1 - Community and Prevention-Oriented, Population-Focused Practice

Question 1

A community is concerned about the threat of bioterrorism. Which of the following best describes the basis for this concern?

a. ) Bioterrorism has the potential to dissolve community-based programs.
b. ) This threat could cause the health care system to collapse.
c. ) The threat of bioterrorism may divert funds from other public safety health care programs.
d. ) Fear of bioterrorism will increase the need for shelters.

Answer 1

c.) The threat of bioterrorism may divert funds from other public safety health care programs.

Bioterrorism may have an impact on the availability of resources for public safety health care programs. Because funds are diverted it is possible that community-based programs would be eliminated, the health care system could experience changes, and that there would be an increase in the need for shelter. However, all of these things would happen because of the diversion of funds.

Question 2

A PHN develops and implements local public health policies through partnerships with agencies, organizations, and consumers within the community. Which of the following core public health functions is being used?

a. ) Assessment
b. ) Prevention
c. ) Assurance
d. ) Policy development

Answer 2

d.) Policy development

Policy development deals with developing and implementing health policies.

Prevention is not a core function, assurance is making sure essential services are available, and assessment refers to systematic data collection.

Question 3

The nurse manager makes sure that the staff members who work in a local clinic are competent in their job responsibilities. Which of the public health core functions is being demonstrated?

a. ) Assurance
b. ) Assessment
c. ) Prevention
d. ) Policy development

Answer 3

a.) Assurance

Assurance refers to making sure a competent health care workforce is available. Prevention is not a core function, assessment refers to systematic data collection, and policy development refers to the need to provide leadership in developing health policies.

Question 4

The PHN analyzes data related to the number and type of United States Environmental Protection Agency air quality standards that a community failed to meet. This data is an example of using which community health profile indicator?

a. ) Sociodemographic characteristics
b. ) Health status
c. ) Health risk factor
d. ) Functional status

Answer 4

c.) Health risk factor

Health risk factors discuss proportions of populations who have particular health conditions or health risks; breathing air of poor quality is a risk to health. The number and proportion of people is a sociodemographic characteristic. Health status includes birth and death rates. Functional status refers to reports of good health status by members of the population.

Question 5

A population is best defined as a:

a. ) high-risk group.
b. ) those interacting within a school or institutional setting.
c. ) collection of individuals who share at least one common characteristic.
d. ) geographical location within a community.

Answer 5

c.) collection of individuals who share at least one common characteristic.

A population or aggregate is a collection of individuals who have one or more personal or environmental characteristics in common. High risk groups, school or institutional setting, and geographical location within the community all describe types of populations, not the definition of population.

Question 6

A PHN has been prepared at the graduate level. Which of the following activities should the practitioner be able to complete?

a. ) Teach public and community health nursing
b. ) Assess and intervene successfully at the aggregate level
c. ) Diagnose and treat disease and have prescriptive authority
d. ) Run for political office as experts in public health policy

Answer 6

b.) Assess and intervene successfully at the aggregate level

According to the Consensus Conference, specialists should have assessment skills that allow them to intervene at the aggregate level. Public health practitioners have a broad range of practice areas within public health and are not limited to only nursing and medicine.

Question 7

The PHN compares the rate of teenage pregnancy in various areas of the city. Which of the core functions of public health is being implemented?

a. ) Assurance
b. ) Assessment
c. ) Prevention
d. ) Policy development

Answer 7

b.) Assessment

Assessment refers to systematic data collection, which this nurse is doing for teenage pregnancy. Prevention is not a core function, assurance is making sure essential services are available, and policy development is needed to provide leadership in developing policies.

Question 8

The nurse is investigating environmental health problems caused by contaminated ground water. Which of the following types of nursing practice is being used?

a. ) Community-oriented
b. ) Community-based
c. ) Policy development
d. ) Tertiary care

Answer 8

a.) Community-oriented

Community-oriented nursing emphasizes the prevention of disease and disability. Community-based nursing practice is a setting-specific practice whereby care is provided for clients and families where they live, work, and attend school. Policy development seeks to build constituencies that can help bring about change in public policy. Tertiary care focuses on highly specialized medical care.

