Community - M

Which one of the following situations represents public health nursing? a.Assessing the services and effectiveness of the school health clinic b.Caring for patients after their outpatient surgeries c.Giving care to schoolchildren at the school clinic and to the children's families d.Treating paediatric patients at an outpatient clinic

ANS: A A public health or population-focused approach would consider the entire group of children receiving care, to see if services are effective in achieving the goal of improving the health of the school population.

Which of the following actions can a CHN take to potentially increase accessibility to health care services for mentally ill homeless clients? a.Apply for a grant to fund a mobile clinic to take health care to the clients. b.Distribute flyers to homeless persons that detail the location of various healthcare services. c.Refer homeless clients to temporary housing facilities. d.Solicit donations for food and clothing to be distributed to the homeless.

ANS: A Accessibility refers to the ability of clients to access needed health care services. While all of the options listed lead to opportunities for achieving better health outcomes, either directly or indirectly, only a mobile health clinic can potentially improve accessibility to health care. Neighbourhood clinics, mobile vans, and home visits can bring health care to people unable to access health care units. Coordinating health care services from a central location often improves client compliance because it reduces the stress of getting to multiple places.

Which of the following best describes community health nursing? a.Focusing on the health care of individual clients in the community b.Giving care with a focus on the group's needs c.Giving care with a focus on the aggregate's needs d.Working with an approach of unique client care

ANS: A By definition, community health nursing is the health care of individual clients in the community.

Which of the following best describes primary health care? a.A comprehensive way to address issues of social justice b.Giving care to manage acute or chronic conditions c.Giving direct care to ill individuals within their family setting d.Having the goal of health promotion and disease prevention

ANS: A By definition, primary health care is comprehensive and addresses issues of social justice and equity. Social justice in the context of health refers to ensuring fairness and equality in health services so that vulnerable individuals in society have easy access to health care.

Ms. LeBlanc, BSc, registered nurse (RN), has just been employed as a CHN. Which of the following questions might be very relevant to her practice as she begins her position? a."Which community groups are at greatest risk for problems?" b."Which patients should I see first as I begin my day?" c."With which physicians will I be collaborating most closely?" d."Who is the nursing assistant to whom I can refer patients?"

ANS: A CHNs apply the nursing process to the entire community; asking which groups are at greatest risk reflects a community-oriented perspective. The other possible responses focus on particular individuals.

While screening for diabetes at a community clinic, a CHN found out that a new client had type 2 diabetes. The CHN then provided counselling, referred the client to an endocrinologist for initial assessment and treatment, helped with arrangements for financial assistance, arranged transportation, and booked a follow-up appointment. What role is this type of service most representative of? a.Case management b.Client advocacy c.Holistic care d.Wrap-around services

ANS: A Case management involves linking clients with services and providing direct community health nursing services, including teaching, counselling, screening, and immunizing. Linking health services is accomplished by making appropriate referrals and by following up with clients to ensure that the desired outcomes from the referral were achieved.

Which of the following actions should a CHN take when using the case management approach with vulnerable populations? a.Be willing to enter into a long-term relationship with families. b.Direct and control the client's care because the CHN knows what is most needed. c.Encourage families to become self-sufficient and less dependent on nursing personnel for advice and referrals. d.Rotate assignments periodically, to prevent attachment and codependency.

ANS: A Case management is a process that enhances continuity and appropriateness of care. When using case management with vulnerable populations, the CHN can offer the greatest benefit when she or he is willing to develop long-term relationships with the families served. Long-term relationships create trust and ensure continuity of care. Care involves a partnership between the CHN and the client. CHNs who direct and control the client's care cannot establish a trusting relationship and may inadvertently foster a cycle of dependency and lack of personal health control measures.

At a district board meeting, the CHN requests funding for an after-school recreation program that promotes healthy, fun activities in an effort to decrease drug abuse. Which level of prevention does this exemplify? a.Primary prevention b.Secondary prevention c.Tertiary prevention d.Primary and secondary prevention

ANS: A Primary prevention includes the promotion of healthy lifestyles and resiliency factors. The harm reduction approach to the issue of substance abuse focuses on health promotion and disease prevention.

