Test Bank Community Public Health Nursing 6th Edition Nies McEwen

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Chapter 02: Historical Factors: Community Health Nursing in Context
Test Bank


1. Which of the following best describes the time period when communities began to agree on collective action to stay healthy?
a. When industrialization occurred
b. When large urban centers began to develop and the population expanded
c. When people gathered together to settle in villages
d. When people were nomads engaged in hunting and gathering

Primitive prehistorical societies had health practices to ensure their survival. Isolation and fumigation were used for thousands of years. This time period is best described by when people were nomads engaged in hunting and gathering. Industrialization, development of large urban centers, and settlement into villages do not describe this time period.

DIF: Cognitive Level: Understand (Comprehension) REF: pp. 20-21

2. Which of the following best describes the first measures used by large communities to ensure community health?
a. Building safe sewage disposal systems
b. Healthy food choices and exercise
c. Praying to the gods for preservation
d. Use of medicine and other herbal remedies

In classical times, large cities grew, and elaborate drainage systems were constructed. In Leviticus, the Hebrews formulated the first hygiene code. This hygiene code protected water and food by creating laws that governed personal and community hygiene, such as contagion, disinfection, and sanitation. This is best described through the building of safe sewage disposal systems. Healthy food choices and exercise, praying to the gods for preservation, and the use of medicine and other herbal measures were not among the first measures used by large communities to ensure health.

DIF: Cognitive Level: Understand (Comprehension) REF: p. 21

3. A nurse has determined that there is always a consistent level of people in the population who experience pneumonia. Which of the following best describes the prevalence of this disease?
a. Prevalent
b. Endemic
c. Epidemic
d. Pandemic

By definition, when diseases are always present in a population they are called endemic. Diseases which were occasionally present and often fairly widespread are called epidemic. Pandemic is used to describe the existence of a disease in a large proportion of the population. Prevalent means widespread, and would not be the best term to describe this disease.

DIF: Cognitive Level: Apply (Application) REF: p. 21

4. Which of the following best describes an innovation introduced by the Romans?
a. Citizenship duties
b. Daily street cleaning
c. Hospitals and nursing homes
d. Daily exercise

The Romans introduced many health innovations such as fresh water, public physicians, hospitals, surgeries, infirmaries, and nursing homes. Unfortunately, these services were only for the wealthy. Citizenship duties, daily street cleaning, and daily exercise were not innovations introduced by the Romans.

DIF: Cognitive Level: Understand (Comprehension) REF: p. 21

5. Which of the following best describes a modern public health practice that was originally developed as a means of self-protection from the Black Death (bubonic plague)?
a. Care in a hospital
b. Chemical intervention
c. Isolation and quarantine
d. Herbal remedies

Modern public health practices, such as isolation, disinfection, and ship quarantines, emerged in response to the bubonic plague. Care in a hospital was originally developed by the Romans. Chemical intervention and herbal remedies were not used to self-protect from the Black Death.

DIF: Cognitive Level: Understand (Comprehension) REF: p. 21

6. Which of the following diseases provided immunity to smallpox?
a. Cowpox
b. Measles
c. Mumps
d. Scarlet fever

Those that had an infection of cowpox were thereafter immune from smallpox, which was endemic and killed about 10% of the population. Measles, mumps, and scarlet fever did not provide immunity to smallpox.

DIF: Cognitive Level: Understand (Comprehension) REF: p. 22

7. A scholar during the Sanitary Revolution created medical topographies. What was the advantage of these surveys?
a. Citizens knew which wells were safe to use for drinking water.
b. People knew what housing areas to avoid.
c. Results demonstrated environmental factors related to regional disease.
d. The king could isolate areas of disease from safe areas.

Survey methods were being used to study health problems. The medical topographies illustrated geographic factors related to regional health and disease. They were able to demonstrate environmental factors related to regional disease. They did not address the safety of wells, housing areas, or the isolation of disease.

DIF: Cognitive Level: Apply (Application) REF: p. 22

8. How did Edwin Chadwick’s ideas help decrease disease in the nineteenth century?
a. The minimum wage was increased leading to improved quality of life.
b. Parish workhouses where poverty-level children labored for their room and board were closed.
c. Social reform legislation resulted in changes such as sidewalks.
d. The new emphasis on individual responsibility encouraged people to act to protect their own health.

