
unintentional injuries being among the top 10.
3. Which of the following statements is accurate descriptions of current social and economic trends in the United States? (Select all
that apply.)
a. Citizens are appreciating the quality of life enjoyed in the United States.
b. Enjoying life is not as important as the need to take care of oneself.
c. People often spend a considerable amount of their own money on complementary
therapies.
d. The gap between the richest and poorest is widening.
e. The composition of families and living patterns are changing.
ANS: A, C, D, E
Several social trends that influence health care include changing lifestyles, a growing appreciation of the quality of life, the
changing composition of families and living patterns, changing household incomes, and a revised definition of quality health care.
People often spend a considerable amount of their own money for these types of therapies because few are covered by insurance. It
is obvious that the gap between the richest and poorest is widening because of the percent wage increase in the higher income
levels. Americans spend considerable money on health care, nutrition, and fitness, because health is seen as an irreplaceable
commodity. To be healthy, people must take care of themselves.
lOMoARcPSD|13778330

Loading page 12...

4. Which of the following provides evidence that the US health care system is in crisis? (Select all that apply.)
a. Health insurance is an expensive benefit for employers to provide.
b. Incompetent or negligent nurses are an ongoing source of medical errors.
c. Long work hours and provider fatigue are a major factor in medical errors.
d. More punitive measures must be taken to decrease provider errors.
e. Consumers want lower costs and high-quality health care without limits.
ANS: A, C, E
Consumers want lower costs and high-quality health care without limits and with an improved ability to choose providers and
services of their choice while employers are typically the purchasers of health care; they want to be able to obtain basic health care
plans at reasonable costs for their employees. Many employers have seen their profits diminish as they put more money into
providing adequate health care coverage for employees. Nurses working long hours pose a serious threat to patient safety because
fatigue slows reaction time, saps energy, and diminishes attention to detail. The Institute of Medicine’s (IOM) report To Err Is
Human recommends that we stop blaming and punishing individuals for errors and instead begin identifying and correcting system
failures by designing safety into the process of care. The report makes it clear that the majority of medical errors today were not
produced by provider negligence, lack of education, or lack of training.
5. A nurse is working at a state health department. Which of the following duties would most likely be completed in this setting?
(Select all that apply.)
a. Administering the Medicaid program
b. Assessing the health needs of the state’s citizens
c. Employing and supervising school health nurses
d. Establishing and maintaining child immunization clinics
e. Providing education regarding established health codes
ANS: A, B, E
State health departments try to prevent and respond to infectious disease outbreaks. They also are responsible for health care
financing and administering Medicaid, providing mental health and professional education, establishing health codes, licensing
facilities and personnel, and regulating the insurance industry. State health departments also give direct assistance to local health
departments in areas such as ongoing assessment of health needs. Employing and supervising school health nurses occur at the
local level, and many times within a specific school. Provision of child immunization clinics occurs at the local level.
lOMoARcPSD|13778330

Loading page 13...

Chapter 04: Government, the Law, and Policy Activism
Stanhope: Foundations for Population Health in Community/Public Health Nursing, 6th Edition
MULTIPLE CHOICE
1. Which of the following best defines the word politics?
a. The art of influencing others
b. The outcome of governmental policies
c. A provision of power for making decisions
d. The result of legislative action
ANS: A
Politics is the art of influencing others to accept a specific course of action. Political action results in governmental policies and
legislation. The result of legislative action typically is done in the form of laws and policies. The provision of power for making
decisions is typically assumed by the government.
2. Which of the following activities is completed by the executive branch of the federal government?
a. Administration of policy
b. Interpretation of policy
c. Proposal of policy
d. Passage of policy
ANS: A
The executive branch administers and regulates policy. The legislative branch proposes policy (as bills) and passes policy (as laws).
The judicial branch interprets laws.
3. A nurse meets with a senator to lobby for passage of a bill to increase funding for interpreter services. With which of the following
branches of the government is the nurse working?
a. Constitutional branch of government
b. Executive branch of government
c. Legislative branch of government
d. Judicial branch of government
ANS: C
The legislative branch of government is composed of the Senate and the House of Representatives. The legislative branch identifies
problems and proposes and then debates, passes, and modifies laws to address those problems. There is not a constitutional branch
of the government. The executive branch administers and regulates policy. The judicial branch interprets laws.
4. Which of the following statements best describes why the federal government has become involved in health care?
a. The states asked the federal level to become involved.
b. Because of rising costs to the states, the federal budget needed to be used to pay
for necessary services.
c. The Constitution gives the federal government the power to promote the general
welfare.
d. This step was necessary to standardize care on a national level.
ANS: C
One of the first constitutional challenges to a federal law passed by Congress was in the area of health and welfare in 1937. The
Supreme Court (judicial branch) reviewed the legislation in question and determined, through interpretation of the Constitution,
that such federal governmental action was within the powers of Congress to promote the general welfare. According to Article I,
Section 8 of the US Constitution Congress has multiple roles in relation to health care: provide for the general welfare, regulate
commerce among the states, raise funds to support the military, and provide spending power. Thus, Congress was within its role to
become involved in health care and was not asked to do so by the states or used to standardize care on the national level.
5. A client states to the nurse, “I have heard the Affordable Care Act is supposed to help improve the health care I receive, but so far I
have seen no benefits from this legislation.” Which of the following statements would be the best reply by the nurse?
a. “Maybe you have not directly seen the changes; however, several things have
changed in health care because of this bill.”
b. “It will take years to see any effects from the act because of the delays in
implementation of the changes.”
c. “This legislation will primarily improve care for the elderly and poor populations,
so this is why you may not have seen any benefits.”
d. “The way health care operates at the federal and state levels has changed, so most
individuals will not see any direct impact.”
ANS: A
It is possible that unless one has been in a situation where changes have been made, that one may not realize any of the effects of
this law. The goal of the Affordable Care Act was to improve the health of the nation and access care. Several changes to health
care have already been made because of this legislation, and more changes will continue in the future. Multiple provisions of the
act will affect individuals and families.
lOMoARcPSD|13778330

Loading page 14...

6. What was the significance of the 1979 Surgeon General’s report?
a. It planned the goals and priorities for the entire Veterans Administration medical
system.
b. It vastly increased funding for health promotion activities.
c. It identified the use of tobacco as a cause of lung cancer.
d. It created national goals for promoting health and preventing disease.
ANS: D
The 1979 Surgeon General’s report began a focus on preventing disease and promoting health for all Americans. It was a national
effort with all levels of government, as well as other interested parties, involved. The 1979 report did not plan goals and priorities
for the Veterans Administration medical system; rather it looked at health of all Americans. There was no funding associated with
the report. It addressed prevention of disease and promotion of health for multiple diseases, not just lung cancer.
7. A nurse is advocating for the public health department to increase the number of public health nurses that it employs. Which of the
following factors should the nurse emphasize?
a. Providing disease investigation training
b. Providing research opportunities
c. Providing leadership experiences
d. Providing salaries commensurate with responsibilities
ANS: D
Through the input of the Division of Nursing’s National Advisory Council for Nursing Education and Practice (NACNEP), the
Division of Nursing sets policy for nursing nationally. A few of the factors indicated by the NACNEP that need to be in place to
support the public health nurse role are competitive salaries commensurate with responsibilities, experience in health promotion
and prevention, long-term trusting relationships in the community, and a commitment to social justice and eliminating health
disparities. The Division of Nursing’s National Advisory Council for Nursing Education and Practice (NACNEP) did not
emphasize the importance of providing disease investigation training, research opportunities, or leadership experiences.
8. A nurse is determining whether a hospital has the right to require infected patients to be isolated against their will. To which type of
law will the nurse refer?
a. Common law
b. Constitutional law
c. Legislation and regulation
d. Judicial law
ANS: B
Constitutional law provides the right to intervene in a reasonable manner to protect the health, safety, and welfare of the citizenry.
State power concerning health care is called police power. This power allows states to act to protect the health, safety, and welfare
of their citizens. The state must show that it has a compelling interest in taking actions, especially actions that might infringe on
individual rights. The state can isolate an individual to prevent an epidemic, even though this infringes on individual rights. The
community’s rights are deemed more important than the individual’s rights when there is a threat to the health of the public.
Judicial law, based on court and jury decisions, and the principles of common law (precedent, justice, fairness, respect for an
individual’s autonomy, and self-determination) are both used by court’s as the basis to make a decision and do not relate to having
the right to isolate a patient. Legislation is law that comes from the legislative branches of the government and regulations are
specific statements of law related to defining or implanting individual pieces of legislation. Neither are as important in this case as
the constitutional law of the police power of the states in regards to isolation of a patient.
9. Who is responsible for determining the scope of practice for registered nurses?
a. American Nurses Association
b. Federal legislators
c. State legislators
d. US Department of Health and Human Services
ANS: C
Health care practitioners are subject to the laws of the state in which they practice. The state nurse practice acts define the practice
of professional nursing, identify the scope of nursing practice, set educational qualifications, and determine legal titles. The nurse
practice act is governed by legislators in each state. The American Nurses Association, US Department of Health and Human
Services, and federal government do not determine the scope of practice for nurses; this responsibility is the role of state
governments. The US Department of Health and Human Services is the agency most heavily involved with the health and welfare
of US citizens.
10. Which of the following statements by a client indicates a lack of understanding regarding an appropriate reason to sue for
professional negligence?
a. “Because the health care workers didn’t turn my mother every 2 hours, she
developed bedsores.”
b. “I received permanent nerve damage because they would not remove a cast that
was too tight.”
c. “My daughter wasn’t given a call light, and for a whole shift no one checked on
her condition.”
d. “They amputated the wrong leg during surgery.”
ANS: C
Professional negligence, or malpractice, is defined as an act (or failure to act) that leads to injury. All of the choices specify an
injury, except for “My daughter wasn’t given a call light, and for a whole shift no one checked on her condition,” in which case the
care was substandard but no injury resulted. The incorrect responses all specify an injury whereas professional negligence, or
malpractice, is defined as an act (or failure to act) that leads to injury.
lOMoARcPSD|13778330

Loading page 15...

