Course Point Questions (Communities)

A colleague asks a nurse during program evaluation, "My outcomes are not what I expected. What should I do?" What is the best response by the nurse?

"Use the outcomes to continue the process; then collect data and assess that data." Rationale: Evaluation should inform the outcomes of the next program. That next program should begin with collecting and assessing data. It is possible that the program should have had evidence-based tools and a validated admissions process, but that information could be collected during the first phase of the next program planning cycle.

A nurse asks, "How will I know my program was successful?" What is the best response?

"Your program is successful if stated goals have been met." Rationale: Program success can only be measured through meeting goals that are established at the beginning of the program. Client satisfaction, health care services, and data collections are tools in the process but not the final means of evaluation.

What statement about false negatives is accurate?

A false negative is when a patient passes a screening but, in fact, truly has the disease. Rationale: A false negative is when a patient passes a screening but in reality actually has the disease. This causes under referral. In addition, disease will not be detected early and can result in individuals suffering from advanced disease. False negative results can occur from a screening test that has high specificity and low sensitivity.

What factor contributes to the effectiveness of a health screening?

Acceptable degree of sensitivity; Ease of administration; Acceptance by the community; Cost-effectiveness Rationale: To screen effectively for the presence of these conditions, a test should be (1) cost-effective, meaning that the cost of producing and distributing the screening tool is justified by the positive effect on protecting the public; (2) easy to use; (3) available to large sectors of the population at risk; (4) sensitive and specific enough to identify true positives and true negatives; (5) backed by a health care infrastructure that can implement programs of care for people wo have a verified risk of disease or physical challenge; and (6) acceptable to clients. The need for periodic screenings is an acceptable factor when necessary.

A comprehensive assessment must consider the entire community and the various populations living in the community. Which of these indicates a comprehensive assessment?

Adults and children living within ten miles of the center of town. Rationale: A comprehensive assessment collects all the information relevant to the community's health. It includes the demographics on the whole population and the community boundaries, and identifies resources within the boundaries.

During an intake assessment at the local health department, the nurse asks a Hispanic client where in Mexico they were born. The client becomes angry and reports being born in Colombia. What is the best action for the nurse to take?

Apologize for the cultural insensitivity and make a mental note to be more careful in the future. Rationale: If nurses make a cultural mistake, they should first apologize and admit a limited amount of knowledge, then express a willingness and openness to learn from the mistake.

A new client is scheduled at the clinic. During the assessment, the nurse notes a circular, dark-pink indention on the client's abdomen. The nurse is aware that the client is not from the United States. What is the nurse's next best action in assessing this client?

Ask the client to describe usual health beliefs and practices when the client becomes sick. Rationale: A person's practices regarding health are influenced by beliefs about causes and effects of illness. In order to be effective in providing care for persons from different cultures, community nurses must be accepting of others' cultural practices.

In providing education to a client at the health department regarding the risk for heart disease, the nurse identifies several protective factors in the client's chart. Which of these items found in the client's chart indicates a protective factor?

Being active in the local church ministries. Rationale: Many factors can decrease the likelihood of illness or disease, including age, exercise, sleeping patterns, and healthy habits.

The occupational nurse would like to identify employees who are at risk for heart disease. The nurse has begun taking blood pressures on all new employees, with the intent of identifying early signs and symptoms so effective treatment can be sought. What ethical principle does this represent?

Beneficence. Rationale: The ethical principle of beneficence means to do good or benefit others. It is the act of being "good" or taking an action to ensure more positive outcomes.

When providing in-home wound care, the nurse notes the client is frequently vocal and screams at relatives when in pain. In performing a cultural assessment, in what area would the nurse document the frequent outburst and vocalizations?

Biological variations. Rationale: Biological variations include physical and biological traits that are unique to culture of a population. This can also include how they perceive pain and express pain.

Identify the best intervention that considers the mental, physical, emotional, social, spiritual, and environmental health affecting a population with mental health challenges.

