Chapter 3: Community-Based Nursing Practice

Test Bank
MULTIPLE C!ICE
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 !
Public health nursing re"uires understanding the needs of a population. A public health nurse
understands factors that influence the political processes used to affect public policy. #he
primary focus of community health nursing is the care of individuals$ families$ and groups in
the community. !y focusing on subpopulations$ the community health nurse cares for the
community as a %hole and considers the individual or family as only one member of a group
at ris&.
'IF Understand ()F *+
,!- ).plain the relationship bet%een public health and community health nursing.
#,P Assessment /SC #eaching01earning
+. A specialist in public health nursing re"uires
a
.
#he same level of education as the community health nurse.
b
.
Preparation at the basic entry level.
c
.
An advanced degree regardless of public health e.perience.
d
.
A graduate level education %ith a focus in public health science.
ANS '
A specialist in public health has a graduate level education %ith a focus in public health
science. Public health nursing re"uires preparation at the basic entry level and sometimes
re"uires a baccalaureate degree in nursing. Not all hiring agencies re"uire an advanced degree
in community health nursing. 2o%ever$ nurses %ith a graduate degree in nursing %ho practice
in community settings are considered community health nurse specialists$ regardless of their
public health e.perience.
'IF Understand ()F *+
,!- ).plain the relationship bet%een public health and community health nursing.
#,P Assessment /SC #eaching01earning
*. #he community health nurse differs from the community3based 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 ma&ing.
ANS A
#he community health nurse understands the needs of a population or community through
e.perience %ith individual families in %or&ing through their social and health care issues. #he
community3based nurse focuses on the needs of the individual or family. Community3based
nursing centers function as the first level of contact bet%een members of a community and the
health care system. #he community3based nurse learns to partner %ith patients and families so
that ultimately the patient and the family become involved in planning$ decision ma&ing$
implementation$ and evaluation of health care approaches.
'IF Understand ()F *+3**
,!- 'ifferentiate community health nursing from community3based nursing.
#,P Assessment /SC #eaching01earning
4. #he type of nursing that focuses on acute and chronic care of individuals and families %hile
enhancing patient autonomy is &no%n as 55555 nursing.
a
.
Public health
b
.
Community health
c
.
Community3based
d
.
Community3focused
ANS C
Community3based nursing involves acute and chronic care of individuals and families and
enhances their capacity for self3care %hile promoting autonomy in decision ma&ing. Public
health nursing focuses on the needs of a population. Community health nursing cares for the
community as a %hole and considers the individual or the family as only one member of a
group at ris&. Community3focused nursing understands the needs of a population or
community.
'IF Understand ()F *+3**
,!- 'ifferentiate community health nursing from community3based nursing.
#,P Assessment /SC #eaching01earning
6. #he community health nurse is administering flu shots to children at a local playground. In
doing so$ the nurse7s focus is on
a
.
Preventing individual illness.
b
.
Preventing community outbrea& of illness.
c
.
Preventing outbrea& of illness in the family.
d
.
#he needs of the individual or family.
ANS !
!y focusing on subpopulations$ the community health nurse cares for the community as a
%hole and considers the individual or the family as only one member of a group at ris&.
Community3based nursing$ as opposed to community health nursing$ focuses on the needs of
the individual or family.
'IF Understand ()F ** ,!- 'iscuss the role of the community health nurse.
#,P Implementation /SC Caring
8. #he community health nurse is providing counseling to a group of teenage girls related to
birth control and disease prevention. #he nurse does this because
a
.
Focusing on subpopulations leads to community health.
b
.
Community health nursing focuses on individuals only.
c
.
Community health nursing e.cludes direct care to subpopulations.
d
.
#he focus is on preventing illness and un%anted pregnancy.
ANS A
!y focusing on subpopulations$ the community health nurse cares for the community as a
%hole and considers the individual or the family as only one member of a group at ris&.
Community health nursing is a nursing practice in the community$ %ith the primary focus on
the health care of individuals$ families$ and groups in a community. Subpopulations are often
a clinical focus. #he goal is to protect$ promote$ or maintain health$ not to prevent illness.
'IF Understand ()F ** ,!- 'iscuss the role of the community health nurse.
#,P Implementation /SC Caring
9. Community3based nursing care ta&es place in community settings such as the home or a
clinic. Ideally$ this is done to
a
.
).ert greater control over individual or family decisions.
b
.
Provide services close to %here patients live.
c
.
Isolate patients and prevent the spread of disease.
d
.