11. Which of the following statements best describes the law in relation to clinical practice by nursing students?
a. Students are considered certified until licensure is obtained.
b. Students are expected to meet the same standard of care as the professional nurse.
c. Students are not legally liable for errors because they practice under the license of
their instructor.
d. Students have a scope of practice determined by the nurse practice act.
ANS: B
Nursing students need to be aware that the same laws and rules that govern the professional nurse apply to them as well. Students
are expected to meet the same standard of care as that met by any licensed nurse practicing under the same or similar
circumstances. Although it is true that students cannot practice outside the scope of practice determined by the nurse practice act,
they also cannot perform the tasks and responsibilities of the licensed practitioner within the scope of practice until they have
received adequate knowledge; therefore, the scope of practice for the student is determined by the instructor, based on the student’s
level of education.
12. A nurse wishes to see a bill passed to support funding for the use of interpreters for clients with limited English proficiency. Which
of the following would be the best time for the nurse to request support from the local senator, who is not on the committee that is
reviewing this bill?
a. When the bill is first assigned to a committee.
b. When the bill is discussed and debated within the committee.
c. When the bill moves out of committee to be heard by the entire Senate.
d. When the bill passes the Senate and moves to the House of Representatives.
ANS: C
Once the bill is passed by committee and moves out of committee to be heard by all senators, it will be important to contact this
senator, who will then be in a position to act on it. To contact the senator when the bill is first assigned to the committee or is being
discussed and debated within the committee is too early to effectively influence the individual senators. The nurse would not want
to wait until after the vote has been taken in the Senate because it would then be too late for the senator to act.
13. The state board of nursing has written new regulations to clarify in a more concrete manner what the nurse practice act allows and
requires. Which of the following effects will this change have on nurses in this state?
a. None, because they are just helpful guidelines for maximum safety.
b. None, because they just give specifics that may change over time.
c. Major, because prudent nurses would follow such regulations.
d. Major, because these rules and regulations have the effect of law and must be
obeyed.
ANS: D
When the legislature passes a law and delegates its oversight to an agency, it gives that agency the power to make regulations.
Because regulations flow from legislation, they have the force of law. Whether prudent or not, nurses are obligated to practice
consistent with these regulations. All nurses have the responsibility to follow the changes that are in place by legislation. They are
laws that must be followed, not guidelines.
14. A bill with the potential to decrease health care services is passed by Congress. Which of the following actions should the nurse
take to influence the bill’s implications?
a. Exercise veto power by calling for petitions from health care agencies.
b. Contact the regulatory agency and participate in public hearings.
c. Call members of congress to request that they rescind the legislation that was
passed.
d. Discuss the change in services with the administrators at the hospital.
ANS: B
Once a bill is passed and becomes law, it is too late to influence congressional members to change their vote; however, it is not too
late to influence the outcome of the vote because the nurse can influence how the law is regulated. An agency typically writes the
regulations that control how the law is implemented in more specific detail. Often this process can be just as important as lobbying
against a bill because it shapes the final implementation of the law. Health care agencies do not have the ability to veto a bill. After
a bill has been passed, it is too late to contact members of congress. Calling the hospital will not change the implications of the bill.
Contact must be made with the regulatory agency in order to influence how the law is regulated.
15. Which of the following agencies has the most influence on the health and welfare of US citizens?
a. Agency for Healthcare Research and Quality (AHRQ)
b. Centers for Disease Control and Prevention (CDC)
c. US Department of Health and Human Services (USDHHS)
d. World Health Organization (WHO)
ANS: C
As the agency to which most health care legislation is delegated, the USDHHS is the agency most heavily involved with the health
and welfare of citizens. The AHRQ and CDC are divisions of the USDHHS. WHO’s policy-making body provides policy options
and guides but not laws. In the textbook, only the USDHHS is discussed regarding its responsibility for Medicare and Medicaid
through the Centers for Medicare and Medicaid Services (CMS).
lOMoARcPSD|13778330

Loading page 16...

16. Which of the following laws established programs for provision of health services for women and children and supported
community-oriented nursing practice?
a. Early Periodic Screening and Developmental Testing (EPSDT) Initiative
b. Healthy People 2000 Initiative
c. Sheppard-Towner Act
d. State Child Health Improvement Act (SCHIP)
ANS: C
The Sheppard-Towner Act of 1921 played an important role in the development of public health policy, public health nursing, and
social welfare policy. Of particular importance was the fact that it established standards for programs to serve women and children
and made nurses available to provide these services in the community setting. Within the Sheppard-Towner Act was a provision to
start the EPSDT initiative. SCHIP provides insurance for children and families who cannot otherwise afford health insurance.
Healthy People 2000 focuses on promoting health and preventing disease for all Americans.
MULTIPLE RESPONSE
1. Which of the following describes the significance of the passage of The Public Health Threats and Emergencies Act? (Select all
that apply.)
a. It funded ongoing activities of the public health system.
b. It led to improved water quality and food safety guidelines.
c. It included funding for public health activities.
d. It validated that the public health system was prepared for terrorism.
e. Expanded the role of Secretary of HHS to include aspects of public health
emergencies.
ANS: B, C
The Public Health Threats and Emergencies Act was the first federal law to comprehensively address the public health system’s
preparedness for bioterrorism and other infectious disease outbreaks and signaled the beginning of renewed interest in public health
as the protector for entire communities. The focus of this law was to address emerging threats to the public’s health and authorize
the Secretary of HHS to take appropriate response actions during a public health emergency, including investigations, treatment,
and prevention. A focus was the improvement of water quality and food safety. It did not support the ongoing activities of public
health. It did not validate the public health system was prepared for terrorism.
2. Which of the following best describes the importance of the World Health Organization (WHO) to the United States? (Select all
that apply.)
a. Provides daily information on disease occurrences.
b. Establishes international standards for antibiotics and vaccines.
c. Creates international legislation regarding international cooperation.
d. Supports national programs to fight disease when asked to do so.
e. Monitors for adverse drug reactions.
ANS: A, B, D, E
Some WHO services that benefit all countries (including the United States) are providing day-to-day information service on the
occurrence of internationally important diseases; publishing the international list of causes of disease, injury, and death; monitoring
adverse reactions to drugs; and establishing international standards for antibiotics and vaccines. Individual countries can request
assistance with strengthening the delivery of health services, supporting national programs to fight disease, and training health
workers—which the United States does not. WHO can suggest but cannot legislate to individual countries.
3. Which of the following activities is the responsibilities of the Centers for Disease Control and Prevention (CDC)? (Select all that
apply.)
a. Conduct research to enhance disease prevention.
b. Detect and investigate infectious disease problems.
c. Develop public health policies.
d. Publish national goals for promoting health and preventing disease.
e. Serves as an advocate of public health polices
ANS: A, B, C, E
The mission of the CDC is to promote health and quality of life by preventing and controlling disease, injury, and disability. To
monitor health, the CDC will detect and investigate health problems, conduct research that will enhance prevention, and develop
and advocate sound public health policies and other prevention strategies. The safety and health of the workplace is the specific
responsibility of OSHA. The CDC cannot write or pass legislation. The USDHHS published national health goals in Healthy
People 2020.
4. A nurse is visiting a state legislator to encourage the legislator to vote for a particular health bill that the state n urses association has
endorsed. Which of the following actions would be most important for the nurse to complete? (Select all that apply.)
a. Encourage the legislator or staff to ask relevant questions.
b. Be friendly and engage in small talk so that rapport can be established.
c. Be aware that legislators are well informed; don’t insult the legislator by stating
information that is obvious.
d. Have a handout that summarizes all the major points in support of the bill.
ANS: A, D
Legislators might not be well informed about every issue, so they need and want important information. The nurse should allow
time for questions or clarifications of information shared and have the material on a handout for the legislator’s convenience. It is
also helpful to invite the legislator to attend nursing conferences or meetings where health issues will be discussed. The nurse
should not waste time with small talk but briefly present his or her stand, emphasizing other nurses who support the bill, because
numbers count. Legislators might not be well informed about every issue, so they need and want important information that the
nurse can provide.
lOMoARcPSD|13778330

Loading page 17...