2. Which one of the following is the best intervention a community health nurse (CHN) can initiate to increase lasting resilience among new immigrants? a.Directing clients to English-as-a-second-language courses b.Giving immigrant clients money to help them get settled c.Identifying areas in the city where housing is less expensive d.Soliciting donations for food, clothing, and other needs

ANS: A Resilience refers to the ability of the client to successfully cope when faced with a threat or hardship. Individuals with low resilience are more inclined to have feelings of hopelessness and may choose suicide as a method to resolve these feelings. Support needs to be provided to those with decreased resilience in order to enhance problem-solving skills and give a greater sense of personal autonomy. When the CHN places emphasis on client strengths and assets rather than client deficits and susceptibility, resilience is more likely to increase.

A CHN is concerned about caregiver stress in the children of older clients with health concerns. Which of the following secondary prevention strategies can the CHN implement to limit caregiver stress? a.Asking caregivers how they are coping with their role b.Encouraging caregivers to periodically take a few hours away from their duties c.Establishing support groups for caregivers of older adult parents d.Referring some caregiving responsibilities to home health nurses (HHNs) or professional caregivers

ANS: A Secondary prevention includes screening that allows for early recognition of health concerns so that prompt interventions can prevent long-term disabilities. By asking caregivers how they are coping (thus screening), the CHN can identify problems early so that interventions can be made to limit the extent of stress, thus paving the way for improving the situation. The other options are either primary or tertiary activities, depending on whether the intervention takes place before or after development of caregiver stress.

What were the first determinants of health as identified by the Lalonde Report in 1974? a.Biology, lifestyle, health care, environment b.Resources, social justice, stable ecosystem, equity c.Biology, genetics, education, social supports d.Income, social status, education, health services

ANS: A The Lalonde Report first identified four determinants of health: biology, lifestyle, health care organization, and environment.

Which of the following is used as a measurement of population health? a.Health status indicators b.Awareness of levels of prevention c.The number of memberships at the local fitness centre d.Reported provincial alcohol and tobacco sales in any given month

ANS: A The focus of community health nursing practice is disease prevention, which is broken down into three levels of prevention: primary, secondary, and tertiary.

Which of the following interventions by the CHN would best serve a vulnerable population? a.Addressing multiple health concerns, including preventive education, when clients present for treatment of an illness b.Establishing a system of networks so that clients may be referred to different services such as preventive care, acute illness care, and chronic treatment c.Providing acute care services that focus on the client's main health concern and setting up appointments at discharge for other concerns d.Referring clients to specialists to address specific health concerns

ANS: A When working with vulnerable populations, it is a good idea to arrange to have as many services as possible available in a single location and at convenient times. This "one-stop shopping" approach to care delivery is helpful for populations experiencing multiple social, economic, and health-related stresses. This becomes especially important if clients have problems accessing health care services.

Which of the following accurately describes an appropriate starting point for the application of a population health approach? a.Emergency life-saving care b.The determinants of health c.Health promotion models d.Risk management

ANS: B The population health approach has, as its starting point, a focus on the determinants of health. Other starting points are also discussed but are not included in the above answer choices.

A CHN suspects that a new client may be a drug addict. When getting the health history of the client, the CHN needs to keep in mind that the client may not admit to drug use. Which one of the following is a primary symptom of addiction? a. Confusion b. Denial c. Forgetfulness d. Mental status changes

ANS: B A primary symptom of addiction involves a refusal to acknowledge that a drug use or substance use problem exists.

Which one of the following is an example of the "advocate" role of the CHN? a.Organizing home care support for a newly discharged older adult client b.Acting as a member of a community action group for provision of accessible transit choices c.Doing prenatal assessments d.Facilitating a self-help group for smoking cessation

ANS: B An advocate provides a voice to client concerns when acting as a member of a community action group for provision of accessible transit choices.

In which of the following scenarios is the PHN most probably fulfilling required employment responsibilities? a.The PHN meets with several groups about community recreation issues. b.The PHN spends the day attending meetings at various health agencies. c.The PHN talks to several people about their particular health concerns. d.The PHN watches television, including a telecast of a city council meeting on the local cable station.

ANS: B Any of these might represent a PHN communicating, cooperating, or collaborating with community residents or groups about health concerns. However, the PHN who spends the day attending meetings at various health agencies is most probably fulfilling requirements effectively, since health is broader than recreation, individual concerns are not as important as aggregate priorities, and watching television is only one-way communication.

Which of the following ethical principles indicates that the CHN is ethically bound to do good within the limitations of time, place, and talent? a.Justice b.Beneficence c.Nonmaleficence d.Distributive justice

ANS: B Beneficence is the ethical principle that states that CHNs are ethically bound to do good within the limitations of time, place, and talent.