(educe the need for self3care.
ANS !
#he ideal is to provide health care services close to %here patients live. #his lessens the cost
of care as %ell as the stress associated %ith the financial burdens of care. #he focus is on the
needs of the individual or family. #he nurse learns to partner %ith patients and families so
they assume responsibility for their health care decisions.
'IF Understand ()F **
,!- 'iscuss the role of the nurse in community3based practice.
#,P Planning /SC Caring
:. #he community3based nurse is caring for a patient %ho is home bound by arthritis and chronic
lung problems. #he patient$ ho%ever$ receives many visitors from the neighborhood and from
former co%or&ers$ as %ell as fre"uent phone calls from e.tended family. ;hen concerned
about ho% the large number of visitors may be fatiguing the patient$ the nurse should
a
.
(estrict the number of visitors for the patient7s %elfare.
b
.
<oice concerns to the patient and proceed according to the patient7s %ishes.
c
.
Allo% visitors to come and go freely as they have been.
d
.
Create visiting hours %hen the patient may see non=family members.
ANS !
;ith the individual and the family as patients$ the conte.t of community3based nursing is
family3centered care %ithin the community. #his focus re"uires a strong &no%ledge base in
family theory$ principles of communication$ group dynamics$ and cultural diversity. #he nurse
learns to partner %ith patients and families$ so ultimately the patient and the family assume
responsibility for their health care decisions.
'IF Apply ()F **
,!- 'iscuss the role of the nurse in community3based practice.
#,P Implementation /SC Caring
>. #he student nurse is trying to determine %hat type of nurse she %ants 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. #he instructor7s
most appropriate response %ould 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
.
(e"uires an advanced nursing degree$ so the student need not %orry.
d
.
Focuses only on maintaining the health of the community.
ANS A
Community health nursing is a nursing practice %ith the primary focus on the health care of
individuals$ families$ and groups in a community. #he goal is to preserve$ protect$ promote$ or
maintain health. Not all hiring agencies re"uire an advanced degree.
'IF Apply ()F ** ,!- 'iscuss the role of the community health nurse.
#,P Implementation /SC Caring
1?. <ulnerable populations include those patients %ho are more li&ely to develop health problems
as a result of
a
.
Pregnancy.
b
.
Nontraditional healing practices.
c
.
).cessive ris&.
d
.
Unlimited access to health care.
ANS C
<ulnerable populations are those patients %ho are more li&ely to develop health problems as a
result of e.cess ris&s or limits in access to health care services$ or %ho are dependent on
others for care. Pregnancy is not a cause of vulnerability$ e.cept in cases %here the mother is
an adolescent$ is addicted to drugs$ or is at high ris& for other reasons. Fre"uently$ the
immigrant population practices nontraditional healing practices. /any of these healing
practices are effective and complement traditional therapies.
'IF @no%ledge ()F **3*4
,!- Identify characteristics of patients from vulnerable populations that influence the community3
based nurse7s approach to care. #,P Assessment
/SC Nursing Process
11. #he instructor is teaching student nurses about identifying members of vulnerable populations
%hen the nursing student as&s$ A;hy is it that not all poor people are considered members of
vulnerable populationsBC #he instructor7s best ans%er %ould be
a
.
AAll poor people are members of a vulnerable population.C
b
.
APoor people are members of a vulnerable population only if they ta&e drugs.C
c
.
APoor people are members of a vulnerable population only if they are homeless.C
d
.
A/embers of vulnerable groups fre"uently have a combination of ris& factors.C
ANS '
/embers of vulnerable groups fre"uently have many ris&s or a combination of ris& factors
that ma&e them more sensitive to the negative effects of individual ris& factors. Individual ris&
factors are not al%ays over%helming$ depending on the patient7s beliefs and values and
sources of social support.
'IF Understand ()F **3*4
,!- Identify characteristics of patients from vulnerable populations that influence the community3
based nurse7s approach to care. #,P Assessment
/SC Nursing Process
1+. #he nurse is ma&ing a home visit to a @orean family %hose daughter gave birth 8 %ee&s
earlier. She finds the daughter in bed %ith a severe headache. #he daughter7s father is holding
her hand and is pressing different parts of the hand and lo%er arm. #he mother e.plains that
the father is trying to cure the headache by using pressure points. #he nurse7s best response
%ould be to
a
.
#ell the father to stop and give the daughter #ylenol.
b
.
As& the mother and0or father to e.plain the procedure.
c
.