5. A nurse would like to become involved in political action. Which of the following actions would be most appropriate for the nurse
to accomplish this goal? (Select all that apply.)
a. Become a member of the state nurses association.
b. Be friendly with everyone, whether supportive or not of your ideas.
c. Focus on being appointed to the state level committees.
d. Focus all your efforts on your specialty practice area and your employment site.
e. Volunteer to serve on relevant committees.
ANS: A, B
A nurse wishing to become politically involved should begin by joining the state nurses association, networking with others
involved, and volunteering to serve on committees or in offices. Be friendly and network to increase your knowledge beyond your
own workplace or specialty and seek opportunities to share expertise with others. Becoming involved locally is a good opportunity
to start becoming involved in political action and allows for networking at the local level. Seeking opportunities beyond one’s
workplace or specialty area allows the nurse to gain additional knowledge and share expertise in specialty area with others.
6. A nurse is testifying at a committee meeting about a health bill. Which of the following actions should be taken by the nurse?
(Select all that apply.)
a. Briefly describe professional education.
b. Discuss how the bill affects more than just nurses.
c. Include factual data and, if possible, statistical information in visual form.
d. Provide written proof of personal and professional qualifications
e. Provide information about relevant expertise and related experience.
ANS: A, B, C, E
Language must be simple and carefully chosen to convey information to listeners and to avoid professional jargon. The nurse must
share a bit of personal education, experience, and expertise to be seen as a credible source, but written proof of credentials is not
necessary unless specifically requested. The testimony must go beyond just nursing’s interest and include accurate, credible data.
The data must be accurate and credible which may not be the case when getting names from the media.
lOMoARcPSD|13778330

Loading page 18...

Chapter 05: Economics of US Health Care Delivery
Stanhope: Foundations for Population Health in Community/Public Health Nursing, 6th Edition
MULTIPLE CHOICE
1. A nurse is discussing how health care rationing occurs in the United States. Which of the following would most likely be discussed
as the criterion that is used to ration health care?
a. Clinic operating hours
b. Ability to pay for services
c. Availability of local provider services
d. Transportation availability
ANS: B
Because there are not enough health care services available to provide desired services to everyone, the focus has been on reducing
costs by controlling the use of services. All of the factors listed affect health care access and therefore affect health care rationing
(either directly or indirectly). The primary determinant, however, is the ability to pay for services. Without this ability, services are
denied; therefore, those without insurance that is accepted by a provider or institution or who do not have the money to pay out of
pocket are unable to obtain services regardless of operating hours, transportation issues, or availability.
2. Which of the following must a nurse be knowledgeable about to make decisions regarding the most cost-effective way to allocate
health care resources?
a. Insurance resources
b. Health care rationing
c. Health economics
d. Medical technology
ANS: C
Economics is the science concerned with the use of resources; health economics is concerned with how scarce resources affect the
health care industry. Insurance resources, health care rationing, and medical technology are important components of health
economics but by themselves do not provide the broad understanding called for in this question.
3. Which of the following individuals would most likely experience a barrier when accessing health care?
a. A 40-year-old female who speaks English as a second language
b. A 25-year-old female with co-pay health insurance
c. A 50-year-old male with hypertension
d. A 30-year-old male who is unemployed
ANS: D
Barriers to accessing care include the inability to afford health care, lack of transportation, physical barriers, communication
problems, childcare needs, lack of time or information, or refusal of services by providers. The unemployed male is most likely to
experience a barrier because of not having a job, which may reduce his access to health insurance and limit his income. Those who
speak English as a second language and have health insurance even with co-pay requirements should both find it easier to access
health insurance than someone who is unemployed since the inability to afford health care is a primary barrier. Medical diagnoses,
such as having hypertension, do not present a barrier to accessing health care.
4. Which person is most likely to be uninsured?
a. An 82-year-old woman with chronic medical problems
b. A 2-year-old whose mother is on welfare
c. A 50-year-old business man who works for a large corporation
d. A 24-year-old man who works part-time at a small business
ANS: D
Young adults (ages 19 to 25 years) account for a disproportionately large share of the uninsured, largely due to their low incomes.
The elderly person would be eligible for Medicare, and the 2-year-old is probably eligible for Medicaid. The man who works at the
large corporation probably has health insurance, because most large businesses provide it.
5. Which of the following is most closely correlated with poor health?
a. Age and gender (i.e., older males)
b. Low socioeconomic status
c. Minority race status
d. High-risk lifestyle behaviors
ANS: B
Poverty is more closely related to health status even when controlling for age, gender, race, education, and lifestyle behaviors. The
rate of uninsured remained higher among people with lower incomes and lower among those with higher incomes. Households of
three with less than $20,000 annual income are at the highest risk for being uninsured. Socioeconomic status has the closest
correlation to health status; thus, age, gender, minority race status, and high-risk lifestyle behaviors do not have the closest
correlation.
lOMoARcPSD|13778330

Loading page 19...

6. A pregnant teenager has approached a nurse asking about ways to improve the health outcomes for her and her unborn child. Which
of the following statements would be most appropriate for the nurse to make?
a. “Don’t drop out of school.”
b. “Sign up for childbirth classes.”
c. “Sign up for the WIC program.”
d. “Take your prenatal vitamins daily.”
ANS: A
The question specifies the health of both the mother and the child. Socioeconomic conditions improve with education. Because
socioeconomic status is inversely related to mortality and morbidity, by becoming better educated, the mother-to-be will be less
likely to live a life of poverty and, as a consequence, will enjoy a greater chance of better health for herself and for her child. The
priority of the nurse should be to encourage the teenager to stay in school as this choice will provide for the best long-term outcome
for the client. Signing up for childbirth classes, the WIC program, and taking prenatal vitamins all address short-term outcomes
which are not as important as the future of the teenager raising this child.
7. A nurse is providing care to a child whose parents do not receive health insurance as an employee benefit and who do not have the
financial resources to pay for health care out of pocket. Which of the following resources should the nurse recommend to the
family?
a. A managed care organization
b. An emergency department
c. Medicaid
d. Medicare
ANS: C
Medicaid provides coverage for adults with low income and their children. Managed care is a type of private insurance while
Medicare is available to persons aged 65 and older. The emergency department would charge a co-pay for care given to both the
child and the parents.
8. Which of the following best explains how the government unintentionally encourages low-income persons to use emergency
departments as their primary care provider?
a. A huge amount of paperwork is required when Medicaid clients go to a
physician’s office.
b. Government regulations require Medicaid clients to use emergency departments
when their primary health care provider is unavailable.
c. Legally, emergency departments must see clients even if clients can’t pay.
d. Physicians’ limited office hours make them unavailable during evenings and
weekends.
ANS: C
People on Medicaid frequently have no primary care provider and may not be able to pay for their care. Although physicians can
choose clients based on their ability to pay, emergency departments are required by law to evaluate every client regardless of
ability to pay. Emergency department co-payments are modest and are frequently waived if the client is unable to pay. Thus, low
out-of-pocket costs provide incentives for Medicaid clients and the uninsured to use emergency departments for primary care
services. Limited physician office hours over the weekend does make it difficult for low-income persons to access care through a
primary care provider; however, this is not influenced by a government decision. The government does not require Medicaid clients
to use the emergency department when their primary care provider is unavailable, rather the policies of the emergency department
to see all clients regardless of ability to pay may inadvertently encourage them to use this service. The paperwork at a physician’s
office that needs to be completed by a Medicaid client is not any different than any other client receiving care at the office.
9. Which of the four main factors that affect health, is the most important?
a. Environment
b. Human biology
c. Lifestyle choices
d. Health care system
ANS: C
Personal biology and behavior (or lifestyle), environmental factors and policies (including physical, social, health, cultural, and
economic environments), social networks, living and working conditions, and the health care system—medical services are said to
have the least effect. Behavior and lifestyle have been shown to have the greatest effect on longevity, with the environment and
biology accounting for the greatest effect on the development of all illnesses.
10. A nurse is trying to maximize the quality of life of clients while reducing health care costs. Which of the following actions would
most likely be completed by the nurse?
a. Assisting in cast application for a client who was injured in a skateboard incident
b. Irrigating the eyes of a client splashed with chemicals
c. Restoring a normal cardiac rhythm following cardiopulmonary resuscitation of a
client with a heart condition
d. Teaching a high school boy about sexually transmitted infections and proper
condom application
ANS: D
Education is primary health care prevention. A proactive investment in disease prevention and health promotion targeted at
improving health behaviors and lifestyle has the potential to improve health status and reduce health care costs. Assisting in a cast
application, irrigating a client’s eyes, and restoring a normal cardiac rhythm are all tertiary prevention methods as a condition has
already occurred and the nurse is focusing on restoring health. In order to maximize quality while reducing health care costs, the
nurse should focus on primary prevention strategies.
lOMoARcPSD|13778330

Loading page 20...

