1. Public health nursing differs from community
health nursing in that public health nursing
|
a.
|
Focuses on individuals
and families.
|
|
b.
|
Understands the needs
of a population.
|
|
c.
|
Ignores political
processes.
|
|
d.
|
Considers the
individual as one member of a group.
|
ANS: B
Public health nursing
requires understanding the needs of a population. A public health nurse
understands factors that influence the political processes used to affect
public policy. The primary focus of community health nursing is the care of
individuals, families, and groups in the community. By focusing on
subpopulations, the community health nurse cares for the community as a whole
and considers the individual or family as only one member of a group at risk.
DIF: Understand REF: 32
OBJ: Explain the
relationship between public health and community health nursing.
TOP: Assessment MSC:
Teaching/Learning
2. A specialist in public health nursing requires
|
a.
|
The same level of
education as the community health nurse.
|
|
b.
|
Preparation at the
basic entry level.
|
|
c.
|
An advanced degree
regardless of public health experience.
|
|
d.
|
A graduate level
education with a focus in public health science.
|
ANS: D
A specialist in public
health has a graduate level education with a focus in public health science.
Public health nursing requires preparation at the basic entry level and
sometimes requires a baccalaureate degree in nursing. Not all hiring agencies
require an advanced degree in community health nursing. However, nurses with a
graduate degree in nursing who practice in community settings are considered
community health nurse specialists, regardless of their public health
experience.
DIF: Understand REF: 32
OBJ: Explain the relationship
between public health and community health nursing.
TOP: Assessment MSC:
Teaching/Learning
3. The community health nurse differs from the
community-based nurse in that the community health nurse
|
a.
|
Understands the needs
of the population.
|
|
b.
|
Focuses on the needs
of the individual.
|
|
c.
|
Is the first level of
contact in the health care system.
|
|
d.
|
Involves the family in
decision making.
|
ANS: A
The community health
nurse understands the needs of a population or community through experience
with individual families in working through their social and health care
issues. The community-based nurse focuses on the needs of the individual or
family. Community-based nursing centers function as the first level of contact
between members of a community and the health care system. The community-based
nurse learns to partner with patients and families so that ultimately the
patient and the family become involved in planning, decision making,
implementation, and evaluation of health care approaches.
DIF: Understand REF:
32-33
OBJ: Differentiate
community health nursing from community-based nursing.
TOP: Assessment MSC:
Teaching/Learning
4. The type of nursing that focuses on acute and
chronic care of individuals and families while enhancing patient autonomy is
known as _____ nursing.
|
a.
|
Public health
|
|
b.
|
Community health
|
|
c.
|
Community-based
|
|
d.
|
Community-focused
|
ANS: C
Community-based nursing
involves acute and chronic care of individuals and families and enhances their
capacity for self-care while promoting autonomy in decision making. Public
health nursing focuses on the needs of a population. Community health nursing
cares for the community as a whole and considers the individual or the family
as only one member of a group at risk. Community-focused nursing understands
the needs of a population or community.
DIF: Understand REF:
32-33
OBJ: Differentiate
community health nursing from community-based nursing.
TOP: Assessment MSC:
Teaching/Learning
5. The community health nurse is administering flu
shots to children at a local playground. In doing so, the nurse’s focus is on
|
a.
|
Preventing individual
illness.
|
|
b.
|
Preventing community
outbreak of illness.
|
|
c.
|
Preventing outbreak of
illness in the family.
|
|
d.
|
The needs of the
individual or family.
|
ANS: B
By focusing on
subpopulations, the community health nurse cares for the community as a whole
and considers the individual or the family as only one member of a group at
risk. Community-based nursing, as opposed to community health nursing, focuses
on the needs of the individual or family.
DIF: Understand REF: 33
OBJ: Discuss the role of the community health nurse.
TOP: Implementation MSC:
Caring
6. The community health nurse is providing
counseling to a group of teenage girls related to birth control and disease
prevention. The nurse does this because
|
a.
|
Focusing on
subpopulations leads to community health.
|
|
b.
|
Community health
nursing focuses on individuals only.
|
|
c.
|
Community health
nursing excludes direct care to subpopulations.
|
|
d.
|
The focus is on preventing
illness and unwanted pregnancy.
|
ANS: A
By focusing on
subpopulations, the community health nurse cares for the community as a whole
and considers the individual or the family as only one member of a group at
risk. Community health nursing is a nursing practice in the community, with the
primary focus on the health care of individuals, families, and groups in a
community. Subpopulations are often a clinical focus. The goal is to protect,
promote, or maintain health, not to prevent illness.