Which one of the following characteristics observed in a teenage boy should always alert the CHN to the possibility of suicide? a.Age between 15 and 19 years b.A homosexual orientation and history of depression c.Threatening to cause harm to peers d.A history of torturing and abusing animals

ANS: B Depression and homosexuality are two of the leading risk factors for adolescent suicide. Those who threaten peers or torture and abuse animals are more likely to cause harm to others than to themselves.

Which of the following statements made by a parent indicates a need for more education about child abuse? a."I have stopped slapping my child, and I am learning to count to 10 before reacting." b."I never spank or hit my children; I yell at them to stop being stupid and if they don't, I tell them that the boogeyman will steal them away at night if they don't obey." c."I use 'time out' when my child acts out or is naughty. Sometimes, my child doesn't cope well with this, but I am persistent." d."When my child misbehaves, I distract him and try to focus his attention on other things. If he throws a tantrum, I just pick him up and leave the store or show or wherever we may be."

ANS: B Emotional abuse involves extreme debasement of feelings and may result in the child feeling inadequate, inept, uncared for, and worthless. A parent is emotionally abusing the children by yelling at them ("to stop being stupid") and frightening them ("boogeyman stealing them away at night").

What term is used interchangeably with the term subpopulations? a.Groups b.Aggregates c.Clients d.Communities

ANS: B Generally, subpopulations are referred to as aggregates within the larger community population.

A CHN who works at a clinic for homeless persons wants to institute a more efficient treatment for chronic wounds. Which of the following actions offers the best way to improve outcomes for these clients? a.Administer antibiotics to all homeless persons with chronic, nonhealing wounds. b.Facilitate daily access to a room with soap, water, and bandages. c.Provide free bandaging supplies to clients at each clinic visit. d.Regularly monitor the wound condition of clients.

ANS: B Health problems faced by homeless people often are related directly to poor access to preventive health care services. The CHN can implement tertiary prevention by designating a wound room in which clients can carry out wound care activities taught during clinic visits. Only infected wounds would need treatment with antibiotics, not all wounds. Free bandaging only addresses one part of the problem and monitoring does not improve outcomes; only treatment does.

What is the focus of health promotion in Canada? a.Achieving consensus on community health needs b.Developing a population approach based on the determinants of health c.Dictating interventions that match the government's identified priorities d.Promoting individual health status

ANS: B In Canada, a population approach focusing on the determinants of health is the direction taken in health promotion, in contrast to the focus on promotion of individual health in some other countries, such as the United States.

Using the Community Mobilization Framework and the three health promotion community mobilization approaches, which element should be addressed first within the framework's social planning component? a.Shifting power relationships b.Problem solving at the community level c.Community participation d.Community social concerns

ANS: B The Community Mobilization Framework identifies the following three health promotion community mobilization approaches to bring about community change: 1) social planning (problem solving at the community level to deal with physical, mental, and social health concerns in the community), which is described as a task-oriented strategy that includes a health care professional as the "expert leader"; 2) locality development (community participation and cooperation to deal with community health concerns, with a focus on process, consensus, and community self-help), with the health care professional as facilitator; and 3) social action (a process with the focus on shifting power relationships and resources so that change occurs to the benefit of the disadvantaged in the community).

A CHN presents a proposal for a program for preventing teen pregnancy to a group of parents. In the discussion that follows the presentation, which of the following responses by a parent indicates the need for additional teaching by the CHN? a."I do not know if my son is sexually active; however, I have decided that I am going to talk to him about birth control, just in case." b."I have found that being very strict and checking on my daughter whenever she is out are the best ways to prevent trouble." c."I plan to sit down with my daughter and have an honest talk about sexuality and potential risks." d."I will start spending more time with my teens when I get home from work."

ANS: B Parents who are extremely demanding and controlling or neglectful, and who have low expectations, are the least successful in instilling good values in their children. Children of parents who are neglectful are the most sexually active, followed by children of parents who are very strict. Furthermore, parents who discuss birth control, sexuality, and pregnancy with their children can positively influence delaying initiation of sexual activity and use of effective birth control. Parents who do not talk about sexuality with their teens may find them more at risk for sexual permissiveness and unwanted pregnancies.

