Chapter 1: Public Health and Nursing Practice

Multiple Choice
Identify the choice that best completes the statement or answers the question.

____	1.	Public health nurses (PHNs) know they must approach a public health issue with an understanding of the related underlying risk factors to develop effective nursing interventions. They evaluate these risk factors from two perspectives:
1.	Disease; individual	
2.	Intervention; government	
3.	Epidemic; population	
4.	Individual; population	

____	2.	A nursing student is studying public health. She learns that, according to C.E.A. Winslow’s definition, some of the goals of public health include disease prevention, promoting health, control of communicable infections, and __________________.
1.	Risk assessment for disease	
2.	Promotion of primary care	
3.	Organization of medical and nursing services for the early diagnosis and preventive treatment of disease	
4.	Governmental safety regulations	

____	3.	If the international medical community was working to contain several worldwide pandemics, they would look to the World Health Organization (WHO), which is:
1.	The public health arm of the United Nations.	
2.	Working to improve health and well-being for the global population.	
3.	Working with nurses to promote public health interventions.	
4.	All of the above.	

____	4.	The Institute of Medicine (IOM), now known as the Health and Medicine Division (HMD) of the National Academies of Sciences, Engineering, and Medicine, stated in their report, The Future of the Public’s Health, that there are three core functions that society carries out to collectively support the optimum conditions for public health. Which one of the following is not one of these functions?
1.	Prevention	
2.	Assessment	
3.	Policy development	
4.	Assurance	

____	5.	With aging, there is an increased prevalence of both noncommunicable (chronic) and communicable disease (NCD). The most pressing issue from a public health perspective based on this increase is:
1.	An increased demand for long-term care	
2.	An increased need for further research	
3.	Further exploration of the developmental stages related to aging	
4.	Decreased cost of medications.	

____	6.	A PHN would like to use the Dahlgren-Whitehead model to help herself and other local practitioners understand health in populations. She understands that the Dahlgren-Whitehead ecological model assumes that:
1.	There are multiple determinants of health, and thus multiple strategies are needed.	
2.	A population and environmental approach is essential.	
3.	Linkages and relationships are crucial.	
4.	All of the above.	

____	7.	The PHN completed a community assessment and found that the obesity rate in one of the neighborhoods was higher than the other neighborhoods in the county. She suspects that this is partially due to limited access to full-service grocery stores and a lack of dedicated safe venues for exercise. Assuming her conclusion is correct, what category or categories of determinants of health would these issues within the community fall into?
1.	Upstream determinants of health	
2.	Downstream determinants of health	
3.	Behavioral determinants of health	
4.	Genetic determinants of health	

____	8.	Two PHNs working in a large urban community notice that community members are rarely engaged in the process of planning interventions aimed at addressing a particular increase in a specific disease in the community. For their next project, they include community collaboration as an essential component of the development, implementation, and evaluation of the program. When questioned by others, they report that there is evidence that community collaboration increases effectiveness and productivity, empowers the participants, strengthens social engagement, and ______.
1.	Decreases disease rates	
2.	Ensures accountability	
3.	Increases the availability of treatment for the targeted disease	
4.	Improves screening rates	

____	9.	Which one of the following scenarios is not an example of community collaboration?
1.	Local service groups working to organize disaster relief for tornado victims	
2.	A city council passing an ordinance to stop smoking in restaurants	
3.	An advocacy group working with the local churches to improve health care for the indigent with mental health disorders	
4.	A school working with the local health department to start a school clinic	

____	10.	Which layer of government is primarily responsible for issuing quarantines during a communicable disease outbreak?
1.	Federal	
2.	State	
3.	Local	
4.	All of the above	

____	11.	As a PHN in a small local public health department, you understand that based on federal mandates your public health department routinely performs all but which of the following?
1.	Surveillance of disease at the local level	
2.	Investigation of disease outbreaks	
3.	Licensing of local hospitals	
4.	Quarantine	

____	12.	The PHN recognizes that environmental science, epidemiology, biostatistics, biomedical sciences, and ____ form the foundational subjects of public health.
1.	Economics	
2.	The humanities	
3.	Social and behavioral sciences	
4.	Anthropology	