DIF: Understand REF: 33
OBJ: Discuss the role of the community health nurse.
TOP: Implementation MSC:
Caring
7. Community-based nursing care takes place in
community settings such as the home or a clinic. Ideally, this is done to
|
a.
|
Exert greater control
over individual or family decisions.
|
|
b.
|
Provide services close
to where patients live.
|
|
c.
|
Isolate patients and
prevent the spread of disease.
|
|
d.
|
Reduce the need for
self-care.
|
ANS: B
The ideal is to provide
health care services close to where patients live. This lessens the cost of
care as well as the stress associated with the financial burdens of care. The
focus is on the needs of the individual or family. The nurse learns to partner
with patients and families so they assume responsibility for their health care
decisions.
DIF: Understand REF: 33
OBJ: Discuss the role of
the nurse in community-based practice.
TOP: Planning MSC:
Caring
8. The community-based nurse is caring for a
patient who is home bound by arthritis and chronic lung problems. The patient, however,
receives many visitors from the neighborhood and from former coworkers, as well
as frequent phone calls from extended family. When concerned about how the
large number of visitors may be fatiguing the patient, the nurse should
|
a.
|
Restrict the number of
visitors for the patient’s welfare.
|
|
b.
|
Voice concerns to the
patient and proceed according to the patient’s wishes.
|
|
c.
|
Allow visitors to come
and go freely as they have been.
|
|
d.
|
Create visiting hours
when the patient may see non–family members.
|
ANS: B
With the individual and
the family as patients, the context of community-based nursing is
family-centered care within the community. This focus requires a strong
knowledge base in family theory, principles of communication, group dynamics,
and cultural diversity. The nurse learns to partner with patients and families,
so ultimately the patient and the family assume responsibility for their health
care decisions.
DIF: Apply REF: 33
OBJ: Discuss the role of
the nurse in community-based practice.
TOP: Implementation MSC:
Caring
9. The student nurse is trying to determine what
type of nurse she wants to be after graduation. In class, she states that
community health nursing is probably not for her because community nursing
focuses only on community issues such as preventing epidemics. The instructor’s
most appropriate response would be that community health nursing
|
a.
|
Focuses on the health
care of individuals, families, and groups in a community.
|
|
b.
|
Focuses only on the
health of a specific subgroup in a community.
|
|
c.
|
Requires an advanced
nursing degree, so the student need not worry.
|
|
d.
|
Focuses only on
maintaining the health of the community.
|
ANS: A
Community health nursing
is a nursing practice with the primary focus on the health care of individuals,
families, and groups in a community. The goal is to preserve, protect, promote,
or maintain health. Not all hiring agencies require an advanced degree.
DIF: Apply REF: 33 OBJ:
Discuss the role of the community health nurse.
TOP: Implementation MSC:
Caring
10. Vulnerable populations include those patients
who are more likely to develop health problems as a result of
|
a.
|
Pregnancy.
|
|
b.
|
Nontraditional healing
practices.
|
|
c.
|
Excessive risk.
|
|
d.
|
Unlimited access to
health care.
|
ANS: C
Vulnerable populations
are those patients who are more likely to develop health problems as a result
of excess risks or limits in access to health care services, or who are
dependent on others for care. Pregnancy is not a cause of vulnerability, except
in cases where the mother is an adolescent, is addicted to drugs, or is at high
risk for other reasons. Frequently, the immigrant population practices
nontraditional healing practices. Many of these healing practices are effective
and complement traditional therapies.
DIF: Knowledge REF:
33-34
OBJ: Identify
characteristics of patients from vulnerable populations that influence the
community-based nurse’s approach to care. TOP: Assessment
MSC: Nursing Process
11. The instructor is teaching student nurses about identifying
members of vulnerable populations when the nursing student asks, “Why is it
that not all poor people are considered members of vulnerable populations?” The
instructor’s best answer would be
|
a.
|
“All poor people are members of a vulnerable
population.”
|
|
b.
|
“Poor people are members of a vulnerable
population only if they take drugs.”
|
|
c.
|
“Poor people are members of a vulnerable
population only if they are homeless.”
|
|
d.
|
“Members of vulnerable groups frequently have a
combination of risk factors.”
|
ANS: D
Members of vulnerable
groups frequently have many risks or a combination of risk factors that make
them more sensitive to the negative effects of individual risk factors.
Individual risk factors are not always overwhelming, depending on the patient’s
beliefs and values and sources of social support.