Question 9

A nurse is conducting vision screenings on children in the school setting. Which type of nursing practice is the nurse performing?

a. ) Community-oriented
b. ) Public health
c. ) Community health
d. ) Community-based

Answer 9

d.) Community-based

Community-based nursing practice is a setting-specific practice whereby care is provided for clients and families where they live, work, and attend school. Community-oriented nursing emphasizes the prevention of disease and disability. Public health nursing focuses on the care within the community as a whole. Community health nursing focuses on the health status of individuals and the effect of their health status on the community as a whole.

Question 10

A nurse is working in a community health nursing practice setting. Which of the following is the nurse most likely to implement?

a. ) Administrating a flu shot to a client in a physician’s office
b. ) Conducting a flu shot clinic at a community center
c. ) Performing a client assessment in a hospital
d. ) Providing supervision of staff in a rehabilitation center

Answer 10

a.) Administrating a flu shot to a client in a physician’s office

Community health nursing practice focuses on the health of individuals, families, and groups and the effect of their health status on the health of the community as a whole. Administrating a flu shot to an individual is the only example that meets this criterion. Performing a client assessment focuses only on individual care and not the community. Providing supervision of staff does not focus on the community. Conducting a flu shot clinic at a community center focuses on protecting the community as a whole and would be considered public health nursing practice.

Question 11

A public health department is using the mission of public health as described by the Institute of Medicine when planning its health programming. Which of the following activities will most likely be implemented?

a. ) Tracking avian flu outbreaks and doing surveillance in the United States
b. ) Providing a flu shot for an elderly person at the health department
c. ) Keeping track of alternative therapies in use in the United States
d. ) Keeping snake antivenom at the Centers for Disease Control and Prevention in Atlanta

Answer 11

a.) Tracking avian flu outbreaks and doing surveillance in the United States

The Institute of Medicine’s stated mission on public health is “to generate organized community and technical knowledge to prevent disease and promote health.” Tracking avian flu outbreaks and doing surveillance applies this concept at a population level. Providing a flu shot for an elderly person only addresses individual care. Keeping track of the use of alternative therapies does nothing to prevent disease or promote health of the population. Keeping snake antivenom is aimed at disease care for an individual, not health promotion or disease prevention.

Question 12

The purpose of public health core functions is to:

a. ) clarify the role of the government in fulfilling the mission of public health.
b. ) ensure the safety of populations in receiving quality health care.
c. ) provide community-based individualized care to every person in the United States.
d. ) unite public and private providers of care in a comprehensive approach to providing health care.

Answer 12

a.) clarify the role of the government in fulfilling the mission of public health.

As defined by the Institute of Medicine in its 1988 report The Future of Public Health, assessment, policy development, and assurance are core functions at all levels of government for the purpose of clarifying the government’s role.

Question 13

To better address emerging public health issues, a PHN plans to complete continuing education in this area. Which of the following content areas should be included in the course that is chosen?

a. ) Leadership
b. ) Ethics
c. ) Communication
d. ) Finance

Answer 13

b.) Ethics

Public health workers should be educated in eight content areas to be able to address emerging public health issues and advances in science and policy: (1) informatics, (2) genomics, (3) cultural competence, (4) community-based participatory research, (5) policy, (6) law, (7) global health, and (8) ethics.

Question 14

A public health department makes sure that the essential community-oriented health services are available in the community. Which of the following core public health functions is being implemented?

a. ) Policy development
b. ) Assessment
c. ) Assurance
d. ) Scientifi knowledge-based care

Answer 14

c.) Assurance

Assurance focuses on the responsibility of public health agencies to ensure certain activities have been appropriately carried out to meet public health goals and plans. Policy development seeks to build constituencies that can help bring about change in public policy. Assessment includes activities that involve collecting, analyzing, and disseminating information on both the health status and the health-related aspects of a community or a specific population. Public health is based on scientific knowledge, but is not a core function.

Question 15

A nurse is working in the community with an aggregate/population. Who is the nurse most likely to interact with?

a. ) Students in a county school system
b. ) Christians around the world
c. ) A patient in the intensive care unit at the local hospital
d. ) People who drink coffee

Answer 15

a.) Students in a county school system

A population or aggregate is a collection of individuals who have one or more personal or environmental characteristics in common. Members of a community who can be defined in terms of geography or a special interest can be seen as constituting a population. The clients in the first option share a geographical and special circumstance (school) characteristic. Christians around the world are too large of a geographical space. A patient cannot be an aggregate/population as there is no one to interact with. People who drink coffee share a common interest, but may not share a common geographical location to interact.

