Chapter 29: State and Local Health Departments Nursing School Test Banks

Chapter 29: State and Local Health Departments
Test Bank

MULTIPLE CHOICE

1. Under the U.S. Constitution, which level of government has primary responsibility for health care of American citizens?
a. County/district level of government
b. Federal level of government
c. State level of government
d. Town/city/village level of government
ANS: C
Under the U.S. Constitution, states retain the power to protect the health and welfare of their residents. Consequently, states have the primary responsibility for public health functions.

DIF: Cognitive Level: Knowledge REF: p. 726

2. Public health funding represents what percentage of total health care funding expenditures?
a. 1% to 4%
b. 5% to 9%
c. 10% to 14%
d. 15% to 19%
ANS: A
Today public health funding remains low, at 3% of the total health care budget.

DIF: Cognitive Level: Knowledge REF: p. 727

3. A nurse is employed by a local health department. Which of the following would be a core responsibility of this role?
a. Assessment and surveillance of the health status of its residents
b. Providing direct care to vulnerable populations in the community
c. Using marketing strategies to educate citizens about healthy lifestyle choices
d. Implementing quality assurance methods at local care facilities
ANS: A
Local health departments cannot act without knowing, through assessment and surveillance, the health needs of its citizens. One of the essential services of public health is monitoring the health status of citizens to identify community health problems; such monitoring can be accomplished through assessment and surveillance.

DIF: Cognitive Level: Application REF: p. 740

4. To qualify to be the chief executive in most state health departments, which of the following is the requirement?
a. Medical doctor with a degree in public health
b. Nurse with expertise in public health and administration
c. PhD in any profession and a degree in public health
d. Political appointment, serving at the discretion of the governor
ANS: D
In most states, the appointments are made by the governor within the limits of the health code of that state. By tradition and, in some states, by law, the chief executive is often a physician.

DIF: Cognitive Level: Comprehension REF: pp. 727-728

5. A nurse has recently been hired by a state health agency. Which of the following activities would the nurse most likely complete?
a. Collaborating with other professionals on the states disaster plan
b. Hiring physicians and nurses to provide direct care to needy clients
c. Performing blood pressure screenings at a community center
d. Assuring quality health care in facilities in the state
ANS: A
State health agencies may provide direct client services, but these are usually targeted at vulnerable or institutionalized populations. Reports have shown that more states have increased emphasis on health planning and development, quality improvement and performance management, bioterrorism preparedness, and emergency medical services oversight and have attempted to reduce direct care services.

DIF: Cognitive Level: Analysis REF: p. 728

6. A public health nurse is employed by a state health department and is coordinating a lead screening program in the state. What is the most likely source of funding for this programming?
a. Federal and state tax dollars
b. Fees for services
c. Local and county tax funds
d. Research and grant funds
ANS: A
Most funding for state health departments comes from public tax dollars provided by the state and federal governments.

DIF: Cognitive Level: Application REF: p. 728

7. A nurse employed by a state health agency has been notified that her position within the agency will be eliminated. Which of the following factors has most likely contributed to this?
a. A downturn in the economy and tax reform efforts mean fewer state tax dollars.
b. Federal government funds given to states for health needs have been used for other purposes.
c. The need to provide care is declining as new mandates from the federal level are felt by local communities.
d. There is a decreased demand for public health services by the community.
ANS: A
The federal government has passed new laws with mandates for action. However, federal funds have decreased. Because of the economy and the national debate about tax reform states find it very challenging to raise taxes.

DIF: Cognitive Level: Application REF: p. 728

8. Which of the following determines the authority, responsibility, and funding of local health departments?
a. County/district legislation
b. The federal government
c. The local health department
d. State legislation
ANS: D
Local health departments obtain their authority through state law. Local health departments may build on state delegation, with additional responsibilities as decided through local ordinances.

DIF: Cognitive Level: Knowledge REF: pp. 728-729

9. When asked, What does your state health department do for you? the average citizen might well respond, Nothing. What does such a response illustrate?
a. Citizens are woefully uninformed about health and health care.
b. Citizens resent being asked personal questions.
c. Health is not a priority for Americans.
d. Most direct services are provided by local health departments.
ANS: D
Most direct services that citizens would receive or know about are provided by local health departments, whereas state agencies are more involved in regulation, coordination, and health monitoring. The more visible services are at the local level.

DIF: Cognitive Level: Application REF: p. 729

10. Which of the following sources produces the most revenue at the local level?
a. Grants
b. Fees for service
c. Levies
d. Resource allocation
ANS: C
Funding sources for local health departments is a combination of local, state, and federal funds. Revenue from local sources is primarily from taxes or a levy. A levy is a mechanism for raising money through the ballot box.