).plain to the father that %hat he is doing %ill not %or&.
d
.
1et the father finish and then give the daughter #ylenol.
ANS !
#he nurse should not Dudge the patient7s0family7s beliefs and values about health. #he nurse
needs to create a comfortable$ nonthreatening environment and to learn as much as possible
about the patient7s culture and values that influence his or her health care practices. #ylenol
may not be an acceptable alternative for this family. CriticiEing the family7s beliefs and
practices %ill only create a barrier to care.
'IF Apply ()F *4
,!- Identify characteristics of patients from vulnerable populations that influence the community3
based nurse7s approach to care. #,P Implementation
/SC #eaching01earning
1*. #he nurse is %or&ing in a community clinic %hen a man and %oman bring a 1+ year3old boy
in$ stating that the child fell do%n a flight of stairs and hurt his arm. #he nurse notices several
other bruises on the child7s body at varying stages of healing. #he boy is placed on the
stretcher. ;hen as&ed ho% he hurt himself$ he states that he does not remember. 2o%ever$ the
nurse notices that the boy continuously avoids loo&ing at the man$ %hile the man stares at him
constantly. #he nurse should
a
.
As& the boy if the man hurt him.
b
.
Confront the man directly.
c
.
As& the man and %oman to step out.
d
.
As& the %oman if the man hurt the boy.
ANS C
As& the man and %oman to step out. ;hen dealing %ith patients at ris& for or %ho have
suffered abuse$ it is important to provide protection and to intervie% the patient at a time %hen
he or she has privacy$ and the individual suspected of being the abuser is not present. #he boy
may be less li&ely to be forthcoming %ith his attac&er in the room. Confronting the man
directly may lead to violence. #he %oman may also be a victim of abuse and may fear
retribution if she discusses their problems %ith health care providers.
'IF Apply ()F *43*6
,!- Identify characteristics of patients from vulnerable populations that influence the community3
based nurse7s approach to care. #,P Implementation
/SC Nursing Process
14. #he nurse is %or&ing %ith a 183year3old pregnant female %ho tells the nurse that she needs an
abortion. #he nurse provides the patient %ith information on alternatives to abortion$ but after
several sessions$ the patient still insists on having the abortion. #he competency of the
counselor re"uires the nurse to
a
.
Insist that the patient spea& %ith a A(ight3to31ifeC advocate.
b
.
Provide a referral to an abortion service.
c
.
(efuse to provide referral to an abortion service.
d
.
'elay referral to an abortion service.
ANS !
As a counselor$ the nurse is responsible for providing information$ listening obDectively$ and
being supportive$ caring$ and trust%orthy. #he nurse does not ma&e decisions but rather helps
the patient reach decisions that are best for him or her. #o refuse to provide a referral or to
delay referral %ould not be supportive of the patient7s decision. Counselors usually suggest
and rarely insist.
'IF Apply ()F *8
,!- 'escribe the competencies important for success in community3based nursing practice.
#,P Implementation /SC Nursing Process
16. #he patient is in the hospital %ith the diagnosis of early3onset AlEheimer7s disease. !efore the
patient is discharged$ the community3based nurse is ma&ing a visit to the patient7s home$
%here he lives %ith his daughter and her family. A maDor focus of this visit %ill be to
a
.
'emonstrate caregiver techni"ues for providing care.
b
.
Stress to the family ho% difficult it %ill be to provide care at home.
c
.
)ncourage the family to send the patient to an e.tended care facility.
d
.
#each the family ho% to have the patient declared incompetent.
ANS A
#he role of the community health nurse$ %hen dealing %ith patients %ith AlEheimer7s disease$
is to maintain the best possible functioning$ protection$ and safety for the patient. #he nurse
should demonstrate to the primary family caregiver techni"ues for dressing$ feeding$ and
toileting the patient %hile providing encouragement and emotional support to the caregiver.
#he nurse should protect the patient7s rights and maintain family stability.
'IF Apply ()F *6
,!- 'escribe the competencies important for success in community3based nursing practice.
#,P Implementation /SC Nursing Process
18. #he community has three components structure or locale$ the people$ and the social systems.
;hile doing a community assessment$ the nurse see&s data on the average household income
and the number of residents on public assistance. In doing so$ the nurse is evaluating %hich of
the follo%ingB
a
.
Structure
b
.
Population
c
.
;elfare system
d
.
Social system
ANS A
)conomic status is part of the community structure. Population %ould involve age and gender
distribution$ gro%th trends$ density$ education level$ and ethnic or religious groups. #he
%elfare system is part of the social system that also includes the education$ government$
communication and health systems.