Question 16

The public health workforce should demonstrate competency in which of the following competency categories?

a. ) Financial planning and management
b. ) Workforce needs assessment
c. ) Acute care services
d. ) Curriculum development

Answer 16

a.) Financial planning and management

Workforce needs assessment, acute care services, and curriculum developments are not considered categories of core competencies of public health. Rather there are eight categories of competency, which include: (1) analytic/assessment, (2) policy development/program planning, (3) communication, (4) cultural competence, (5) community dimensions of practice, (6) basic public health sciences, (7) financial planning and management, and (8) leadership and systems thinking.

Question 17

Population-focused practice focuses on defining the problems or needs of and implementing solutions for:

a. ) individuals.
b. ) aggregates.
c. ) communities.
d. ) geographical regions.

Answer 17

b.) aggregates.

Aggregates are a defined population made up of individuals in communities of a specific geographical region. Population-focused practice is implemented with defined populations or subpopulations. This is larger than the scope of individual care, but may not address the larger needs of the entire community or geographical region.

Question 18

Which of the following are considered barriers to public health nursing? (Select all that apply.)

a. ) The mindset that the only role for the nurse is at the bedside
b. ) The structures within which nurses work and the process of role socialization within those structures
c. ) Few nurses receive graduate-level preparation in the concepts and strategies of the disciplines basic to public health
d. ) The steady decline in the number of job opportunities in the area
e. ) The inability to equally distribute the increasing funds

Answer 18

a.) The mindset that the only role for the nurse is at the bedside

b.) The structures within which nurses work and the process of role socialization within those structures

c.) Few nurses receive graduate-level preparation in the concepts and strategies of the disciplines basic to public health

Barriers exist in thinking that nurses only work in a hospital at the bedside, the process of role socialization in public health which can be a very autonomous profession, and that few nurses have had advanced education in public health. The number of job opportunities continues to increase, but the amount of funding allotted to public health continues to decline.

Question 19

A community health nurse collects data about the number and proportion of persons aged 25 or older with less than a high school education. Which of the following best describes this data?

a. ) Sociodemographic characteristics
b. ) Health status data
c. ) Health risk factors
d. ) Health care resource consumption information

Answer 19

a.) Sociodemographic characteristics

The number and proportion of people is a sociodemographic characteristic. Health status includes birth and death rates. Health risk factors discuss proportions of populations who have particular health conditions or health risks. Health care resource consumption refers to spending on health care per capita.

Question 20

A nurse performs activities to meet the primary goals of public health. Which of the following is the nurse most likely to complete?

a. ) Ensuring that a newly diagnosed 40-year-old hypertensive man takes his medication
b. ) Finding home care for a 70-year-old client recuperating from a hip replacement
c. ) Conducting an infant car seat safety check
d. ) Contacting a local hospice to admit a terminally ill 60-year-old woman

Answer 20

c.) Conducting an infant car seat safety check

The correct answer is concerned with the health of many people, while the other answers address individual interventions. According to the Core Functions Project, all levels of health care, including population-based public health care, must be funded or the goal of health of populations may never be reached.

Question 21

A nurse is using a population focus when providing public health nursing care. Which of the following statements best describes the care that is being provided?

a. ) Priority is given to the highest risk population.
b. ) Direct caregiving is limited to preventive measures, such as administration of immunizations.
c. ) Attention is given to the population or community as a whole, regardless of whether they do or do not access the health care system.
d. ) Only populations outside institutional settings are considered.

Answer 21

c.) Attention is given to the population or community as a whole, regardless of whether they do or do not access the health care system.

PHNs are concerned with the health of the entire population. Priority is given to the entire population, not just the group at highest risk or those outside of institutional settings. Direct caregiving is not the focus of public health nursing care.

Question 22

A nurse is implementing quality performance standards in a public health department. Which of the following best describes the importance of this action?

a. ) Quality performance standards are used to guide improvement in the public health system.
b. ) Quality performance standards rigidly control public health.
c. ) Quality performance standards guide administrators to monitor public health at the national level.
d. ) Quality performance standards can be used as hiring guidelines for nurses.

Answer 22

a.) Quality performance standards are used to guide improvement in the public health system.