DIF: Cognitive Level: Knowledge REF: p. 729

11. A local health department is considering writing a grant to expand services for young women and children in the community. Which of the following factors would lead the agency to decide not to apply for available grant funding?
a. The employment of quality grant writers at the agency is too expensive.
b. The grant-writing process is not the most efficient way to obtain more funding.
c. The restrictions and accountability costs may exceed the money received.
d. The staff is unfamiliar with the grant application process.
ANS: C
The costs to the department of the restrictions and accountability imposed by the grantor may exceed the benefits obtained with the money. When money is no longer granted, the jobs paid for by those funds are lost.

DIF: Cognitive Level: Application REF: pp. 730-731

12. A public health nurse has been asked to be part of a coalition to promote legislation to ban smoking in public places in the state. Why is it important for the nurse to be part of this coalition?
a. The nurse can prioritize community health care needs to address the problem.
b. The nurse can determine the needs of others and the priority of any care needed.
c. The nurse can effectively communicate among various stakeholder groups.
d. The nurse can educate other people and enforce the legislation when it is passed.
ANS: C
Although not the only ones with expertise in public health, public health nurses are very effective at communication among various interested groups, such as support groups and legislators. It is not easy to assess and prioritize among competing needs, especially when legislation requiring certain actions without funds to engage in those actions is passed.

DIF: Cognitive Level: Application REF: p. 731

13. For what population size are most local health departments responsible?
a. Populations of 50,000 or fewer
b. Very large populations of 100,000 or more
c. Very large populations of 250,000 or more
d. Populations of more than 1 million residents
ANS: A
The majority of local public health programs, many in small towns and rural areas, serve populations of 50,000 or fewer.

DIF: Cognitive Level: Knowledge REF: p. 732

14. Aside from administrative staff, which professional group represents the majority of professionals in public health departments?
a. Epidemiologists
b. Nurses
c. Physicians
d. Environmental sanitarians
ANS: B
The majority of public health providers are nurses.

DIF: Cognitive Level: Knowledge REF: p. 732

15. Which of the following professionals inspects or assesses the safety of water supplies, restaurants, dairies, sewers, and swimming pools for public health departments?
a. Environmental sanitarians
b. Epidemiologists
c. Public health director
d. Public health nurse
ANS: A
Environmental sanitarians are concerned with safe air, water, food, and housing.

DIF: Cognitive Level: Knowledge REF: p. 732

16. A school health nurse contacted the public health department with concern that increasing numbers of parents were calling the school and reporting their child would not be in attendance because of a sore throat and fever. Which professional staff member would be most helpful in such a situation?
a. An epidemiologist, who might determine whether a disease outbreak was occurring
b. A nurse, who could give home care to each of the ill children
c. A physician, who could visit each of the ill children
d. The principal of the school, who could insist that the children stay in isolation
ANS: A
The fact that an increasing number of children are ill on one day with the same symptoms is suggestive of an epidemic. The epidemiologist would be most helpful in determining whether a disease outbreak were occurring; this professional would use knowledge of statistics and the natural history of disease model.

DIF: Cognitive Level: Application REF: p. 733

17. Which branch of the federal government funds the Women, Infants, and Children (WIC) supplemental food program?
a. The Centers for Disease Control and Prevention
b. The Department of Agriculture
c. The Department of Health and Human Services
d. The Public Health Department
ANS: B
WIC is funded by the Department of Agriculture to provide supplemental foods, infant formula, and nutrition education.

DIF: Cognitive Level: Knowledge REF: p. 733

18. A public health nurse is employed by a state health department and provides disease investigation and tracks contacts of persons infected with the human immunodeficiency virus (HIV). Which agency is most likely to provide funding for this position?
a. Centers for Disease Control and Prevention
b. Department of Agriculture
c. Department of Health and Human Services
d. Federal Public Health Department
ANS: A
Money from the Centers for Disease Control and Prevention (CDC) funds disease investigation staff who track contacts of persons infected with specific sexually transmitted diseases (STDs), including syphilis, gonorrhea, and HIV.

DIF: Cognitive Level: Application REF: p. 733

19. A young pregnant woman is unemployed and does not have access to health insurance. Which of the following programs would be able to assist her in obtaining health insurance?
a. Sliding fee scale
b. Women, Infants, and Children Supplemental Food program (WIC)
c. Medicare
d. Medicaid
ANS: D
Medicaid, also known as Title XIX, consists of both federal and state funds and is the primary source of money for service reimbursement. The priority populations for Medicaid funding are pregnant women, infants, and children (2 through 18 years of age) and some older adults who need chronic disease treatment or nursing home care.