Edwin Chadwick’s Report on the Sanitary Conditions of the Labouring Population of Great Britain led to legislation for social reform, including child welfare, factory management, clean water, sewers, fireplugs, and sidewalks. This report did not address increasing the minimum wage, closing parish workhouses, or increasing individual responsibility.

DIF: Cognitive Level: Understand (Comprehension) REF: p. 22

9. Which of the following best describes how John Snow was able to decrease deaths from cholera?
a. Removed a source of contaminated water
b. Created the world’s first antibiotic
c. Encouraged the new process of vaccination
d. Helped pass laws that required home quarantine

John Snow demonstrated that cholera was transmissible through contaminated water. He removed the pump handle from the contaminated water so an alternate source of water had to be used. Alexander Fleming created the first antibiotic. Legislators were responsible for encouraging the new process of vaccination and passing laws related to home quarantine.

DIF: Cognitive Level: Understand (Comprehension) REF: p. 23

10. Which of the following best describes the achievement that Lemuel Shattuck is well known for in the United States?
a. Publishing the census of Boston, which demonstrated the effect of sanitary reforms
b. Demonstrating the usefulness of vital statistics by analyzing environmental data
c. Developing ideas about public health care reform, which were eventually adopted
d. Establishing a state board of health to deal with the problems he had noted

Lemuel Shattuck organized the American Statistical Society and issued a census, which demonstrated high mortality rates. His report of the Massachusetts Sanitary Commission recommended modern public health reforms. However, nothing was actually done about the recommendations for almost two decades. Eventually, however, the merit of his ideas was recognized.

DIF: Cognitive Level: Understand (Comprehension) REF: p. 23

11. Which of the following nursing interventions would have most likely been used by Florence Nightingale when treating wounded soldiers?
a. Establishing private visits with spouses
b. Improving food, clothing, and cleanliness
c. Administering intravenous medications
d. Completing a community assessment of the army hospital

Discovering the appalling conditions of the hospital, Florence Nightingale set up diet kitchens and a laundry and provided food, clothing, dressings, and laboratory equipment. Her focus on environmental improvements did not address private spousal visits, administration of IV (intravenous) medications, or completion of a community assessment.

DIF: Cognitive Level: Understand (Comprehension) REF: p. 23

12. Which of the following best describes how Nightingale responded to challenges about her suggestions for reform of health care?
a. She influenced male friends as political leaders to publicize her ideas.
b. She conveyed her statistical data in more detail and depth, and shared it with political leaders.
c. She encouraged those who challenged her to come up with more acceptable approaches to lowering the death rate.
d. She understood their concerns and tried to word her suggestions in a more politically acceptable way.

Nightingale felt very strongly about the unnecessary loss of life and shared her findings widely. When prominent male leaders challenged her conclusions, she rewrote her report in more depth and redistributed it to members of Parliament and military leaders.

DIF: Cognitive Level: Understand (Comprehension) REF: p. 24

13. When comparing a surgeon today with a surgeon of Nightingale’s time, which of the following best describes the primary difference in how they would operate on a patient?
a. Current physicians have better surgical equipment (tools).
b. Current physicians have nursing support staff in the operating room.
c. Current physicians would carefully scrub between cases.
d. Current physicians would prescribe antibiotics in the operating room to avoid possible infections.

Physicians in Nightingale’s time believed in spontaneous generation, which stated that disease organisms grew from nothing, and were unaware of how diseases spread. Consequently, they did not use sanitary operating procedures, including scrubbing between cases. The different surgical equipment, nursing support, and use of antibiotics do not describe the primary difference.

DIF: Cognitive Level: Apply (Application) REF: p. 24

14. Which of the following scientific beliefs or ideas eventually changed medical practice and decreased morbidity and mortality?
a. Bad fluids cause disease, which can be cured by their removal.
b. Specific contagious organisms cause disease.
c. Spontaneous generation theory—disease grows naturally.
d. The miasmic theory—environmental conditions cause disease.

The emergence of the germ theory of disease focused diagnosis and treatment on the individual organism and the individual disease. The theories related to bad fluids causing disease, spontaneous generation, and miasmic theory were all proven to be incorrect.

