Community Exam 2

Functional Family Assessment

1. Instrumental nutritional assessment, assessment of any medical conditions, disabilities, or limitations 2. Expressive family member roles. Communication skills that are practiced now/ needed alliances and disputes among family members. Prevailing beliefs- spiritual, religious and basic family values. Family health values. Members who have influence and power (including income sources) Problem solving skills

Developmental Family Assessment

1. past experiences shared between family members 2. present stage of family development 3. future foals and tasks of family health, coping with transitions and attachments

Which nursing model used to assess family health needs employs genograms and ecomaps to identify relationships? a. Family systems (Anderson) b. Life span development (Rankin) c. Functional health patterns (FHPs) (Gordon) d. Rituals and routines (Clausson and Berg)

A

Which of the following agencies has the most influence on the health and welfare of US citizens? a. US Department of Health and Human Services (USDHHS) b. Centers for Disease Control and Prevention (CDC) c. World Health Organization (WHO) d. Agency for Healthcare Research and Quality (AHRQ)

A As the agency to which most health care legislation is delegated, the USDHHS is the agency most heavily involved with the health and welfare of citizens. The AHRQ and CDC are divisions of the USDHHS. WHO's policy-making body provides policy options and guides but not laws. In the textbook, only the USDHHS is discussed regarding its responsibility for Medicare and Medicaid through the Centers for Medicare and Medicaid Services (CMS).

Making sure that essential community-oriented health services are available defines which of the core public health functions? a. Assurance b. Scientific knowledge-based care c. Policy development d. Assessment

A Assurance includes making sure that essential community-oriented health services are available in the community. The definition does not fit the terms assessment, policy development. Scientific knowledge-based care is not a core function of public health. Assessment is systematic data collection on the population, monitoring the population's health status, and making information available about the health of the community. Policy development refers to efforts to develop policies that support the health of the population, including using a scientific knowledge base to make policy decisions.

A PHN has assessed issues in a community and is ready to formulate a nursing diagnosis for the community as the client. What does the nurse need to remember? a. Include the factors related to the diagnosis b. The diagnosis should be broad to cover a lot of community needs c. Community diagnosis does not use the standard nursing format d. The deficits of the community are the primary focus of the diagnosis

A Community diagnoses should include statements about the strengths of the community and possible sources for community solutions, as well as the community's weaknesses or problem areas. In addition, they should portray a community focus, include the community response, and identify any related factors that have potential for change through community health nursing. These may also include wellness diagnoses, which indicate maintenance or potential change responses (due to growth and development), when no deficit is present. Diagnoses statements should be narrow enough to guide interventions and use the standard nursing diagnosis format.

Two nurses plan to walk under a huge downtown bridge where various homeless persons live. Why would the nurses go to such an unsafe area? a. To assess the needs of the homeless who live there b. To distribute some of their own surplus clothes to those who can use them c. To share with various churches and other charities what is needed d. To demonstrate their courage and commitment

A In most nursing practices, the client seeks out and requests assistance. In public health nursing, the nurse often reaches out to those who might benefit from a service or intervention, beginning with assessment of needs. The other answers reflect responses where the nurse is trying to give assistance to this population that may or may not be helpful or welcomed.

A nurse is practicing in the community and has a community-oriented practice. Which of the following best describes the activities of this nurse? a. Sharing assessment findings and health goals that are unique to the community's concerns with every group that is interested. b. Writing articles for the local newspaper highlighting the various programs and services of the local health department c. Inviting all the parents of asthmatic children in the school to meet together for mutual support d. Providing care to an active caseload of 50 families in the neighborhood

A Meeting with all interested community groups is the only way to keep the focus on the community rather than on individuals. Although it is not possible to know the nurse's goals from the nurse's behavior, giving care to select groups does not represent the whole community. Publicizing services increases knowledge but doesn't necessarily help eligible clients access care.

After a flood, during the disaster recovery phase, which of the following older adults is most in need of psychological support? a. The older adult who keeps lamenting the loss of his family photos b. The older adult who keeps asking if he can go back home yet c. The older adult who keeps talking about how expensive his home theater was and how he will never be able to afford to replace it d. The older adult who keeps asking if loans will be available for him to rebuild

A Older adults react deeply to the loss of personal possessions because of the high sentimental value attached to the items. Family photos are a part of family history and are not replaceable. This type of a loss warrants psychological support. Homes and electronic equipment can be replaced, so the older adult may be able to eventually access loans to rebuild his home and replace his equipment. Because these things are replaceable, it is likely that that the older adult will be able to better cope with these losses than with something that is irreplaceable. Depending on the loss of the older adult, he/she may have a need for relocation rather than returning home.