DIF: Understand REF:
33-34
OBJ: Identify
characteristics of patients from vulnerable populations that influence the
community-based nurse’s approach to care. TOP: Assessment
MSC: Nursing Process
12. The nurse is making a home visit to a Korean
family whose daughter gave birth 6 weeks earlier. She finds the daughter in bed
with a severe headache. The daughter’s father is holding her hand and is
pressing different parts of the hand and lower arm. The mother explains that
the father is trying to cure the headache by using pressure points. The nurse’s
best response would be to
|
a.
|
Tell the father to
stop and give the daughter Tylenol.
|
|
b.
|
Ask the mother and/or
father to explain the procedure.
|
|
c.
|
Explain to the father
that what he is doing will not work.
|
|
d.
|
Let the father finish
and then give the daughter Tylenol.
|
ANS: B
The nurse should not
judge the patient’s/family’s beliefs and values about health. The nurse needs
to create a comfortable, nonthreatening environment and to learn as much as
possible about the patient’s culture and values that influence his or her
health care practices. Tylenol may not be an acceptable alternative for this
family. Criticizing the family’s beliefs and practices will only create a
barrier to care.
DIF: Apply REF: 34
OBJ: Identify
characteristics of patients from vulnerable populations that influence the
community-based nurse’s approach to care. TOP: Implementation
MSC: Teaching/Learning
13. The nurse is working in a community clinic when
a man and woman bring a 12 year-old boy in, stating that the child fell down a
flight of stairs and hurt his arm. The nurse notices several other bruises on
the child’s body at varying stages of healing. The boy is placed on the
stretcher. When asked how he hurt himself, he states that he does not remember.
However, the nurse notices that the boy continuously avoids looking at the man,
while the man stares at him constantly. The nurse should
|
a.
|
Ask the boy if the man
hurt him.
|
|
b.
|
Confront the man
directly.
|
|
c.
|
Ask the man and woman
to step out.
|
|
d.
|
Ask the woman if the
man hurt the boy.
|
ANS: C
Ask the man and woman to
step out. When dealing with patients at risk for or who have suffered abuse, it
is important to provide protection and to interview the patient at a time when
he or she has privacy, and the individual suspected of being the abuser is not
present. The boy may be less likely to be forthcoming with his attacker in the
room. Confronting the man directly may lead to violence. The woman may also be
a victim of abuse and may fear retribution if she discusses their problems with
health care providers.
DIF: Apply REF: 34-35
OBJ: Identify
characteristics of patients from vulnerable populations that influence the
community-based nurse’s approach to care. TOP: Implementation
MSC: Nursing Process
14. The nurse is working with a 16-year-old pregnant
female who tells the nurse that she needs an abortion. The nurse provides the
patient with information on alternatives to abortion, but after several
sessions, the patient still insists on having the abortion. The competency of
the counselor requires the nurse to
|
a.
|
Insist that the
patient speak with a “Right-to-Life” advocate.
|
|
b.
|
Provide a referral to
an abortion service.
|
|
c.
|
Refuse to provide referral
to an abortion service.
|
|
d.
|
Delay referral to an
abortion service.
|
ANS: B
As a counselor, the
nurse is responsible for providing information, listening objectively, and
being supportive, caring, and trustworthy. The nurse does not make decisions but
rather helps the patient reach decisions that are best for him or her. To
refuse to provide a referral or to delay referral would not be supportive of
the patient’s decision. Counselors usually suggest and rarely insist.
DIF: Apply REF: 36
OBJ: Describe the
competencies important for success in community-based nursing practice.
TOP: Implementation MSC:
Nursing Process
15. The patient is in the hospital with the
diagnosis of early-onset Alzheimer’s disease. Before the patient is discharged,
the community-based nurse is making a visit to the patient’s home, where he
lives with his daughter and her family. A major focus of this visit will be to
|
a.
|
Demonstrate caregiver
techniques for providing care.
|
|
b.
|
Stress to the family
how difficult it will be to provide care at home.
|
|
c.
|
Encourage the family
to send the patient to an extended care facility.
|
|
d.
|
Teach the family how
to have the patient declared incompetent.
|
ANS: A
The role of the
community health nurse, when dealing with patients with Alzheimer’s disease, is
to maintain the best possible functioning, protection, and safety for the
patient. The nurse should demonstrate to the primary family caregiver
techniques for dressing, feeding, and toileting the patient while providing
encouragement and emotional support to the caregiver. The nurse should protect
the patient’s rights and maintain family stability.
DIF: Apply REF: 35
OBJ: Describe the
competencies important for success in community-based nursing practice.