What is the basis for the difference between health promotion and health protection? a.The assurance of the highest possible quality in care b.The motivation to change behaviour c.Delivery of care by a group of health care providers d.The achievements of social marketing campaigns

ANS: B Pender et al. (2002) differentiate between health promotion and health protection on the basis of motivation for behaviour change. These authors describe health promotion as the motivation to change behaviour in order to enhance well-being and reach one's optimal health potential. In contrast, the motivation for health protection is to avoid disease, to screen for early detection, and to restore health following illness.

Which of the following is a primary cause of vulnerability? a.Breakdown of family structures b.Poverty c.Prejudice d.Social isolation

ANS: B Poverty is a primary cause of vulnerability. The lack of financial resources may cause some people to not seek preventive health services. This leaves them vulnerable and with increased risk of experiencing the effects of preventable illnesses.

Which of the following is the simplest definition of primary health care? a.It is based on a multidisciplinary group of health care providers working as a team. b.It provides essential care that is universally accessible to persons in a community and encourages self-management, self-reliance, and competence. c.It focuses on health promotion and disease prevention among those who can afford to engage in behaviours that facilitate them. d.It is based on local efforts to meet the Declaration of Alma-Ata, known as Health for All.

ANS: B Primary health care is generally defined as essential care made universally accessible to individuals and families in a community with their full participation and at a cost that the community can afford.

By which of the following actions can the CHN best ensure long-term positive health outcomes in pregnant teens from low-income groups and their children? a.Help teen mothers learn about body changes during pregnancy. b.Develop programs that enable teen mothers to complete their education. c.Offer courses in proper care of babies. d.Monitor pregnant teens for early detection of problems in pregnancy.

ANS: B Programs that enable the teen mother to complete her education increase her chances for a better future and improved health care over the long term, across the lifespan. Issues to discuss include education and career plans, family finances and qualifications for outside assistance, and personal values about pregnancy and parenting at this time in her life.

A CHN is asked by a parent group to explain the risk factors for alcoholism. Which of the following statements should the CHN include in the explanation? a.Alcoholism is determined solely by environment. b.Alcoholism is determined partly by genes. c.Alcoholism is higher in women. d.Persons born with fetal alcohol syndrome are alcoholics from birth.

ANS: B Research has shown conclusively that alcoholism is, at least in part, genetic and not just the result of family environment.

Which level of prevention is a CHN practising when she offers homeless clients yearly tuberculosis (TB) screening and free treatment for those who test positive? a.Primary prevention b.Secondary prevention c.Tertiary prevention d.Secondary and tertiary prevention

ANS: B Screening homeless persons for TB and providing medications to those who test positive are examples of secondary prevention. The TB screening identifies the disease in its early stages. Medications work to prevent further development of the disease.

Which one of the following public health services represents secondary prevention? a.Administering the influenza vaccine to a community of seniors b.Initiating an infant car seat safety screening program for parents in low-income housing c.Starting a rehabilitation clinic for middle-aged adults residing in low-income housing d.Setting up a support group for teenage mothers of infants with Down syndrome

ANS: B Secondary prevention seeks to detect disease early in its progression—for example, through mass screening programs.

CHNs at a clinic for homeless persons are concerned that clients rarely return for follow-up after their TB skin (Mantoux) tests. Which policy would be the most appropriate one for addressing this situation? a.Call all homeless clients 48 hours after testing to remind them to return to the clinic for follow-up. b.Have the homeless persons read the test result themselves and then mail in the results on a postage-paid card coded to protect privacy. c.Readminister the test if the client returns later than scheduled for follow-up. d.Routinely refer all homeless clients for chest X-rays.

ANS: B Secondary preventive activities are aimed at reducing the prevalence or pathological nature of a condition. They involve early diagnosis, prompt treatment, and the limitation of disability. CHNs can work with homeless and near-homeless aggregates to provide education about existing services and strategies for influencing public policy that will provide more comprehensive services for homeless and near-homeless persons. If necessary, CHNs should develop a method for homeless individuals to read the reaction to the TB skin test themselves and send the results to the facility where the skin test was administered.

Which of the following definitions reflects "client as society"? a.Groups within a population working together on a defined activity b.Systems that incorporate the social, political, economic, and cultural infrastructure to address issues of concern c.People and the relationships that emerge among them as they develop and share environments d.A large group of people who have at least one characteristic in common and who reside in close proximity

ANS: B Systems that incorporate the social, political, economic, and cultural infrastructure to address issues of concern is the definition of client as society.

