CH 6: Community Assessment

Which of the following is a major factor in determining which people or groups are most likely to be helpful to a particular individual? a. Anyone who has time to be available b. Environmental proximity c. Same employment responsibilities d. Similar religious faith

ANS: B Although it is certainly more common to have friends who are similar to ourselves in many ways, those most likely to be called on and respond are those in close environmental proximity. DIF: Cognitive Level: Understand (Comprehension) REF: p. 93

Which of the following best describes how care can be appropriately given in a community? a. Provide individualized care to unique individuals as much as resources allow. b. Consider the community itself as the "client." c. Administer care according to the priorities of the local health department. d. Prioritize care for the sickest populations first.

ANS: B As it is clearly impossible and impractical to give service to each person in a community, the best approach considers the community itself to be the unit of service. DIF: Cognitive Level: Understand (Comprehension) REF: p. 92

The nurse is interviewing community members as part of a community assessment. Which of the following groups of people would the community health nurse most likely want to interview? a. Bankers who could share economic data on the community b. Long-time residents who were informal leaders in the community c. Pastors and other religious leaders who share the faith of the community d. Realtors who could share housing and living conditions in the community

ANS: B The nurse needs to interview key informants in the community to gather data about the health of the community. Although each group could share some information, the long-time informal leaders would be most knowledgeable about the overall strengths and concerns of the community. DIF: Cognitive Level: Apply (Application) REF: p. 101

Which of the following is a central function unique to community health nursing? (Select all that apply.) a. Being willing to travel to give care in an appropriate setting b. Collaborating and cooperating with other health care team members c. Gathering appropriate comprehensive assessment data on the community d. Incorporating epidemiological approaches throughout the nursing process e. Keeping accurate and detailed medical records on care given f. Being willing to contribute to health policy development

ANS: C, D, F Although all nurses ideally arrange transportation to their employment site, keep accurate records, and collaborate with health care team members, only community health nurses are expected to engage in comprehensive community assessment, incorporate epidemiology, and contribute to health policy development. DIF: Cognitive Level: Understand (Comprehension) REF: p. 93

Which of the following activities would be most helpful to a person in whom a serious chronic illness has been diagnosed? a. Discuss it with a religious leader on a confidential, do-not-tell basis b. Join a support group of others with the same illness c. Share the diagnosis with coworkers and neighbors to gain sympathy and support d. Tell extended family because many diseases have a genetic component

ANS: B Although a person might choose to do any of these, the most helpful action over the long term is to join a support group with persons having the same diagnosis for mutual learning, sharing of resources, and support. Religious leaders could also be helpful, but many people do not have a religious leader. DIF: Cognitive Level: Apply (Application) REF: p. 93

Which of the following best describes how people typically respond when asked of what community are they a member? a. Geographic community (neighborhood or city) b. House of worship participants or members c. Occupational or professional group d. Those who are devoted to a particular craft or hobby

ANS: A Although individuals might well respond in terms of any of the possible responses, the most common response is in terms of geographic location of one's home or place of residence. DIF: Cognitive Level: Understand (Comprehension) REF: p. 93

Which of the following best describes how the U.S. Census Bureau surveys are helpful to a community health nurse? a. They provide the distribution of age, sex, race, and ethnicity in the community. b. They document the mortality and morbidity of the community. c. They ensure that all community residents are involved. d. They temporarily give employment opportunities to residents.

ANS: A Although they may offer temporary employment to some community residents and ideally all residents are counted, the value of the Census Bureau data is in clarifying the distribution of age, sex, race, and ethnicity of the community, which may also suggest health needs. The Census Bureau does not collect data on mortality and morbidity. DIF: Cognitive Level: Understand (Comprehension) REF: p. 97

A community health nurse found a very small number of families in the community who were desperately in need of basic preventive health services. Which of the following ethical approaches supports expending agency resources on these few, but needy, families? a. Beneficence suggests focusing on the most needy, so resources should be expended on these families. b. Deontological ethics suggest that the nurse must give priority to the intervention that would have the broadest impact. c. Utilitarianism (the most good for the largest number) would suggest continuing to focus on broader community needs. d. Virtue ethics would suggest focusing on these families to support the nurse's own character development.

