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Nies: Community/Public Health Nursing, 5th Edition
Chapter 02: Historical Factors: Community Health Nursing in Context
1. When did communities first begin 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. While people were nomads engaging in hunting and gathering
Primitive prehistorical societies had health practices to ensure their survival. Isolation and fumigation were used for thousands of years.
DIF: Knowledge REF: 19 and 21
2. Historically, what were among the first measures large communities began to undertake 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.
DIF: Knowledge REF: 21
3. What is the proper term for those diseases that are always at a consistent level in populations?
a. A lack of appropriate public health measures
By definition, when diseases are always present in a population they are called endemic.
DIF: Knowledge REF: 21
4. Besides a fresh safe water supply, what other innovation(s) did the Romans introduce?
a. Citizenship duties including daily exercise
b. Daily street cleaning
c. Hospitals and nursing homes
d. Making services available to all residents of the city
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.
DIF: Knowledge REF: 21
5. What measure(s) did persons use for self-protection from the Black Death (bubonic plague) in the fourteenth century?
a. Care in a hospital or from a physician
b. Chemical intervention
c. Isolation and quarantine
d. Protection from a priest or church
Modern public health practices such as isolation, disinfection, and ship quarantines emerged in response to the bubonic plague.
DIF: Knowledge REF: 21
6. With what endemic infectious disease did people choose to become infected?
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.
DIF: Knowledge REF: 22
7. What was the advantage of creating medical topographies?
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.
DIF: Application REF: 22
8. How did Edwin Chadwick’s ideas help decrease disease in the nineteenth century?
a. Because of differences in life spans by economic class, the minimum wage was increased.
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 an Inquiry Into 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.
DIF: Comprehension REF: 22
9. How did John Snow 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.
DIF: Knowledge REF: 23
10. Lemuel Shattuck is well known in the United States for which achievement?
a. His Census of Boston, which demonstrated the effect of sanitary reforms
b. Demonstrating the usefulness of vital statistics for analyzing environmental data
c. His ideas concerning public health care reform, which were eventually adopted
d. Massachusetts immediately set up a State Board of Health to deal with problems he 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: Comprehension REF: 23
11. What nursing interventions did Florence Nightingale use in treating wounded soldiers?
a. Established private conjugal visits with spouses
b. Improvements in food, clothing, and cleanliness
c. Same nursing techniques used today minus the modern technology
d. The nursing process, at that time called the problem-solving process
Discovering the appalling conditions of the hospital, Florence Nightingale set up diet kitchens and a laundry and provided food, clothing, dressings, and laboratory equipment.
DIF: Knowledge REF: 23
12. How did Nightingale respond to some powerful leaders challenging her suggestions for reform of health care beyond the military war arena?
a. Being a woman, she used 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: Comprehension REF: 26
13. Comparing a surgeon today with a surgeon of Nightingale’s time, what would be the primary difference in how they 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 and were unaware of how diseases spread. Consequently, they did not use sanitary operating procedures.
DIF: Application REF: 26
14. What scientific belief or idea 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.
DIF: Comprehension REF: 27
15. Why did local and state governments start to become more involved in controlling disease?
a. Employers asked for government assistance.
b. Employers could not make a profit when employees were always ill.
c. Physicians demanded support in their individual efforts.
d. Too many citizens were too upset by 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.
DIF: Comprehension REF: 27
16. What eventually was helpful in decreasing the incidence of tuberculosis (TB)?
a. A volunteer organization began a public campaign of education.
b. Federal funding was devoted to seeking causes and cures of TB.
c. Physicians began surveillance of TB cases.
d. States built large public hospitals to treat patients with TB.
The National Tuberculosis Association enlisted community support through a campaign of public health education with many voluntary health organizations assisting. Physicians fought being required to maintain surveillance of TB and TB health education. States did have to build large state hospitals for treatment but that did not notably decrease incidence.