DIF: Cognitive Level: Understand (Comprehension) REF: p. 26

15. Why did local and state governments start to become more involved in controlling disease?
a. Hospitals were becoming overcrowded.
b. Businesses were unable to make a profit when employees were ill.
c. Physicians demanded government support in their individual efforts.
d. Citizens were becoming upset with local conditions.

Community outcry for social reform forced state and local governments to take notice of deplorable conditions and take more responsibility for controlling the spread of bacteria and other microorganisms. Hospital overcrowding, unprofitability of businesses, and physician demand for government support did not influence the increased involvement of local and state governments.

DIF: Cognitive Level: Understand (Comprehension) REF: p. 26

16. Which of the following interventions was the first step in controlling the incidence of tuberculosis (TB)?
a. Institutions were required to report TB cases.
b. Federal funding was devoted to seeking TB causes and cures.
c. Physicians began surveillance of TB cases.
d. States built large public hospitals to treat patients with TB.

Physicians fought being required to maintain surveillance of TB and TB health education. States had to build large state hospitals for treatment but that did not notably control the incidence. The New York City Health Department required institutions to report cases of TB in 1894 and required physicians to do the same in 1897.

DIF: Cognitive Level: Understand (Comprehension) REF: p. 27

17. Which of the following best describes the overall result of Abraham Flexner’s report?
a. All medical schools reorganized into the German model.
b. Citizens were encouraged to become more involved in medical education.
c. Folk healers again became more widely used than physicians.
d. Funding was withdrawn from weak medical schools.

Funding was withdrawn such that scientifically inadequate medical schools closed, not reorganized into the German model. The Flexner report outlined shortcomings of weak schools that were not built on the German model of a scientific base. Physicians now emerged who had been taught the germ theory of disease. The report did not address citizen involvement in medical education or the increased use of folk healers.

DIF: Cognitive Level: Understand (Comprehension) REF: p. 27

18. Which of the following groups was primarily responsible for the establishment of the first school of public health?
a. The American Medical Association
b. The Association of State Departments of Public Health
c. The federal government
d. The Rockefeller Foundation

Philanthropic foundations influenced many health care efforts. The Rockefeller Sanitary Commission strived for the eradication of hookworm. This model of prevention was so successful that the Rockefeller Foundation established the first school of public health in 1916.

DIF: Cognitive Level: Understand (Comprehension) REF: p. 27

19. A family living in England in 1860 was part of the community where district nursing was implemented. Who would most likely have seen this family?
a. A social worker and a nurse
b. A health teacher and a nurse
c. A nurse
d. A physician and a nurse

A nurse and a social worker were assigned to each district to meet the needs of their communities in nursing, social work, and health education. This plan was widely accepted and very successful.

DIF: Cognitive Level: Apply (Application) REF: p. 28

20. Which of the following interventions was most helpful in assisting people become educated on healthful living in nineteenth-century England?
a. Brochures were distributed without charge in public places.
b. Health visitors joined nurses in providing care in the homes.
c. Nurses spent the majority of their time teaching families.
d. Schools set up health programs for neighborhood adults.

Health pamphlets alone had little effect, so health-visiting services enlisted home visitors to distribute health information to the poor. Eventually, although Nightingale thought district nurses should be the health teachers, district nurses provided care for the sick while the health visitor provided health information in the home.

DIF: Cognitive Level: Understand (Comprehension) REF: p. 28

21. Which of the following best describes the district nursing service created in the United States by Lillian Wald and Mary Brewster?
a. House on Henry Street
b. Visiting Nurses Association
c. New York City District Nursing Service
d. Wald and Brewster Nursing Service

They established a district nursing service on the Lower East Side of New York City called the House on Henry Street for all the unemployed and homeless immigrants who needed health care. It later evolved into the Visiting Nurse Association of New York City and helped establish public health nursing in the United States.

DIF: Cognitive Level: Understand (Comprehension) REF: p. 28

22. Which of the following statements best summarizes Wald and Brewster’s approach to home nursing?
a. “All services all the time”
b. “Helping people to help themselves”
c. “One person, one family, at a time”
d. “Your home or ours”

The nursing service adopted the philosophy of meeting health needs of aggregates including social, economic, and environmental determinants of health. This aggregate approach empowered people of the community. A later director summarized their role as “one of helping people to help themselves.” Because they were empowering others, the other statements do not fit this philosophy.

