NR-442 Community Health Nursing - Set 1 - Part 1

Correct Answer: Part B, which pays for outpatient medical services

Part B is Medicare's medical insurance and pays for provider visits, outpatient care, laboratory work, preventive services, and durable medical equipment such as canes and walkers. Original Medicare covers this walker under Part B. Option a is incorrect because Part D is the voluntary outpatient drug benefit delivered by private plans under a formulary. It pays for medications the client fills at a pharmacy, not for mobility equipment. Option b is incorrect because this client is not admitted anywhere. Hospital insurance activates with an inpatient stay, a skilled nursing admission, or a home health or hospice episode, none of which applies here. Option d is incorrect because Medicare Advantage is not a separate benefit category but the arrangement in which a private plan administers the Part A and Part B benefits, including equipment coverage.

Correct Answer: Agency for Healthcare Research and Quality

Health services research is the mission of the Agency for Healthcare Research and Quality, covering patient safety, quality measurement, evidence synthesis, improvement tools, and national quality and disparities data. It studies how care is delivered. Option b is incorrect because the biomedical research agency investigates the biology of disease and funds basic, clinical, and translational science. Its institutes generate knowledge about illness rather than tools for improving delivery systems. Option c is incorrect because surveillance, outbreak investigation, immunization recommendations, and health statistics define that agency's work. Infection prevention guidance overlaps with safety, yet care transitions and delivery quality fall outside its central charge. Option d is incorrect because behavioral health is its defined territory, funded through block grants to states along with the crisis lifeline and a national survey. General hospital safety work is not part of that portfolio.

Correct Answer: Area Agency on Aging support services

Medicare pays for skilled, intermittent care for a homebound client, so custodial help with bathing, dressing, and meals falls outside it. Area Agency on Aging programs and Medicaid home and community-based services cover that need. Option a is incorrect because home health coverage requires homebound status, a provider's order, and a medically necessary skilled need. This man meets none of the skilled criteria, so the agency would be denied payment. Option b is incorrect because inpatient rehabilitation follows an acute event and requires intensive therapy the client can tolerate. Nothing here describes a hospitalization or a functional loss needing that intensity of restorative care. Option d is incorrect because hospice serves people with a terminal prognosis who have chosen comfort-focused care. Needing assistance with daily activities is not a terminal illness, and a hospice referral would misrepresent this man's situation.

Correct Answer: Sanitary reform guided by displayed mortality statistics

Nightingale found that filth, crowding, and poor ventilation killed more soldiers than wounds, and sanitary reform dropped the death rate. She then displayed cause of death graphically so lawmakers would act. Option b is incorrect because her lasting contribution was environmental and statistical rather than operative. Nurses did not perform surgery, and the mortality drop at Scutari followed cleaning, ventilation, and nutrition. Option c is incorrect because Mary Breckinridge introduced nurse midwifery to the United States through the Frontier Nursing Service in Kentucky. That work came decades later, in a rural American setting. Option d is incorrect because John Snow traced cholera deaths to the Broad Street pump in London during the same decade. Snow was a physician mapping an outbreak, not a nurse reforming an army hospital.

Correct Answer: Locate a federally qualified health center accepting Medicaid

Low and slow Medicaid payment leads many dentists to limit or decline these patients, so a card is not an appointment. Federally qualified health centers accept Medicaid and offer sliding-scale fees, making them the dependable referral here. Option a is incorrect because dental coverage for adults is an optional state benefit that many states do provide, and it is mandatory for children. Declaring it absent would end a search that should continue. Option b is incorrect because emergency departments can relieve pain and treat infection but rarely perform definitive dental work. Sending her there produces a costly visit and leaves the underlying tooth problem untreated. Option c is incorrect because nothing in the story suggests lost eligibility. The offices are refusing new Medicaid patients, which is a payment problem on their side rather than an enrollment problem on hers.

Correct Answer: The committee and subcommittee hearings and markup

Most bills die in committee, where hearings are held and text is marked up. That makes the committee and subcommittee stage the strongest point of influence for nursing advocacy, and it is exactly where this bill now sits. Option a is incorrect because by the time a bill reaches the President the content is fixed and both chambers have already passed identical text. Influence exercised that late changes nothing about the language. Option b is incorrect because conference committee work happens only after each chamber has passed its own version. This bill has not cleared a single vote yet, so that stage lies far ahead. Option d is incorrect because appropriations is a separate process that funds a program already authorized in law. It matters greatly later, yet it cannot shape a bill that has not been adopted.