ANS: A Each response is an accurate portrayal of a branch of ethics. Beneficence and social justice would give moral advantage to the most vulnerable. By caring for these families, the demands of utilitarianism (the most good for the largest number) would also be met as caring for the weakest supports the whole community. DIF: Cognitive Level: Apply (Application) REF: p. 99

An individual lives in a healthy community. Which of the following characteristics would this community most likely display? a. Ability to adapt and respond to changes b. Lack of environmental pollution c. Low unemployment rate d. Ongoing growth in population

ANS: A The community's ability to respond effectively to changing dynamics and meet the needs of its members indicates productive functioning. A community may or may not be able to control environmental pollution because the pollution is often from outside the community itself. Similarly, employment, or lack thereof, may be due to factors outside the community's control. In many communities, growth is not expected; simply not losing more population is a great achievement.

A community health nurse wants to obtain an overview of the community, but has limited time and resources. Which of the following methods would the nurse most likely use to obtain this information? a. Engage in a windshield survey b. Establish a health department committee of community leaders willing to fill out periodic surveys related to various health issues in the community c. Live in the community for several years d. Review public health department records from up to 5 years ago

ANS: A The easiest way to obtain an overview of the community is through a windshield survey by driving or walking throughout the area and making organized observations. A group that is willing to respond to surveys and review public health records and that lives in the community would be very helpful but not easy or fast

A community health nurse has completed a community assessment and is now writing a community diagnosis for the problem. Which component of the diagnosis will be used to summarize the assessment data of the problem? a. Identification of the health risk b. Evidence supporting the choice of priority c. The aggregate that needs the intervention d. The cause of the identified health problem

ANS: A The identification of the health problem or risk represents a synthesis of all assessment data. DIF: Cognitive Level: Apply (Application) REF: p. 102

Which of the following are considered the most important determinants of a healthy community? (Select all that apply.) a. Child-friendly neighborhoods b. Several different choices of houses of worship c. Employment opportunities d. Low crime rate e. Safe food and water supplies f. Varied housing choices

ANS: A, D The public is more concerned with quality-of-life issues, with the most important determinants of a healthy community being low crime rates and a child-friendly neighborhood environment. Although employment opportunities are important, many are low-paying, no-benefit service positions that are inadequate to support family life. Although the food may be expensive, most cities have safe food and water supplies. DIF: Cognitive Level: Understand (Comprehension) REF: p. 97

Which of the following best describes the aspects central to the definition of community? (Select all that apply.) a. Geographic boundaries at a point in time b. Whatever is most convenient for the nurse c. Patterns of disease found d. Persons who share common goals and interests e. Persons who band together to address a shared problem f. The name the people have given themselves

ANS: A, E, F The person-place-time model suggests epidemiologists examine demographic characteristics of the community (person characteristics), geographic or environmental factors (place), and a point in time (i.e., the present in comparison with the past and hope for future). Therefore, using the model, any item related to geographic boundaries, persons with shared goals, or a particular time would be correct. DIF: Cognitive Level: Understand (Comprehension) REF: p. 93

Which of the following provides the most accurate way to explain community health nursing? a. Being employed outside a medical center, such as in a physician's office b. Focusing care on the community as a whole c. Providing care within the community, rather than a hospital or extended-care facility d. Working for a public health department

ANS: B Not only is community a context or place where a community health nurse gives care, but the community as a whole is the focus of the nurse's efforts. Being employed outside a medical center, providing care within the community, and working for a public health department all describe settings where a community health nurse may be employed, but do not demonstrate the emphasis on providing population-focused care.

A nurse was debating about which approach to use to both obtain data about community needs and encourage community participation in their resolution. Which of the following approaches would be most effective in meeting both goals? a. A community forum, open to all interested residents of the community b. A community survey mailed to all residents c. Establishing focus groups with selected participants d. Conducting in-depth interviews with select community residents

ANS: C All of the responses would be helpful in obtaining information about the community. However, only focus groups promote group interaction and encourage further participation in planning solutions to identified problems. DIF: Cognitive Level: Apply (Application) REF: pp. 101-102

Which of the following best describes what community members receive from each other? a. Safe environment to live and work b. Entertainment and recreational opportunities c. Socialization and role fulfillment d. Useful services such as physicians and medical centers

ANS: C Almost all communities have socialization and role fulfillment opportunities. Not all communities are safe environments, have medical centers, or offer recreational opportunities. DIF: Cognitive Level: Understand (Comprehension) REF: p. 94

A nurse is helping a community develop its capacity to address future problems. Which of the following activities is the nurse most likely implementing? a. Addressing problems in priority order b. Promoting collaboration and team building c. Developing community competence d. Providing education about health issues

ANS: C Although such activities are educational, collaborative, and ideally do address problems in some order by priority, building a community's capacity to address future problems is called developing community competence. DIF: Cognitive Level: Apply (Application) REF: p. 95