A nurse is implementing a primary prevention strategy to address abuse in the community. Which of the following actions is the nurse most likely taking? a. Lobbying for passage of legislation to outlaw physical punishment in schools b. Referring caregivers to community respite centers if abuse is beginning to occur c. Encouraging others to interfere when they see children hit or hurt in a public place d. Screening each pregnant woman privately for intimate partner abuse

A Primary prevention involves action before damage has occurred. The other options are all screening for abuse or reactions to abuse that has already taken place. Encouraging others to interfere when they see children hit or hurt in a public place and referring caregivers to community respite if abuse is beginning to occur are examples of tertiary prevention because the abuse is already occurring. Screening pregnant women for intimate partner abuse is secondary prevention as it is a screening aimed at early detection of the problem.

Which of the following is a basic assumption of public health efforts? A. The health of individuals cannot be separated from the health of the community. B. Health care is the most important priority in government planning and funding. C. Health disparities among any groups are morally and legally wrong. D. The government is responsible for lengthening the life span of Americans.

A Public health practice focuses on the community as a whole, and the effect of the community's health status (resources) on the health of individuals, families, and groups. The goal is to prevent disease and disability and promote and protect the health of the community as a whole. Public health can be described as what society collectively does to ensure that conditions exist in which people can be healthy. The basic assumptions of public health do not judge the morality of health disparities. The focus is on prevention of illness not on spending more on illness care. Additionally, individual responsibility for making healthy choices is the directive for lengthening life span not the role of the government.

In the health planning process, what does the PHN do in the assessment stage? (select all that apply) a. data collection b. goal setting c. design implementation d. operationalize a plan

A B Assessment involves data collection, interpretation, and goal setting. During the health planning process, a community health nurse creates a plan during the analysis and design stage, which correlates to the planning phase of the nursing process. Implementation involves how to operationalize the plan and a design for monitoring progress. Evaluation involves examining the costs and benefits, judging the potential outcomes, modifying the plan, presenting the plan to the sponsoring group or agency, and obtaining acceptance..

Why do community nurses care about assessing families? SATA a. Community health nurses sometimes make home visits to patients and their families b. Family members are frequently involved with a pt when the pt seeks health care c. Family is a building block of the community d. Families often have values and needs unique to their unit, in addition to greater cultural and community values

A B C D

A home health nurse is creating a care plan for an individual who recently had surgery. Which tasks does the home health nurse understand as health responsibilities of the family? (Select all that apply.) a. Care provision and management for the chronically ill, disabled, and aging family members b. Development of the members' sense of caring within the family as a unit c. Emotional support for the client and guidance during life cycle transitions d. Socialization of members regarding a sense of duty toward optimal health e. Providing education about cost containment and when to use the health care system

A C

Which of the following factors may lead to increased violence? (Select all that apply.) a. Having experienced violence as a child b. Adequate social support c. Feelings of powerlessness d. Heavy drug use

A C D Factors that increase violence include seeing violence in daily life or in the media, living in poverty with few opportunities for employment, and feelings of powerlessness. Crowded environments can be a factor but can also lead to banding together for the common good. Adequate social support is a positive factor and may lead to decreased violence, not increased.

A community nurse is preparing to develop a plan to work with families as the clients in a local community. What reasons would a family assessment need to be completed with the families prior to developing the plan? (Select all that apply.) a. Families are a significant building block of the local community. b. Community health nurses must first gauge the actual need of all members of the local community. c. Families often have unique values and needs. d. Members usually rally around families to ensure the health of the community. e. Community health nurses sometimes make visits to clients and their families.

A C E

In completing a developmental family assessment, what question would the community health nurse include? a. Are there any medical conditions, disabilities, or limitations of family members? b. How do family members cope with transitions and attachments within the family? c. What are the boundaries of roles in this family? d. Who settles disputes among the family members?

