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Community exam 1 - Test bank
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Community Health Nursing (NR-442)
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Chapter 01: Health: A Community View
Nies: Community/Public Health Nursing, 7th Edition
MULTIPLE CHOICE
1. Which best describes the primary reason that Americans are concerned about health care?
a. Politicians are discussing how to improve health care.
b. The media has provided mixed messages about the health care system.
c. Our national health care costs keep increasing.
d. The new health care system offers free services to Americans.
ANS: C
The primary reason for the focus on health care is the constantly increasing costs, which
cannot be sustained. The costs of caring for the sick accounted for the majority of escalating
health care dollars, which increased from 5% of the gross domestic product in 1965 to
17% in 2015. Politicians and the media both influence Americans’ perceptions about health
care; however, they are not the primary reason why Americans are concerned. The new health
care system will change the health care access and availability, but will not necessarily be
offering any free services to Americans.
DIF: Cognitive Level: Understand (Comprehension)
2. A nurse has begun to lobby with politicians for changes to the health care system. Why is this
involvement important?
a. Nurses, as central characters in several popular TV series, are currently very
visible in American media.
b. Nurses are primarily responsible for managing the various units in our health care
system.
c. Nurses are the largest segment of health care providers.
d. Nurses are the only group that is employed both inside and outside of hospitals.
ANS: C
As the largest segment of health care providers, nurses are informed about the current health
care system and all the problems that result from people not seeking care until they are
desperately ill. Nurses, as the American Nurses Association (ANA) emphasize, usually
believe that health care is a right, not a privilege. Therefore, nurses, whose work is central to
our current health care delivery system, can also be instrumental in working politically to
create a health care delivery system that will meet health needs. While nurses are in several
current TV series and are employed both inside and outside of hospitals, physicians and other
health care providers are as well. Nurses are often managers, but managers often have other
backgrounds, such as business administration.
DIF: Cognitive Level: Understand (Comprehension)
3. What conclusion can be drawn from examining where nurses are employed?
a. There is a trend toward consolidation of health care into large central medical
centers.
b. There is an increased emphasis on community-based health care.
c. There is an obvious need to decrease health care costs by cutting positions.
d. Managed care organizations (MCOs) are employing nurses to improve customer
relations.
ANS: B
MCOs are employing nurses in many capacities. Although hospitals are closing and acute care
is increasingly found in central medical centers, the same trend may be seen in an increase in
neighborhood-based practice centers. While positions are cut in most industries, health care is
recognized as an area where growth in employment is expected. However, nurses are
increasingly employed in community settings as opposed to hospitals. This change reflects the
move toward community-based care rather than hospital-based tertiary care. To help decrease
the continued rise in health care costs, the increased emphasis is on disease prevention rather
than high-cost treatment.
DIF: Cognitive Level: Understand (Comprehension)
4. Which ethical belief would be most helpful in the current health care crisis?
a. Emphasis should be on individual and corporation freedom in the marketplace.
b. Emphasis should be on individual autonomy and freedom of choice.
c. Emphasis should be on social justice and collective responsibility.
d. Emphasis should be on the effectiveness of technology in resolving problems.
ANS: C
Public health recognizes the necessity of collective action in keeping the environment safe and
in egalitarian tradition and vision. An overinvestment in technology and seeking of cures
within the market justice system has stifled the evolution of a health system to protect and
preserve the health of the population. Although individual autonomy and freedom of choice
are important, so is the recognition of collective responsibility in ensuring social justice,
which entitles all people to basic necessities.
DIF: Cognitive Level: Apply (Application)
5. What is the primary problem seen in Healthy People 2020’s emphasis on choosing healthy
lifestyle behaviors, such as daily exercise or healthy food choices?
a. Emphasis on other lifestyle choices, such as not smoking and minimal use of
alcohol or drugs, is also needed.
b. All of us must work together to make unhealthy behaviors socially unacceptable.
c. It costs more to make healthy choices, such as buying and eating fresh fruits and
vegetables as opposed to quick and cheap fast-food choices.
d. Public policy emphasizes personal responsibility but ignores social and
environmental changes needed for well-being.
