Chapter 32: Rural Health Nursing School Test Banks
Chapter 32: Rural Health
1. Which of the following descriptions is the most accurate example of a rural community?
a. The residents of the community are subject to environmental hazards.
b. It takes longer than 30 minutes to get from the community to health care services.
c. The community has less than 20,000 residents.
d. The residents of the community say, This is smaller than where I grew up.
All of the descriptions could be used in an attempt to define rural, but each aspect has problems. A definition of rural has not yet been decided. However, in relation to health care, the time needed to get to a health care facility has a major influence on care outcomes.
DIF: Cognitive Level: Application REF: p. 800
2. What is the poverty rate in rural areas?
National estimates report that in rural areas, more than 40% of all families live below the poverty level.
DIF: Cognitive Level: Knowledge REF: p. 801
3. Why are children at risk on their own familys farm?
a. Children often help with the work without much regard for training or safety.
b. It is expected that children fulfill the roles that are assigned to them.
c. Machinery can injure someone faster than a parent can turn the machine off.
d. Parents are too busy completing their own tasks to supervise the children.
Farming is one of the four most dangerous industries. Agricultural work is inherently dangerous but also must be performed under adverse conditions such as mud or extreme heat or cold. On family farms, spouses, children, and other relatives often help without much regard to competency, training, or safety. Of all industries, agriculture has by far the highest number of injuries and deaths among children.
DIF: Cognitive Level: Comprehension REF: p. 803
4. An adolescent in a rural community has recently committed suicide. What is the significance of this event in the community?
a. Rural residents are less religious than urban residents and less capable of coping with the loss.
b. Because of the size of the community, it is likely that no one will discuss what has happened.
c. There could be a cluster of such deaths in small towns where everyone knows everyone so well.
d. Without the adolescent to work, the family may have increased economic difficulties.
Because of the cluster or copycat phenomenon related to self-inflicted death, in several towns the suicide rate has reached epidemic proportions, with three or more suicide incidents occurring in a very short time (after one suicide, there is an increased incidence of additional suicides in a community). In small towns or rural areas, where most people are fairly well acquainted, a sudden death can be devastating to students and to the community as a whole.
DIF: Cognitive Level: Application REF: pp. 802-805
5. What was one purpose of Rural Health Clinic (RHC) Public Law 95-210?
a. To define rural areas as underserved and therefore eligible for many tax reductions
b. To encourage utilization of advanced practice nurses by providing reimbursement for their services under Medicare and Medicaid
c. To fund structures (building, equipment, supplies) for rural health care providers
d. To pay for physicians to serve in rural underserved areas
RHC Public Law 95-210 was originally passed by Congress in 1977. The law defined core primary care, created reimbursement mechanisms, and encouraged utilization of midwives and nurse practitioners, among others, by providing reimbursement even without a full-time physician available. Reimbursement is based on cost so that additional revenues to eligible rural practices can be generated.
DIF: Cognitive Level: Knowledge REF: pp. 803-804
6. A program to recruit advanced-practice nurses to practice in a rural community is being developed. The program developers have applied to receive federal training monies to help fund the costs of the program. Which of the following questions must be addressed when they apply for these funds?
a. Does the health of the clients improve as a result of interventions?
b. Have professional schools increased enrollment?
c. Are advanced-practice nurses taught to embrace rural cultural values?
d. Should improvements be made to the buildings and equipment at the agency?
Federal training dollars have been linked to program outcomes. The question of whether the clients health improves as a result of interventions is the only question that addresses outcomes. For example, the goal is not simply to educate professionals but to prepare providers who are capable and willing to increase access to care for underserved and minority populations.
DIF: Cognitive Level: Synthesis REF: p. 804
7. A family nurse practitioner is employed in a rural health clinic. What generalization would the practitioner most likely be able to make about the local clients?
a. They carefully budget their money in order to afford health insurance.
b. They define health as self-actualization of potential.
c. They are fatalistic and oriented to the land, nature, and the seasons.
d. They are open to sharing their problems and accepting my advice.
Rural families are often fatalistic because both their work and their recreation are dependent on the land throughout the seasons. They usually know everyone in the community, keep their problems within the family, define health as the ability to fulfill their work requirements, and are too poor for health insurance. These are, of course, generalizations, to which there are many exceptions.
