Chapter 11 community
Ans: D Feedback: According to Lewin, change occurs in the following stages: unfreezing the old behavior, implementing the change, and then refreezing the new change in place to integrate it into the system. Planning, relearning, integrating, and coordinating are not stages of change.
After teaching a class about the stages of change, the instructor determines that the class understands the information when they identify the following as the proper sequence of stages? A) Unfreeze, plan, and integrate B) Plan, organize, and coordinate C) Plan, relearn, and integrate D) Unfreeze, change, and refreeze
Ans: C Feedback: Planning to use an interpreter when presenting information to a group of new immigrants from a non-English speaking country is the best option among those listed. Pictures will not effectively convey the meanings that the clients need. Guessing about the native language and attempting to speak it will not be effective either, as the nurse should never assume anything and unless the language is native to the nurse, the nurse will not be any more effective at communicating with the clients. Talking clearly and slowly, being sure to enunciate each word, might be appropriate for a group of immigrants from a non-English speaking country who have been in this country for a while and have been learning the language.
When a community health nurse is planning to teach a group of new immigrants from a non-English speaking country about the need for immunizations, the nurse should include which in his or her plans? A) Using a lot of pictures B) Guessing about the native language and attempting to speak it C) Using an interpreter D) Talking clearly and slowly, being sure to enunciate each word
Ans: C Feedback: Informal teaching such as anticipatory guidance and counseling requires the teacher to be prepared, but there is no defined plan of presentation. Lecture and demonstration are formal methods of teaching. Visual images also are often used with formal teaching.
A community health nurse is providing informal teaching to groups of parents about typical childhood developmental milestones. Which of the following would the nurse mostly likely be using? A) Lecture B) Demonstration C) Anticipatory guidance D) Visual images
Ans: B Feedback: The principle of self-understanding relates to the change agent (the community health nurse) should be able to clearly define his or her role and learn how others define it. The principle of flexibility is the ability of the change agent to adapt to unexpected events and make the most of them. The principle of interdependence is that a change in one part of a system affects other parts and a change in one system may affect other systems. The principle of proper timing relates to the knowledge that even the right change may not occur if the timing is not right.
The community health nurse evaluates his or her own past personal habit of smoking as he or she prepares to talk to a group of people about the importance of smoking cessation. The nurse recalls that he or she had several unsuccessful attempts before quitting 1 year ago today. The nurse decides to share this information with the group and tells them that all the attempts he or she had made before stopping smoking were necessary steps for his or her eventual success. Which principle of change was the nurse enacting? A) Principle of flexibility B) Principle of self-understanding C) Principle of interdependence D) Principle of proper timing
Ans: C Feedback: The community nurse in this scenario is using power-coercive change strategies that are based on fear. Normative-reeducative change strategies present new information and directly influence people's attitudes and behaviors through persuasion. Empiric-rational change strategies are based on the assumption that people are rational and, when presented with empiric information, will adopt new practices that appear to be in their best interest
The community health nurse is presenting sexuality education to a group of sixth grade students. The community health nurse tells the students that they must never have unprotected sexual intercourse or they will die from a sexually transmitted infection and displays pictures of people dying from AIDS. The nurse is using which change strategy? A) Normative-reeducative B) Rational-empiric C) Power-coercive D) Planned change
Ans: B Feedback: For psychomotor learning to occur, the nurse must ensure that the learner is physically, intellectually, and emotionally capable of performing the skill. Otherwise, the other two conditions, having a sensory image and practicing the skill, would not occur. A willingness to listen is an important aspect for all learning, especially learning in the affective domain
To ensure learning in the psychomotor domain, which of the following would be most important for the nurse to ensure about the learner? A) Has a sensory image of how to do the skill B) Has the ability to perform the necessary skill C) Is willing to listen to the information about the skill D) Can continue to practice the skill independently
Ans: A, D, E Feedback: Pender's Health Promotion Model has been revised from the earlier framework that was published in 1980 and has been revised to reflect a number of major theoretical changes. It is viewed as an effective model. It focused on predicting behaviors that influence health promotion and includes the variable of interpersonal influence of others.