DIF: Cognitive Level: Application REF: p. 735

20. A public health nurse working in the late 1800s would have most likely provided care to which of the following clients?
a. An 80-year-old man who had diabetes
b. A 40-year-old woman who did not have health insurance
c. A 20-year-old woman who was pregnant
d. A 30-year-old man who had Down syndrome
ANS: C
From its beginning, public health nursing focused on persons living in poverty and ill persons, especially pregnant women and new mothers and their newborns. The 20-year-old female who was pregnant is the best example of the population that was served during this time period. Persons with chronic diseases and disability were not the focus of care, and health insurance did not exist at that time.

DIF: Cognitive Level: Analysis REF: p. 735

21. A nurse has recently been hired to work as a public health nurse at a local health department. She wonders what her role will be in this new setting. Which of the following documents would provide this information?
a. Community Health Certification Criteria from the American Nurses Credentialing Center (ANCC)
b. The states nurse practice act
c. Public Health Nursing: Scope and Standards of Practice
d. The Future of Public Health
ANS: C
The American Nurses Association publishes a Scope and Standards of Practice for most clinical specialties. The scope and standards provide guidance and define and direct public health professional nursing practice in all settings, including the role of the advanced-practice public health nurse. The ANCC offers specialty certification in advanced public health nursing; however, these criteria do not describe the role of the public health nurse. The state nurse practice act outlines nursing practice in the state, but it is not specific to the public health setting. The Future of Public Health indicated public health functions were poorly focused and the public health infrastructure was inadequate. It noted changes that should be made in the future.

DIF: Cognitive Level: Application REF: p. 736

22. Which of the following activities is a public health nurse most likely to be involved in during the twenty-first century?
a. Preventing the spread of communicable diseases
b. Assisting uninsured clients in obtaining health care services
c. Providing direct care services for uninsured individuals
d. Developing multiagency collaborations and partnerships
ANS: D
Public health nursing is more effective when problems are approached in collaboration with other agencies. The trend is toward development of numerous and diverse health-related partnerships and this activity is recommended in the Institute of Medicines report The Future of Nursing.

DIF: Cognitive Level: Application REF: p. 738

MULTIPLE RESPONSE

1. Which of the following changes have occurred in public health since 1990? (Select all that apply.)
a. Renewed focus on primary care to the medically indigent
b. Development of coalitions and partnerships to provide care to populations
c. Improved emergency preparedness with funding for such preparation
d. Improved surveillance and infrastructure as a result of fears about terrorism
e. Increased emphasis on primary care to individuals and families
f. Increased funding from Medicaid for services rendered
ANS: B, D
In response to the Institute of Medicine report titled The Future of Public Health, there has been an emphasis on population-based care and the development of coalitions and partnerships to provide health care. Fears about terrorism and possible biologic infections have led to improvements in surveillance. Primary care is being increasingly referred to various managed care providers and is not a priority of local health departments. Thus, most local health departments no longer collect Medicaid fees. Emergency preparedness is federally mandated, but no federal funds were forwarded to the states in order to achieve preparedness.

DIF: Cognitive Level: Comprehension REF: p. 740

2. A nurse is employed by a local public health department and provides direct care services to clients in the community. Which of the following payer sources is likely to be responsible for reimbursing for this care? (Select all that apply.)
a. Legislative appropriations
b. The client who uses a sliding fee scale
c. Private insurance
d. State health agency
e. Centers for Disease Control and Prevention
f. Medicare and Medicaid
ANS: B, C, F
Many nursing services providing direct care have a service fee. A sliding fee scale is used to determine what percentage of the fee the client will pay on the basis of the clients financial assets. If the client has a third-party payer, such as Medicare, Medicaid, or private insurance, some departments will bill that source or provide the client with a receipt to file for reimbursement. Legislative appropriations and state health agencies may pay for programming at the local level; however, most of these funds are not used for direct care services.

DIF: Cognitive Level: Application REF: p. 739 | p. 741

3. A public health nurse is assessing the health of the community and planning appropriate public health interventions. Which of the following models could the public health nurse use? (Select all that apply.)
a. Protocol for Assessing Community Excellence in Environmental Health (PACE-EH)
b. Leiningers Cultural Beliefs in Practice model
c. Mobilizing Action through Partnerships and Planning (MAPP)
d. Neumans Adaptation of Systems model
e. The Quad Councils Public Health Nursing model
f. The Wheel (Minnesota Interventions Wheel)
ANS: A, C, F
PACE-EH, MAPP, and the Minnesota Interventions Wheel are frequently used. Leiningers Cultural Beliefs in Practice model, Neumans Adaptation of Systems model, and the Quad Councils Public Health Nursing model do not exist.

DIF: Cognitive Level: Application REF: pp. 744-745

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