ANS: D
Although all responses are accurate, the primary problem is the emphasis on personal choices
in the Healthy People 2020 objectives. Emphasis on personal choices ignores the need for
community responsibility and action that addresses environmental or cultural restraints to
health.
DIF: Cognitive Level: Apply (Application)
6. What responsibility does the American Nurses Association (ANA) Code of Ethics require of
the nurse beyond giving excellent care to patients?
a. Accept longer work schedules to ensure that professional care is always available
Individual behavior choices are responsible for about 50% of health outcomes. Individual
choices are affected through interaction with other individuals, and their mutual social and
physical environments. The number of health care providers has not played a major role in the
health outcomes in the community in comparison to individual health behaviors. The quality
of public safety officers and number of public health officials have not been identified as
major contributors to the determinants of health.
DIF: Cognitive Level: Apply (Application)
10. What change could most effectively lead to a longer life span in Americans?
a. Parenting and sexual behavior classes in all public school systems
b. Legislation restricting alcohol and drug use
c. Notably reducing speed limits on all state and federal highways, and changing the
age limit for driving to 21 years of age
d. The belief that smoking is shameful and disgusting, as well as expensive,
becoming the social norm
ANS: D
Smoking is responsible for almost 20% of all deaths in the United States. Although smoking
is an individual’s choice, all people are affected by social norms. Parenting and sexual
behavior classes and legislative changes may influence health, but may not necessarily lead to
a longer lifespan. Community health nurses should recognize that health is influenced by a
web of factors, some that can be changed and some that cannot. Influencing social norms may
better promote change among Americans.
DIF: Cognitive Level: Apply (Application)
11. What is the health issue causing the most concern in the United States today?
a. Diabetes epidemic
b. Increase in cardiac disease
c. Increase in obesity
d. Rise in cancer rates
ANS: C
The widespread increase in incidence of overweight and obesity has led to calls for
population-based measures to address this issue. The overarching problem of obesity has led
to an increase in diabetes as well as cardiac disease. If this health issue was controlled, there
should be in a decrease in the other health issues.
DIF: Cognitive Level: Understand (Comprehension)
12. What factors are most responsible for the increasing length of life of Americans over the past
100 years?
a. Better nutrition and family planning options
b. Education concerning the need to reduce salt and fat in the diet
c. Improved medical care, including exciting new technologies
d. More efficient cancer screenings and early intervention
ANS: A
Average increased life span over the past 100 years can be largely attributed to higher
standards of living, better nutrition, a healthier environment, and having fewer children.
Public health efforts such as immunization and medical care have also contributed.
DIF: Cognitive Level: Understand (Comprehension)
13. Why would a public health nurse want to know about morbidity and mortality statistics on the
local, state, and national level?
a. To be able to share current trends in health problems with the community
b. To be able to observe the community’s statistics over time and compare the
community with other communities
c. To justify local budgets and the need for increased income from citizens
d. To publicize current health issues and suggest appropriate actions to citizens
ANS: B
Although being informed and being able to educate the public is always preferred and nurses
often do have to justify budgets, data are needed to compare the local community with itself
over time and with other communities so that problems may be recognized and action taken to
confront health issues. The first step is always to recognize problems as they develop.
DIF: Cognitive Level: Apply (Application)
14. How do public health efforts differ from medical efforts in improving the health of our
citizens?
a. Medical care providers autonomously choose appropriate interventions, whereas
public health care providers must engage in whatever actions legislation requires.
b. Medical care providers are self-employed or agency employed, whereas public
health care providers are employed by and paid through the government.
c. Medical care providers focus only on individuals, whereas public health care
providers focus only on aggregates.
d. Medical care providers focus on disease diagnosis and management, whereas
public health care providers focus on health promotion and disease prevention.