These standards were developed by the Centers for Disease Control and Prevention in 1998. They set the bar for the level of performance that is necessary to deliver essential public health services (PHSs). These standards were developed around the 10 essential PHSs. They focus on the overall public health system rather than on single organizations and describe an optimal level of performance. They are intended to support a process of quality improvement. State and local communities can assess their performance using certain available tools. They are not meant to control public health or be used for hiring guidelines.

Question 23

A public health staff nurse has a clear understanding of population-focused practice. Which of the following characteristics would the nurse most likely display?

a. ) Volunteering for a local community action coalition
b. ) Able to perform interventions with individuals in the community
c. ) Able to improve the effectiveness of care provided
d. ) Considered a PHN specialist

Answer 23

c.) Able to improve the effectiveness of care provided

Public health staff nurses who have a clear understanding of population-focused care improve their effectiveness and efficiency of practice; have professional satisfaction by seeing how individual care contributes to health at the population level; and appreciate the practice of others who are population-focused specialists. PHN specialists are prepared at the master’s level and function in an administrative role.

Question 24

Public health nursing is a specialty because:

a. ) it has a distinct focus and scope of practice.
b. ) it must be done by a registered nurse with a master’s degree.
c. ) it is focused on disadvantaged citizens.
d. ) it performs interventions at the acute care level.

Answer 24

a.) it has a distinct focus and scope of practice.

Public health nursing has a distinct focus and requires a special knowledge base. The other answers are not characteristics of a specialty.

Question 25

A PHN collects data and monitors the health status of the population. Which of the following core public health functions is being implemented?

a. ) Assessment
b. ) Prevention
c. ) Assurance
d. ) Policy development

Answer 25

a.) Assessment

Assessment consists of systematic data collection and monitoring health status. Prevention is not a core function, assurance is making sure essential services are available, and policy development is needed to provide leadership in developing policies.

Question 26

A local senator has proposed changes to the health care delivery system in the United States. Based on current trends, which of the following is most likely to occur?

a. ) There will be new opportunities provided for public health specialists.
b. ) It will result in isolated care being provided to individuals.
c. ) There will be an increased emphasis in specialty care.
d. ) It will increase the utilization of acute care services.

Answer 26

a.) There will be new opportunities provided for public health specialists.

Proposed changes in the health care delivery system will provide new opportunities for public health specialists and result in the creation of new roles within the system. The proposed changes will build an integrated system (not isolated), decrease emphasis on acute care services, and focus on health promotion and disease prevention.

Question 27

Which statement about community health nursing practice is correct?

a. ) It focuses on the delivery of personal health services to individuals and families.
b. ) It provides care to protect the health of the community as a whole.
c. ) It emphasizes the setting where care is provided for clients and families.
d. ) It requires a baccalaureate preparation for practice.

Answer 27

a.) It focuses on the delivery of personal health services to individuals and families.

By definition, the first option is correct. Public health nursing provides care to protect the health of the community as a whole. Community-based nursing practice emphasizes the setting where care is provided for clients and families. It is generally assumed that a graduate of any baccalaureate program has the necessary basic preparation to function as a beginning staff PHN; however, this is not a requirement for public health nursing or community health nursing practices.

Question 28

A nurse provides for the availability of essential personal health services for people who would otherwise not receive health care. Which of the public health core functions is being used?

a. ) Assessment
b. ) Prevention
c. ) Assurance
d. ) Policy development

Answer 28

c.) Assurance

Assurance deals with the availability of health services. Prevention is not a core function, assessment refers to systematic data collection, and policy development refers to the need to provide leadership in developing health policies.

Question 29

PHNs are looking to improve population-focused care in the community. Which of the following best describes a key opportunity for the nurses to accomplish this goal?

a. ) Assuming traditional nursing roles
b. ) Influencing public health policy
c. ) Conducting community assessments
d. ) Specializing in community-based nursing practice

Answer 29

b.) Influencing public health policy

PHNs must move into positions in which they can influence policy formation. They must assume positions that are not traditionally considered nursing. Conducting community assessments is part of public health nursing practice, not necessarily a key opportunity to improve practice. Specializing in community-based nursing practice is setting-specific and does not relate to a key opportunity to improve population-focused care.

Question 30

Which of the following describes the consequence of the successful implementation of the Affordable Care Act?

a. ) Americans will pay closer attention to their health status.
b. ) The majority of the population will be covered by insurance.
c. ) Public health departments will need to increase the number of nursing positions.
d. ) The prevalence of obesity will decrease.