Case-finding Rationale: All of these are important interventions. Case-finding locates individuals and families with identified risk factors and connect them to resources.

Identify the best intervention that considers the mental, physical, emotional, social, spiritual, and environmental health affecting a population experiencing emergency, disaster, and terrorism issues.

Collaboration Rationale: Collaboration seeks information and generates solutions to health problems or issues through interactive problem solving.

A colleague tells a nurse, "I don't know the problem yet, but I am going to try implementing a program first and see if it makes a difference." The nurse should note that the colleague is skipping which steps in the Omaha System?

Collecting data, stating the problem, and identifying the admission problem rating.

When considering health behaviors, term mainstream is used when discussing interventions directed toward which system level?

Community. Rationale: Interventions directed at different system levels can be described as upstream (at the societal, environmental, or policy levels), mainstream (at the population or community level), or downstream (at the individual level).

When considering health views, which statement is the basis for discussions concerning the effect of culture?

Cultural world views are responsible for the different beliefs regarding the cause of illness. Rationale: Different cultural world views tend to reflect different ideas about what causes disease. Beliefs and values are fundamental and differ concerning the origin and treatment of illness as well as the perception of health and wellness.

What is the fundamental criterion for making a screening mandatory?

Degree of physical harm resulting from the lack of screening Rationale: Some screening are mandatory because of the physical and economic costs that may result if they are not performed (e.g. newborn screenings)> The remaining options may be considerations but is not the fundamental criteria for mandatory screening.

A community nurse who routinely works in the immunization clinic notes an influx of new patients from Russia. The nurse wants to improve self-awareness of this new population. What steps can the nurse take to cultivate cultural sensitivity toward this new client population?

Demonstrate a genuine interest in the lives and culture of the new clients; interview some of the new members and inquire about cultural values. Rationale: There are many ways to improve cultural sensitivity, including interviewing individuals about culture and beliefs, being interested and keeping an open mind, and participating in a cultural event in the community.

What is the correct order in developing an evaluation plan for community-level interventions?

Develop evaluation questions, identify where you will find the data you need, and plan how you will analyze your data. Rationale: Steps in developing the evaluation plan include the following: 1). Develop evaluation questions "focused on what happened, how well it happened, why it happened the way it did, and what the results were." 2). Determine indicators of measures you will use to answer your evaluation questions. 3). Identify where you will find the data you need to measure your indicators and answer your questions. 4). Decide what method you will use to collect data 5). Specify the time frame for when you will collect data.

What outreach method includes the nurse reaching out to individuals and families through home visits, churches, or school meetings?

Direct outreach. Rationale: Outreach is a specific health intervention that locates populations-of-interest or populations who may be at risk for particular health problems. Methods of direct outreach may include reaching out to individuals and families through home visits, churches, or school meetings.

The similarities between the nursing process and the epidemiological process include...

Entire ADPIE model. Rationale: The ADPIE module includes assessment, diagnosis, planning, implementation, and evaluation. These steps are common to both the nursing process and the epidemiological process.

A community nurse is reviewing the disease statistics of an assigned new area. What assessment framework is the nurse utilizing in assessing this community?

Epidemiological. Rationale: The epidemiological studies framework is used when assessing a community according to the amount and distribution of disease or health conditions in a population.

What is the initial nursing intervention when conducting a cultural assessment regarding the health beliefs and values of a member of a non-white American culture?

Establishing an accepting environment. Rationale: Whatever method is chosen, it is important to create an atmosphere that encourages the client to tell his or her own story, with all its cultural nuances. Although the remaining options are valuable, they are based on an accepting environment between the nurse and the patient.

The intervention scheme component of the Omaha System focuses on client change and evaluation. (T/F)

False. Rationale: The intervention scheme component focuses on care plans and services. The problem rating scale of outcomes focuses on client change and evaluation.