Which of the following statements accurately describe Pender's Health Promotion Model? Select all that apply. A) It has been revised to reflect a number of major theoretical changes. B) It is not effective. C) It is unrelated to interpersonal influence of others. D) It allows the community health nurse to predict health promotion behaviors which enhances the ability to work with clients. E) Individual characteristics and experiences are seen to interact with behavior-specific cognitions and affect to influence specific behavioral outcomes.
Ans: C Feedback: Community health nurses must look at the social determinant of health as the root causes of disease and health inequities. This requires that nurses look beyond the individual behavior and have a broader scope of what underlies illness.
Which of the following statements most accurately describes the nurse's role as an educator related to the social determinants of health? A) The nurse must focus on individual behavior and encourage people to take responsibility for their own behavior. B) The nurse must examine one or two factors that contribute to our state of health. C) The nurse must look at the root causes of disease and health inequities. D) The nurse must lecture people about what is right and wrong behavior
Ans: A Feedback: The woman's behaviors support the tenets of Knowles' adult learning theory. She is a self-directed learner, experienced, ready to learn, and is problem centered rather than theoretically oriented. Bandura's social learning theory attempts to explain behavior and facilitate learning. With social learning theory, learners are benefitted by role models, building self-confidence, persuasion, and personal mastery. The Gestalt-Field family of cognitive theories assumes that people are neither good nor bad; they simply interact with their environment and their learning is related to perception. Maslow's hierarchy of needs requires lower level basic needs to be met before working toward self-actualization.
A 32-year-old wife and mother of two children was a bank manager before entering the nursing program. She is finishing a Baccalaureate nursing program in a few months. She learns best when she can plan and carry out her own learning activities, uses past experiences to help with current learning, and applies learning immediately. Which learning theory best fits this woman's learning style? A) Knowles' adult learning theory B) Bandura's social learning theory C) The Gestalt-Field family of theories D) Maslow's Hierarchy of Needs theory
Ans: A Feedback: In the first stage, a disequilibrium develops and the system is more vulnerable to change. People in this stage have a sense of dissatisfaction and have a void that they would like to fill. When the client stated, "I have been reading a lot about the healing powers of many fruits and vegetables...," he or she was expressing disequilibrium. When the client stated, "I have started to try one serving of fruit and one serving at vegetables at each meal...," he or she was indicating that he or she is changing. When the client stated, "I still hate fruits and vegetables...," he or she was expressing opposition to change which is not a part of the change process. When the client stated, "Today I ate a total of 10 servings of fruits and vegetables...," the client was expressing that the change has become established as an accepted and permanent part of the system.
A client who needs to lose weight as part of an overall plan to become healthier has contracted with a nurse for behavior change. The client is working on increasing fruits and vegetables in his or her diet and currently consumes less than one fruit or vegetable per day. The nurse knows that the client is in the unfreezing stage of change when the client stated: A) "I have been reading a lot about the healing powers of many fruits and vegetables. I never ate many fruits and vegetables as a child so I am not sure how to prepare them. Can you refer me to some sources of information?" B) "I have started to try one serving of fruits and one serving of vegetables at each meal. I am starting to discover some of my favorites." C) "I still hate fruits and vegetables and I don't think I will be successful at integrating them into my diet." D) "Today I ate a total of 10 servings of fruits and vegetables. I really do like them and I feel great!"
Ans: A Feedback: Synthesis, the fifth level of cognitive learning, is the ability not only to break down and understand the elements of a situation but also to form elements into a new whole. Synthesis combines all of the earlier levels of cognitive learning to culminate in the production of a unique plan or solution. The objective with the verb create demonstrates this level. Being able to compare foods of varying salt content reflects analysis. Practicing eating meals demonstrates application. Listing foods demonstrates knowledge.
A community health nurse develops a written teaching plan for a community education program about nutrition and salt-reduction. Which objective would reflect synthesis learning in the cognitive domain? A) The client will create an enjoyable meal using low-sodium foods. B) The client will compare the salt content in a variety of packaged foods. C) The client will practice eating meals that contain low-sodium foods. D) The client will list foods that are low in sodium.