ANS: D
Medical care providers are restricted by insurance and government regulations. Providers may
also be employed in government facilities, such as Veterans Administration facilities.
However, medical care providers primarily focus on diagnosis and treatment of disease,
whereas public health care providers try to promote health and prevent disease. Although
medical care providers primarily focus on individuals and public health care providers
primarily focus on aggregates, their practice is not limited to only individuals or only
aggregates.
DIF: Cognitive Level: Apply (Application)
15. Which primary prevention would the school nurse choose to address the school’s number of
unwed pregnancies?
a. Create a class on parenting for both the moms-to-be and the dads-to-be.
b. Convince the school board to allow sex education classes to include birth control
measures.
c. Employ the moms-to-be as 1-hour-a-day employees in the school daycare center
for children born to school students.
Of the choices given, health promotion activities would make the largest difference. Increased
expenditures on acute care will not notably change the health of the population, whereas
funding that addresses health promotion such as education and safe environments would
improve the health of the aggregate.
DIF: Cognitive Level: Apply (Application)
18. Which task will be most helpful in meeting the public health agency’s goals?
a. Complete staff evaluations in preparation for individual meetings to plan their
agency and individual goals for the next year.
b. Actively participate in community agencies’ collaborative action plan to meet the
community’s health goals for the year.
c. Meet with the college of nursing faculty to finalize student objectives and
schedules for the next semester.
d. Teach a free course in healthful living for community residents.
ANS: B
Although all tasks may be necessary and important, intra-agency cooperation to meet the
health goals of the community as a whole is more central to the agency’s mission than other
choices that meet the needs of individuals or groups rather than the community as a whole.
DIF: Cognitive Level: Analyze (Analysis)
19. A community health nurse is overwhelmed with all that needs to be done in one day. Which
task could most easily be postponed?
a. Reviewing the most recent hospital patient data collected by the local college of
nursing
b. Deciding which of several possible new clinic options would be most effective in
better meeting the needs of the local community
c. Evaluating the results of the most recent community-wide screening program
before planning for the next community health program
d. Giving testimony to the state legislature on a new health and safety bill
ANS: A
All of the tasks are related to assessing needs, implementing new care options, or evaluating
health outcomes measures in the community except reviewing hospital patient data. Hospital
patient data may be helpful but not directly related to the agency’s ability to promote primary
health and prevent disease.
DIF: Cognitive Level: Analyze (Analysis)
20. A nurse who works on the surgical unit at the local hospital was asked by the home health unit
to make a home visit to a patient who had been discharged the previous day and to give
follow-up care (for overload pay). What kind of nursing would this nurse be doing?
a. Acute care hospital nursing
b. Community-based nursing
c. Community health nursing
d. Public health nursing
ANS: B
The nurse is caring for a patient in the home. Community-based nursing is nursing somewhere
in the community. Community-based nursing practice refers to “application of the nursing
process in caring for individuals, families and groups where they live, work or go to school or
as they move through the health care system” (McEwen and Pullis, 2009, p. 6).
Community-based nursing is setting specific, and the emphasis is on acute and chronic care
and includes such practice areas as home health nursing and nursing in outpatient or
ambulatory settings. As the nurse is not focusing on the health of the community but on an
individual, it is not community or public health nursing. It is not acute care hospital nursing
because the nurse is seeing the patient in his or her home.
DIF: Cognitive Level: Apply (Application)
21. Which task is most crucial for the community health nurse to do well?
a. Review the most recent morbidity and mortality data.
b. Create a new clinic to better meet local health needs.
c. Evaluate the results of the recent screening program.
d. Give testimony regarding proposed state health legislation.
ANS: D
Public health’s core functions are assurance, assessment, and policy development. Giving
testimony regarding legislation directly reflects policy development, which would have a
wider impact than the other options, which are more local and narrow in focus.
