Chapter 1- Health Care Needs for the 21st Century

MULTIPLE CHOICE

	1.	The nurse is teaching a class on global trends linked with nursing practice. Which response from a student indicates a need for additional teaching?
1.	Technology is a huge force in global change.	
2.	Humans have had increasing effect on the natural environment.	
3.	Technology has slowed the development of new infectious diseases.	
4.	Medical tourism is a legitimate, growing source of income for many nations.	

ANS:	3

	Feedback	
1	Science and technology are huge drivers of global change.	
2	There is increasing awareness of humankind’s effect on the planet including environmental resources.	
3	Although technology has flourished, more than 30 new infectious diseases have been identified since 1973, and the next pandemics are predicted to arise from organisms not yet identified.	
4	Medical tourism is one of the fastest growing industries in the health-care sector and is a positive source of revenue for many nations.	

PTS:	1	
KEY:	Content Area: Global trends | Integrated Process: Nursing Process | Client Need: Health Promotion and Maintenance | Cognitive Level: Comprehension | Question Type: Multiple Choice

	2.	Which of the following statements on global trends linked with nursing practice is inaccurate?
1.	Globalization ensures the equal distribution of costs and benefits of health care.	
2.	Parts of the world may be considered more youthful than other parts of the world.	
3.	By 2025, the majority of the world's population will live in urban areas.	
4.	As countries modernize, the risk for developing certain health problems changes.	

ANS:	1

	Feedback	
1	The costs and benefits of globalization are not always distributed equally—globalization does not ensure equal distribution of health-care costs and benefits. 	
2	Trends in birth, death, immigration, and migration patterns point toward population growth in Asia and Africa that will result in them becoming the youthful areas of the world.	
3	In 2009, 50% of the world’s population lived in urban areas; by 2025, this is projected to increase to 57%.	
4	A shift from traditional diseases, such as those resulting from infection, to modern diseases that result from lifestyle choices has been noted in developed countries.	

PTS:	1	
KEY:	Content Area: Global trends | Integrated Process: Nursing Process | Client Need: Health Promotion and Maintenance | Cognitive Level: Comprehension | Question Type: Multiple Choice

	3.	The nurse is coordinating care with a family whose 10-year old daughter has diabetes. Which of the following principles of care coordination guides the nurse's actions?
1.	Provide the right care at the right time for the right person.	
2.	Identify health problems and intervene.	
3.	Allow families to initiate contact as they determine all their needs.	
4.	Ensure family privacy by limiting interdisciplinary information exchange.	

ANS:	1

	Feedback	
1	Providing the right care at the right time for the right person is a principle of health-care reform to obtain the best quality outcomes in the best possible way.	
2	The nurse must form a partnership with the family and negotiate to create a plan that fits with the family priorities and concerns.	
3	The nurse must work together with the family to determine needs and assist them in contacting resources if the family wishes the nurse to do so.	
4	The nurse must consider privacy laws, institutional policies, and family preferences to create an effective care coordination communication plan.	

PTS:	1	
KEY:	Content Area: Care coordination | Integrated Process: Nursing Process | Client Need: Safe and Effective Care Environment | Cognitive Level: Comprehension | Question Type: Multiple Choice

	4.	The nurse is teaching a class on coordinating care for families with a chronically ill member. Which response made by a student indicates a need for further teaching in the area of family assessment?
1.	Identifying accessible community resources is an important aspect of family assessment.	
2.	Family engagement in shared health-care decision-making has little impact on health outcomes.	
3.	Lifestyle factors to assess include family access to food, housing, and transportation.	
4.	Money spent is not always linked to better health outcomes.	

ANS:	2

	Feedback	
1	The nurse will benefit families greatly by providing families with appropriate resource information in their home communities for health promotion and chronic disease management.	
2	Shared decision-making occurs within therapeutic relationships that honor family preferences and unique circumstances.	
3	Environmental factors include family access to food, housing, and transportation; lifestyle factors include tobacco use, lack of adequate nutrition, physical inactivity, and substance abuse.	
4	The U.S. spends much more on health care than the other 12 industrial nations in the Organization for Economic Cooperation and Development, but the quality and availability of care varies.	

PTS:	1	
KEY:	Content Area: Global trends | Integrated Process: Nursing Process | Client Need: Safe and Effective Care Environment | Cognitive Level: Comprehension | Question Type: Multiple Choice

	5.	Health disparities occur as a result of which of the following?
1.	Groups being at different risk for disease.	
2.	Equal distribution of health-care dollars.	
3.	Gender equity.	
4.	Multicultural understandings.	

ANS:	1

	Feedback	
1	Health disparities refer to differences in health outcomes that occur between groups, usually in minority or at-risk groups.	
2	Health disparities occur as a result of unequal distribution of health-care dollars.	
3	Health disparities occur as a result of being treated differently based on gender.	
4	Health disparities occur with misunderstanding of cultures that leads to differences in treatment. 	