Which of the following is a requirement for reaching the goal "health for all"? a.Self-actualization b.A system for health c.Elimination of lower- and upper-class categories d.Total compliance with immunizations and vaccines with all groups

ANS: B The requirements identified to reach the "health for all" goal include 1) basic needs, 2) belonging and engagement, 3) healthy living, and 4) a system for health.

Which type of thinking is most reflective of looking at a macroscopic, big-picture population focus? a.Collaborative thinking b.Upstream thinking c.Holistic thinking d.Downstream thinking

ANS: B Upstream thinking uses a macroscopic, big-picture population focus, whereas downstream thinking is a microscopic, individual curative focus.

During a group counselling session for perpetrators of intimate partner violence, which of the following statements made by one of the clients indicates a lack of insight into his violent behaviour? a."I have been taking out my frustrations about work on my girlfriend." b."I love my girlfriend and didn't want to hurt her; it was an accident." c."It might be a good idea for me to temporarily leave the house when I feel I am getting angry." d."When I drink alcohol, I become more abusive toward my girlfriend."

ANS: B Violence is defined as those nonaccidental acts that result in physical or psychological injury. Although the client may now be feeling remorse, at the time that the violent act was committed against the girlfriend, his intent was to inflict harm.

Which one of the following public health services represents primary prevention? a.Developing a health education program about the dangers of smoking b.Providing a diabetes clinic for adults in low-income neighbourhoods c.Providing an influenza vaccination program in a community retirement village d.Teaching school-aged children about the positive effects of exercise

ANS: C Although all the services listed are appropriate and valuable, providing influenza vaccines to healthy adults represents the primary level of health prevention.

A CHN is orienting a new recruit to a health clinic that primarily serves vulnerable populations. Which of the following statements by the CHN indicates a need for additional information? a."If a client who does not speak English comes in, you must obtain an interpreter right away." b."We try to take care of as many problems as possible in one visit, so when you check the client in, ask about additional concerns." c."You will like working with Filipino immigrants because they have close-knit family structures." d."You will need to assist the client by scheduling any referral or follow-up appointments."

ANS: C Assumptions are not helpful. Each person and family should be assessed individually. No two people or groups are alike. Both good and bad stereotyping can create problems. For example, even though Filipino families are generally close knit, by assuming that all Filipino families are this way, clinic care providers will likely miss recognizing such issues as family violence.

Which one of the following is the most important ingredient for effective community development? a.Adequate funding b.Appropriate location for the services provided c.Community participation d.Professional expertise

ANS: C Community participation is absolutely essential to community development. The most effective changes come with active participation by the people who live in the community. Community development is a process whereby community members identify health concerns impacting their community that require the development of capacity-building skills to bring about a realization of the needed change, with the goal of a secure and healthy community that benefits all community members.

In his document entitled Achieving Health for All: A Framework for Health Promotion, Epp supported a community and policy focus in health promotion. Which one of the following did he recommend? a.Cooperating fully with the WHO member nations in implementing the plan internationally b.Denying that the goal of health is socially and economically productive lives for all citizens c.Taking actions that foster public participation d.Focusing primarily on disease prevention and health promotion in selected areas

ANS: C Epp's framework supported a community and policy focus in health promotion through fostering public participation (e.g., heart-healthy physical activity promotion initiatives), strengthening community health services (e.g., increasing community mental health services), and coordinating healthy public policy (e.g., a nationwide ban on the sale and use of baby walkers).

Which definition accurately reflects the meaning of the term health inequities? a.Health inequities are the accumulation of multiple factors that lead to poor health. b.Health inequities occur when people are more inclined to become ill and usually do not seek appropriate care. c.Health inequities are unfair differences in health that could be avoided with reasonable action. d.Health inequities are wide variations in health status and services among certain population groups.

ANS: C Health inequities refers to differences in health that could be avoided if reasonable action was taken, and therefore these differences are considered to be unfair and socially unjust.

Which of the following is the primary explanation for life expectancy increasing so notably during the twentieth century? a.An increase in findings from medical laboratory research b.Incredible advances in surgical techniques and procedures c.Improved sanitation and other public health activities d.Increased use of antibiotics to fight infections

ANS: C Improvement in control of infectious diseases through immunizations, sanitation, and other public health activities led to the increase in life expectancy from less than 50 years in 1900 to more than 77 years in 2002.