____	13.	As defined by the World Health Organization (WHO), an example of a health promotion intervention is ____ whereas a risk reduction/health protection intervention is ____.
1.	Conducting a health fair; funding a school exercise program	
2.	Giving a free exercise class; conducting a flu vaccine outreach program	
3.	Providing flu medication free to older adults; a diet class for teenagers	
4.	Offering a tour of a hospital; a relaxation technique class	

____	14.	From a health promotion perspective, how could an occupational health nurse advise a company to encourage its employees to work towards good health?
1.	Lower insurance premiums for employees who demonstrate good health habits	
2.	Have employee exercise classes or discounted health club memberships	
3.	Have incentives for healthy eating	
4.	All of the above	

____	15.	Diversity refers to all of but which of these concepts?
1.	Race	
2.	Culture	
3.	Ethnicity	
4.	Environment	

Multiple Response
Identify one or more choices that best complete the statement or answer the question.

____	16.	Many of the emerging threats for public health are tied to increasing globalization. Which of the following reflect these globalization threats? (Select all that apply.)
1.	Greater disparities between rich and poor	
2.	Greater need for newer technology	
3.	Greater distribution of tobacco and alcohol	
4.	Emergence or re-emergence of communicable diseases	
5.	Increased need for improved transportation	

____	17.	Several nurses who work in the emergency department of an urban hospital notice during the evening shift that a number of children in a certain ethnic population have all come in presenting with similar symptoms. The first step the nurses take to address the issue is which of the following? (Select all that apply.)
1.	Increase antibiotic therapy availability	
2.	Identify characteristics of the disease	
3.	Group patients by diagnosis	
4.	Notify the public health department	
5.	Assess the environment of the patients	

____	18.	The  six standards of practice for public health nursing include which of the following? (Select all that apply.)
1.	Assessment	
2.	Population diagnosis and priorities	
3.	Outcomes identification	
4.	Planning	
5.	Mitigation	

____	19.	Which of the following activities of PHNs reflect the PHN Core Competencies? (Select all that apply.)
1.	Develop policy for handling a local quarantine.	
2.	Understand dietary restrictions when planning a program for new immigrants.	
3.	Create a financial plan for implementing a community level health intervention.	
4.	Develop a treatment plan for persons with a specific communicable disease.	
5.	Analyze data to determine rates of disease in the community.	

Chapter 1: Public Health and Nursing Practice
Answer Section

MULTIPLE CHOICE

	1.	ANS:	4
Objective: 5. Identify the key roles and responsibilities of public health nurses (PHNs). 
Page:
Heading: Introduction to Public Health 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity 
Cognitive Level: Comprehension
Concept: Critical Thinking, Promoting Health
Difficulty: Easy
	Feedback	
1	The approach cannot be disease based because diseases can affect populations in multiple locations, but the risk factors can be different.	
2	Interventions occur after the public health event, and governments can only follow the evidence of public health studies.	
3	An epidemic is an occurrence of a disease and has the same limitations as a disease-based approach.	
4	PHNs assess risk for disease and other public health issues at both the individual level, so that they can intervene on a one-to-one situational basis, as well as at the population level to identify risk factors beyond the individual level and implement population-level interventions.	

PTS:	1	REF:	2	CON:	Promoting Health | Critical Thinking

	2.	ANS:	3
Objective: 2. Describe public health in terms of current frameworks, community partnerships, and the concept of population health. 
Page:  
Heading: Public Health Science and Practice 
Integrated Processes: Nursing Process 
Client Needs: Health Promotion and Maintenance
Cognitive Level: Knowledge 
Concept: Infection; Nursing Roles; Promoting Health 
Difficulty: Easy
	Feedback	
1	Risk assessment is considered a part of disease prevention.	
2	Promotion of primary care occurred through the Alma Ata World Health Organization conference not Winslow’s definition.	
3	Health-care providers are an essential component of public health.	
4	The goal of public health is to guide governmental policy but not to create regulations.	