DIF: Cognitive Level: Analyze (Analysis)
22. A new public health nurse carefully assessed all the local mortality and morbidity data in
preparation for making appropriate planning suggestions at a meeting next week. What other
action is crucial before the nurse can feel prepared?
a. Ask other nursing staff their perceptions of the community’s needs.
b. Assess the nurse’s own assets, strengths, and ability to contribute.
c. Meet members of the community to determine their culture and values.
d. Review discussions and decisions from previous meetings.
ANS: C
Community health nurses must work with the community. It is essential to assess an
aggregate’s needs and resources and identify its values. The best way to do this is by meeting
with the members of the community to determine their culture and values. Assessing one’s
own assets, asking other nursing staff, and reviewing previous discussions will not allow the
nurse to assess the needs of the community.
DIF: Cognitive Level: Apply (Application)
23. Why are high-risk and vulnerable subpopulations identified by public health nurses before
deciding on appropriate interventions?
a. It is easiest to make improvements among these groups.
b. Populations are not homogeneous, and resources are limited.
c. Such groups are most vocal about their needs and wants.
d. These groups are often recipients of special funding.
ANS: B
1. What are the leading health indicators found in Healthy People 2020? (Select all that apply.)
a. Financial issues
b. Health system issues
c. Individual behaviors
d. Issues related to legal and illegal immigration
e. Legislative issues
f. Physical and social environmental factors
ANS: B, C, F
Ten leading health indicators are identified in Healthy People 2020, including individual
behaviors, physical and social environmental factors, and health systems issues. Financial
issues, issues related to legal and illegal immigration, and legislative issues are not found in
Healthy People 2020.
DIF: Cognitive Level: Understand (Comprehension)
2. What historically have been public health nurses’ two most important priorities? (Select all
that apply.)
a. Establishing school nursing to improve care of children
b. Engaging in political activity to improve living conditions
c. Giving superb clinical bedside care in the home
d. Increasing funding to public health efforts
e. Teaching family members how to care for their family
f. Working with the community to confront health issues and poverty
ANS: B, F
Neither administering bedside clinical nursing nor teaching family members to deliver care in
the home has adequately addressed the true determinants of health and disease. The early
public health nurses resolved that collective political activity should focus on improving
social and environmental conditions such as poverty.
DIF: Cognitive Level: Understand (Comprehension)
3. Based on Healthy People 2010, what are the two primary goals of Healthy People 2020?
(Select all that apply.)
a. Eliminate health disparities.
b. Expand health promotion activities in every community.
c. Improve funding, including diverting funds from other priorities to health care.
d. Improve health outcomes measures to be more consistent with other developed
nations’ outcomes.
e. Increase quality and years of healthy life.
f. Reduce mortality and morbidity figures nationwide.
ANS: A, E
As published, the two goals are to increase quality and years of healthy life and eliminate
health disparities. Expanding health promotion activities in every community, improving
funding and improving health outcomes, and reducing mortality and morbidity are not the
primary goals of Healthy People 2020.
DIF: Cognitive Level: Understand (Comprehension)
Chapter 03: Thinking Upstream: Nursing Theories and Population-Focused Nursing
Practice
Nies: Community/Public Health Nursing, 7th Edition
MULTIPLE CHOICE
1. Which statement best summarizes Lillian Wald’s achievements?
a. She suggested new nursing specialties.
b. She demonstrated how to improve health in communities.
c. She gave expert clinical nursing care to her clients.
d. She was appointed a national nursing leader.
ANS: B
Lillian Wald improved health in a community by using diplomacy and neighborhood power.
She was elected president of a national nursing organization and created new nursing
specialties such as school nursing. However, she is primarily known for her creation of Henry
Street House (see Chapter 2 of text), which led to the Visiting Nurses Association and notably
improved health in many communities.
DIF: Cognitive Level: Understand (Comprehension)
2. Which statement best describes “thinking upstream”?
a. Modifying economic, political, and environmental factors
b. Preparing for nursing career long-term goals by planning now
c. Seeking causes of water and air pollution “upstream” from cities
d. Trying to understand how or why someone got ill
ANS: A
Upstream thinking actions focus on modifying economic, political, and environmental factors
that are the precursors of poor health throughout the world.