Ans: D Feedback: Behavioral theory is grounded in stimulus-response behaviors, and changes occur in response to stimuli. The nurse is also using conditioning through reinforcement as described by Skinner. Meeting a hierarchy of needs is based upon Maslow, a humanistic theorist. Self-confidence and personal mastery reflect social learning theory. A person's natural tendency to learn is based upon humanistic theories.
A community health nurse has been getting good attendance and group participation in her Saturday class on newborn care for young mothers. The participants receive free transportation and a $10 food voucher for attending. When they participate, prizes are distributed. This nurse is using behavioral theory to encourage clients, focusing the teaching on which of the following concepts? A) Meeting a hierarchy of needs B) The learner's self-confidence and personal mastery C) A person's natural tendency to learn D) Changes in response to a stimulus
Ans: D Feedback: Naming three foods reflect the knowledge level of the cognitive domain of learning. Comparing nutrient values reflects analysis; eating well-balanced meals reflects application; and planning recipes reflects synthesis
A community health nurse has been teaching nutrition to a group of seniors in a local senior center. After attending the nurse's class on nutrition, the nurse determines the group's cognitive level of learning. Which of the following indicates knowing? A) Comparing the nutrient value in foods B) Eating well-balanced meals C) Planning recipes that are low in fat D) Naming three foods high in iron
Ans: A Feedback: Normative-reductive strategies not only give information but also directly influence people to change attitudes and behaviors through persuasion. Use of power or coercion is associated with the power-coercive change strategy. The Empiric-rational change strategy is based on the assumption that people are rational and, when presented with empiric information, will adopt new practices that appear to be in their best interest. The empiric-rational strategy is best used with clients who can assume a relatively high degree of responsibility for their own health.
A community health nurse is applying the normative-reductive strategy of change when working with clients. In doing so, the nurse engages them into changing their behavior in addition to providing education, based on which assumption? A) Information alone is not enough, and behaviors change through persuasion. B) Compliance by the client system will occur through the use of power to effect change. C) People are rational and will adopt a new practice because it is in their best interest. D) The clients can assume a high degree of responsibility for their own help.
Ans: C Feedback: Elementary school-aged children would most likely be in the concrete operations stage of cognitive development where the child can solve concrete problems and recognize others' viewpoints. The preconceptual stage would apply to children between the ages of 2 to 4 years when language development is rapid and everything is related to "me." The intuitive thought stage would apply to children between the ages of 4 to 7 years when egocentric thinking diminishes and words are used to express thoughts. Formal operations stage would apply to adolescents when the child uses rational thinking and can develop ideas from general principles and apply them to future situations.
A community health nurse is preparing a teaching program for a group of elementary school-aged children about substance abuse awareness. The nurse would implement strategies that address which cognitive phase of development? A) Preconceptual B) Intuitive thought C) Concrete operations D) Formal operations
Ans: C Feedback: At the application level, the learner not only understands the material but can apply it to new situations, transferring understanding into practice. This is reflected by words such as practice, demonstrate, use, illustrate, and employ. Knowledge level learning would be reflected by words such as define, repeat, list, name, or recall. Comprehension level learning would be reflected by words such as restate, describe, explain, identify, and discuss. Analysis level learning would be reflected by words such as distinguish, debate, question, compare, examine, or calculate.
A teaching plan for a group of new mothers has the following objective: "The mothers will describe the principles that relate to safety while diapering their newborn." The nurse is attempting to achieve learning at which level of the cognitive domain? A) Knowledge B) Comprehension C) Application D) Analysis
Ans: A Feedback: The principle of participation requires involvement of the persons who will be affected by the change. The principle of proper timing requires that it be the right time to introduce the change. The principle of resistance to change involves responding to the instinctive nature of the desire to preserve the status quo because change poses a threat to stability and security. The principle of interdependence requires the view that every system has many subsystems intricately related such that a change in one part of the system may affect other parts.