PTS:	1	REF:	3	CON:	Infection | Nursing Roles | Promoting Health

	3.	ANS:	4
Objective: 2. Describe public health in terms of current frameworks, community partnerships, and the concept of population health. 
Page: 
Heading: Introduction to Public Health 
Integrated Processes: Nursing Process 
Client Need: Safe and Effective Care Environment: Safety and Infection Control
Cognitive Level: Application [Applying] 
Difficulty: Easy
Concept: Promoting Health; Health-Care System; Management; Safety 
Difficulty: Easy
	Feedback	
1	The World Health Organization (WHO) is the “directing and coordinating authority for health within the United Nations system”.	
2	The WHO has the capability to monitor global epidemiological situations.	
3	The WHO brings resources and knowledge to nurses who are working directly with patients for them to make informed decisions.	
4	The WHO is the public health arm of the United Nations and works toward both of the previously mentioned goals.	

PTS:	1	REF:	15-17	
CON:	Promoting Health | Health-Care System | Management | Safety	

	4.	ANS:	1
Objective: 4. Explore the connection between environment, resource availability, and health. 
Page: 
Heading: Public Health Science and Practice 
Integrated Processes: N/A 
Client Need: Health Promotion and Maintenance 
Cognitive Level: Knowledge 
Concept: Assessment; Promoting Health 
Difficulty: Easy
	Feedback	
1	Prevention is not considered a core function of public health, as assessment, policy development, and assurance have prevention as an implied goal of each function.	
2	Assessment focuses on analysis and collection of data, as well as the monitoring of health problems and needs.	
3	Policy development uses the acquired knowledge from assessments to create useful public health policies.	
4	Assurance creates trust in health-care agencies to provide necessary services that are in line with public health goals.	

PTS:	1	REF:	3	CON:	Assessment | Promoting Health

	5.	ANS:	1
Objective: 2. Describe public health in terms of current frameworks, community partnerships, and the concept of population health. 
Page:  
Heading: Introduction to Public Health > Public Health Frameworks: Challenges and Trends 
Integrated Processes: Nursing Process 
Client Need: Safe and Effective Care Environment: Management of Care 
Cognitive Level: Analysis
Concept: Immunity; Infection; Promoting Health 
Difficulty: Easy
	Feedback	
1	As the percent of the population over the age of 65 increases, so does the prevalence of chronic disease and the need for long-term care. From a population public health perspective, decreased availability of care will result in increased morbidity and mortality, and decreased quality of life.	
2	An increased need for further research is important but is not the most pressing issue.	
3	Further exploration of developmental stages related to aging might help in understanding response to disease but is not the most pressing issue.	
4	Decreased cost of medications will assist in access to treatment but is only one aspect of long-term care needs.  	

PTS:	1	REF:	4	CON:	Immunity | Infection | Promoting Health

	6.	ANS:	4
Objective: 4. Explore the connection between environment, resource availability, and health. 
Page: 
Heading: Introduction to Public Health > Public Health Frameworks: Challenges and Trends 
Integrated Processes: Nursing Process 
Client Need: Safe and Effective Care Environment: Management of Care 
Cognitive Level: Analysis [Analyzing] 
Concept: Evidence-Based Practice; Promoting Health 
Difficulty: Moderate
	Feedback	
1	Location and social systems are two of many determinants in the ecology of a public health problem.	
2	This model asserts that the environment of the affected population is a key component in assessing risk factors.	
3	Social systems, families, and communities play a role in the health or lack of health for an individual or a population.	
4	The Dahlgren-Whitehead model is key to understanding the layers of influence and relationships regarding population health and how important environment is to said health. Thus, all of the answer choices together are correct.	

PTS:	1	REF:	5	CON:	Evidence-Based Practice | Promoting Health

	7.	ANS:	1
Objective: 3. Investigate determinants of health within the context of culture. 
Page:  
Heading: Introduction to Public Health > Public Health Frameworks: Challenges and Trends 
Integrated Processes: Nursing Process 
Client Need: Health Promotion and Maintenance 
Cognitive Level: Analysis
Concept: Promoting Health; Economics 
Difficulty: Moderate
	Feedback	
1	Upstream refers to determinants of health that include the physical as well as conditions in the social environment creating poor health,	
2	Downstream refers to the biological and behavioral bases for disease.	
3	Genetic determinants of health occur at the individual biological level. 	
4	Behavioral determinants of health occur at the individual level.	

