Test bank for Community Public Health Nursing 7th Edition by Nies
Chapter 01: Health: A Community View
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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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
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to clients.
b. Recognize the need for experienced nurses to mentor new graduates to help
increase and expand the number of professionals available.
c. Support health legislation to improve accessibility and cost of health care.
d. Volunteer to work overtime as needed to ensure maximum quality of care.
ANS: C
The ANA Code of Ethics promotes social reform by focusing on health policy and legislation
to positively affect accessibility, quality, and cost of health care. The code does not directly
address workplace issues, such as work schedules or need for overtime.
DIF: Cognitive Level: Analyze (Analysis)
7. What is the community health nursing definition of health?
a. Health is a person’s goal-directed purposeful process toward well-being or
wholeness.
b. Health is an individual’s physical, mental, and social well-being, not merely the
absence of disease or infirmity.
c. Health is the mutual adaptation between a person and his or her environment in
meeting daily existence.
d. Health is families and aggregates choosing actions to ensure safety and well-being.
ANS: D
The text stresses that health is not just the result of an individual’s choices, but choices and
actions of individuals, families, groups, and communities that lead to better health.
DIF: Cognitive Level: Apply (Application)
8. How does community health nursing define community?
a. A group of persons living within specific geographic boundaries
b. A group of persons who share a common identity and environment
c. A group of persons who work together to meet common goals
d. A group of persons who resolve a community concern
ANS: B
Community health nurses work with both geopolitical groups (within specific geographic
boundaries) and phenomenological groups (who have a common identity based on culture,
history, or goals). A particular phenomenological group may or may not have been a planned
group—that is, a group that came together to resolve a recognized common problem or to
meet a common goal. However, of all the choices, a group of persons who share a common
identity (phenomenological group) and environment (which implies a specific geographic
setting) is the broadest and most complete definition.
DIF: Cognitive Level: Apply (Application)
9. Which variable has a major influence on a community’s health?
a. Behavior choices made by persons in the community
b. Number of health care providers and hospitals in the community
c. Quality of the public safety officers (police officers, firefighters, etc.)
d. The number and credentials of public health officials in the community
ANS: A
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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
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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.
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d. Establish a class where all the unwed moms-to-be can learn infant care.
ANS: B
Primary prevention relates to activities directed at preventing a problem before it occurs by
altering susceptibility or reducing exposure for susceptible individuals. Primary prevention
consists of two elements: general health promotion and specific protection. Health promotion
efforts enhance resiliency and protective factors and target essentially well populations.
Specific protection efforts reduce or eliminate risk factors. Although all choices would be
appropriate actions in a school, only education regarding sexuality and birth control would
help prevent future pregnancies.
DIF: Cognitive Level: Apply (Application)