DIF: Cognitive Level: Application REF: pp. 804-805
8. A new family nurse practitioner at the rural health clinic soon saw much strength in the community. What might be some resources used and accepted by ill people in a rural area?
a. Charity efforts that are publicized and coordinated by members of the nearby city
b. Family and friends who volunteer to help with food, cleaning, child care, and other tasks
c. Use of the extended-care facility in the community until the ill person feels better
d. Care that is coordinated by social services and the public health agency
Rural residents, many of whom are related to each other, typically accept help from family, friends, and other community members with the understanding that someday such help will be reciprocated. However, formal support from agencies cannot be accepted because of the cost and inability to pay back for such support.
DIF: Cognitive Level: Application REF: p. 805
9. A nurse is working in a rural health clinic. Which of the following situations may cause difficulties in maintaining confidentiality at the clinic?
a. Neighbors care about each other and will ask the nurse questions.
b. Neighbors recognize each others cars in the clinic parking lot.
c. The nurse will want to share information in a quest to seek assistance for the client.
d. The nurse will have to use names in referring clients to other agencies for assistance.
Most people in a small town are recognized by the car that they drive, so seeing the car in the clinic parking lot can jeopardize confidentiality. Assumptions may be made about anyone seen in the building, even if it is not to attend the clinic. Leaks in confidentiality result from such chance encounters.
DIF: Cognitive Level: Application REF: p. 808
10. A new female family nurse practitioner employed at the rural health clinic became very frustrated. What might be cause for complaint?
a. I cant survive on this salary with the high cost of living here!
b. I make this incredible salary, but there is nowhere here to spend it.
c. The men seem to make all the health decisions.
d. The clients keep asking me when Im going to get married.
Salaries are lower, as is the cost of living in rural areas. Although she is a professional, as a woman she would be expected to fulfill female roles, such as wife and mother, and may be seen primarily in relation to her family relationships.
DIF: Cognitive Level: Application REF: p. 809
11. A nurse is employed in a rural area. What might be a dismaying reality about this setting of nursing practice?
a. Cultural values require clients to refuse pain relief medications.
b. Farmers have to visit care providers when not busy in the fields.
c. Rural residents have a tendency to use folk healers instead of scientific care providers.
d. There is no off duty because everyone feels free to request information or service any time.
There is no distinction between being the nurse on duty at the clinic and being a resident of the community. The newcomers role will be that of nurse, and everyone will feel free to ask questions at any time and at any place.
DIF: Cognitive Level: Application REF: p. 810
12. The registered nurse came to see many strengths and resources in the rural area. Among these were that rural residents are
a. Diverse, both in ethnic groups and in age groups.
b. Politically open to new ideas and approaches.
c. Very resourceful and self-reliant.
d. Willing to spend money to improve safety.
Rural residents are very resourceful and self-reliant. In addition, they are conservative, often having fewer financial resources available.
DIF: Cognitive Level: Application REF: pp. 810-811
13. What is the most common definition of health among those living in rural areas?
a. Balance or homeostasis
b. Capable of fulfilling work requirements
c. Feeling of well-being, not merely the absence of disease
d. Purposive adaptive response to stimuli
Some people living in rural areas define health as the ability to work and to do what needs to be done, or illness is not being able to do ones usual work. Therefore, rural residents often do not seek health care until they are too ill to work.
DIF: Cognitive Level: Knowledge REF: p. 813
14. Which of the following is part of the first level of social support for people living in rural communities?
a. Big city charities that rely on agricultural donations to help feed urban poor persons
b. Church or civic group assistance, to which a person is expected to contribute when able
c. Professional agencies or people who are paid financially for their contribution
d. Volunteer assistance by family and friends, which one is expected to reciprocate as needed
Rural residents prefer services from friends, extended family, and neighbors with the understanding that they will reciprocate when possible and when other people need assistance.