11. Which of the following caused health care providers to begin to focus on individual infections and trauma in the 1900s in the
United States?
a. Education of health care providers moved into universities.
b. People finally had enough money to pay for medical care.
c. The improved outcomes of hospital care were recognized.
d. Advances were made in sewage disposal, and water and milk quality.
ANS: D
Environmental conditions influencing health began to improve with major advances in water purity, sanitary sewage disposal, milk
quality, and urban housing quality. The health problems of this era were no longer mass epidemics but individual acute infections
or traumatic episodes. The education of health care providers did move into universities during this time period; however, this is
not the reason why there was an increased focus on infections and trauma. Health care was paid for primarily by individuals during
this time period so there was not an increase in the amount of money available to pay for health care. The outcomes of hospital care
improved because of the advances that were being made in technology, not because health care providers were focusing more on
infections and trauma.
12. Which of the following accurately describes a challenge that will be faced by health care providers in the 21st century?
a. Lack of available space to provide care for clients in hospitals
b. Emergence of new and old communicable and infectious diseases
c. New guidelines for chronic disease management
d. Increased use of technology leading to a decreased need for health care workers
ANS: B
In the 21st century, the emergence of new and the reemergence of old communicable and infectious diseases are occurring as well
as larger foodborne disease outbreaks and acts of terrorism. Care for clients continues to move out of the hospital setting and into
the community. Chronic disease management will be a challenge for health care providers; however, new guidelines should ease
the care provided for these diseases and wouldn’t be seen as a challenge. The use of technology will continue to increase, but the
need for health care workers will not be decreasing. New health care careers will emerge because of the changes in technology.
13. Which of the following demographic factors is expected to have the greatest influence on national health care spending?
a. The aging population
b. Use of diagnosis-related groups to determine reimbursement
c. Insurance reform
d. An increasing number of people without health insurance
ANS: A
The aging population is expected to affect health services more than any other demographic factor. The majority of older adults
rely on publicly funded programs. As the Baby Boom generation ages and retires, federal expenses for Social Security and health
care will increase. The use of diagnosis-related groups to determine reimbursement started in 1983 and is not expected to have a
great influence on national health care spending at this time. Insurance reform is not a demographic factor. Due to the Affordable
Care Act, the number of people without health insurance is decreasing.
14. Which of the following groups pays the largest amount for health care in the United States today?
a. Consumers
b. Federal and state government
c. Insurance companies and other third-party payers
d. Hospitals and health care providers
ANS: B
Combined state and federal governments paid the most for health care in 2018. Health care financing has evolved from a time when
the most money was expended by consumers, then to a system financed by third-party payers such as insurance companies, and
finally, to today, when state and federal government payments (primarily through Medicare and Medicaid) pay more than private
insurance companies or consumers. From 1960 to 2018, the percentage of third-party public insurance payments increased and the
percent of out-of-pocket payments declined.
15. Which of the following services would be covered under Medicare Part A?
a. Blood draw to assess PT/INR
b. Physical therapy visit
c. Stay in skilled nursing facility
d. Transportation by an ambulance
ANS: C
Medicare Part A covers hospital care, home care, and skilled nursing care. Medicare Part B covers “medically necessary” services,
such as health care provider services, outpatient care, home health, and other medical services such as diagnostic services and
physiotherapy.
16. A Medicare recipient has elected to pay a monthly premium for Medicare that will cover expenses such as durable medical
equipment. Which of the following best describes this part of Medicare?
a. Part A
b. Part B
c. Part C
d. Part D
ANS: B
Medicare Part B is a supplemental (voluntary) program; it provides coverage for services that are not covered by Part A, such as
laboratory services, ambulance transportation, prostheses, durable medical equipment, and some supplies. Medicare Part A covers
hospital care, home care, and skilled nursing care. Medicare Part C plans are coordinated care plans that include health
maintenance organizations, private fee-for-service plans, and medical savings accounts. Medicare Part D provides prescription drug
coverage.
lOMoARcPSD|13778330

Loading page 21...

17. Which of the following criterion is now used for deciding the amount of the reimbursement before care is provided?
a. A proportion of actual cost arbitrarily decided by the Medicare panel
b. The federal budget constraints for the current fiscal year
c. Hospital and health care provider feedback and political persuasion
d. Prospective payment scale based on the medical diagnosis
ANS: D
As a result of rising health costs, Congress passed a law in 1983 that mandated an end to cost-plus reimbursement and instituted a
prospective payment system (PPS) for inpatient hospital services to shift the cost incentives away from the providing of more care
and toward more efficient services. The basis for prospective reimbursement is the 468 diagnosis-related groups (DRGs). There is
not a Medicare panel that determines the actual cost of services. Payments are determined in advance based on DRGs and are not
determined by the budget of the federal government. Hospital and health care provider feedback do not influence the prospective
reimbursement; rather, the third-party payer establishes the amount of money that will be paid for the delivery of a particular
service before offering the services to the client.
18. Which of the following payment systems tries to keep clients healthy through education and health promotion, with the goal of
reducing the need for professional health care intervention and therefore also lowering cost?
a. Managed care plan
b. Fee-for-service payment
c. Prospective reimbursement
d. Retrospective reimbursement
ANS: A
The concept of managed care is that costly care could be reduced if consumers had access to education and health promotion.
Fee-for-service payment encourages more services to be given. Reimbursement, whether prospective or retrospective, is based on
the same criteria, but managed care integrates the financing and the delivery of health care.
19. Which of the following terms describes when a nurse practitioner receives a set monthly payment to take care of a group of clients
regardless of the services needed and provided?
a. Capitation
b. Fee for service
c. Rationing
d. Retrospective reimbursement
ANS: A
In payment by capitation, practitioners are paid a set amount to provide care to a given client or group of clients for a set period of
time. In the fee-for-service payment system, which is like the retrospective reimbursement, the practitioner determines the costs of
providing a service, delivers the service to a client, submits a bill for the delivered service to a third-party payer, and is paid by the
third-party payer. Rationing implies reduced access to care and potential decreases in the acceptable quality of services offered.
20. A client expresses concern that health care coverage based on capitation may have negative side effects. Which of the following
would most likely be a consequence of capitation?
a. Coercing clients to attend health promotion education classes
b. Encouraging clients to seek care elsewhere
c. Increasing the number of interventions to maximize payment
d. Neglecting to order certain tests or treatment to minimize cost to the provider
ANS: D
In capitated arrangements, physicians and other practitioners are paid a set amount to provide care to a given client for a set period
of time and amount of money. Thus, neglecting to order certain tests or treatment would be a way for the provider to maximize the
amount of money received to provide care to members of this group. In a capitated arrangement, the provider would most likely not
increase the number of interventions used or coerce clients to attend health promotion classes as both of these strategies would cost
the provider more money, and the provider will be receiving a set amount of money to provide care for a given client for a set
period of time. It is unlikely that the provider would encourage clients to seek care elsewhere; rather the provider would be
conscientious about the number of tests and treatments that are ordered in order to try to contain costs.
21. When did medicine in the United States make a shift away from the treatment of acute infection to care of chronic illnesses?
a. Between 1890 and 1920
b. Between1920 and 1940
c. Between 1940 and 1960
d. Between 1945 and 1984
ANS: D
The later part of the 20th Century (1945-1984) ushered in a shift away from acute infectious health problems of previous stages
toward chronic health problems such as heart disease, cancer, and stroke.
22. A nurse is implementing a primary prevention strategy focusing on economics within the community. Which of the following
interventions is the nurse most likely completing?
a. Applying for a grant to establish a daycare center to serve dependent older adult
clients living with working families
b. Persuading legislators to pass a bill offering health care financial aid to families at
risk
c. Screening cocaine addicts for financial assistance eligibility for drug treatment
d. Referring clients with renal failure to apply for Medicare
ANS: B
Primary prevention occurs before an illness or condition develops. Of the options provided, only persuading legislators to pass a
bill offering health care financial aid to families at risk addresses initiating interventions before an illness occurs. Applying for a
grant and referring clients with renal failure both demonstrate the use of tertiary prevention as the illness or condition has already
developed. Screening cocaine addicts displays the use of secondary prevention as a screening technique is being used to identify
the problem as soon as possible.
lOMoARcPSD|13778330

Loading page 22...