During an assessment, the community health nurse is gathering data to determine what characteristics and possible health needs are similar for all community members. Which framework will the nurse choose in approaching this assessment analysis?

Familiarization Rationale: Familiarization data gathering begins with examining the information already available on the community, and then gathers first-hand data to get a working knowledge of the community. The approach is best used in working with families, groups, organizations, or populations.

Which model asks direct and probing questions to assess family health in 11 different areas?

Functional health patterns (FHPs) (Gordon) Rationale: Functional health patterns assess health patterns in 11 areas of family health using direct and probing questions. None of the other models identified rely on this distinctive questioning format.

What is the source for established national objectives and health outcomes that guide health promotion in the United States?

Health People 2020 Rationale: Healthy People 2020 are national objectives for improved health outcomes that guide the health promotion and disease prevention efforts in the United States. None of the other options has that specific goal.

Which tool is most useful to the community health nurse planning health promotion activities for both the environmental and community level systems?

Health impact pyramid. Rationale: The health impact pyramid is a useful framework for community health nurses when planning health promotion interventions at multiple levels. Although useful, none of the other options focus on multilevel system interventions.

What are risk factors for susceptibility to disease in vulnerable populations?

Health status, resource availability, relative risk, income. Rationale: Flaskerud and Winslow developed a model of vulnerability to demonstrate the web of vulnerability causation, which includes resource availability, relative risk, and health status. Vulnerable groups or populations have a disproportionately greater risk of poor health.

What intervention can be used to prevent adverse health consequences and empower vulnerable populations through the sharing of knowledge, skills, and information?

Health teaching. Rationale: Health teaching can be used to empower vulnerable populations through the sharing of knowledge and information. For instance, by empowering sexually active teens and adolescents with the skills they need to prevent pregnancy and sexually transmitted infections, the nurse can help prevent negative health outcomes before they begin.

What is the goal of a community health assessment (CHA)?

Identification of community health resources; prioritization of community-focused health interventions; associating health need with possible community resource; effective assessment of existing community health problems. Rationale: The goal of a CHA is to identify the community health problems that are the priorities for intervention as well as community resources available to address each health problem or need. Financing the interventions are not a CHA goal.

The state public health nurse would like to gather information on general predictive predictive risk factors related to stroke. The nurse has identified the U.S. Adults: National Health Interview Survey sponsored by the Centers for Disease Control (CDC) as a good place to begin the search. Why would the nurse choose this type of assessment tool?

In this survey, data are analyzed to identify mortality risks for a population. Rationale: Secondary data are data collected by public and state agencies. The National Health Interview Survey is a survey that is continually conducted nationwide and is the main source of health data on the population in the United States.

How is community diagnosis different from individual diagnosis?

Individual diagnosis creates the goals for individual care; community diagnosis creates a tentative hypothesis. Rationale: In individual diagnosis, health care needs and assets are identified and goals and objectives for care are established. In community diagnosis, a problem is described by person, place and time, a tentative hypothesis is formulated, and data analyzed to test the hypothesis.

The public health nurse is performing a community assessment. What community-specific factors will the nurse consider when performing this assessment?

Internal influences such as the local economy; purpose of the community; boundaries; physical characteristics Rationale: In preparing for a community assessment, the nurse will examine community-specific factors such as boundaries of the community, physical characteristics such as geographical location, characteristics of the population, and the purpose of the community

The nurse is asked about performing community health interventions. What is a correct statement?

Interventions are always based on assessment data. Rationale: The foundation of a community health intervention is performing a health assessment. Interventions are always based on assessment data or evidence. Additionally, it is essential to involve the community and the community stakeholders in order to determine the most appropriate interventions that will have the greatest impact.

A social history is a vital assessment tool related to which nursing models?

Life span development (Rankin) Rationale: Social history provides a background in which to frame particular health behaviors or events within a broader perspective. Application to diverse groups could be difficult without knowledge of their history. None of the other models identified rely on social history as heavily.