DIF: Cognitive Level: Understand (Comprehension)
3. Which statement best describes a weakness of early nursing theories?
a. Many nurses did not know or understand the theoretical basis of nursing practice.
b. Most nursing theories focused on microscopic individual concerns.
c. The theories did not reflect the actual world of nursing practice.
d. The theories had global applicability to nursing practice.
ANS: B
Most nursing theories have an extremely narrow focus on individual nurse–patient care
situations. This microscopic focus ignores the broader global social macroscopic perspective.
DIF: Cognitive Level: Understand (Comprehension)
4. Which best describes the primary purpose of nursing theory?
a. To improve nursing practice
b. To demonstrate that nursing is a profession
c. To organize nursing knowledge
d. To serve as a basis for ongoing nursing research
The HBM is based on the assumption that the primary reason people act is disease avoidance.
Such avoidance means they perceive themselves as susceptible to a serious disease, there is
some cue to action, and there are more benefits than barriers to acting.
DIF: Cognitive Level: Understand (Comprehension)
8. Which assumption of the Health Belief Model (HBM) is problematic?
a. People have both free will and access to health resources.
b. People listen to the advice given by health care professionals.
c. People are influenced by health messages given over media channels.
d. People make what they perceive as rational decisions in a given situation.
ANS: A
The HBM assumes that people have access to health resources, but such resources are not
always available to certain groups. Economic, political, and environmental constraints
interfere with free choice. The HBM may effectively promote behavior change by altering the
patient’s perspectives, but it does not acknowledge the health professional’s responsibility to
reduce health care barriers. The HBM places the burden of action exclusively on the client.
DIF: Cognitive Level: Understand (Comprehension)
9. A nurse is using Milio’s framework for prevention to improve the health of clients. Which
would the nurse most likely implement?
a. Create appropriate national health policies.
b. Develop health programs that make healthy choices the easiest choices.
c. Promote nationwide educational programs with information on making healthy
choices.
d. Stress that clients are responsible for their own health.
ANS: A
The range of available choices is critical in shaping a society’s overall health status. Policy
decisions in governmental and private organizations shape these choices. Hence,
national-level policy making is the best way to impact the health of most Americans rather
than continue to concentrate on imparting information in an effort to change individual
behaviors. Milo challenged the notion that the main determinant for unhealthful behavior
choice is lack of knowledge.
DIF: Cognitive Level: Apply (Application)
10. A nurse is using Milio’s approach when caring for a client. Which advantage will the nurse
experience?
a. It will allow for care interventions outside the hospital system.
b. It will demonstrate the effectiveness of using a variety of community resources.
c. It will encourage the assessment of the personal and societal resources of the
client.
d. It facilitates open communication between the client and the nurse.
ANS: C
As the model focuses on sociopolitical and environmental constraints to a client’s free choice,
it also encourages assessment of such constraints, as well as suggesting alternative avenues to
helping the patient obtain needed care. Milio encourages the practice of nursing from a broad
understanding of health and illness.
DIF: Cognitive Level: Apply (Application)
11. Which health-related variable is examined by the critical theoretical perspective?
a. Cultural beliefs
b. Effect of history and tradition
c. Ethnic and racial differences
d. Social inequalities
ANS: D
Critical theoretical perspective examines social inequalities within the broader political,
economic, and social systems of society that keep people from reaching their full potential.
Cultural beliefs, the effect of history and tradition, and ethnic and racial differences are not
examined by the critical theoretical perspective.
DIF: Cognitive Level: Understand (Comprehension)
12. A nurse is using the critical theoretical perspective in daily nursing practice. Which activity
would the nurse most likely complete?
a. Criticize health insurance programs as a barrier to health care.
b. Expose social values underlying the health care system.
c. Promote individual freedom and decision-making.
d. Exert control over the client’s environment.