Which of the following actions is a way in which the CHN can help prevent depression in older adults who are at high risk for it? a.Encourage them to move to a nursing home where they will have the company of others in the same age group. b.Monitor for signs and symptoms of depression. c.Organize a health promotion program for older adults at the local centre. d.Encourage older adult clients to focus on their strengths rather than their weaknesses.

ANS: C It is important for CHNs to recognize that older adults who are depressed usually have a clinically different presentation from that of clients in other age groups. Older adults who are depressed tend to present with many bodily complaints, such as chronic pain, nausea and vomiting, and insomnia, and usually do not express feelings of sadness, guilt, or worthlessness. The depression rate among older adults is half that among younger people, but the presence of a physical or chronic illness increases rates of depression. Activities to improve the mental health status of older adults include public education programs, prevention approaches, and the provision of mental health services in primary care. Depression rates for older adults in nursing homes range from 15% to 25%, and thus this would not be a good place to recommend for social networking. Encouraging older clients to focus on their strengths rather than their weaknesses can sound insensitive if (1) the weaknesses are, indeed, profound, and (2) the necessary tools for coping are not provided along with the advice. Monitoring for signs and symptoms of depression only monitors health issues, rather than preventing them.

Which of the following actions by a case manager would be classified as primary prevention? a.Advocating for the client whose values conflict with those of the medical service provider b.Collaborating between nursing and occupational health personnel c.Educating a group regarding community services that are available if they are ever needed d.Resolving conflict between a primary care clinic and a tertiary care facility

ANS: C Primary prevention involves the use of the information exchange process to increase the client's understanding of the health care system. Remember that primary prevention occurs at a point before an illness or a problem occurs. In all of the other options, the client's health concern already exists and interventions have been employed.

An intravenous (IV) drug abuser admits to the CHN that he has no desire to give up his addiction, so the CHN counsels him on the importance of sterilizing his needles to prevent infection and transmission of blood-borne diseases. Which level of prevention does this action represent? a.Primary prevention b.Secondary prevention c.Tertiary prevention d.Primary and tertiary prevention

ANS: C Tertiary prevention is implemented in people who already have a health concern or problem (in this instance, someone who is already addicted) to prevent complications (harm reduction). In this instance, because the client does not plan to stop the drug abuse, the CHN is trying to prevent complications arising from use of contaminated needles. Emphasis is placed on reducing the transmission of blood-borne diseases through contaminated needles. Giving up the addiction is the best solution but unrealistic for many addicts. Using the harm reduction model, the CHN should provide education on cleaning needles with bleach between uses and about needle exchange programs to decrease the spread of blood-borne pathogens.

Which one of the following is an example of tertiary prevention by a CHN? a.Administering the Mantoux (skin) test to identify persons with TB b.Assessing for signs and symptoms of active TB c.Directly observing clients with active TB as they take their antituberculosis medications d.Interpreting TB skin test results

ANS: C Tertiary prevention is implemented when CHNs provide directly observed therapy (DOT) to those with active TB.

Which report focused on the introduction of the "health field concept" with its four domains? a.Epp Report b.Black Report c.Lalonde Report d.WHO Commission Report on Social Determinants

ANS: C The Lalonde Report focused on the introduction of the health field concept with four domains: human biology, lifestyle, environment, and health care system as determinants of health.

Which of the following main ideas was Lalonde highlighting in his report entitled A New Perspective in the Health of Canadians (1974)? a.Access to health care and cost and quality of health care b.Appropriate legislation to control health care organizations c.The influence of biology, environment, and lifestyle on good health d.Accessibility and health promotion

ANS: C The Lalonde Report initiated a shift, especially in Canada, from a primarily biomedical view of disease and health to consideration of certain aspects of health promotion. The Lalonde Report increased the awareness of human biology, environment, and lifestyle as determinants of health and, therefore, as influencers of health. He urged improvements in the environment, increased knowledge in human biology, and modifications of self-imposed risks arising from individual health choices and related behaviours to increase the population health status of Canadians.

Which community health nursing practice area receives funding from the private sector? a.Telenurses b.Corrections nurses c.Nurse entrepreneurs d.Street or outreach nurses

ANS: C The nurse entrepreneur receives private funding, whereas all of the other community health nurse (CHN) roles are with provincially or federally funded positions.