MULTIPLE RESPONSE
1. In which of the following situations would the federal government provide money through tax relief for private enterprise? (Select
all that apply.)
a. A business pays for part of health insurance premiums for its employees.
b. A business purchases gifts for its employees to award them for their service.
c. An employer provides health screenings.
d. An employer requests reimbursement for employee transportation costs.
e. An employer offers immunizations to all eligible employees.
ANS: A, C, E
Businesses can pay for disease prevention and health promotion services for employees (and sometimes their families) in the form
of immunizations, health screenings, and counseling. The business can then deduct these costs as a business expense, which
reduces the amount the business owes the government in taxes on their profits. Similarly, when businesses subsidize health
insurance for their employees—and families—this is also a business expense, which decreases the amount the business would
otherwise pay in taxes. Thus, the government indirectly provides the money, but the business, a part of the private sector, decides
how it is used. A business purchasing gifts for its employees and an employer requesting reimbursement for employee
transportation costs do not result in tax relief for the business. Rather, the business providing health insurance and health
promotion/disease prevention services allows the amount of taxes that the business owes to the government to be reduced.
2. Which of the following best explains why clients who have Medicaid have poor health outcomes? (Select all that apply.)
a. Clients may have preexisting conditions not covered by insurance.
b. Many physicians won’t accept Medicaid clients.
c. Medicaid won’t pay for certain medical interventions.
d. Medicaid recipients are noncompliant with their health care providers’
recommendations.
e. There is a general hesitancy among those eligible to seek health care.
ANS: A, B, C
The primary reasons for delay, difficulty, or failure to access care include inability to afford health care and a variety of
insurance-related reasons, including the insurer not approving, covering, or paying for care; the client having preexisting
conditions; and physicians refusing to accept the insurance plan. Practical problems such as lack of childcare, transportation, long
waiting periods, and communication issues also interfere. Noncompliance is not a primary reason why Medicaid clients have poor
outcomes. There is no research to confirm that Medicaid recipients are reluctant to seek medical care. Rather there are usually other
compounding factors that interfere with the client following the regimen or accessing other needed health care services which result
in the poor health outcomes.
3. A nurse would like to help members of the community focus on receiving primary preventive health care services. Which of the
following interventions should be implemented by the nurse? (Select all that apply.)
a. Publicize data on success of health promotion efforts.
b. Lobby for decreased reimbursement for secondary and tertiary care services.
c. Establish standards for appropriate screenings at specific intervals.
d. Encourage members of the military service to engage in appropriate healthy
lifestyle behaviors.
e. Provide transparency to the public regarding service costs and savings.
ANS: A, E
Reasons given for the lack of emphasis on prevention in clinical practice and lack of financial investment in prevention include
provider uncertainty about which clients should receive services and at what intervals, lack of information about preventive
services, negative attitudes about the importance of preventive care, lack of time for delivery of preventive services, delayed or
absent feedback regarding success of preventive measures, less reimbursement for these services than for curative services, lack of
organization to deliver preventive services, and lack of use of services by the poor and elderly. Considering how health care dollars
are spent in the United States, it would not be reasonable to lobby for decreased funding for secondary and tertiary services, as this
would result in less care available for individuals. Requiring people to change their lifestyle would be illegal.
4. Which of the following are some major differences in health care today, as compared with the first half of the 20th century? (Select
all that apply.)
a. Consumers are influenced by advertising for specific health care agents or
procedures.
b. The emphasis is on the continued expansion of health care facilities, especially
acute care hospitals.
c. Education and specialization of personnel have increased.
d. The need to create new ways to pay for health care is a central focus.
e. Hospital stays are much shorter.
ANS: A, C, E
Since the 1980s, the United States has been in a period of limited resources, with an emphasis on containing costs, restricting
growth in the health care industry, and reorganizing care delivery. Results have included shorter hospital stays and substitution of
one set of personnel (such as nurse practitioners) for another set (physicians). Such trends are made more challenging by increased
direct marketing to consumers. Also with increased knowledge has come increased education and specialization. Shorter hospital
stays continue to occur so there is a focus on expanding care in the community, not in acute care hospitals. Containment of costs is
a major focus; however, creation of new payment methods has not been part of this conversation.
lOMoARcPSD|13778330

Loading page 23...

Chapter 06: Ethics in Public and Community Health Nursing Practice
Stanhope: Foundations for Population Health in Community/Public Health Nursing, 6th Edition
MULTIPLE CHOICE
1. Which of the following is generally considered to be nursing’s first code of ethics?
a. Nightingale Pledge
b. Code for Professional Nurses
c. Code of Ethics for Nurses
d. Principles of the Ethical Practice of Public Health
ANS: A
The Nightingale Pledge is generally considered to be nursing’s first code of ethics. After the Nightingale Pledge, the Code for
Professional Nurses was formally adopted by the ANA House of Delegates in 1950. It was amended and revised five more times,
until, in 2001 the ANA House of Delegates adopted the Code of Ethics for Nurses with Interpretive Statements. The Principles of
the Ethical Practice of Public Health was approved in 2002.
2. A nurse didn’t know what to do when faced with a particular ethical dilemma because an option that would have a good outcome
didn’t seem possible. The nurse decided to talk to the agency supervisor and decide what action to take. Which of the following
best describes the nurse’s actions?
a. Appropriate, because the supervisor is responsible for the nurse’s choices.
b. Intelligent, because the supervisor has access to resource persons (clergy,
physicians, administrators) who might know of options the nurse hadn’t
considered.
c. Justified, because this provides an opportunity to discuss the issue but the nurse
maintains responsibility for the decision.
d. Wise, because the supervisor would be more knowledgeable concerning agency
priorities and traditional practices.
ANS: C
Ethically, each nurse is responsible for his or her own decisions and cannot avoid ethical accountability by relying on obedience to
a supervisor or any external rule or policy. The supervisor is not responsible for the nurse’s choices, the nurse must maintain
responsibility for his/her own decisions. The nurse should have access to the same resources as the supervisor and should have
similar knowledge as the supervisor.
3. Which of the following is the first and most crucial step in a generic ethical decision-making process?
a. Assess the context or environment in which the decision must be made.
b. Consider the various ethical principles or theories.
c. Identify the ethical issues and dilemmas.
d. Make a decision and act on it.
ANS: C
The first step in the ethical decision-making framework is to identify the ethical issue or dilemma. After the first step of identifying
the ethical concern, the following steps are: (2) place the ethical issue or dilemma within a meaningful context, (3) obtain all
relevant facts, (4) reformulate ethical issues or dilemmas, if needed, (5) consider appropriate approaches to action or options, (6)
make the decision and take action, and (7) evaluate the decision and action.
4. A nurse is asked to meet with a family who recently immigrated from Botswana (Africa). After the physician tells the husband the
wife’s diagnosis of breast cancer, the family thanks the physician and starts to leave. Ethically, which of the following is the
nurse’s most important action?
a. Emphasizing that the family must set up a surgical appointment for the wife
immediately
b. Assessing the family’s current living situation, including insurance and other
assets
c. Educating the family concerning the usual treatment and the prognosis of breast
cancer
d. Interviewing the family concerning their perspective of the threat to the family’s
well-being
ANS: D
The United States is a multicultural nation with diverse ethnic groups and diverse values. Before any intervention can be made, the
health care professionals must understand the family’s cultural, psychological, social, communal, and environmental contexts,
because these contexts affect the way issues are formulated and decisions are made. Consequently, it is crucial to interview the
family to determine their understanding of the situation before deciding what, if any, intervention must be made. In many cultures,
the family, rather than the individual, is the unit of primary concern. Setting up a surgical appointment immediately would not be
an appropriate action for the nurse to take as this would be a premature action for anyone who has just been told that she has
cancer. Assessing the family’s current living situation would not be the first concern of the nurse; the first concern should focus on
the family’s well-being. After assessing the family’s well-being, the next action of the nurse may be to educate the family about the
treatment and prognosis of breast cancer.
lOMoARcPSD|13778330

Loading page 24...