PTS:	1	REF:	6	CON:	Promoting Health | Economics

	8.	ANS:	2
Objective: 4. Explore the connection between environment, resource availability, and health. 
Page: 
Heading: Introduction to Public Health > Public Health Frameworks: Challenges and Trends 
Integrated Processes: Teaching/Learning 
Client Need: Health Promotion and Maintenance 
Cognitive Level: Application [Applying] 
Concept: Nursing Roles; Communication; Collaboration 
Difficulty: Easy
	Feedback	
1	Although decreased disease rate is a definite sign that the health population is improving, community collaboration is a vehicle that brings participants together to address health issues such as rates of disease. Community collaboration efforts are a good way to achieve this.	
2	Accountability among members of a community is improved when communities are actively engaged in health programs.	
3	Availability of treatment may not be an identified risk factor for the increase in the rate. 	
4	Improving screening rates may not be an identified risk factor for the increase in the disease rate.	

PTS:	1	REF:	6	CON:	Nursing Roles | Communication | Collaboration

	9.	ANS:	2
Objective: 2. Describe public health in terms of current frameworks, community partnerships, and the concept of population health. 
Page: 
Heading: Introduction to Public Health > Public Health Frameworks: Challenges and Trends 
Integrated Processes: Nursing Process 
Client Need: Communication and Documentation Cognitive Level: Application [Applying] 
Concept: Promoting Health; Collaboration 
Difficulty: Easy
	Feedback	
1	This collaboration benefits the community’s public health after a natural disaster.	
2	Community collaboration can include advocating for change in regulations but does not involve direct legislative activity that is the responsibility of governmental bodies.	
3	A volunteer group can offer valuable services to enhance the lives of people suffering from mental illness.	
4	This community-based institution is an example of a social system that can work with a health department to use each other’s strengths to produce a meaningful project.	

PTS:	1	REF:	6	CON:	Promoting Health | Collaboration

	10.	ANS:	3
Objective: 6. Identify the formal organization of public health services from a global to local level. 
Page: 
Heading: Introduction to Public Health > Public Health Organization and Management 
Integrated Processes: Nursing Process 
Client Need: Safe and Effective Care Environment: Safety and Infection Control 
Cognitive Level: Analysis
Concept: Health-Care System, Regulation, Infection
Difficulty: Easy

	Feedback	
1	The Constitution did not provide for a national public health agency but rather assigned that duty to the states. Although the Centers for Disease Control and Prevention (CDC) provides ongoing research, sets guidelines, and offers support, quarantines are usually the responsibility of local health departments.	
2	State constitutions empower the states to establish state boards of health. Their duty is to protect the citizens, but quarantines are mostly managed at the local level.	
3	Quarantines are managed at the local level with assistance from the state if needed.	
4	All levels of government are not needed or agile enough to handle local health crises.	

PTS:	1	REF:	17	CON:	Health-Care System | Regulations | Infection

	11.	ANS:	3
Objective: 6. Identify the formal organization of public health services from a global to local level. 
Page: 
Heading: Introduction to Public Health > Public Health Organization and Management 
Integrated Processes: Communication and Documentation 
Client Need: Safe and Effective Care Environment: Safety and Infection Control 
Cognitive Level: Application [Applying] 
Concept: Health-Care System, Regulations 
Difficulty: Easy
	Feedback	
1	Local public health departments protect the health of the citizens that live in their county, municipality, or township. In conjunction with the state public health department and the Centers for Disease Control and Prevention, they conduct routine surveillance to help identify an increase in disease. 	
2	Once there is a disease outbreak, local health departments participate in the outbreak investigation in coordination with the state public health department and the Centers for Disease Control and Prevention.	
3	Hospitals are licensed by state and federal agencies, not local health departments.	
4	Local public health department in coordination with the state public health department and the Centers for Disease Control and Prevention implement and monitor quarantine efforts in the event of communicable disease outbreak that warrants isolation of those with the disease.	