What is the next step when an individual has not passed the screening test and a disease is possibly detected?

Make a referral for a diagnosis

What is true about children and adolescent populations?

Of all children who are poor, 1/3 are African American. Rationale: Children and adolescents are an especially vulnerable population. Twenty percent of children younger than 6 years of age are living in poverty, and children in single-parent homes are twice as likely to be poor than children in two-parent homes. Of all the children who are poor, 1/3 are African American.

What is a true statement about health interventions in specific populations?

Outreach is an effective strategy for intervening in substance abuse. Rationale: Outreach is very helpful when dealing with substance abuse because people are often more receptive to taboo subjects in an environment where they are more comfortable. Outreach could include having a booth with pamphlets on preventing overdose and addiction at music concerts, or even assisting at the first aid tent at festivals.

Which of these locations or strategies would be an effective way for the nurse to communicate the dangers of diabetes to introverts?

Pamphlets. Rationale: Try a non-confrontational method or location to share important health information to the introverted population in your community. Some people absorb information better in a state of privacy.

A school nurse plans and implements a sexually transmitted infection (STI) program for teenage girls. What is a program goal according to the Omaha System?

Participants will explain the two causes of STIs and teach back sage sexually practices at the end of the program. Rationale: The Omaha System evaluates program effectiveness through goals that demonstrate client knowledge, behavior, and client status. The other objectives are valid in some simpler models, but do not address the comprehensive program evaluation of the Omaha System.

Which factor affects the way a family identifies its health risks?

Past experiences with illness; methods used to cope with stress; cultural view of wellness; Ability to pay for health care Rationale: Families approach the idea of health risk in many different ways depending on (1) what they have learned from their experiences in their family or origin; (2) economic circumstances, especially health care insurance coverage; (3) stress and coping styles; and (4) internal and external culture. Cognitive skills are not universally the same among the family members and so is not a major factor.

Given a list of nursing interventions, identify the best intervention that facilitates capacity building among the vulnerable populations and their communities.

Patient advocate. Rationale: The faith community nurse's role as patient advocate may be unique because the faith community nurse has an ongoing relationship with the congregation member, may know family members, and can directly follow-up on recommendations and additional referrals.

Which factor is considered when determining social determinants of health?

Place of birth; childhood experiences; age; employment history Rationale: The circumstances in which people are born, grow up, live, work, and age and the systems put in place to deal with illness are termed the social determinants of health. These circumstances are in turn shaped by the wider context, including economics, social policies, and politics.

The community nurse is performing an assessment on a community related to an identified problem of obesity. Which approach is best to use for this type of community assessment?

Problem-oriented Rationale: In this type of assessment approach, a single problem is identified and the community is assessed in terms of the specific problem.

When considering cultural influences, how would the nurse interpret a Chinese patient's lack of eye contact during a discussion about a newly prescribed medication as a sign of what?

Respect. Rationale: In many cultures (e.g., Native American, Chinese, Haitian), a younger client meeting the gaze of a clinician is a sign of disrespect. However, in other cultures. (e.g., white American or German), eye contact is a necessary sign of respect. A clinician from those cultures might misinterpret lack of eye contact as signifying limited understanding, inattention, depression, or noncompliance.

In preparing a health and wellness care plan for the local senior citizen center, the nurse ensures the consideration of the three universal needs. What are the three universal human needs of the community?

Safety and security; sense of belonging. Rationale: After basic physiological needs are met including air, food, and water, then people work toward safety and security and the need for a sense of belonging.

Identify the best intervention that considers the mental, physical, emotional, social, spiritual, and environmental health of a population's cultural influences.

Screening Rationale: Screening monitors health events through ongoing, systematic collection, analysis, and interpretation of health data for planning, implementing, and evaluating public health interventions.