What information is most important to keep in mind when caring for a pregnant teen? a.All teen pregnancies are considered high risk. b.Limited knowledge can lead to pregnancy complications. c.Pregnant teens are less likely to focus on proper prenatal nutrition. d.Pregnant teens who are poor are more likely to have poorer health outcomes.

ANS: C The nutritional needs of a pregnant teenager are especially important. The CHN needs to assess the pregnant teenager's current eating pattern and provide creative guidance to address the issue of the demands of pregnancy on a normally changing teenager's body and a teenager's usual nutritional habits of fast foods and snacking.

What is the focus of the definition of health in the Ottawa Charter on Health Promotion? a.Health is an outcome. b.Enjoying life is more important than the need to maintain one's health. c.Health is incorporated into one's activities of daily living. d.Health is a way to maintain a stable environment.

ANS: C The perspective taken in this text is based on the Ottawa Charter definition of health: "to reach a state of complete physical, mental and social well-being, an individual or group must be able to identify and to realize aspirations, to satisfy needs, and to change or cope with the environment." Therefore, the World Health Organization (WHO) identified health as a resource for everyday living, i.e., taking a holistic approach that includes physical, social, and personal capabilities, with health being viewed positively. When using this definition, health is no longer viewed as an outcome (or a state to be reached); rather, health is incorporated into one's activities of daily living. Today, Health Canada continues to apply the Ottawa Charter definition of health. The view of health as a resource proposes that communities and individuals use this resource to manage and even change their environments.

A client reports that the narcotic she took for pain on a regular basis made her feel bad and that when she tried an alternative analgesic, she experienced withdrawal symptoms. What is this client suffering from? a.Drug abuse b.Drug addiction c.Drug dependence d.Substance abuse

ANS: C The terms drug dependence and drug addiction often are used interchangeably, but they are not synonymous. Drug dependence is a state of neuroadaptation caused by the chronic, regular use of a drug. People who are dependent on drugs must continue using them to prevent withdrawal symptoms. Drug addiction, in contrast, is a pattern of abuse characterized by an overwhelming preoccupation with the use (compulsive use) of a drug and securing its supply, and a high tendency to relapse if the drug is removed.

What is the most important feature of the Diffusion of Innovation Theory? a.It avoids high-cost treatments and suggests cheaper alternatives. b.It gives members incentives to use only network providers. c.It shows that individuals adopt innovations at different rates. d.It advocates working with geographically based communities.

ANS: C This theory shows that individuals adopt innovations at different rates.

A mother confides to the CHN that her live-in boyfriend pushed her 2-year-old child because he was crying too much. She begs the CHN not to tell anyone because her boyfriend has agreed to take anger management classes. What should the CHN do? a.Abide by the mother's wishes because this information was provided in confidence. b.Arrange for the earliest available counselling for the boyfriend. c.Advise the mother to take the child away from the boyfriend and find alternate housing right away. d.Report the incident to the child protection agency.

ANS: D All individuals in Canada who suspect child abuse are required to report it to the proper child protection agencies as mandated by law. First Nations peoples have their own child protection agencies. All of the other options put the child's welfare at risk.

A CHN suspects that an elementary school student is being physically abused. Which action would be the most appropriate one for the CHN to take? a.Ask the student about the abuse. b.Document findings in the student's school record. c.Discuss the suspicions of abuse with the student's teachers or the family's spiritual leader. d.Notify legal authorities.

ANS: D All individuals in Canada who suspect child abuse are required to report it to the proper child protection agencies, as mandated by law. First Nations peoples have their own child protection agencies.

A CHN often has to make resource allocation decisions. In such cases, which of the following approaches will help the CHN to arrive at the decision? a.Choosing a moral or ethical principle b.Choosing the cheapest, most economical approach c.Choosing the most rational outcome d.Choosing the needs of the aggregate, rather than the needs of a few individuals

ANS: D Although all of the answers represent components of the CHN's decision-making process, the predominant needs of the population outweigh the expressed needs of one person or a few people.

Which one of the following actions is the best example of enabling in a family with an alcoholic father? a.The father asks the CHN to explain why his continued drinking is dangerous. b.The son threatens to leave the home because he finds his father's behaviour embarrassing. c.The teenage daughter turns to a favourite teacher for support. d.The wife tells her husband's boss that her husband is sick when he is actually inebriated.

ANS: D Enabling is the act of shielding or preventing the addict from experiencing the consequences of his or her addiction.