As part of a community-wide program addressing the needs of seniors in the county, the nurse engages the seniors as well as their families in the program. The nurse is demonstrating which principle for effecting positive change? A) Participation B) Proper timing C) Resistance to change D) Interdependence
Ans: D Feedback: The nurse was aware that all systems instinctively resist change and was prepared to discuss aspects of the clients' cultural background that related to their current state of health. This is the principle of resistance to change. The principle of participation means that persons affected by the proposed change should participate as much as possible in every step of the planned change process. The principle of proper timing requires that it be the right time to introduce the change. The principle of self-understanding relates to the change agent (the community health nurse) should be able to clearly define his or her role and learn how others define it.
The community health nurse is talking to a group of clients about the health importance of consuming a low-fat diet. The clients are members of a particular cultural group that grows their own food and consumes a lot of animal protein. The clients state that their forefathers ate a diet that was high in animal protein and they had lived into their 90s. The community health nurse expects this argument and points out that their ancestors did not have the luxury of modern machines and they had to engage in a lot more activity than the current generation. This is an example of which principle of effecting change? A) Principle of participation B) Principle of proper timing C) Principle of self-understanding D) Principle of resistance to change
Ans: B Feedback: The steps of the PRECEDE-PROCEED model are similar to the nursing process, and thus this model has become a useful tool for nurses teaching in the community. It does emphasize outcomes with evaluation of the outcomes as the final step. But these are not reasons for nurses selecting this model. The client's or community's perception of the problem is key to this model.
When choosing an appropriate model for health education, community health nurses often select the PRECEDE-PROCEED model for which reason? A) It emphasizes the desired outcome of the teaching. B) The steps are similar to those of the nursing process. C) The nurse's perception of the problem is the key to this model. D) Evaluation of outcomes is the final step.
Ans: A Feedback: Before any teaching can begin, it is essential to assess the clients' readiness to learn. Once this is determined, the nurse can determine the clients' perceptions of the problem and identify the appropriate subject matter. Ensuring a conducive environment occurs when the teaching begins.
When developing an educational program for the community, which of the following must the community health nurse do first? A) Assess the clients' readiness to learn B) Ensure a conducive environment for learning C) Assess the client's perception of the problem D) Determine the appropriate subject matter
Ans: D Feedback: During the changing or moving stage, people experience a series of attitude transformations, ranging from early questioning to full acceptance and commitment to accomplishing the change. They examine, accept, and try the innovation and the nurse helps them see the value of the change, encourages them to try it, and assists them in adopting it. Motivation for the change is part of the unfreezing stage. Showing a lack of resistance to the change and integration of the change characterize the refreezing stage.
When implementing a program for teaching parenting to a group of teenagers, the community health nurse determines that the group is in the changing/moving stage of change when the group demonstrates which of the following? A) Motivation for change B) Integration of the change C) Lack of resistance to the change D) Beginning adoption of the change
Ans: A, D, E Feedback: Health promotion is behavior that is motivated by the desire to increase well-being and actualize human potential. This is different from disease prevention/health protection, which is behavior motivated by a desire to actively avoid illness, detect it early, or maintain functioning within the constraints of illness. The activities of teaching a class of kindergartners how to properly wash their hands, teaching a group of preschoolers about different fruits and vegetables that they might like to try, and teaching a mother and baby exercise group are focused on well-being and not a particular illness. The activities of being a guest on a talk show to provide information how to avoid an infection that is endemic, encouraging an individual whose blood pressure screening was abnormal to have their blood pressure rechecked in 1 week, and leading a group of stroke survivors in soft exercise are focused on avoiding specific illnesses and not on improved general health
Which of the following are examples of a community health nurse providing health promotion teaching? Select all that apply. A) The community health nurse teaches a class of kindergartners how to properly wash their hands. B) The community health nurse is a guest on a radio talk show to provide information how to avoid an infection that is endemic. C) The community health nurse encourages an individual whose blood pressure screening was elevated to have his or her blood pressure rechecked in 1 week. D) The community health nurse teaches a group of preschoolers about different fruits and vegetables that they might like to try. E) The community health nurse teaches a mother and baby exercise group. F) The community health nurse leads a group of stroke survivors in soft exercise.