Answer 30

b.) The majority of the population will be covered by insurance.

One consequence of successful implementation of the Affordable Care Act might actually be that the majority of the population would be covered by insurance and public health agencies will not need to provide direct clinical services in order to assure that those who need them can receive them. The Affordable Care Act will not directly cause Americans to pay closer attention to their health status or decrease the prevalence of obesity.

Question 31

The public health nurse (PHN) must participate in the essential services of public health. Which of the following most accurately describes one of the essential services of public health?

a. ) Monitoring health status by completing a community assessment
b. ) Diagnosing and investigating health problems in the world
c. ) Informing, educating, and empowering people about health issues
d. ) Working in law enforcement to regulate health and ensure safety

Answer 31

c.) Informing, educating, and empowering people about health issues

The PHN monitors health status in several ways, completing a community assessment is only one way that health status is monitored. The PHN would not diagnose or solve “world” problems, or work in law enforcement. Rather, the PHN would participate with local regulators to protect communities and empower people to address health issues.

Question 32

One of the primary focuses of improving the health of the American people in the twenty-first century is to address:

a. ) bioterrorism and global health threats.
b. ) delivery of individual care and hygiene.
c. ) the need for increased hospital and acute care.
d. ) chronic disease and disability management.

Answer 32

a.) bioterrorism and global health threats.

There are new concerns, and of the most serious are bioterrorism and globally induced infections, such as the avian flu. These threats will divert health care funds and resources from other health care programs to be spent for public safety. The others are not related to public health or are concerns that have been present for many years.

Question 33

Which of the following statements about public health is accurate?

a. ) Prevention of early deaths can be more effectively accomplished by medical treatment than by public health approaches.
b. ) Expenditures and resources for public health have increased in recent years.
c. ) Historically, gains in the health of populations have been related largely to changes in safety, sanitation, and personal behavior.
d. ) Reform of the medical insurance system is the single change needed to improve the health of Americans.

Answer 33

c.) Historically, gains in the health of populations have been related largely to changes in safety, sanitation, and personal behavior.

Fielding and Tilson have asserted that most of the increase in life span has been made through improvements in sanitation, clean water supplies, making workplaces safer, improving food and drug safety, immunizing children, and improving nutrition, hygiene, and housing. Medical treatment has not made as significant of an impact on the life span as public health measures. Funding for public health in recent years has been on a gradual decline. Although reform of the medical insurance system may help improve the health of Americans, there are many other factors that will need to be addressed.

Question 34

A PHN provides a clinic for HIV-positive citizens in the community. Which of the following best describe this activity?

a. ) Primary prevention
b. ) Health education
c. ) Tertiary prevention
d. ) Policy making

Answer 34

c.) Tertiary prevention

This clinic is for clients who already have a disease process; therefore, it is tertiary prevention (preventing deterioration in a patient, a relapse, or disability and dependency by anticipatory nursing and medical care). Primary prevention is using general and specific measures in a population to promote health and prevent the development of disease (incidence) and using specific measures to prevent disease in those who are predisposed to developing a particular condition. Health education would involve providing specific education to this population. Policy making is formulating plans by an organization in order to make decisions.

Question 35

The necessary basic preparation for public health nursing is a(n) _____ in nursing.

a. ) associate’s degree
b. ) baccalaureate degree
c. ) master’s degree
d. ) Doctor of Nursing Practice degree

Answer 35

b.) baccalaureate degree

A bachelor of science in nursing (BSN) is the necessary basic preparation to function as a beginning staff PHN. An associate’s degree is not enough for basic preparation. A master’s degree or Doctor of Nursing Practice degree would be part of preparation for advanced practice.

Question 36

A nurse is implementing community-based nursing care. Which of the following nursing interventions is the nurse most likely to complete?

a. ) Assessing the health needs of a defined community
b. ) Providing care to families in a community
c. ) Promoting the health of an entire community
d. ) Investigating environmental health problems in a community

Answer 36

b.) Providing care to families in a community

Community-based nursing practice is a setting-specific practice whereby care is provided for families where they live, work, and attend school. The focus is on acute and chronic care and the provision of services. Providing care to families is the only intervention that accurately describes this definition. Assessing the health needs of a community, promoting the health needs of an entire community, and investigating environmental health problems in a community would be considered public health nursing practice.