B

A nurse is assessing the structure dimension of a community's health. Which of the following data will the nurse examine? a. Statistics of morbidity and mortality in comparison with similar communities b. Treatment and service use patterns from local health agencies and care providers c. Health risk profiles of selected aggregates d. The community's commitment to health

B Community health, when viewed from the structure of the community, is usually defined in terms of community characteristics, as well as services and resources. Indicators used to measure community health services and resources include service use patterns, treatment data from various health agencies, and provider/client ratios. The community's commitment to health is part of the process dimension of the community. Health risk profiles and vital statistics are part of the status dimension of the community.

During the assessment phase, the nurse compiles and interprets available data and draws conclusions as to the community's strengths and concerns. Which of the following best describes why the nurse would also conduct interviews with key informants? a. To ensure that others agree with the nurse's plans for interventions b. To generate nonstatistical data such as values, beliefs, and perceived needs c. To confirm the nurse's initial findings and conclusions d. To encourage community partners to feel the data belongs to them

B Data generation is the process of developing data that do not already exist, through interaction with community members, individuals, families, or groups. Such information might include the community's knowledge and beliefs, values and sentiments, and goals and perceived needs. Such data are collected by interviews and observation. Interviews with key informants provide data; the purpose is not to ensure agreement with the nurse's plan or confirm findings. The key informants are formal or informal leaders within the community and although they may have information to share about the community, it may not be important that they feel that they "own" the data.

Which of the following best describes a normative, developmental life event that can increase the risk for illness? a. A family is involved in a motor vehicle crash. b. A first pregnancy c. The family wage earner is laid off from his job. d. A group of teens experiment with recreational drugs.

B Life events can increase the risk for illness and disability. Normative events are those that are generally expected to occur at a particular stage of development or of the life span. Although pregnancy is a normal condition, it carries risks such as the development of eclampsia or more minor health problems such as constipation and hemorrhoids. Additionally, pregnancy (and the birth that follows) will alter family dynamics and may increase risk for psychological stressors. The incorrect responses are not normative life events.

A nurse is focused on mitigation of disasters at the international level. Which of the following activities would the nurse most likely complete? a. Develop a notification procedure to be used by the international disaster relief office. b. Provide community educational programs and training on how to prepare for disasters. c. Recruit volunteers to be a part of the disaster team that will travel to the afflicted area. d. Request donations be sent to the affected area.

B Mitigation refers to actions to prevent specific disasters from occurring or to reduce the severity of a disaster's effects if it cannot be avoided. Providing community educational programs on disaster preparedness is the only intervention that addresses mitigation. Requesting donations be sent to the affected area occurs during the disaster and is known as the response. Developing a notification procedure would occur as part of the preparedness stage. Depending on the timing of the recruitment, this would be part of either the preparedness or response stage.

Which of the following is the top risk factor for intimate partner homicide? a. The husband has made threats against wife before. b. The pregnant wife has previously called 911 because of husband's beating her. c. The woman's young daughter also lives with them. d. There is a gun in the house.

B The top risk factor for intimate partner homicide (IPH) is previous domestic violence. Other risk factors are access to guns, estrangement, threats to kill or threats with a weapon, nonfatal strangulation, and a stepchild in the home if the victim is a female; however, these are not the top risk factor. Among families experiencing IPV, homicide risk is increased during a woman's pregnancy.

What makes a community competent? (select all that apply) a. Not having access to healthcare issues b. Effective collaboration to meet community needs c. The ability to gain consensus on goals and priorities for the community d. Knowing when to involve the PHN for the empowerment of the community to meet their goals

B C

The PHN knows that a situational crisis has which of the following characteristics? (select all that apply) a. not ever positive b. arising from external circumstances c. stressful d. expected

B C A situational crisis is a stressful, disrupting event arising from external circumstances that occur suddenly to a person, group, aggregate, or community. Situational crises often occur without warning. Situational crises occur to people because of where they are in time and space. Situational crises cannot be predicted, expected, or planned. Some situational crises arise from positive events such as significant job promotion or sudden acquisition of great wealth because the change makes increased demands on individuals who must make major life adjustments.

Which of the following activities are the responsibilities of the Centers for Disease Control and Prevention (CDC)? (Select all that apply.) a. Publish national goals for promoting health and preventing disease such as Healthy People 2030. b. Detect and investigate infectious disease problems. c. Develop and advocate public health policies. d. Conduct research to enhance disease prevention.

B C D The mission of the CDC is to promote health and quality of life by preventing and controlling disease, injury, and disability. To monitor health, the CDC will detect and investigate health problems, conduct research that will enhance prevention, and develop and advocate sound public health policies and other prevention strategies. The safety and health of the workplace is the specific responsibility of OSHA. The CDC cannot write or pass legislation. The USDHHS published national health goals in Healthy People 2020.