PTS:	1	
KEY:	Content Area: Health disparities | Integrated Process: Nursing Process | Client Need: Health Promotion and Maintenance | Cognitive Level: Comprehension | Question Type: Multiple Choice

	6.	Which statement best describes health inequity?
1.	Differences in health outcomes between groups.	
2.	Disruptions in family health due to war.	
3.	Shifts in population health due to changing immigration patterns.	
4.	Differences in infectious disease risk between genders.	

ANS:	1

	Feedback	
1	Health inequity refers to differences or inequalities in health outcomes between groups.	
2	War is best described as a social factor that can disrupt health.	
3	Change in immigration patterns is best described as a social factor that can influence health.	
4	Differences in infectious disease risk leading to health inequities are typically due to poverty, not gender. 	

PTS:	1	
KEY:	Content Area: Health inequity | Integrated Process: Nursing Process | Client Need: Health Promotion and Maintenance | Cognitive Level: Evaluation | Question Type: Multiple Choice

	7.	Which of the following best describes the health implications of industrialization in remote areas?
1.	Economic opportunities outweigh the health risks.	
2.	Projects protect local health by developing indigenous crops.	
3.	Local people have more dollars for health care through new job opportunities.	
4.	Access to health-care facilities is improved.	

ANS:	3

	Feedback	
1	Industrial processes often lead to environmental conditions such as erosion, air pollution, or contaminated ground water that have unwelcome health effects. Economic gains go to project developers, not the indigenous people.	
2	Projects typically develop land for high-value nonindigenous crops that require fertilizers and irrigation, which pose health risks rather than protect health.	
3	Increased employment provides economic resources to enable local people to seek health care.	
4	Industrialization is not a guarantee that health-care facilities will be built and access increased.	

PTS:	1	
KEY:	Content Area: Perspectives on health and illness | Integrated Process: Nursing Process | Client Need: Health Promotion and Maintenance | Cognitive Level: Evaluation | Question Type: Multiple Choice

	8.	Which of the following is an example of the effects of globalization on health care?
1.	Globalization makes the exchange of health-care information more difficult.	
2.	The health-care costs and benefits of globalization are distributed equitably.	
3.	Globalization eases the transition of foreign-educated nurses into U.S. employment.	
4.	Global demand for nurses continues to exceed supply.	

ANS:	4

	Feedback	
1	Globalization includes the international exchange of ideas, languages, peoples, and popular culture, and eases the exchange of health-care information.	
2	Globalization does not ensure equal distribution of the benefits and costs of health care. Manufacturers take advantage of cheap labor, and workers are not always afforded the same protections from one nation to the next. 	
3	Globalization does not ease the transition of foreign educated nurses into U.S. employment. Pathways for becoming a nurse differ greatly across nations, as do regulations guiding nursing practice.	
4	The global demand for nurses exceeds supply. An increase of 712,000 nurses is predicted to be needed by 2020 to meet health care demand in the U.S. alone.	

PTS:	1	
KEY:	Content Area: Globalization’s effects on health care | Integrated Process: Nursing Process | Client Need: Health Promotion and Maintenance | Cognitive Level: Comprehension | Question Type: Multiple Choice

	9.	Which of the following statements about links between families and their community is inaccurate?
1.	The negative influences of poverty and unrest continue for generations even after community conditions improve.	
2.	Understanding the culture of the community is essential for being able to address family health needs.	
3.	Families in low-resourced areas contend with malnutrition.	
4.	Political unrest has little effect on the health and well-being of families.	

ANS:	4

	Feedback	
1	Employment rates do not often capture the discouragement experienced by people who have long lost hope of ever finding a job. 	
2	Understanding the culture of communities is essential for addressing individual and family health and illness needs.	
3	Food supply is often limited by uneven food distribution in low-resourced areas.	
4	Political unrest can result in displaced populations that have increased health risks.	

PTS:	1	
KEY:	Content Area: Family and community health linkages | Integrated Process: Nursing Process | Client Need: Health Promotion and Maintenance | Cognitive Level: Comprehension | Question Type: Multiple Choice

	10.	Which of the following statements on women and health is inaccurate?
1.	Women worldwide are often able to overcome poverty and its ill effects on health.	
2.	Women represent two-thirds of the world’s poor people.	
3.	Women’s rights are a way to understanding personal health and well-being.	
4.	Women in developing countries often die as a result of pregnancy complications and childbirth.	

ANS:	1

	Feedback	
1	Women often work for meager pay, have little financial security, and are unable to make personal decisions affecting their well-being.	
2	Women comprise two-thirds of the world’s poor population and often experience poverty.	
3	In male dominated cultures, women are often treated as second-class citizens, are primary targets of physical and sexual violence, and have little voice in society or at home.	
4	Lack of prenatal care in developing countries often results in fatalities for women.	