DIF: Knowledge REF: 27
17. The Carnegie Commission appointed Abraham Flexner to evaluate medical schools on the basis of the German model. What was the overall result of his 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.
The Flexner Report outlined shortcomings of weak schools that were not built on the German model of a scientific base. Funding was withdrawn such that scientifically inadequate medical schools closed. Physicians now emerged who had been taught the germ theory of disease.
DIF: Comprehension REF: 27
18. What group 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: Knowledge REF: 27
19. When William Rathbone created district nursing, who was sent to each district?
a. A social worker and a nurse
b. For safety’s sake, two nurses always went together.
c. Hospital-educated expert clinical nurses
d. Women selected by Rathbone’s now-recovered wife
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: Knowledge REF: 28
20. What was successful in helping people become educated on healthful living in nineteenth-century England?
a. Brochures 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: Knowledge REF: 29
21. What was the name of 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: Knowledge REF: 29
22. How might the approach to home nursing established by Wald and Brewster best be summarized?
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.”
DIF: Knowledge REF: 29
23. What did Lillian Wald help create that was very useful for poor children?
a. Child employment centers where the work day was 8 hours a day, not 16 hours
b. Day-care centers for pre–school-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.
DIF: Comprehension REF: 30
24. What has research concluded about 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 hoppers.”
DIF: Knowledge REF: 30
25. As in other developed countries, what is 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: Knowledge REF: 31
26. What helps explain the increased numbers of 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: Comprehension REF: 31
27. How do we explain the continued incidence of infectious diseases 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: Application REF: 31
28. What is 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: Analysis REF: 32
29. What is the issue of major concern among feminists regarding health care?
a. Equality in pay for both female and male hospital employees
b. Reproductive freedom for women
c. That research include female as well as male subjects so findings are available for both genders
d. That women be included on hospital boards of directors and other leadership positions
e. That women receive as aggressive medical treatment as males currently receive
Feminists believe that all people are inherently equal and deserve equal opportunities. In health care, feminism focuses on reproductive freedom for women.
DIF: Knowledge REF: 32
30. Based on public health issues today, what is the major challenge for health care provider education?
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: Comprehension REF: 33-34
1. With what tool(s) did Florence Nightingale 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 change 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.
DIF: Knowledge REF: 23
2. Many of Nightingale’s ideas were absorbed into nursing education in both England and other countries. Which of the following of Nightingale’s ideas were forgotten until recently? Select all that apply.
a. Need for education for women
b. Recognizing 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. Use of statistics and a sound research base
ANS: B, F
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: Knowledge REF: 26
3. Why do folk healers continue to be consulted by many people, including well-educated American citizens? Select all reasons 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 often use social interventions involving the whole family, as well as friends and neighbors.
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.
DIF: Comprehension REF: 28
4. What current emphases are focusing attention on public health? Select all that apply.
a. Cost containment and managed care models
b. Fear of bioterrorism within our borders
c. Increased funding for health promotion and disease prevention
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
ANS: A, B
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. Unfortunately, funding has not increased, and legislation is not focused on public health. However, because bioterrorism is a major current concern and steps are being taken to be able to respond quickly and appropriately to a bioterrorist threat, public health has again become an area of focus.
DIF: Comprehension REF: 21 and 32
5. What 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.
ANS: A, C
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: Comprehension REF: 32
6. What do contemporary historians now suggest has been previously ignored in relation to health care? Select all that apply.
a. Churches’ role in giving of care to the ill and the needy
b. Extensive care giving by female healers in the home
c. How expensive medical care has always been
d. Influence of discovery of antibiotics and other medicines
e. Social and environmental contexts of care
f. The need for church officials to reclaim spiritual aspects of care
ANS: B, E
Historians have typically ignored the extensive care by women healers, referring to them as marginal amateurs, as well as the major influence of social and environmental contexts on health and medical care that is necessary to place health care in a broader context.
DIF: Comprehension REF: 34
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