5. The nurse learns that a family has declined an elective medical intervention for a health care problem because paying for the care
would drastically reduce the family’s resources and ability to meet the needs of other family members. Ethically, which of the
following actions should be taken by the nurse?
a. Appreciate that the family has made the decision that it feels is best and take no
further action if it is clear the family has made an informed choice.
b. Stress that each individual in society has a right to health care and the family will
have to create some way to raise funds for the needed treatment.
c. Talk to the media to see whether a campaign to raise funds for the family can be
created.
d. Try to convince the agency to give the care for free, even if it means economic
stress for the agency, because the medical need is obvious.
ANS: A
According to Callahan, although the nurse may attempt moral persuasion to change the family’s values, in the absence of
immediate and grievous harm, no ethical requirement exists to interfere with the family’s values. Because there is no immediate or
grievous harm, it is not in the best interest of the nurse to interfere with the family’s decision. Thus, the other answers are not an
appropriate action for the nurse to take.
6. Some nurses are debating about the appropriate action to take in relation to a particular family. The father is ill, and the other
family members have chosen to continue working rather than take time off to care for the ill family member. One nurse states, “It is
a wife’s responsibility to care for an ill husband.” Which of the following ethical approaches is being used by this nurse?
a. Consequentialism
b. Communitarianism
c. Deontological ethics
d. Principlism
ANS: C
The nurse is focusing on duty, which is a deontological approach based on the moral obligation to engage in certain actions. The
nurse is focusing on duty, which is a deontological approach based on the moral obligation to engage in certain actions. Based upon
this understanding, none of the other options correctly describes the nurse’s statement.
7. Some nurses are debating about the appropriate action to take in relation to a particular family. One member of the family is ill, and
the other family members have chosen to continue working rather than take time off to care for the ill family member. One nurse
states, “The whole family is being affected and will fall apart if they don’t focus on their family’s needs first before anything else.”
Which of the following ethical approaches is being used by this nurse?
a. Communitarianism
b. Deontology
c. Principlism
d. Utilitarianism
ANS: D
By focusing on the whole family, not individual members, and the consequences or outcomes for the whole family during this time
of stress, the nurse is taking a utilitarian approach. Principlism relies on these ethical principles to guide decision-making.
Communitarianism is similar to virtue ethics and looks at the relationship and responsibility between the individual and the
community. The ethical approach of deontology describes adhering to moral rules or duty rather than to the consequences of the
actions.
8. Some nurses are debating about the appropriate action to take in relation to a particular family. One member of the family is ill, and
the other family members have chosen to continue working rather than take time off to care for the ill family member. One nurse
states, “But it doesn’t have to be an either/or situation. Perhaps each family member could take a turn calling in sick just 2 or 3
days. That way they could all take a turn at helping and yet not upset their employers. Wouldn’t that be fair?” Which of the
following ethical approaches is being used by this nurse?
a. Communitarianism
b. Deontology
c. Principlism
d. Utilitarianism
ANS: C
The nurse is focusing on ethical principles—in this case, beneficence (do good for the ill family member), nonmaleficence (do no
harm, even to the employer), and justice (everyone takes a turn and shares equally). Communitarianism is similar to virtue ethics
and looks at the relationship and responsibility between the individual and the community. The ethical approach of deontology
describes adhering to moral rules or duty rather than to the consequences of the actions. Utilitarianism is a consequentialist ethical
theory associated with outcomes or consequences in determining which choice to make.
9. Some nurses are debating about the appropriate action to take in relation to a particular family. One member of the family is ill, and
the other family members have chosen to continue working rather than take time off to care for the ill family member. One nurse
states, “It’s not up to us; it’s the family’s decision. They know what is best for them.” Which of the following ethical approaches is
being used by this nurse?
a. Communitarianism
b. Deontology
c. Principlism
d. Utilitarianism
ANS: C
The nurse is using an ethical principle, namely autonomy, in which each person or group can choose those actions that fulfill its
values and goals. Therefore, the nurse is using Principlism—that is, basic principles are the basis of the nurse’s actions.
Communitarianism is similar to virtue ethics and looks at the relationship and responsibility between the individual and the
community. The ethical approach of deontology describes adhering to moral rules or duty rather than to the consequences of the
actions. Utilitarianism is a consequentialist ethical theory associated with outcomes or consequences in determining which choice
to make.
lOMoARcPSD|13778330

Loading page 25...

10. Which of the following is the dominant issue in ethical debate around an issue such as continuing or withdrawing treatment in acute
health care?
a. Doing what is best for the community
b. Doing what is best for the family
c. Obeying legal mandates
d. Upholding ethical principles
ANS: D
In acute care settings with a single localized issue, the primary ethical principles are usually applied, with patient autonomy being
the dominant or most crucial principle. Upholding ethical principles should be the first consideration before obeying legal mandates
or doing what is best for the community or family.
11. The staff cannot reach an agreement on what is the right thing to do in relation to a specific patient. Which of the following
approaches should the nurse use in personally deciding what is right?
a. Do whatever will not get the nurse in trouble with employer.
b. Do whatever is supported by an ethical expert, such as the hospital chaplain.
c. Do whatever the nurse would recommend to anyone in a similar situation.
d. Do whatever the nurse supervisor would feel comfortable reporting to
administration.
ANS: C
One of the rules in deontological decision-making is to determine whether the proposed actions can be generalized so that all
persons in similar situations are treated similarly. In the same way, Principlism suggests the nurse examine the context and make
the decision that can be morally justified within that context. In order to apply the deontological ethics decision process, the nurse
must first determine the moral rules that serve as standards by which individuals can perform their moral obligations, examine their
own personal motives, and then determine whether the proposed actions can be generalized. Doing whatever will not get the nurse
in trouble, whatever is supported by an ethical expert, or whatever the nurse supervisor feels comfortable with is not an appropriate
way to make an ethical decision.
12. A man entered the emergency department bleeding profusely and screaming, “I’ve got to see a doctor right now! I’ve got a right to
see a doctor! I’m hurt. You have to take care of me!” Which of the following premises would ethically justify such a demand for
immediate attention?
a. All hospitals receive federal money and all capable employed adults pay taxes, so
all adults have a right to what their tax money has purchased.
b. Saving an individual’s life improves society and upholds tradition.
c. Our society believes that all persons should be treated equally and that basic
needs, such as not dying if death can be avoided, should be met.
d. The man has a property right to his own body, and the government is responsible
to ensure that property rights are protected.
ANS: C
The ethical theory of egalitarianism suggests that everyone is entitled to equal rights, equal treatment, and an equal share of the
goods of society—and that the government’s role is to ensure this happens, at least on a basic level. Therefore, the man has a right
to emergency care. Hospital funding and use of taxpayer money does not demonstrate the use of an ethical principle. Saving an
individual’s life may or may not improve society. There is not an ethical principle that states that the man has a property right to his
own body.
13. From an ethical standpoint, what is the problem with the belief that everyone should receive his or her fair share, that life should
always be fair, and that everyone should make his or her own decisions?
a. With this belief, the needs of society as a whole are ignored.
b. Insufficient resources exist to give everyone a fair share.
c. This belief leads to a propensity for some people to like to be taken care of.
d. Some people think they deserve more than others.
ANS: A
All principles of justice focus on the individual, which ignores the needs of society as a whole. The rights of an individual may
conflict with the rights of the community as a whole. It is recognized that distribution should be based on what needs and deserves
there is considerable disagreement that exists when considering what these terms mean in the context of fairness.
14. A health care provider refuses to order pain medication for a drug addict who has been severely injured in a car accident. When
reminded by nurses that pain medication has not been ordered, the provider merely replies that the patient’s suffering from the pain
of his injuries will build character and that the addicted patient needs to get off drugs. Which of the following ethical theories is
being using (or misusing)?
a. Consequentialism
b. Communitarianism
c. Deontological ethics
d. Virtue ethics
ANS: D
Virtue ethics emphasizes practical reasoning applied to character development. Although such action by a care provider is
paternalistic and unethical on many grounds, the physician may truly be concerned with enabling the injured addict to learn from
his experience and possibly develop into a drug-free person. Communitarianism is similar to virtue ethics and looks at the
relationship and responsibility between the individual and the community. When decisions are based on outcomes or consequences,
it is known as consequentialism. The ethical approach of deontology describes adhering to moral rules or duty rather than to the
consequences of the actions.
lOMoARcPSD|13778330

Loading page 26...

15. Which of the following is considered the most important goal in nursing today?
a. Adapting to technological advances such as electronic medical records
b. Demonstrating caring as the basis of nursing practice
c. Distinguishing nursing care from medical care
d. Seeking evidence-based outcomes to demonstrate nursing’s contribution to care
ANS: B
Since the mid-1980s, nurses have written about caring as the essence of nursing and as the ethical and moral ideal of nursing
practice. Caring is part of the core values of public health nursing and addresses the importance of the fiduciary relationship
between the patient and the care provider. The primary goal of nursing is not to adapt to technological advances, distinguish
nursing from medical care, or seek evidence-based outcomes; rather, the goal of nursing is to implement caring which has been the
moral ideal of nursing for many years.
16. With which of the following ethical approaches are Gilligan and Noddings associated?
a. Distributive justice approach
b. Feminine ethic
c. Principlism approach
d. Virtue ethics
ANS: B
Gilligan and Noddings are associated with the approach known as the feminine ethic, which focuses on the morality of
responsibility in relationships that emphasize connection and caring as a moral imperative. Distributive justice (fair distribution of
the benefits and burdens of society), Principlism (relying on ethical principles for decision- making), and virtue ethics (seeking to
enable persons to flourish as human beings) were not developed by Gilligan and Noddings.
17. How are ethics and public policies similar?
a. Both are abstract principles that often differ in actual practice.
b. Both are best achieved by persons in high political office who can effect change.
c. Both strive for the public good.
d. Both use general principles in making decisions.
ANS: C
An important goal of both policy and ethics is to achieve the public good, and both are involved in good citizenship. Ethics
involves the application of specific principles when making decisions. There is nothing that supports that ethics and public policies
are better achieved by those in high political office.
18. A new nurse states to a nursing colleague, “But why do I have to be involved in politics? I just want to be the very best clinical
nurse I can.” Which of the following would be the best response from the nursing colleague?
a. “As long as you pay your membership fee to the American Nurses Association,
you have participated in the profession’s political endeavors.”
b. “Political action is the way you try to fulfill your ethical responsibilities to
clients.”
c. “You’re absolutely right; if you are good clinically, you have fulfilled your
obligation.”
d. “When you’ve completed your clinical orientation, then you’ll have time to be
involved in politics.”
ANS: B
To be a good clinical nurse, the nurse needs resources and supportive policies that can be obtained only through political action to
ensure those very resources and policies. Many clients are members of vulnerable groups who have often previously lacked access
to quality care at an affordable cost. The American Nurses Association Code of Ethics for Nurses emphasizes political action as the
mechanism to affect social justice and reform regarding homelessness, violence, and stigmatization. Nurses need to be involved in
the political process in more ways than only being a dues paying member to the American Nurses Association. Clinical practice is
not the same as political involvement; political involvement is necessary to achieve the advocacy role of the nurse. Nurses must
make a conscious effort to be involved in political action.
19. Which of the following would confirm that the nurse’s advocacy has been truly successful or effective?
a. Audiences agree with the nurse who is serving as advocate.
b. Legislators discuss appropriate legislation to better allocate resources.
c. People verbalize that the disenfranchised should be better treated.
d. Systematic social changes are made to improve quality of life.
ANS: D
Advocacy is the application of information and resources to effect systematic changes that shape the way people in a community
live to reduce death and disability and improve quality of life in the community. Only when systematic social changes are made to
improve quality of life can advocacy be considered truly effective. Systematic change encompasses the complete role of the nurse
as an advocate. Audiences do not necessarily have to agree with the nurse who is serving as advocate as different populations may
have different views than the nurse. Advocacy goes beyond only working with legislators to allocate resources. Serving those who
are disenfranchised is only one part of the advocacy role.
20. How can nurses know whether they have been effective in assessing the community and planning and implementing appropriate
interventions?
a. Ask community leaders for their opinion of the interventions.
b. Examine the morbidity and mortality rate of the community.
c. Reassess the community to determine whether obvious needs have been met.
d. Systematically survey community residents regarding their perception.
ANS: B
The end products of appropriate advocacy are decreased morbidity and mortality. In other words if advocacy has been effective,
public health problems will be decreased. Effectiveness cannot be assessed accurately by asking community leaders for their
opinions, reassessing the community, or surveying community members regarding their perception; data must be collected to
determine results.
lOMoARcPSD|13778330