TOP: Implementation MSC:
Nursing Process
16. The community has three components: structure or
locale, the people, and the social systems. While doing a community assessment,
the nurse seeks data on the average household income and the number of
residents on public assistance. In doing so, the nurse is evaluating which of
the following?
|
a.
|
Structure
|
|
b.
|
Population
|
|
c.
|
Welfare system
|
|
d.
|
Social system
|
ANS: A
Economic status is part
of the community structure. Population would involve age and gender
distribution, growth trends, density, education level, and ethnic or religious
groups. The welfare system is part of the social system that also includes the
education, government, communication and health systems.
DIF: Understand REF: 37
OBJ: Describe elements of a community assessment.
TOP: Implementation MSC:
Nursing Process
17. The patient is being readmitted to an inner city
hospital for chest pain after being discharged 3 months earlier after having a
heart attack. The patient was referred to the hospital’s cardiac rehabilitation
program after her previous admission. The patient states that she began going
to cardiac rehabilitation and liked it but stopped. When asked why, she states
that, at the beginning, the classes were at 9 AM, but then got switched
to 7 PM, when it’s dark. The cardiac rehabilitation
program was within walking distance of the patient’s home. What is the most
likely cause of the patient’s unwillingness to go to cardiac rehabilitation?
|
a.
|
Lack of transportation
|
|
b.
|
Fear of walking at
night
|
|
c.
|
Reimbursement issues
|
|
d.
|
Noncompliance
|
ANS: B
A community assessment
should be done to determine the level of community violence at night in the
patient’s neighborhood. She claimed that she liked the program when it was at 9
AM. She did not mention finances as a reason for
not going, and the program was within walking distance to her house.
Noncompliance is a label given unfairly to patients. Most “noncompliance” is
caused. The cause should be identified and dealt with, so the therapy will be
successful.
DIF: Apply REF: 37 OBJ:
Describe elements of a community assessment.
TOP: Implementation MSC:
Nursing Process
MULTIPLE RESPONSE
1. Community-based nursing requires a strong
knowledge base in which of the following? (Select all that apply.)
|
a.
|
Family theory
|
|
b.
|
Communication
|
|
c.
|
Group dynamics
|
|
d.
|
Focus on the
individual
|
|
e.
|
Cultural diversity
|
ANS: A, B, C, E
With the individual and
family as the patients, the context of community-based nursing is
family-centered care within the community. This focus requires a strong
knowledge base in family theory, principles of communication, group dynamics,
and cultural diversity. The nurse leans to partner with patients and families,
not just with individuals.
DIF: Knowledge REF: 33
OBJ: Discuss the role of
the nurse in community-based practice.
TOP: Assessment MSC:
Teaching/Learning
2. Community-based nursing centers function as the
first level of contact between members of a community and the health care
delivery system. Ideally, health care services (Select all that apply.)
|
a.
|
Are provided where
patients live.
|
|
b.
|
Reduce the cost of
health care for the patient.
|
|
c.
|
Provide direct access
to nurses.
|
|
d.
|
Exclude interference
from family or friends.
|
ANS: A, B, C
Community-based nursing
centers function as the first level of contact between members of a community
and the health care delivery system. Ideally, health care services are provided
near where patients live. This approach helps to reduce the cost of health care
for the patient and the stress associated with the financial burdens of care. In
addition, these centers offer direct access to nurses and patient-centered
health services and readily incorporate the patient and the patient’s family or
friends into a plan of care.
DIF: Understand REF: 33
OBJ: Discuss the role of
the nurse in community-based practice.
TOP: Planning MSC:
Caring
3. Of the following list of patients, which would
be considered at high risk to be members of a vulnerable population? (Select
all that apply.)
|
a.
|
An immigrant who
speaks only Chinese
|
|
b.
|
An Hispanic truck
driver who speaks limited English
|
|
c.
|
A 22-year-old pregnant
woman
|
|
d.
|
A 15-year-old rape
victim
|
|
e.
|
A 40-year-old
schizophrenic
|
ANS: A, B, D, E
For some immigrants,
access to health care is limited because of language barriers and lack of
benefits, resources, and transportation. Immigrant populations face multiple
diverse health issues that cities, counties, and states need to address. These
health care needs pose significant legal and policy issues. For some
immigrants, access to health care is limited because of language barriers and
lack of benefits, resources, and transportation. Low-risk mothers and babies
usually are not considered vulnerable populations unless other factors are
noted. Physical, emotional, and sexual abuse (such as rape), as well as
neglect, is a major public health problem affecting older adults, women, and
children. When a patient has a severe mental illness such as schizophrenia,
multiple health and socioeconomic problems will need to be explored.
DIF: Evaluation REF:
33-35
OBJ: Identify
characteristics of patients from vulnerable populations that influence the
community-based nurse’s approach to care. TOP: Planning
MSC: Caring