DIF: Cognitive Level: Understand (Comprehension) REF: p. 28

23. Which of the following did Lillian Wald help establish?
a. Child employment centers with shortened work days
b. Daycare centers for preschool-aged children
c. Nurseries for infants of working mothers
d. School health nursing for school-aged children

Wald convinced the New York City Health Commissioner to put a public health nurse into a school. The experiment was so successful that schools adopted nursing on a widespread basis, thereby creating the field of school health nursing. Child employment centers, daycare centers, and nurseries for working mothers were not created by Wald.

DIF: Cognitive Level: Understand (Comprehension) REF: p. 28

24. Which of the following statements best summarizes the view of nurses as seen in novels over the past 100 years?
a. Nurses are and have always been seen as very strong intelligent women.
b. For the past 50 years, nurses were primarily viewed as promiscuous women.
c. Nurses are controlling, almost sadistic women who enjoy their power over patients.
d. Nurses are obedient handmaidens to physicians, following whatever orders are given.

Nurses were strong independent women in novels until the 1960s and 1970s when they were presented very negatively as promiscuous “bed hopping honeys.”

DIF: Cognitive Level: Understand (Comprehension) REF: p. 32

25. Which of the following best describes the primary focus of health care efforts in the United States?
a. Acute illnesses and trauma
b. Chronic diseases
c. Diarrhea and starvation
d. Infectious diseases

Whereas diarrhea, starvation, and infectious diseases are major causes of death in developing countries, in developed countries such as the United States, chronic diseases are the primary cause of mortality.

DIF: Cognitive Level: Understand (Comprehension) REF: p. 30

26. Which of the following statements best describes why there is an increased need for advanced practice nurses in primary care?
a. Clinics are being built in many middle-class neighborhoods.
b. Hospitals are increasing their number of beds.
c. More nurses are choosing to obtain master’s degrees.
d. Most physicians are specialists.

Because so many physicians are specialists and there is increasing demand for primary care providers, there are increased opportunities for advanced practice nurses in primary care. Hospitals are decreasing the number of beds, not increasing them.

DIF: Cognitive Level: Understand (Comprehension) REF: p. 30

27. Which of the following statements best explains the continued incidence of infectious disease in the United States today?
a. Illness theory explains that there are many causes of illness resulting from environmental conditions.
b. No single theory adequately explains why a particular person gets a particular illness at a particular time.
c. The germ theory explains that a specific infection is caused solely by the invasion of particular bacteria.
d. The theory of susceptibility states that an individual only gets ill when there is extensive stress in his or her life.

Each theory explains some disease under some conditions, but no single theory accounts for all disease. Infectious agents cause disease when a person is susceptible as a result of stress and/or environmental conditions.

DIF: Cognitive Level: Apply (Application) REF: p. 31

28. Which of the following best describes the primary concern both historically and today for many people when they become ill?
a. Can they get an appointment to see their physician in a timely fashion?
b. Can they get admitted to their local hospital without delay?
c. How can they afford to take time off from work and lose pay to be ill?
d. Will the expenses be covered by their health insurance?

This question assumes students are aware of current social reality related to illness, health insurance, and employment realities. Historically, the greatest health concerns were lost wages associated with sickness. Today many employment positions do not offer health insurance. In addition, many employment positions do not have sick leave; if you are not at work, you do not get paid.

DIF: Cognitive Level: Analyze (Analysis) REF: p. 31

29. Which of the following statements best describes the increase in life expectancy among Americans during the twentieth century?
a. Life expectancy increased by 30 years; the majority can be attributed to advances in medical technology.
b. Life expectancy increased by 30 years; the majority can be attributed to public health efforts.
c. Life expectancy increased by 30 years; the majority can be attributed to improved physician education.
d. Life expectancy increased by 30 years; the majority can be attributed to increased access to care.

During the twentieth century, the health and life expectancy of persons living in the United States improved dramatically. It is important for nurses to realize that of the 30 years of life expectancy gained during the century, 25 years were attributable to public health efforts. The advances in medical technology, improved physician education, and increased access to care have not had the impact on increasing life expectancy that the public health efforts have had.