Loading page 27...

21. How can ethics be applied to public health nursing practice?
a. Ethics and actual nursing practice are not related.
b. Knowing ethics allows nurse to recognize the source of most problems.
c. Ethics is constantly involved in nurses’ clinical decisions.
d. Although ethics is important, political and legal responsibilities are more
important in practice.
ANS: C
Ethical problems in public health nursing include inequities in power, unacceptable practices, inequitable resource allocation,
conflict between ethics and law, and inadequate systems support for nursing. Therefore, ethics permeates every aspect of public
health nursing as nurses attempt to meet the needs of the community. Ethical principles are applied in nursing practice on a regular
basis and assist with problem-solving. The use of ethics does not allow the nurse to recognize the source of most problems. The
used of ethics is more important than political and legal responsibilities in practice.
MULTIPLE RESPONSE
1. Three nurses disagree over the appropriate treatment for a woman who is an excellent candidate for hospice care. The first nurse
believes that deciding on care rather than cure is the woman’s decision and no one else can decide for her. The second nurse says
that it is the responsibility of the health care team to do good for the woman, and if the physician thinks there is still a possibility of
cure, then the nurses should do everything they can to implement the treatment plan. The third nurse states that it isn’t fair for the
family members to expend all their resources on the woman, who is probably going to die anyway. Which of the following
conclusions can be drawn from this dispute? (Select all that apply.)
a. Ethical principles can conflict with one another.
b. The nurses are each using different ethical approaches.
c. The first nurse is correct because autonomy demands that the woman decide for
herself.
d. There is no single accepted approach for resolving such disagreements.
ANS: A, B, D
One of the criticisms of using ethical principles is that they can conflict with one another in any given situation. No rule exists for
helping resolve such conflicts. Each nurse can apply different ethical principles to reach their own ethical decision. Because there is
no one rule to assist with solving an ethical conflict, and ultimately no one right answer, there is not a correct decision that can be
made.
lOMoARcPSD|13778330

Loading page 28...

Chapter 07: Culture of Populations in Communities
Stanhope: Foundations for Population Health in Community/Public Health Nursing, 6th Edition
MULTIPLE CHOICE
1. Which of the following best describes most Americans’ attitude toward immigrants?
a. Ambivalence, because there are no clear solutions about how to address their
needs.
b. Strongly negative, because immigrants take jobs that native-born Americans
could have instead.
c. Strongly positive, because immigrants bring useful job skills and often join
previous family members already in the United States.
d. Strong opposition to further immigration, because of the increasing population in
the United States.
ANS: A
Most Americans are ambivalent about immigration, recognizing both the positive and negative aspects involved and realizing that
it is a complex issue that has no clear solutions. Because Americans are ambivalent, there is neither a strong negative nor a positive
attitude toward immigrants. However, many times immigrants do enter the United States because they have useful job skills or
family ties. They are more likely to be low-income workers who work in low-wage, blue-collar jobs and industries.
2. Earlier in the week, a nurse carefully taught a patient from a different culture exactly how much medication to take and emphasized
the importance of taking the correct amount. However, the patient is back in the hospital today with symptoms of an overdose
although the patient denies taking more than the label indicated. Which of the following is the most likely explanation?
a. The patient was taking more mediation in the hope of getting well faster.
b. The patient was also taking folk medicines that had many of the same effects and
perhaps some of the same ingredients as the prescribed medication.
c. The patient truly did not understand and thought the dose being taken was correct.
d. The patient had a unique response to the medication and should have a smaller
dose ordered.
ANS: B
For fear of disapproval, a person may not tell the nurse that he or she is using folk medicine as well as Western medication. The
two medicines may have cumulative effects that could be dangerous to the client. Nurses who lack cultural knowledge may develop
feelings of inadequacy and helplessness because they are often unable to effectively help their clients. It is unlikely that the patient
was taking too much medication, taking the incorrect dose, or having a unique reaction to the medication. Rather the nurse should
first interview the patient about use of folk medicine which may interact with the prescribed medication regimen.
3. A nurse wishes to develop cultural competence. Which of the following actions should the nurse take first?
a. Complete a survey of all the various ethnicities represented in the nurse’s
community.
b. Consider how the nurse’s own personal beliefs and decisions are reflective of his
or her culture.
c. Invite a family from another culture to join the nurse for an event.
d. Study the beliefs and traditions of persons living in other cultures.
ANS: B
Cultural awareness requires self-examination and an in-depth exploration of one’s own beliefs and values as they influence
behavior. Cultural awareness is the first element in the model of cultural competence. Following the development of cultural
awareness, the next step is cultural knowledge in which information about organizational elements of diverse cultures and ethnic
groups is collected. The next stage of the model, cultural skill, occurs with the effective integration of cultural awareness and
cultural knowledge to obtain relevant cultural data and meet the needs of culturally diverse clients. The fourth construct essential to
this model is cultural encounter, which is the process that permits nurses to seek opportunities to engage in cross-cultural
interactions with clients of diverse cultures to modify existing beliefs about a specific cultural group.
4. A nurse is caring for a client of another culture. Which of the following actions would be the most appropriate for the nurse to take?
a. Alter personal nonverbal behaviors to reflect the cultural norms of the client.
b. Keep all behaviors culturally neutral to avoid misinterpretation.
c. Rely on friendly gestures to communicate caring for the client.
d. Avoid any pretense of prejudice by treating the client in the same way as any
other client.
ANS: A
Cultural competence in nursing includes adoption of culturally congruent behaviors. Culturally skillful nurses use appropriate touch
during conversation, modify the physical distance between themselves and others, and use strategies to avoid cultural
misunderstandings while meeting mutually agreed-upon goals. Nurses who strive to be culturally competent are expected to respect
other cultures and value diversity. These behaviors tend to provide more responsive care. Nurses should be knowledgeable of other
cultures and communicate with the client based on cultural norms. Culturally skillful nurses understand the unique difference
among individuals within a given culture and work with those individuals to learn more about their culture and provide culturally
sensitive care.
lOMoARcPSD|13778330

Loading page 29...