The Canadian Community Health Nursing Standards of Practice identifies a community health nurse (CHN)'s role as advocate in creating public policy, as supporter of community action to influence public policy, and as instrument for societal change. Which one of the following is an example of a healthy public policy? a.Immunizations b.Behaviour change c.Marketing materials d.Crib/bed safety initiatives for infants and young children

ANS: D Examples of a healthy public policy include crib/bed safety for infants and young children, restraint use in long-term-care institutions, seatbelt use for populations, and a tobacco ban in communities.

Which one of the following is the cause of the greatest overall costs to the community for providing health care to the homeless? a.The need for increased preventive services to address the health conditions of the homeless population b.The need for more frequent clinic visits by homeless clients for multiple health problems c.The spread of contagious diseases by homeless people to those they pass on the street d.The fact that most of the care for homeless people takes place in hospital emergency departments

ANS: D Homeless persons encounter the same problems accessing health care (e.g., lack of money, lack of housing, lack of transportation) that others do in impoverished conditions. Therefore, health care of homeless persons tends to be crisis oriented and sought in emergency departments. Low-income Canadians have the highest mortality rates and the highest rates of hospitalizations and emergency visits.

How is the contemplation stage for changing behaviour different from the precontemplation stage for changing behaviour? a.During the contemplation stage, the client does not yet intend to change his or her behaviour within the next 6 months. b.During the contemplation stage, there is a lack of readiness to change behaviour. c.During the precontemplation stage, there is a readiness to change behaviour. d.During the contemplation stage, the client is thinking about changing behaviour within the next 6 months.

ANS: D In the precontemplation stage, an individual is not considering a change in behaviour within the next 6 months; there is no readiness for change. However, in the contemplation stage, an individual is starting to think about a change in behaviour within the next 6 months.

A PHN strives to prevent disease and disability, often in partnership with other community groups. Which one of the following is an appropriate summary of the PHN's role? a.The PHN asks the political leaders what interventions should be chosen. b.The PHN assesses the community and decides on appropriate interventions. c.The PHN uses data from the main health care institutions in the community to determine needed health services. d.The PHN works with community members to carry out public health functions.

ANS: D It is crucial that the PHN work with members of the community to carry out core public health functions.

Whenever Ms. LeBlanc, BSc, RN, talks to the women at the senior citizens' centre, she reminds them that the only way the centre will be able to afford a driver and a van service for those who cannot drive themselves is to continue to write letters to their local city council representatives, requesting funding for such a service. What is Ms. LeBlanc doing? a.Ensuring that the women do not expect Ms. LeBlanc herself to do anything about their problem b.Demonstrating that she understands the women's concerns and needs c.Expressing empathy, support, and concern d.Helping the women engage in political action locally

ANS: D PHNs have an imperative to work with the members of the community to carry out public health functions.

The health of which of the following is the primary focus of public health nurses (PHNs)? a.Families b.Groups c.Individuals d.Populations

ANS: D PHNs use knowledge of nursing, social sciences, and public health sciences for the promotion and protection of health and for the prevention of disease among populations.

Which one of the following is an example of self-efficacy? a.Attending a walk-in clinic for health care b.Allowing others input into one's health decisions c.Paying for a fitness centre membership d.Making healthy food choices while grocery shopping

ANS: D Self-efficacy refers to a belief that one can control one's life and have the ability to carry out actions required to prevent disease; a specific example is making healthy food choices while grocery shopping.

1. Which one of the following is the designation given to groups at high risk of having poor health outcomes? a.Cumulative risk groups b.Health disparity groups c.Resilient populations d.Vulnerable populations

ANS: D Specific populations who are more vulnerable—that is, at-risk populations who are more susceptible to poor health because of socioenvironmental factors—are often referred to as vulnerable populations.

Which one of the following is perhaps the most helpful idea among the unlimited suggestions for how to improve health care in Canadian communities? a.Increasing funding and personnel to advance new pharmaceutical interventions b.Increasing funding for further research into the most effective medical interventions c.Increasing technological advances to constantly improve surgical survival rates d.Involving communities in their health care and encouraging their participation in decisions about health care

ANS: D The strategy of strengthening community action, as outlined in the Ottawa Charter, refers to empowering communities. It involves engaging communities from the grassroots, or "bottom up" (referred to as "locality development" as outlined by Rothman), so as to involve community members in identifying health issues and planning and initiating interventions specific to their communities. In this way, communities take ownership and have control over health issues affecting them and the health of their members.