ANS: B
Improvements can only be made if societal and personal values are made explicit. Once these
values are recognized, they are more easily confronted. Change may be sought toward a more
just society. Society must change for health and medical care to improve. Inequities of health
care are connected to historically located social arrangements and cultural values of society.
DIF: Cognitive Level: Apply (Application)
13. A nurse is using Healthy People 2020 as a guide to improve the health and well-being of the
community. Which strategy would the nurse most likely implement?
a. Address the root causes of health problems.
b. Choose one of the 28 focal areas for emphasis in funding and media attention.
c. Concentrate on the goals of improving the quality of life.
d. Continue funding expansion of the health care system.
e. Expand efforts to put all medical records on electronic media.
ANS: A
The chapter emphasizes the need to go beyond individual lifestyle behaviors to the social,
economic, political, and value-laden processes of daily life that affect health (social
determinants of health). Based on Healthy People 2020, advances are needed in these areas in
order to improve health.
DIF: Cognitive Level: Apply (Application)
One of the propositions of Milio’s framework is that alteration in patterns of behavior
resulting from decision-making of a significant number of people in a population can result in
social change. Some behaviors, such as tobacco use, have become difficult to maintain in
many settings or situations in response to organizational and public policy mandates.
Increasing taxation on unhealthy food choices may make it more difficult for community
members to make these unhealthy choices.
DIF: Cognitive Level: Apply (Application)
MULTIPLE RESPONSE
1. A nurse has a broad, aggregate focus when providing care to clients. Which best describes
how this approach will help improve client outcomes? (Select all that apply.)
a. Ensures that collaborative efforts of many professionals will be used
b. Confirms the individual’s responsibility for resolving the health problem
c. Empowers decision-making based on both individual and community goals, needs,
and priorities
d. Enables the nurse to ask for assistance from other community professionals
e. Encourages allocation of time for population-focused preventive efforts
f. Upholds professional nursing standards of care
ANS: C, E
Having a broader focus will help both nurse and patient make appropriate decisions.
Unfortunately, it cannot ensure that others will help. Ideally, it will help both parties recognize
that health problems are not just an individual’s responsibility but often a result of
environmental, sociopolitical, and economic factors as well. Encouraging the nurse to allocate
time for population-focused health promotion efforts will also help the nurse’s individual
clients over the long term.
DIF: Cognitive Level: Apply (Application)
2. A community health nurse is using the Health Belief Model (HBM) as a basis for providing
client care. Which best describes the problems associated with using the HBM? (Select all
that apply.)
a. It ignores the need to reduce health system barriers to action.
b. It is extremely difficult to change the client’s belief system.
c. It is the nurse’s responsibility to persuade clients to engage in the appropriate
behavior.
d. Clients do not have the knowledge to correctly analyze the seriousness of the
disease or their susceptibility to it.
e. Clients expect health professionals to take preventive actions for them.
f. The choice and the burden for acting are entirely with the client.
ANS: A, F
A major problem with this model is that the burden for taking action is totally with the client.
The model requires health professionals to assume responsibility for modifying the client’s
perceptions so they recognize the need to act. Although the line between persuading and
educating is a fine one, nurses are responsible for education. Persuasion may border on
coercion. Further, the model assumes that all responsibility is personal, ignoring barriers in
the health care system, which may make it difficult for an individual to take appropriate
action.
DIF: Cognitive Level: Apply (Application)
3. A nurse is using the critical theoretical perspective in practice. Which best describes how the
nurse would respond when a client suggests that the physician prescribe a widely advertised
medication for tension and anxiety? (Select all that apply.)
a. Can you tell me what is going on in your life right now?
b. Do you know anyone else who is suffering such tension and anxiety?
c. How does your family feel about you having so much tension and anxiety?
d. Would you consider using the generic equivalent of this medication?
e. What led you to believe this medication would be of help to you?
f. What have you tried in the past to relieve tension and anxiety?