'IF Understand ()F *9 ,!- 'escribe elements of a community assessment.
#,P Implementation /SC Nursing Process
19. #he patient is being readmitted to an inner city hospital for chest pain after being discharged *
months earlier after having a heart attac&. #he patient %as referred to the hospital7s cardiac
rehabilitation program after her previous admission. #he patient states that she began going to
cardiac rehabilitation and li&ed it but stopped. ;hen as&ed %hy$ she states that$ at the
beginning$ the classes %ere at > A/$ but then got s%itched to 9 P/$ %hen it7s dar&. #he
cardiac rehabilitation program %as %ithin %al&ing distance of the patient7s home. ;hat is the
most li&ely cause of the patient7s un%illingness to go to cardiac rehabilitationB
a
.
1ac& of transportation
b
.
Fear of %al&ing at night
c
.
(eimbursement issues
d
.
Noncompliance
ANS !
A community assessment should be done to determine the level of community violence at
night in the patient7s neighborhood. She claimed that she li&ed the program %hen it %as at >
A/. She did not mention finances as a reason for not going$ and the program %as %ithin
%al&ing distance to her house. Noncompliance is a label given unfairly to patients. /ost
AnoncomplianceC is caused. #he cause should be identified and dealt %ith$ so the therapy %ill
be successful.
'IF Apply ()F *9 ,!- 'escribe elements of a community assessment.
#,P Implementation /SC Nursing Process
MULTIPLE "E#P!N#E
1. Community3based nursing re"uires a strong &no%ledge base in %hich of the follo%ingB
(Select all that apply.)
a
.
Family theory
b
.
Communication
c
.
Froup dynamics
d
.
Focus on the individual
e
.
Cultural diversity
ANS A$ !$ C$ )
;ith the individual and family as the patients$ the conte.t of community3based nursing is
family3centered care %ithin the community. #his focus re"uires a strong &no%ledge base in
family theory$ principles of communication$ group dynamics$ and cultural diversity. #he nurse
leans to partner %ith patients and families$ not Dust %ith individuals.
'IF @no%ledge ()F **
,!- 'iscuss the role of the nurse in community3based practice.
#,P Assessment /SC #eaching01earning
+. Community3based nursing centers function as the first level of contact bet%een members of a
community and the health care delivery system. Ideally$ health care services (Select all that
apply.)
a
.
Are provided %here patients live.
b
.
(educe the cost of health care for the patient.
c
.
Provide direct access to nurses.
d
.
).clude interference from family or friends.
ANS A$ !$ C
Community3based nursing centers function as the first level of contact bet%een members of a
community and the health care delivery system. Ideally$ health care services are provided near
%here patients live. #his approach helps to reduce the cost of health care for the patient and
the stress associated %ith the financial burdens of care. In addition$ these centers offer direct
access to nurses and patient3centered health services and readily incorporate the patient and
the patient7s family or friends into a plan of care.
'IF Understand ()F **
,!- 'iscuss the role of the nurse in community3based practice.
#,P Planning /SC Caring
*. ,f the follo%ing list of patients$ %hich %ould be considered at high ris& to be members of a
vulnerable populationB (Select all that apply.)
a
.
An immigrant %ho spea&s only Chinese
b
.
An 2ispanic truc& driver %ho spea&s limited )nglish
c
.
A ++3year3old pregnant %oman
d
.
A 163year3old rape victim
e
.
A 4?3year3old schiEophrenic
ANS A$ !$ '$ )
For some immigrants$ access to health care is limited because of language barriers and lac& of
benefits$ resources$ and transportation. Immigrant populations face multiple diverse health
issues that cities$ counties$ and states need to address. #hese health care needs pose significant
legal and policy issues. For some immigrants$ access to health care is limited because of
language barriers and lac& of benefits$ resources$ and transportation. 1o%3ris& mothers and
babies usually are not considered vulnerable populations unless other factors are noted.
Physical$ emotional$ and se.ual abuse Gsuch as rapeH$ as %ell as neglect$ is a maDor public
health problem affecting older adults$ %omen$ and children. ;hen a patient has a severe
mental illness such as schiEophrenia$ multiple health and socioeconomic problems %ill need
to be e.plored.
'IF )valuate ()F **3*6
,!- Identify characteristics of patients from vulnerable populations that influence the community3
based nurse7s approach to care. #,P Planning
/SC Caring