PTS:	1	
KEY:	Content Area: Gender perspective about health or illness | Integrated Process: Nursing Process | Client Need: Health Promotion and Maintenance | Cognitive Level: Comprehension | Question Type: Multiple Choice

	11.	A nurse is developing an international health project on delivery of prenatal care to low-resourced communities. Which of the following principles guides the nurse’s planning?
1.	Nurses are in the best position to decide what the community needs.	
2.	The project is dependent on political influences or partisanship.	
3.	Short- and long-term goals contribute to the sustainability of the project.	
4.	Local community leaders are best to oversee the project.	

ANS:	3

	Feedback	
1	International projects must be based on grass-roots requests from communities.	
2	Successful international projects are independent of political influence or partisanship.	
3	Projects must be built for long-term sustainability through engaging community participants in identifying short- and long-term goals.	
4	Successful international projects are overseen by established, qualified advisory boards.	

PTS:	1	
KEY:	Content Area: International health project characteristics | Integrated Process: Teaching/Learning | Client Need: Health Promotion and Maintenance | Cognitive Level: Application | Question Type: Multiple Choice

MULTIPLE RESPONSE

	1.	Which of the following are social determinants of health?
1.	Family income.	
2.	Presence of food and water in the home.	
3.	Age of the family member with an illness.	
4.	Distance traveled to the workplace.	

ANS:	1, 2, 4
Rationale: 
Social determinants of health are factors that arise from the social or physical environment that can lead to health problems. Age is not a social or physical factor; however, income is a factor that arises from the social environment, while food and water and the distance one must travel to the workplace are components of the physical environment, all of which can influence health.

PTS:	1	
KEY:	Content Area: Social determinants of health | Integrated Process: Nursing Process | Client Need: Health Promotion and Maintenance | Cognitive Level: Comprehension | Question Type: Multiple Response

	2.	Which of the following nursing actions are considered primary care?
1.	Making sure that all family members are immunized.	
2.	Monitoring chronic conditions of a family member over time.	
3.	Supporting families in critical care situations.	
4.	Educating elders in the family about screening for colon cancer.	

ANS:	1, 2, 4
Rationale:
Supporting families in critical care situations is typically a role for hospital-based nurses rather than primary care nurses, who work in communities and in clinics where they ensure that all family members are immunized, monitor chronic conditions of a family member over time, or educate elders in the family about screening for colon cancer. These actions can reduce modifiable risk factors and thus decrease the potential of acquiring diseases and complications at earlier ages. Education can motivate people to seek care that can prevent and detect diseases early.

PTS:	1	
KEY:	Content Area: Care coordination | Integrated Process: Nursing Process | Client Need: Safe and Effective Care Environment | Cognitive Level: Comprehension | Question Type: Multiple Response

	3.	Which of the following groups would be considered a vulnerable population?
1.	Intergenerational households.	
2.	Families experiencing social isolation.	
3.	Frail elderly.	
4.	Migrating families.	

ANS:	2, 3, 4
Rationale:
Vulnerable populations include those who are at risk for health problems. Intergenerational households do not pose risk for health problems; in fact, this arrangement may benefit members by providing social interactions never previously considered. Social isolation is a risk factor for health problems, although it is less common in undeveloped countries where people are less likely to live alone. Aging increases the likelihood of acquiring multiple noncommunicable diseases, while migration can increase the risk of spreading infectious diseases among populations.

PTS:	1	
KEY:	Content Area: Global trends | Integrated Process: Nursing Process | Client Need: Safe and Effective Care Environment | Cognitive Level: Comprehension | Question Type: Multiple Response

	4.	Which of the following represent United Nations Millennium Development Goals and Targets?
1.	Global education to at least the elementary level.	
2.	Protection and improvement of the environment.	
3.	Treatment of infectious diseases.	
4.	Improved health of fathers.	

ANS:	1, 2, 3
Rationale:
Access to good education is a social indicator of health and disease risk, and improved education globally is a Millennium Goal. Erosion, contaminated groundwater, shrinking aquifers, air pollution, and urbanization are environmental factors that can result in unwelcome health effects, and thus protection of the environment is a Millennium Goal. Treating infectious diseases is a Millennium Goal, since the spread of infectious diseases can be influenced by changes in human behavior, often occurring at the family level. Improving the health of mothers, not fathers, is an international goal that improves overall population health.

PTS:	1	
KEY:	Content Area: Global trends | Integrated Process: Nursing Process | Client Need: Safe and Effective Care Environment | Cognitive Level: Comprehension | Question Type: Multiple Response

COMPLETION

	1.	The increase in health-care-related knowledge has shifted education of health-care providers from a focus on ____________________ to a focus on ____________________.

ANS:	
memorization, accessing and analyzing information.
Rationale: 
Advances in communication and technologies allow nurses to draw on and select from global knowledge. The nurse must be able to search for evidence on the effectiveness of various forms of care or interventions and analyze it to identify what best alleviates a problem.

PTS:	1	
KEY:	Content Area: Global trends | Integrated Process: Nursing Process | Client Need: Safe and Effective Care Environment | Cognitive Level: Comprehension | Question Type: Completion