ANS: A, F
The best answer is to ask what is going on in the client’s life at that moment because
situational stresses often occur to everyone. Next, asking what previously has been effective
in relieving the symptoms may suggest more appropriate actions than medication. Although
generics would be less expensive than brand-name medication, medication should not be the
first approach to resolving a symptom before even examining why the symptom is occurring.
DIF: Cognitive Level: Analyze (Analysis)
4. According to the critical theoretical perspective, which should be held responsible for many of
the illnesses of Americans today? (Select all that apply.)
a. Advertisers who market sugar- and fat-saturated food products
b. Alcoholic beverage manufacturers, marketers, and sellers
c. Manufacturers of products that increase morbidity and mortality
d. Corporations who modify their emission rates
e. Restaurants that attempt to keep meal costs low
f. Tobacco manufacturers who sponsor sports events
ANS: A, B, C, F
McKinlay (1979) further delineated the activities of the “manufacturers of illness—those
individuals, interest groups, and organizations which, in addition to producing material goods
and services, also produce, as an inevitable byproduct, widespread morbidity and mortality”
(pp. 9, 10). The manufacturers of illness embed desired behaviors in the dominant cultural
norm and thus foster the habituation of high-risk behavior in the population. The
manufacturers of illness include everyday examples such as the tobacco industry, the alcohol
industry, and multiple corporations that produce environmental carcinogens. The existing U.
Health Care System, in a misguided attempt to help, devotes its efforts to changing the
products of the illness manufacturers and neglects the processes that create the products.
DIF: Cognitive Level: Analyze (Analysis)
4. A nurse was becoming frustrated. She had given her client extensive information on his health
problem, but the client continued to be noncompliant in making needed changes. Which
principle had the nurse forgotten?
a. A person may have a higher priority than improving his or her health.
b. Information, while necessary, will not motivate people to change.
c. People need repetition over time to be able to absorb information.
d. Physicians, not nurses, are perceived as experts in health.
ANS: B
Information alone is rarely enough to motivate a person to act. Information is necessary to
know what to do and how to do it before the person chooses to act, but other factors are
primarily responsible for motivating people to change their behavior. Although other priorities
may result in delay of change, the fact that the client has returned to the nurse demonstrates
interest in changing. Repetition may be helpful, but apparently the nurse has given
information on more than one occasion because she believes extensive information has been
given.
DIF: Cognitive Level: Apply (Application)
5. The nurse working with a client to change behavior to maximize health asked the client to
bring his family to the next visit. Which best describes why the nurse wants the family to
come with the client?
a. To analyze the family’s beliefs about health
b. To determine the family’s support of the client
c. To establish the family’s communication patterns
d. To evaluate the family’s approval of the proposed changes
ANS: D
Under the Theory of Reasoned Action, it is assumed that all behavior is determined by
intentions, which are determined by attitude toward the behavior and the norms associated
with the behavior. That in turn is determined by whether or not important persons approve or
disapprove of the behavior. The family’s beliefs about health, support of the client, and
communication patterns are irrelevant if the family does not approve of the changes that have
been proposed.
DIF: Cognitive Level: Apply (Application)
6. A nurse is using the theory of reasoned action when working with a client to exercise on a
regular basis. Which would be the easiest way for the nurse to determine if the client will
engage in this activity?
a. The client’s intention to exercise regularly
b. The client’s perception of the threat of illness if he doesn’t exercise regularly
c. Society’s emphasis on the importance of regular exercise
d. The pros and cons of regular exercise
ANS: A
The theory of reasoned action attempts to predict a person’s intention to perform or not
perform a certain behavior based on the assumption that all behavior is determined by one’s
behavioral intention. The client’s perception of the threat of illness, the opinion of society, and
benefits of regular exercise are not major factors discussed using the theory of reasoned
action.