PTS:	1	REF:	19	CON:	Regulations | Health-Care System

	12.	ANS:	3
Objective: 1. Identify how public health plays a central role in the practice of nursing across settings and specialties. 
Page:  
Heading: Public Health as a Component of Nursing Practice Across Settings and Specialties > Health From a Population Perspective 
Integrated Processes: Nursing Process 
Client Need: Health Promotion and Maintenance 
Cognitive Level: Knowledge 
Concept: Evidence-Based Practice; Promoting Health 
Difficulty: Moderate
	Feedback	
1	Although economics could be a useful tool to assess the impact of a health program, it is not considered one of the foundational subjects of public health.	
2	The humanities are not considered one of the foundational subjects of public health.	
3	Many branches of social and behavioral sciences are useful for analysis of public health issues.	
4	The study of man and his development is not considered one of the foundational subjects of public health. 	

PTS:	1	REF:	2	CON:	Evidence-Based Practice | Promoting Health

	13.	ANS:	2
Objective: 2. Describe public health in terms of current frameworks, community partnerships, and the concept of population health. 
Page:  
Heading: Health Promotion, Risk Reduction, and Health Protection 
Integrated Processes: Nursing Process 
Client Need: Health Promotion and Maintenance 
Cognitive Level: Application [Applying] 
Concept: Promoting Health 
Difficulty: Easy
	Feedback	
1	Both of these options are health promotions because they create opportunities to improve health through individual behavior change.	
2	A health promotion intervention, such as an exercise class, creates an opportunity to improve health through individual behavioral change, whereas a risk reduction program, such as administering vaccinations, involves actions taken to reduce a person’s risk for disease.	
3	Free medication for the flu is a treatment program that occurs when disease is present and not related to either health promotion or protection, and a diet class is a health promotion program aimed at individual behavior change.	
4	The hospital tour is educational but not related to health promotion or protection, and the relaxation techniques class is health promotion exercise aimed at individual behavior change.	

PTS:	1	REF:	7	CON:	Promoting Health	

	14.	ANS:	4
Objective: 4. Explore the connection between environment, resource availability, and health. 
Page: 
Heading: Health Promotion, Risk Reduction, and Health Protection 
Integrated Processes: Nursing Process 
Client Need: Health Promotion and Maintenance 
Cognitive Level: Application [Applying] 
Concept: Promoting Health; Nursing Roles 
Difficulty: Moderate
	Feedback	
1	Financial benefits or savings would promote behavioral change.	
2	Health club memberships would facilitate the employees’ ability for change.	
3	Encouraging a good diet through incentives would promote healthy behavior.	
4	All of the options previously listed promote good health and reduce the risk for illness.	

PTS:	1	REF:	15	CON:	Promoting Health | Nursing Roles

	15.	ANS:	4
Objective: 3. Investigate determinants of health within the context of culture. 
Page: 
Heading: Health Promotion, Risk Reduction, and Health Protection > The Context of Health 
Integrated Processes: Nursing Process 
Client Need: Health Promotion and Maintenance 
Cognitive Level: Knowledge 
Concept: Diversity; Promoting Health 
Difficulty: Moderate
	Feedback	
1	Race continues to be used to identify groups and as a marker for diversity.	
2	Culture refers to beliefs, values, and norms shared across a group of people and reflects diverse world views.	
3	Ethnicity reflects diversity in that specific groups differ based on geographic origin, language and dialect, religious faith, folklore, and food preferences.	
4	Environment is an important factor in understanding the context of health but is separate from the concept of diversity.	