DIF: Cognitive Level: Understand (Comprehension) REF: p. 31

30. Which of the following is a major challenge for health care provider education today?
a. Ensuring that research findings related to families and groups are included in the curriculum
b. Expanding the curriculum to allow additional experiences in community health settings outside the hospital
c. Increasing course emphasis on environmental influences on health
d. Refocusing the curriculum from care of the individual to needs of aggregates

There is an obvious need for a primary care curriculum that prepares students to meet the needs of aggregates through community strategies that include understanding of statistical data and epidemiology. Primary health care and health promotion rather than acute care treatment would be emphasized. Such a curriculum would move the focus from the individual to a broader population approach.

DIF: Cognitive Level: Understand (Comprehension) REF: p. 32


1. Which of the following tool(s) were used by Florence Nightingale to create change? (Select all that apply.)
a. Her incredible beauty and personality
b. Influence of all the nurses Nightingale trained
c. Political advocacy
d. Publication of treated soldiers’ death rate changed from 42% to 2%
e. Use of statistics to demonstrate the effectiveness of her interventions
f. Wealth of her family and relatives

ANS: C, D, E
Nightingale focused on the aggregate of British soldiers and used graphically depicted statistics and other data to demonstrate effectiveness of her interventions, which allowed her to become a political advocate on behalf of the soldiers. Nightingales’ beauty and personality, influence among nurses, and wealth were not tools used to create change.

DIF: Cognitive Level: Understand (Comprehension) REF: p. 24

2. Which of the following of Nightingale’s ideas were forgotten until recently? (Select all that apply.)
a. The need for education for women
b. The influence of environment on health
c. The importance of clinical practice for expertise to develop
d. The need to recognize gender role limitations
e. The problem-solving (nursing) process
f. The use of statistics and a sound research base

As the text remarks, it is interesting to note that the paradigm for nursing education and practice did not incorporate her emphasis on statistics and a sound research base. It is also curious why her writing on health’s social and environmental determinants was not consulted until much later.

DIF: Cognitive Level: Apply (Application) REF: p. 24

3. Which of the following best describes why folk healers are used by many people? (Select all that apply.)
a. Folk healers are often effective.
b. Folk healers do not charge for their efforts.
c. Folk healers integrate religion and medicine.
d. Folk healers use media very effectively.
e. Folk healers may involve the whole family.
f. Many physicians recommend folk healers.

ANS: A, C, E
Folk healers offer repeated success, as many of their medicines are effective; their healing practices are socially cohesive, often including family and neighbors; and folk healers often integrate religion and morality with medicine. Folk healers usually have a charge for their services. Folk healers may or may not be using media to promote their services. Most physicians do not recommend folk healers.

DIF: Cognitive Level: Understand (Comprehension) REF: p. 27

4. What current emphases are focusing attention on public health? (Select all that apply.)
a. Cost containment and managed care models
b. Focus on disease prevention and health promotion
c. Increased funding for care of chronic diseases
d. Liberal politicians encouraging public health as part of a national health reform
e. Movies showing national disasters and government lack of preparedness
f. Shortage of the H1N1 flu vaccine

With a current focus on cost containment and organization of health care services under managed care, the emphasis is increasingly on the community and public health. The community need for a focus on prevention, health promotion, and home care may become more widespread with the changing patterns of reimbursement. Holistic care requires multiple dimensions and must have more attention in the future. Unfortunately, funding has not increased, politicians and legislation are not focused on public health, and there has not been an emphasis on movies showing national disasters and lack of government preparedness.

DIF: Cognitive Level: Understand (Comprehension) REF: p. 30

5. Which of the following were the chief factors that led to the creation and growth of Blue Cross hospital insurance? (Select all that apply.)
a. Hospitals banded together, and their leaders encouraged such plans.
b. Hospitals thought such a plan would allow them to expand further and faster.
c. It was an employer alternative to increasing employee pay compensation.
d. Nurses fought for the right of all citizens to purchase insurance as desired.
e. Physicians were concerned with nonpayment of their office fees.
f. Politicians encouraged this alternative to government-supported health care.

Physicians later sought insurance plans, but originally only hospitals created insurance plans based on American Medical Association (AMA) leadership encouragement. During World War II increasing salaries was not an option, so offering health insurance helped ensure employee retention. Although government-supported health plans were suggested as early as the 1930s, politicians were not seriously discussing government-supported care.

DIF: Cognitive Level: Understand (Comprehension) REF: p. 31