1. The American health care system will continue to evolve and change.

Which of the
following groupings of health care trends will have the greatest influence on the health
care transformation process at the present time?

A. Aging of the population, globalization, and medical technology advances

A. Funding levels, political structure, and professional licensure requirements

B. Longevity, population density, and digital divide

C. Managed care, workforce shortages, and level of education of the population

Increases in the number of aging baby boomers as well as the longevity of the
elderly, advances in medical technology such as telehealth and electronic
medical record keeping, and globalization with its associated need for increased
surveillance of new and reemerging infectious diseases are currently having the
greatest impact on the transformation of our health care system. This involves
the reallocation of resources, standardization of information transfer, and
funding challenges.

2. The U.S. public health system is operated at the three distinct levels with collaboration
and interface across all level. The agency that assumes the responsibility for improving
health by expanding access to primary care for low-income, uninsured, or rural
individuals is :

A. Agency for Healthcare Research and Quality

B. Health Resources and Services Administration

C. Local Health Department

D. State Health Department

The Health Resources and Services Administration of the Department of Health

and Human Services at the federal level of the public health system is
responsible for directing grant programs that improve the nation's health by
expanding access to primary care for low-income and uninsured people,
focusing on mothers and their children, people with HIV/AIDS, and residents of
rural areas.

3. The major factor that drives the current discussions about Medicare shortfall in the
middle of the twenty-first century is :

A. Diversity of the US Health care workforce

B. Longevity of the US population

 C. Percentage of elderly in the U.S. population

D. Percentage of foreign-born in the U.S. population

In the 2000 census the Medicare-eligible U.S. population totaled 35.1 million,
but by 2030 that same population is projected to grow to 69.7 million. The cost
of Medicare and its share of the gross domestic product can be expected to rise
astronomically, which has given rise to discussions of a Medicare shortfall in the
middle of the century. The vastly increased numbers of elderly people and their
higher percentage in the population means that there will be fewer workers
paying taxes into the Medicare system at the same time that the elderly will be
consuming an ever-increasing amount of health resources.

4. The Indiana Nurse-Managed Clinic initiative is providing community-based primary

and preventive care as well as specialty care, community screenings, local health
assessments, and health education and health care coordination, targeted to medically
insured individuals regardless of ability to pay. This initiative best describes a system of :

A. Managed Care

B. Primary Care

C. Primary Health Care

D. Private health care

Nurse-managed clinics incorporate primary care and public health care;

therefore they provide primary health care when the broad range of services
focuses on prevention, basic health services, and education and is provided at
the community level

5. The best argument(s) for supporting community-as-client nursing are which of the
following? Select all that apply.

A. Change for the benefit of the community-client must often occur at several
levels.
B. The impact of environment on health has long been established
C. Changes in the health of individuals will affect the health of their communities.
D. The idea of providing health-related care within the community is not new.
E. Direct hands-on nursing care delivered to individuals of families in community
settings is important
The idea that health-related services are provided within a community is not
new. At the turn of the century, most persons stayed at home during illnesses.
As a result, the practice environment for all nurses (such as community health
nurses, public health nurses, and visiting nurses) was the home rather than the
hospital. These roles continue to exist today. Early textbooks on public health
nursing included lengthy descriptions of the home environment and tools for
assessing the extent to which that environment promoted the health of the
family members. By the 1950s, schools, prisons, industrial settings
(occupational health), and neighborhood health centers were added to the list
of sites for nursing practice. However, the practice became oriented toward
direct-care services to individuals and families and began to lose the
community/population focus. Today, direct-care services provided at the
individual and family level are defined as community-based nursing practice if
the target remains at the direct-care service level and the practice does not
address overall community health issues (i.e., common community-related
health problems). Presently, there is a resurgence in population-focused health
care. Due to the findings from initiatives such as Healthy People 2010 and the
World Health Organization's Healthy Communities and Cities, it is now
understood that social change related to health behaviors and the use of health
policy are more efficient and effective in improving health status overall.

6. A rural public health nurse is in the first phase of a community assessment to

determine the community health status characteristics of the local county. This
initial data gathering should most likely begin with which agency?
A. County public health department
B. National Centers for Disease Control and Prevention
C. State vital statistics
D. US Census Bureau
Community health is characterized by status, structure, and process
dimensions. Status or outcome involves biological, emotional, and social
attributes. The biological (or physical) aspect of community health is often
measured by traditional morbidity and mortality rates, life expectancy indices,
and risk factor profiles. Data gathering is the process of obtaining existing,
readily available data. These data describe the demography of the community
but also include the vital statistics, such as mortality and morbidity data. The
state bureau of vital statistics would be the best source, especially for rural
counties that may not have biostatisticians at the county level. Raw data
submitted to the state by the local community would be consolidated at the
state level. All states have such bureaus.

7. Knowledge of various learning theories is important for community health nurses

involved in health education. Enhancing self-confidence and self-efficacy are important
aspects of which learning theory?

A. Cognitive Learning
 B. Humanistic Learning
C. Behavioral Learning
D. Social Learning Theory

Enhancing self-confidence and self-efficacy are both important aspects of Social

Learning Theory.

8. The community health nurse is asked to review a draft of a brochure developed for
distribution to clients. The nurse finds the brochure generally well designed but suggests
replacing several words with simpler words that have fewer syllables and more
commonly used. What is the best explanation for the nurse’s recommendation?
A. The nurse assumes the clients are uneducated because they have low income.
B. The nurse knows that English may not be the primary language of many clients.
C. The nurse is assuming that most of the client’s will read at a fifth grade level
D. The nurse knows that more difficult words will pose a barrier to some clients.
Materials written at a simpler level can be effective learning tools for clients
who read at different levels

9. The second step in the community assessment process for community health nurses
involves:
A Writing a community diagnosis
B. Evaluating outcomes
C. Collecting assessment data
D. Planning community interventions
The second step in the community assessment process is synthesizing
assessment data into diagnostic statements about the community's health.

10. When writing a community diagnosis, the community health nurse notes that
“among” phrase:
A. Is a synthesis of all assessment data
The "among"
B. Is the supporting data phrase specifies
the aggregate
C. Specifies the aggregate that will benefit from the nurse’s plan that will be the
beneficiary of
D. Describes the cause of health problem and directs focus of
the nurse's action plan. The identification of the health problem represents a
synthesis of all assessment data. The "related to" phrase describes the cause of
the health problem and directs the focus of the intervention. The health
indicators are the supporting data.

11. A community health nurse, working as a school health nurse, has determined through
a community assessment that the focus of programs and health education or the academic
school year should address the problem of childhood diabetes and obesity. In planning, it
is important for the nurse to allow time for individual nursing assessment and education
for children with the diagnosis of diabetes as well as planning classroom education
programs. The nurse is demonstrating an understanding of which important community
health nursing concept?

A. Health planning
B. Aggregate health care
C. Community as a client
D. Use of the nursing process
Community health nurses focus care on health needs of aggregates; however,
individual, families, and groups are important parts of aggregates.
Appropriate nursing care and health promotion planned for aggregates affect
individuals and vice versa

12. Which of the following factors assist the nurse when determining priorities for
aggregates? Select all that apply.
A. The aggregates preferences
B. The number of individuals affected by the health problem
C. The nurse’s preferences
D. The availability of resources

Factors that assist the nurse in determining priorities for aggregate health care
include the aggregate's preferences; the number of people affected; the severity
of the health problem; the available solutions, resources, and time; and
individuals with skills to help solve the problem