Ans: B, C, E Feedback: Factors that influence an individual's ability to maintain good health include social factors, such as access to social and economic opportunities and equitable social interactions, and physical factors, such as access to safe housing and safe workplaces. Being related to a politician may or may not have a positive impact on the social determinants of health.
Which of the following are factors to consider related to the social determinants of health? Select all that apply. A) Being marginalized B) Access to safe housing C) Safe workplaces D) Being related to a politician E) Access to social and economic opportunities
Ans: A Feedback: The social determinants of health affect a wide range of health, functioning, and quality-of-life outcomes and risks. There is a growing inequity in the distribution of disease, illness, and wellness across our society and not all people are treated equally. It is not enough to do this because it is the right thing to do. If the community health nurse believes in social justice, this is one thing but really implementing social justice in considering outcomes and risks is more accurate.
Which of the following endings to this sentence most accurately describes the reason a community health nurse must consider the social determinants of health? The community health nurse must consider the social determinants of health A) because the social determinants of health affect a wide range of health, functioning, and quality-of-life outcomes and risks. B) because in our country all people are treated equally. C) because it is the right thing to do. D) because the community health nurse believes in social justice.
Ans: B Feedback: The nurse who recognizes clients' participation in a group praises them for completing assignments or commends them for sticking to diet plans will have more success than the nurse who only criticizes failures.
Which of the following interventions by the nurse is most likely to have a positive influence on the client's adoption of a new healthy behavior? A) Providing feedback about what the client is doing incorrectly B) Providing feedback about what the client is doing correctly C) Not providing feedback D) Not providing role modeling of the desired change
Ans: A Feedback: The secondary level of prevention would be exemplified by the community health nurse when teaching clients how to navigate the health care system to receive prompt treatment. Teaching clients about the importance of immunization is focused on the primary level of prevention. Teaching stroke survivors about the importance of diet, rest, and exercise to prevent a secondary health problem is focused on the tertiary level of prevention. Teaching a class on sensible nutrition for adolescents is focused on the primary level of prevention
Which of the following is the best example of a community health nurse focusing on the secondary level of prevention? A) Teaching clients how to navigate the health care system to receive prompt treatment B) Teaching clients about the importance of immunization C) Teaching stroke survivors about the importance of diet, rest, and exercise to prevent a secondary health problem D) Teaching a class on sensible nutrition for adolescents
Ans: B Feedback: A brightly lit conference room with comfortable chairs would be the best example of a positive learning environment among the choices listed. A local diner, seated near the door to the kitchen during lunchtime would not be a good choice as it is likely very noisy. A kindergarten classroom with small chairs that are low to the ground would not be a good choice as the adults could not comfortably sit in the chairs. A park on a beautiful, sunny day would not be a good choice as there would be too many distractions making it difficult for the clients to focus.
Which of the following is the best example of a positive learning environment for a group of developmentally disabled adults? A) A local diner, seated near the door to the kitchen during lunchtime B) A brightly lit conference room with comfortable chairs C) A kindergarten classroom with small chairs that are low to the ground D) A park on a beautiful, sunny day
Ans: C Feedback: Ideally, the community health nurse focuses on the primary level. Because the primary level of prevention is not possible in all cases, a significant share of the nurse's time is spent teaching at the secondary or tertiary level.
Which of the following statements about teaching at three levels of prevention is most accurate? A) Ideally, the community health nurse would focus at the tertiary level of prevention. B) The outcome of focusing on the tertiary level of prevention is to help diminish years of morbidity and limit subsequent infirmity. C) It is ideal to focus on the primary level of prevention. D) Community health nurses do not spend a significant share of time teaching at the secondary level.
Ans: D Feedback: To determine client participation, one of the first questions that need to be answered is, "What does the client want to learn?" This directly influences the client's participation in the educational process. Asking the question about what the client knows about the problem determines the client's readiness to learn. Asking about the client's view of the problem helps identify the client's perceptions. Asking about special seating helps to ensure that the educational environment is conducive to the client's needs.
Which question would the community health nurse use as a guide to determine a client's participation in a teaching program? A) "What does the client know about the current problem?" B) "How does the client view the current situation?" C) "Does the client need special seating?" D) "What does the client want to learn?"