DIF: Cognitive Level: Knowledge REF: p. 813
1. What is a problem when urban dwellers move into rural areas, seeking a more satisfying lifestyle? (Select all that apply.)
a. Aging water, sewage, housing, and schools in the rural area
b. Expectations for the amenities in art, recreation, and sports
c. Complaints arising from farming by neighbors, such as odors and insects
d. Disruption of local informal helping networks
e. Farmers reluctance to sell their land, especially for development
f. Sudden increase in money being difficult for the community to absorb
ANS: A, D
Both out-migration and in-migration can create problems that, in many instances, a small town cannot solve because of the lack of resources. Population shifts disrupt long-established informal helping networks, creating a need for unusual kinds of human services. Existing local infrastructures and public services are unable to keep pace with the growth. For instance, aging utilities (water, sewage, and communication systems), housing units, and schools are inadequate to handle the increased demands associated with the influx of local residents.
DIF: Cognitive Level: Comprehension REF: p. 813
2. Why are rural residents considered a group at high risk for health problems? (Select all that apply.)
a. They are very self-sufficient and self-reliant.
b. Few health care providers are locally available.
c. The residents are exposed to high-powered machinery, extensive sun, and chemicals.
d. They have difficulty accessing affordable insurance if they are self-employed.
e. They must travel long distances to obtain specialized services.
f. They work in dangerous occupations (farming and ranching).
ANS: B, C, D, E, F
Rural residents, including elderly persons and children in the family, often work in dangerous occupations without immediately accessible health care. The poverty rate is high, since many are unemployed or retired. Agriculture is considered one of the four most dangerous occupations in America because its workers are exposed to lightning, farm machinery, firearms, drowning, and accidents involving vehicles such as snowmobiles and all-terrain vehicles. In comparison with urban residents, rural residents suffer higher rates of chronic illnesses, mental illness, and stress-related diseases. Problems include machinery accidents, skin cancer from sun exposure, and breathing problems from exposure to chemicals and pesticides. Rural communities find it difficult to recruit or to retain qualified health care providers, and so the residents must travel long distances to obtain care. Being self-employed, few have health insurance or workers compensation insurance.
DIF: Cognitive Level: Comprehension REF: p. 810
3. A rural family is trying to obtain health care. Which of the following barriers would they be most likely to encounter? (Select all that apply.)
a. Fewer health care providers in the community
b. Greater travel distances for health care, especially for pregnant women and young children
c. Less willingness to accept help from local health care providers
d. Little attention being paid to the problems of the rural population by federal legislators
e. Many competing insurance companies with different rules and policies
f. Providers of health care inadequately prepared to cope with differences between rural and urban lifestyle and values
ANS: A, B, F
Problems for rural residents that serve as barriers to obtaining health care, in comparison with urban residents, include greater travel distances for health care, especially for pregnant women and young children; availability of fewer health care providers in the community; less cultural and educational encouragement for health promotion behaviors; lower probability of having health insurance; and, often, lower income.
DIF: Cognitive Level: Application REF: p. 811
4. A local community hospital that is highly valued by its community has just announced that it will be closing within the next year. What would be the most anticipated reason for its closure? (Select all that apply.)
a. The departure of a health care provider resulted in an inadequate number of providers to staff the hospital.
b. Clinics and home care are being used more so that there is no need for a hospital in the community.
c. Large care networks have purchased the hospital but have found it unprofitable.
d. Most residents prefer to access the specialized services available in the large city nearby.
e. It is too expensive for the hospital to meet the new magnet hospital standards.
f. Nurses have demanded a salary increase, which they feel is necessary because of their multiple responsibilities.
ANS: A, C
An out-of-community transfer by even one physician may cause a small hospital to close its doors because of insufficient staff. Large, expanding health care systems are buying out small hospitals and physician practices; then, to cut costs and improve profits, outreach services to rural communities are reduced or eliminated, forcing residents to travel to large city hospitals or do without health care.
DIF: Cognitive Level: Application REF: p. 811
5. Many nurses enjoy the independence and creativity of being among the few professional caregivers in a rural community. What might be a problem in this situation? (Select all that apply.)
a. Feelings of being alone and isolated
b. Feelings of being overwhelmed with responsibility
c. Absence of physicians to delegate the nurses responsibilities
d. Absence of professional colleagues to offer support and consultation
e. Difficulty in accessing resources when questions arise
f. Standards of practice that are different in rural settings
ANS: A, B, D
With computers and telemedicine, the nurse can obtain information, but responsibilities can be overwhelming because there are few other resources in the community to assist. There are no other nurses around with whom to discuss clinical situations or from whom to obtain support or consultation.
DIF: Cognitive Level: Comprehension REF: p. 814