5. A male nurse had a habit of sitting with the lower part of one leg resting over the knee of his opposite leg when collecting a client’s
history. He stopped doing this around specific clients after being told that they were offended when he exposed the sole of his foot
(shoe) to their face. Which of the following was exhibited by the nurse when he changed his behavior?
a. Cultural accommodation
b. Cultural imposition
c. Cultural re-patterning
d. Cultural skill
ANS: D
Cultural skill is the effective integration of cultural knowledge and awareness to meet client needs—in this case, the clients need to
not be offended by having the bottom of the nurse’s foot or shoe in view of the client’s face. The nurse using cultural skill makes
sure that nonverbal communication techniques take into consideration the client’s use of body language and space. Cultural
accommodation involves negotiation with clients to include aspects of their folk practices with the traditional health care system to
implement essential treatment plans. Cultural imposition is the process of imposing one’s values on others. Cultural re-patterning is
working with clients to make changes in their health practices if cultural behaviors are harmful or decrease their well-being.
6. The nurse practitioner (NP) discovered that an immigrant client is not taking the penicillin prescribed because his illness is “hot”
and he believes that penicillin, a “hot” medicine, will not provide balance. Which of the following terms best describes the action
taken by the NP when the client’s prescription is changed to a different yet equally effective antibiotic?
a. Cultural awareness
b. Cultural brokering
c. Cultural knowledge
d. Cultural skill
ANS: C
Cultural knowledge is information about organizational elements of diverse cultures and ethnic groups; emphasis is on learning
about the client’s worldview from an emic (native) perspective. Cultural skill involves the provision of care that is beneficial, safe,
and satisfying to the client. The medication change allows the client to retain his cultural beliefs and also satisfies the nurse
practitioner’s need to prescribe an effective antibiotic. Cultural awareness is the self-examination and in-depth exploration of one’s
own biases, stereotypes, and prejudices that influence behavior. Cultural brokering is advocating, mediating, negotiating, and
intervening between the client’s culture and the biomedical health care culture on behalf of clients.
7. An immigrant who takes metamizole (banned in the United States) for pain may experience life-threatening agranulocytosis. Which
of the following actions would be taken by a nurse who employs cultural re-patterning?
a. Complete a cultural assessment to identify any other dangerous medications that
the client may be taking.
b. Put this into perspective by considering that many drugs used in the United States
cause agranulocytosis.
c. Explain the harmful effects of metamizole and recommend an alternative
medication for pain.
d. Recognize that taking metamizole is common among persons living in Mexico
and accept this as a cultural tradition.
ANS: C
Cultural re-patterning means that the nurse works with clients to help them reorder, change, or modify their cultural practices when
the practice is harmful to them. Completing a cultural assessment involves learning more about the client’s culture but does not
address the need to consider changing or modifying cultural practices. In order to complete cultural re-patterning, the nurse has to
take an action to resolve this potential problem.
8. A health care worker tells a nurse, “It does no good to try to teach those Medicaid clients about nutrition because they will just eat
what they want to no matter how much we teach them.” Which of the following is being demonstrated by this statement?
a. Cultural imposition
b. Ethnocentrism
c. Racism
d. Stereotyping
ANS: D
Stereotyping occurs when someone attributes certain beliefs and behaviors about a group to an individual without giving adequate
attention to individual differences. In this instance, the health care worker makes the assumption that clients with low incomes are
not educable. The health care worker is guilty of making another assumption as well: noncompliance among other Medicaid clients
the worker has known may have been related to an inability to afford nutritious food. Cultural imposition is the belief in one’s own
superiority, or ethnocentrism, and is the act of imposing one’s values on others. Ethnocentrism is a type of cultural prejudice at the
population level which involves the belief that one’s own group determines the standards for behavior by which all other groups
should be judged. Racism refers to the belief that persons who are born into a particular group are inferior in intelligence, morals,
beauty, or self-worth.
9. An American nurse says, “I’m not going to change the way I practice nursing based on where the client is from because research
shows that Western health care technology and research is best.” Which of the following is being demonstrated by the nurse’s
statement?
a. Ethnocentrism
b. Prejudice
c. Racism
d. Stereotyping
ANS: A
Ethnocentrism, a type of cultural prejudice at the cultural population level, is the belief that one’s own group determines the
standards for behavior by which all other groups are to be judged. For example, some American nurses and providers may think,
“The way we do it is the only right way to provide this care.” Prejudice refers to having a deeply held reaction, often negative,
about another group or person. Racism refers to the belief that persons who are born into a particular group are inferior in
intelligence, morals, beauty, or self-worth. Stereotyping occurs when attributing certain beliefs and behaviors about a group to an
individual without giving adequate attention to individual differences.
lOMoARcPSD|13778330

Loading page 30...

10. A nurse states, “The best way to treat a client from another country is to care for them the same way we would want to be cared for.
After all, we are all humans with the same wants and needs.” What does this statement reflect in relation to culture?
a. Awareness
b. Blindness
c. Knowledge
d. Preservation
ANS: B
Cultural blindness is the tendency to ignore differences between cultures and to act as if they do not exist. People from different
cultures may have different expectations, wants, and needs. Cultural awareness is the self-examination and in-depth exploration of
one’s own biases, stereotypes, and prejudices that influence behavior. Cultural knowledge is information about organizational
elements of diverse cultures and ethnic groups; emphasis is on learning about the client’s worldview from an emic (native)
perspective. Cultural preservation means that the nurse supports and facilitates the use of scientifically supported cultural practices
from a person’s culture along with those from the biomedical health care system.
11. A Spanish-speaking family comes to the public health department. No one in the family speaks English, and nobody at the health
department speaks Spanish. Which of the following actions should be taken by the nurse?
a. Attempt communication using an English–Spanish phrase book.
b. Call the local hospital and arrange a referral.
c. Emphatically state, “No hablo Español” (I don’t speak Spanish).
d. Obtain an interpreter to translate.
ANS: D
Communication with the client or family is required for a careful assessment. When nurses do not speak or understand the client’s
language, they should obtain an interpreter. The nurse must use strategies that will allow effective communication with the client.
The client has the right to receive effective care, to judge whether the care was appropriate, and to follow up with appropriate
action if the expected care was not received. The nurse must contact an interpreter in order to provide the best care for the
client—attempting communication using a book, stating that he or she does not speak English, and arranging for a referral do not
address the priority action of finding an interpreter.
12. A nurse who is explaining to an immigrant client why it is important to take medication states, “The medication takes a couple of
weeks to be effective, but then you should feel better.” When the client is next seen, no medication has been purchased. Which of
the following is the most likely explanation?
a. The nurse emphasized that eventually the client would feel better, but the client
needed to feel better immediately so didn’t bother with the drug.
b. The medication required a trip to the pharmacy, and the client just hadn’t had
time to obtain the drug yet.
c. The medication was too expensive for the client’s family.
d. The client really hadn’t understood why the medication was important.
ANS: A
If we look closely at what the nurse stated, there may have been a cultural disconnect based on time perception. Many nurses are
future oriented, whereas many families may place greater value on quality of life and view present time as being more important.
When nurses discuss health promotion and disease prevention strategies with persons from a present orientation, they should focus
on the immediate benefits these clients would gain rather than emphasizing future outcomes. The cultural disconnect of time should
be the immediate concern of the nurse. It is possible that the client did not have the necessary resource or did not understand the
importance of the medication, but the nurse should first investigate the potential cultural disconnect.
13. A client is crying softly and saying, “What did I do to deserve this punishment, Lord?” Which of the following responses by the
nurse would be the most appropriate?
a. “God doesn’t punish people. You’re sick just because of bad luck.”
b. “I can call the hospital chaplain to help you talk about these feelings.”
c. “What can I do to be helpful to you right now?”
d. “Would you like to confess your sins and repent so this illness will go away?”
ANS: C
Some clients may view their illness as punishment for misdeeds and may have difficulty accepting care from nurses who do not
share their beliefs. Because the nurse may not be a member of the client’s religious faith group, an open-ended response showing
caring is the most appropriate statement. The most therapeutic response from the nurse is an open-ended question. This allows the
client to share information and not feel like his or her actions are being judged by the nurse. Also, this allows the nurse to not give
advice or offer false information to the client.
14. A patient who identifies as Buddhist enters the hospital for diagnostic testing just before lunch time. The nurse tells the aide to give
a meal tray to the new patient, because no tests will be done until later that evening. The aide gives the patient a meal of Salisbury
steak, bread, green beans, and potatoes with brown gravy. The patient eats nothing but a slice of bread and the green beans. Which
of the following considerations was omitted by the nurse?
a. The patient should not be served any food until a primary care provider’s order is
obtained.
b. The patient’s Buddhist faith probably requires a vegetarian diet.
c. The patient may be too frightened about the tests to want to eat very much.
d. The patient may have diabetes or be allergic to some foods.
ANS: B
Although it is always wise to check with a patient before sending in food, the meal given to this patient was offensive. Most
Buddhists are vegetarians and don’t eat meat. The nurse should be aware of the cultural considerations that should be made for
Buddhist patients. The nurse should ask the client about dietary restrictions before ordering a meal for the client so that these
considerations can be made. The nature of the test determines the fasting requirements; no order is needed. Whether the client is
diabetic or allergic to some foods should be determined upon admission.
lOMoARcPSD|13778330

Loading page 31...

28 more pages available. Scroll down to load them.

Preview Mode

100%

Study Now!

XY-Copilot AI

Unlimited Access

Secure Payment

Instant Access

24/7 Support

AI Assistant

Document Details

Subject

Nursing

Test Bank for Foundations for Population Health in Community/Public Health Nursing, 6th Edition (Chapters 1-32)

Study Now!

Document Details

Related Documents

The Psychiatric-Mental Health Nurse Practitioner Certification Review Manual (2020)

Test Bank for Medical-Surgical Nursing in Canada, 4th Edition

Test Bank for Community and Public Health Nursing: Evidence for Practice, 3rd Edition (Chapters 1-25)

Test Bank For Psychiatric Mental Health Nursing: Concepts Of Care In Evidence-Based Practice, 8th Edition

Test Bank for Pharmacology and the Nursing Process, 10th Edition (Chapters 1-57)

Test Bank For Understanding Medical-Surgical Nursing, 5th Edition

Test Bank for Fundamentals of Nursing, 11th edition (Chapters 1-24)

Test Bank for LPN to RN Transitions, 5th Edition (Chapters 1-18)

Test Bank for Maternity and Women's Health Care, 13th Edition (Chapters 1-37)

Test Bank for Fundamentals of Nursing, 10th Edition (Chapters 1-11)