A community health nurse is trying to determine the success of a planned intervention. Which of the following would the community health nurse most likely examine? a. Changes in funding made available to the agency to continue their efforts b. An increase or decrease in the number of persons asking for assistance c. Current problem data to compare with original baseline data d. Feedback from community residents

ANS: C By comparing baseline data, the nurse can construct benchmarks to gauge the achievement of program objectives. Such epidemiological data are also important for documentation of a program's long-term effectiveness. The planned intervention would most likely cause some type of a change in funding, change in service use, and allow the residents to provide feedback; however, these things would not provide the best information about success of the program. DIF: Cognitive Level: Apply (Application) REF: pp. 102-103

Which of the following best describes when a community health nurse would try to collect data on a health issue? a. When available data exists b. When data must be purchased from the agency that collects it c. When there is no source of previously collected data d. When the data previously collected is available to the public

ANS: C Formal data collection does not exist for all health data. Therefore, many nurses must perform additional data collection, compilation, and analysis. It is not necessary for the nurse to try to collect data on a health issue if there is available existing data, the ability to purchase data, and the nurse is able to use previously collected data that is available for public information. DIF: Cognitive Level: Understand (Comprehension) REF: p. 99

Which of the following best describes shoe leather epidemiology? a. Implementing the wheel model of epidemiology b. Engaging in extensive truth seeking like a detective in the community c. Traveling throughout the community to absorb an overall impression of it d. Facilitating sharing of the community's history by community leaders

ANS: C Shoe leather epidemiology refers to establishing hypotheses about the community's health, strengths, and possible problems through the down-to-earth approach of traveling through the area, and observing and interacting with community members. Implementing the wheel model, engaging in truth seeking, and facilitating sharing of the community's history do not demonstrate the process of traveling through the community to absorb its overall impression. DIF: Cognitive Level: Understand (Comprehension) REF: p. 95

All of the needed objective data on a specific health problem are available for the community health nurse. Which of the following best describes why the nurse would also interview community residents about the health problem? a. To confirm the accuracy of the previously collected data b. To emphasize to residents the importance of the health problem c. To obtain the residents' personal insights and beliefs about the problem d. To update the previously collected data

ANS: C The nurse must understand the community's perspective on health status, the services used or required, and their concerns. Official data do not capture this type of information. Data collected directly from an aggregate may be more insightful and accurate. DIF: Cognitive Level: Apply (Application) REF: p. 99

Which of the following from vital statistics records is useful to community health nurses? (Select all that apply.) a. Relatively early age of death may suggest a new pathogen in the community b. Divorce rate, suggesting whether children will need additional services c. Documentation of the mortality and morbidity of the local community d. Indication of whether the total population is growing or declining e. Records of occurrence of congenital malformations f. Stability of marriages, making family structure become obvious

ANS: C, D, E Vital statistics record births, marriages, divorce, adoptions, and deaths in the community. Useful information would include conditions of birth, such as congenital malformations from the birth records. Death records suggest local mortality and morbidity trends. Overall growth or decline in the community's population can be seen. DIF: Cognitive Level: Understand (Comprehension) REF: p. 99

A nurse begins to collect information about a particular health problem from community residents. Which of the following potential problems would most likely arise? a. Residents might become suspicious about why the nurse needs this information. b. Residents might believe the nurse is becoming intrusive in their personal lives. c. Residents might wonder why they are being asked about the problem when previous surveys may also have asked about the same problem. d. Residents might begin to expect service to be given to address the problem.

ANS: D Although the process of needs assessment can indicate strengths and weaknesses, it can also raise expectations for new services to address problems. It is also possible that this data collection may cause residents to become suspicious and wonder why this data collection is necessary. However, in most cases, this is not problematic. The problem will arise if residents expect that services will be provided when they may not. DIF: Cognitive Level: Apply (Application) REF: p. 101

A public health nurse wanted statistics on the disability, illness, and other health-related variables for the state. Which of the following would be the best resource for the nurse to obtain the most extensive data? a. State health department records b. State department of vital statistics c. The Centers for Disease Control and Prevention d. The National Center for Health Statistics

ANS: D The National Center for Health Statistics compiles annual National Health Survey data. It also publishes reports on prevalence of disability, illness, and other health-related variables. It tracks trends by nation, state, and year. The state health department records, state department of vital statistics, and Centers for Disease Control and Prevention will not provide all of the data that the nurse is trying to find. DIF: Cognitive Level: Apply (Application) REF: p. 99