DIF: Cognitive Level: Apply (Application)
7. A nurse is using the theory of planned behavior when working with a client to change her
behavior and improve her health. Which consideration should be made by the nurse?
a. If environmental limitations may prevent the person from acting
b. The availability of needed environmental supports for the client
c. The client’s belief about factors that may facilitate or impede the behavior
d. If the suggested behavior is actually the most effective approach
ANS: C
The theory of planned behavior stresses that perceived control is a major factor in whether or
not the client performs the behavior. Thus, the nurse needs to understand the client’s beliefs
about factors that may facilitate or impede the behaviors. Using this theory, the environment
is not considered as a major factor in client change, nor is the analysis as to if the behavior is
the most effective approach.
DIF: Cognitive Level: Apply (Application)
8. Some people believe that the air within their workplace makes them ill. Which premises
support this belief?
a. They consistently feel worse on workdays and weeks without holidays.
b. There has been media coverage of “sick buildings” where there is very little air
exchange with fresh air outside.
c. Research has demonstrated that some buildings emit poisonous vapors that make
anyone who works there ill.
d. When a small group of persons begins to believe something, the others in the
larger group begin to believe it as well.
ANS: A
As the question discusses risk, the textbook states that the risk factor must precede the
problem and that the problem would increase with exposure. Feeling ill only on workdays
would imply that some factor in the workplace is responsible. The media coverage, research
related to poisonous vapors, and “group think” responses do not address the fact that the
repeated exposure to the risk factor may be what is making them ill.
DIF: Cognitive Level: Apply (Application)
9. It is rumored that there is something in the workplace that is causing persons employed there
to feel ill. Which action would be most appropriate for the nurse to take?
a. Ask researchers to set up a study to confirm the health hazard in the environment.
b. Assess the risk, including identifying any toxic substance.
c. Confirm the extent to which the illness resulted from intergroup agreement on the
illness and cause.
d. Insist that the media not further spread stories of possible sick buildings until the
truth of the situation can be studied.
ANS: B
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Community exam 1 - Test bank
Course: Community Health Nursing (NR-442)
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Chapter 01: Health: A Community View
Nies: Community/Public Health Nursing, 7th Edition
MULTIPLE CHOICE
1. Which best describes the primary reason that Americans are concerned about health care?
a.
Politicians are discussing how to improve health care.
b.
The media has provided mixed messages about the health care system.
c.
Our national health care costs keep increasing.
d.
The new health care system offers free services to Americans.
ANS: C
The primary reason for the focus on health care is the constantly increasing costs, which
cannot be sustained. The costs of caring for the sick accounted for the majority of escalating
health care dollars, which increased from 5.7% of the gross domestic product in 1965 to
17.8% in 2015. Politicians and the media both influence Americans’ perceptions about health
care; however, they are not the primary reason why Americans are concerned. The new health
care system will change the health care access and availability, but will not necessarily be
offering any free services to Americans.
DIF: Cognitive Level: Understand (Comprehension)
2. A nurse has begun to lobby with politicians for changes to the health care system. Why is this
involvement important?
a.
Nurses, as central characters in several popular TV series, are currently very
visible in American media.
b.
Nurses are primarily responsible for managing the various units in our health care
system.
c.
Nurses are the largest segment of health care providers.
d.
Nurses are the only group that is employed both inside and outside of hospitals.
ANS: C
As the largest segment of health care providers, nurses are informed about the current health
care system and all the problems that result from people not seeking care until they are
desperately ill. Nurses, as the American Nurses Association (ANA) emphasize, usually
believe that health care is a right, not a privilege. Therefore, nurses, whose work is central to
our current health care delivery system, can also be instrumental in working politically to
create a health care delivery system that will meet health needs. While nurses are in several
current TV series and are employed both inside and outside of hospitals, physicians and other
health care providers are as well. Nurses are often managers, but managers often have other
backgrounds, such as business administration.
DIF: Cognitive Level: Understand (Comprehension)
3. What conclusion can be drawn from examining where nurses are employed?
a.
There is a trend toward consolidation of health care into large central medical
centers.
b.
There is an increased emphasis on community-based health care.
c.
There is an obvious need to decrease health care costs by cutting positions.
d.
Managed care organizations (MCOs) are employing nurses to improve customer
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