A school nurse is checking the students in the seventh grade for scoliosis. What type of assessment is scoliosis testing?

Screening. Rationale: The secondary level of prevention is aimed at early detection and includes screenings.

When considering community health assessment, which intervention is an example of secondary prevention?

Screenings. Rationale: Secondary prevention is a planned effort to minimize the impact of disease or injury once it is in effect. Secondary prevention is used at an early stage of pathogenesis or physical or emotional challenges. Screening is an example of such prevention. The other options are examples of primary preventions.

A public health nurse is administering a Tuberculin test to a hospital employee. What type of screening is this test?

Selective Rationale: A mass screening is the screening of a large number of people to detect signs and symptoms early to prevent the spread of disease or illness.

Which area of questioning is explored when assessing family health routines?

Self-care; safety and precaution; mental health behaviors; illness care Rationale: Denham (2002) identified six categories of family health routines; self-care, safety and precaution, mental health behaviors, illness care, and member caregiving. Family care and not individual care is considered.

What is true about social justice? Social justice refers to...?

Sharing common burdens and advantages. Rationale: Social justice is a chief principle of public health, and refers to the equitable sharing of both common burdens and advantages. The basis of social justice is a value system in which health care is a right, rather than a privilege. Achieving health equity is a goal.

What are reasons the Omaha System is highly regarded as an evaluation tool in community settings?

Six-step design; based on universal nursing principles; proven efficacy and comprehensive scope; provider-client relationship. Rationale: Except for global programs, all of these are reasons the Omaha System is highly regarded as an evaluation tool in community settings for nursing practice.

The Omaha System consists of three relational components. What component is not part of the Omaha System?

Skilled Needs Scheme. Rationale: The relational components of the Omaha System are a problem classification scheme, an intervention scheme, and a problem rating scale of outcomes.

What are examples of predictive health factors at the family, community, and/or society level?

Smoking cigarettes; Chronic stress and anxiety Rationale: Predictive health factors are those factors that can increase the likelihood of disease or condition. Tobacco use and chronic stress are two factors that increase the risk for disease.

The school nurse is preparing to address the Parent-Teacher Association (PTA) at the school to provide education on the importance of obtaining vaccination. Who is affected by this type of public health outreach

Society. Rationale: Vaccinations reduce the incidence of certain communicable diseases. Most of American society accepts immunizations as a part of overall care of self.

A school nurse has identified a depression screening instrument to use for middle-school students who are referred by the teaching staff. What ethical consideration should the nurse make prior to performing the screening of students?

The availability of resources if the student has a positive screening. Rationale: Screenings are only effective if there are resources to which the nurse can refer the client. In providing early treatment, many problems can be reduced or avoided.

The nursing process in community health focusses on...

The population. Rationale: The focus of the nursing process is on caring for the client within his or her family; whereas the focus of the epidemiologic process is on caring for the population of the community as a whole.

Process evaluations focus on how well the program was implemented and looks at the processes, activities, and capacity building. (T/F)

True

A client at the public health clinic reports performing self-breast examinations monthly. Which protective health factor does this represent?

Valuing health. Rationale: Clients in the community who value their health can learn skills as a means of self-protection to detect early signs and symptoms of disease such as self-breast examination or testicular examinations. When a woman engages in routine breast self-examinations, have regular mammograms, eat a balanced diet and avoiding the extended use of estrogen, she is promoting breast health and demonstrating the belied of valuing health.

The Omaha Model has shown to be successful with which type of community healthcare nursing?

Visiting Home Nursing. Rationale: The work on creating this model began in the 1970s by the Visiting Nurse Association of Omaha, Nebraska.

The nurse is asked what is meant by "vulnerability" on the context of community health nursing. What is the best response?

Vulnerability is any factor that increases the chances for poor health. Rationale: Vulnerability is any factor that increases the chances for poor health. Community health nurses care for many types of vulnerable populations, who depend on the nurse for advocacy and support.