PTS:	1	REF:	7	CON:	Diversity | Promoting Health

MULTIPLE RESPONSE

	16.	ANS:	1, 3, 4
Objective: 1. Identify how public health plays a central role in the practice of nursing across settings and specialties. 
Page: 
Heading: Introduction to Public Health > Public Health Frameworks: Challenges and Trends 
Integrated Processes: N/A 
Client Need: Health Promotion and Maintenance 
Cognitive Level: Comprehension [Understanding] 
Concept: Addiction; Promoting Health; Economics; Infection
Difficulty: Easy

	Feedback	
1	Globalization has resulted in widening of disparity between low-income and high-income countries especially in relation to food security and environmental degradation.	
2	In public health, better strategies for managing health care and current resources are needed more than newer technology.	
3	The widespread availability of tobacco and alcohol increases the abuse of these substances and the problems that accompany it.	
4	Some of the diseases that have emerged or re-emerged as a result of globalization are HIV, AIDS, severe acute respiratory syndrome, hepatitis, malaria, diphtheria, cholera, Ebola, and Zika virus. There is a need for planning for these possible pandemics using limited resources.	
5	Although improved transportation has resulted in increased globalization, further improvements are not a public health threat.  	

PTS:	1	REF:	4	CON:	Addiction | Promoting Health | Economics | Infection

	17.	ANS:	2, 3, 4, 5
Objective: 4. Explore the connection between environment, resource availability, and health. 
Page: 
Heading: Health Promotion, Risk Reduction, and Health Protection > Population-Focused Care Across Settings and Nursing Specialties 
Integrated Processes: Nursing Process 
Client Need: Physiological Integrity 
Cognitive Level: Synthesis
Concept: Assessment; Critical Thinking
Difficulty: Easy

	Feedback	
1	Antibiotics may not be a necessary route of treatment for the diagnosis.	
2	The first step is to note and compare symptoms, onset, and other information to ascertain whether this is the same illness and if it is potentially due to a common cause.	
3	Grouping the patients according to diagnosis will allow the health-care team to give better care and help create a care map but would not be the first step.	
4	Once the data on symptoms, onset, and other key information has been gathered, the next step is to inform the public health department if warranted. 	
5	Evaluating the environment of the patients may create an understanding of why the illness occurred and prevent a re-occurrence of the illness and would occur as part of the public health department’s outbreak investigation, if one is warranted.	

PTS:	1	REF:	9 | 10	CON:	Infection | Assessment

	18.	ANS:	1, 2, 3, 4
Objective: 5. Identify the key roles and responsibilities of public health nurses (PHNs). 
Page: 
Heading: Public Health Nursing as a Specialty > Public Health Nursing Scope and Standards of Practice 
Integrated Processes: N/A 
Client Need: N/A
Cognitive Level: Knowledge 
Concept: Regulations; Nursing Roles
Difficulty: Easy

	Feedback	
1	The PHN collects comprehensive data pertinent to the health status of populations.	
2	The PHN analyzes the assessment data to determine the diagnoses or issues.	
3	The PHN identifies expected outcomes for a plan specific to the population or situation.	
4	The PHN develops a plan that prescribes strategies and alternatives to attain expected outcomes.	
5	Mitigation is a part of emergency preparedness and disaster management 	

PTS:	1	REF:	13	CON:	Regulations | Nursing Roles

	19.	ANS:	1, 2, 3, 5
Objective: 5. Identify the key roles and responsibilities of public health nurses (PHNs). 
Page: 
Heading: Public Health Nursing as a Specialty > Public Health Nursing Scope and Standards of Practice 
Integrated Processes: N/A 
Client Need: N/A 
Cognitive Level: Application [Applying] 
Concept: Infection; Nutrition; Diversity; Nursing Roles 
Difficulty: Easy

	Feedback	
1	Policy development/program planning is an essential skill for a PHN.	
2	To reach a population that might not receive adequate health care, cultural competency and communication skills are needed to overcome any barriers.	
3	Financial and management skills are needed to maintain the sustainability of programs.	
4	Development of individual treatment plans is part of the basic skills of all nurses and does not reflect a specific PHN competency.	
5	One of the new challenges PHNs face is preparing the public for sudden, catastrophic health events, such as bioterrorism.	

PTS:	1	REF:	15	CON:	Infection | Nutrition | Diversity | Nursing Roles