Correct Answer: Lobbying, because a named bill is being targeted

Lobbying is the defined subset of advocacy aimed at the passage or defeat of a specific piece of legislation. Because the nurse names a bill and asks for a vote, this meeting is lobbying. Option b is incorrect because testimony is delivered on the record at a committee hearing or a public rulemaking session. A private meeting in a legislator's office produces no such official record. Option c is incorrect because coalitions form when two or more groups pool capacity toward a shared health goal. Nothing here describes partners joining forces, only one nurse speaking to one lawmaker. Option d is incorrect because campaigning works to elect or defeat a person seeking office. This nurse is asking a sitting senator about pending legislation, which is an entirely different political activity.

Correct Answer: COBRA continues employer group coverage after job loss

COBRA as a benefit lets a worker and dependents keep the employer's group plan temporarily after job loss or another qualifying event, paying the full premium. EMTALA, enacted inside the same statute, imposes the emergency duty. Option a is incorrect because the screening and stabilization duty belongs to EMTALA, which happened to be enacted within the COBRA statute. Naming COBRA for it is the exact mix-up this client's friend made. Option b is incorrect because Medicaid enrollment depends on state income and category rules, never on a layoff itself. A newly unemployed worker may qualify, but the statute in question does not place him there. Option c is incorrect because no federal plan appears when a job ends. The very same employer policy simply continues, and the worker now pays the employer's share too, which is why the cost feels so steep.

Correct Answer: Policy development, because public understanding is built

In the current framework, communicating effectively to inform and educate falls under policy development. Informing and educating residents creates the public understanding and will that later supports policy, even though teaching feels like a service. Option b is incorrect because assurance covers legal action, equitable access, workforce, evaluation, and infrastructure. A media campaign hands out understanding rather than a service, so students who choose this are trusting how the activity feels. Option c is incorrect because nothing in the scenario collects or analyzes overdose data. Assessment would describe counting cases by neighborhood or interviewing survivors, and the department here is sending a message outward instead. Option d is incorrect because verifying that staff hold current skills is the workforce element of assurance, aimed at employees and contracted providers. The campaign in this scenario is directed at residents, not at personnel.

Correct Answer: Funding behavioral health block grants nationwide

The Substance Abuse and Mental Health Services Administration is the federal behavioral health lead. It administers the community mental health and substance use block grants, supports the suicide and crisis lifeline, and fields a national drug use survey. Option a is incorrect because licensing of health facilities is a state function exercised under police power, not a federal one. Block grant dollars flow to states, but the license itself is issued locally. Option b is incorrect because drug approval belongs to the Food and Drug Administration, which judges safety and effectiveness before a medication reaches the market. The behavioral health agency pays for treatment rather than licensing products. Option d is incorrect because workplace inspection and citation authority rests with the Occupational Safety and Health Administration inside the Labor Department. Employer hazards fall outside the behavioral health agency's grant-making mission entirely.

Correct Answer: Reinforce previously taught newborn feeding instructions

Reinforcing teaching that the registered nurse has already delivered is within the practical nurse scope. Assessment, nursing diagnosis, and evaluation require nursing judgment and stay with the registered nurse, who remains accountable for outcomes. Option a is incorrect because forming a nursing diagnosis is a judgment step in the nursing process. Steps of that process cannot be handed to another worker, no matter how experienced that worker is. Option c is incorrect because an initial assessment establishes the baseline everything else is built on. A practical nurse may gather and report data, yet interpreting that data into an assessment belongs to the registered nurse. Option d is incorrect because judging whether goals were met closes the nursing process and shapes the next plan. Only the registered nurse who set those goals can decide whether they were reached.

Correct Answer: Distribution by documented risk and expected benefit

Public health rests on social justice, which distributes by need rather than by market position. Allocating scarce vaccine to those at documented risk protects the most people and satisfies distributive justice. Option b is incorrect because ability to pay is the rule of market justice, where care is a commodity earned individually. Public health rejects that rule precisely because it leaves the sickest and poorest unprotected. Option c is incorrect because a queue rewards whoever heard the news first, usually the best connected residents. Speed of asking has no relationship to who will actually transmit or die from the disease. Option d is incorrect because political pressure measures influence, not need. Allocation driven by lobbying fails the fairness test, since a measure falling unevenly on a less powerful group cannot be justified.

Correct Answer: "States hold police power to protect community health."

The Tenth Amendment reserves police power to the states, letting them protect health, safety, and welfare even by limiting individual liberty. The Supreme Court upheld compulsory smallpox vaccination on that reasoning in the Jacobson decision. Option a is incorrect because the national government holds no general police power and reaches health mainly through spending, taxation, interstate commerce, and border controls. School exclusion is a state and local matter. Option b is incorrect because a health officer may issue exclusion and control orders directly under delegated state authority. Courts become involved when an order is contested or when detention of a person is sought. Option c is incorrect because due process constrains every exercise of this power. A measure must be necessary, reasonable, proportionate, and the least restrictive alternative that will work, with notice and a chance to object.

Correct Answer: Notify the federal quarantine station serving that airport

The federal government holds quarantine authority at ports of entry and to prevent interstate spread, and the national disease agency operates quarantine stations at major airports. Viral hemorrhagic fever is a federally quarantinable disease. Option a is incorrect because voluntary cooperation is preferred but cannot be the first step when a legally quarantinable disease is suspected at a border. The authorized officer must be engaged before the traveler moves on. Option b is incorrect because the nurse practice act governs delegation, scope, and licensure rather than detention of a traveler. Boards of nursing hold no power to restrict anyone's movement during a communicable disease event. Option d is incorrect because county departments act within their own jurisdiction and have no authority over entry at the national border. Sending the traveler into the community first would defeat the purpose of screening arrivals.

Correct Answer: "Quarantine restricts movement while exposure could still become illness."

Quarantine applies to people who have been exposed but are not yet ill, restricting movement through the maximum incubation period so that illness is detected early if it develops. Option a is incorrect because isolation is reserved for people who are ill or confirmed infected, and this contact has neither symptoms nor a positive result. The memory hook is isolation equals ill. Option b is incorrect because disease reporting is a separate legal duty owed by providers and laboratories to the health department. No reporting statute confines a well person to the home without end. Option c is incorrect because it swaps the two terms. Exposure without illness calls for quarantine, and using the word isolation here would wrongly label an exposed but well contact as an infectious case.

Correct Answer: A private plan administers the benefit, in several network forms

What defines Part C is that a private plan administers the Medicare benefit under contract. Those plans come as health maintenance organizations, preferred provider organizations, private fee-for-service plans, and special needs plans. Option b is incorrect because gatekeeping belongs to the health maintenance organization design, not to Part C itself. A preferred provider version of the same benefit lets a member reach a specialist without one. Option c is incorrect because enrollees keep both parts and receive that coverage through the private plan instead of the government. Nothing is dropped, and administration of the same hospital and medical benefit simply moves. Option d is incorrect because most of these plans bundle prescription coverage directly into the package. A client who chooses one usually gains drug benefits rather than losing the ones she already had.

Correct Answer: Offer personalized information about his own risk

This client is in precontemplation, with no intention of changing. The matched intervention raises awareness through personalized risk information offered without pressure, which is what moves someone toward considering a change. Option a is incorrect because setting a date belongs to the preparation stage, when a person already intends to act soon. Pushing a date on someone who sees no problem usually ends the conversation. Option b is incorrect because pharmacotherapy supports a quit attempt that has been chosen. Handing medication to a man who has not decided to stop wastes the resource and skips several stages. Option d is incorrect because relapse prevention is aimed at people already maintaining a change. Nothing has been changed yet here, so a group built around holding gains has no application.

Correct Answer: Lillian Wald, who founded the Henry Street Settlement

Wald and Mary Brewster opened the Henry Street Settlement in 1893 and lived among the tenement families they served. She coined the term public health nurse and is regarded as the founder of the specialty. Option a is incorrect because Nightingale worked in the Crimea, not New York, and her contribution was sanitary reform supported by statistical display of mortality data. She never practiced in American tenements. Option c is incorrect because Breckinridge served the mountains of eastern Kentucky, bringing nurse midwifery to rural families on horseback. Her setting was frontier and rural, the opposite of a crowded urban immigrant district. Option d is incorrect because Rogers was placed in New York City schools out of Henry Street, becoming the first school nurse. She extended Wald's work rather than founding public health nursing herself.

Correct Answer: The Indian Health Service and its urban programs

The Indian Health Service is the federal direct-service system for American Indian and Alaska Native people from federally recognized tribes, working through its own facilities, tribally operated programs, and urban Indian health programs. Option b is incorrect because that agency funds community health centers, the National Health Service Corps, and rural and maternal programs. It pays for safety-net access broadly rather than running a tribal system. Option c is incorrect because Medicare, Medicaid, CHIP, and the Marketplace are insurance programs administered there. Coverage pays other people to deliver care, while the woman is asking about a system that treats her directly. Option d is incorrect because child welfare, Head Start, and family assistance sit in that division of the department. None of those programs provides the clinical services this client used on tribal land.

Correct Answer: Medicare requires a skilled nursing or therapy need

Medicare home health requires all three conditions together. The client must be homebound, under the care of a physician or advanced practice provider, and in need of intermittent skilled nursing or therapy. Option a is incorrect because Medicare deliberately excludes long-term custodial care. Bathing, dressing, and supervision are personal care rather than skilled care, and Medicaid home and community-based services are the usual payer for them. Option b is incorrect because aide services under this benefit are intermittent and attached to an ongoing skilled plan of care. Promising unlimited hours would set the daughter up for a denial and a bill. Option d is incorrect because room and board in a residential setting has never been a Medicare benefit. Families paying for assisted living rely on private savings or on a state waiver program.