Which of the following best describe the importance of the World Health Organization (WHO) to the United States? (Select all that apply.) a. Creates international legislation regarding international cooperation. b. Establishes international standards for antibiotics and vaccines. c. Supports U.S. programs to fight disease. d. Provides daily information on disease occurrences.

B D Some WHO services that benefit all countries (including the United States) are providing day-to-day information service on the occurrence of internationally important diseases; publishing the international list of causes of disease, injury, and death; monitoring adverse reactions to drugs; and establishing international standards for antibiotics and vaccines. Individual countries can request assistance with strengthening the delivery of health services, supporting national programs to fight disease, and training health workers—which the United States does not. WHO can suggest but cannot legislate to individual countries.

What is the definition of family in community health? a. A group of individuals who share a common place of living, have formal ties, and share responsibilities to provide for all members. b. Several people who work together in their environment to meet their basic needs. c. Two or more people who identify themselves as a family and rely on each other to some extent to meet basic needs. d. People living together who share the same values and beliefs.

C

During which phase of the home visit does the nurse document what was accomplished? a. In-home phase b. Previsit phase c. Postvisit phase d. Termination phase

C A major task of the postvisit phase is documenting the visit and services provided. Major tasks of the pre-visit phase are to initiate contact with the family and schedule the home visit. During the in-home phase, the nurse-client relationship is established. During the termination phase the visit is reviewed with the family and plan for future visits is made.

The PHN is reviewing the emergency response plan of the local community. What action should be included in the plan? a. A surveillance system that reports ED discharges b. Making sure the plan includes policies to reduce disparities c. Surveillance systems that are adequate for the community to detect early disease trends d. Educating the community about the plan so they can decide how it fits with their value systems

C Actions related to bioterrorism include ensuring that adequate surveillance systems are in place for early detection; educating emergency and other health personnel about symptoms, treatment, and prevention of further spread; and establishing coordinated response plans with health and law enforcement officials. Educating communities so they can make decisions that best fit their value systems would apply to genetics and genomics. Educating the public about potential dangers of environmental contamination reflects the issue of climate changes. Advocating for policies to reduce disparities reflects the issue of the global economy.

A nurse is conducting a health risk appraisal. Which of the following activities is the nurse assessing when using this tool? a. Risk reduction activities b. Illness prevention activities c. Unhealthy activities d. Health promotion activities

C Health risk appraisal refers to the process of assessing the presence of specific factors in each of the categories that have been identified as being associated with an increased likelihood of an illness, such as cancer, or an unhealthy event, such as an automobile accident. Therefore, the nurse would assess for unhealthy behavior and activities in the areas of biological and age-related risk, social and physical environment risk, and behavioral risk. Incorrect Activities to promote health, prevent illness, or reduce risks would be advantageous, not risky.

What activity of the nurse best reflects a PHN's focus on population health? a. Actively collaborating with private clinics in the area to help achieve health goals for the children with asthma. b. Before implementing the asthma program, understanding the children's cultural differences. c. Obtaining data about the incidence and prevalence of asthma among the children in the community. d. Developing a program to teach children about asthma.

C Population focus implies that the nurse uses population-based skills such as epidemiology, research in community assessment, and community organizing as the basis for interventions. Community orientation is reflected when a community health nurse develops a program to prevent a future disease, considers cultural differences, and actively collaborates with other health care professionals to achieve the common goals.

Which of the following statements is the best explanation as to why some countries are more violent than others? a. Population differences are the main determinant—for example, having more males than females. b. Geographical differences are the primary factor. c. Violence is a learned behavior controlled or allowed by social norms. d. Civilized societies are less violent than primitive societies.

C Some societies are basically nonviolent, and for them violence is not a significant health problem. Violence is a learned behavior, and social norms can keep violence at low levels or even eliminate it. The learned culture of the society is the best indicator for violence, not the differentiation between civilized or primitive, geographic location, or population differences among males and females.

A home health nurse who is visiting a family for the first time asks, "Could we review your extended family and other persons or groups with whom you interact each week?" Which of the following provides the best rationale for the nurse asking this question? a. To understand the extended family relationships b. To communicate with relevant others as needed c. To assess the family's environment and social resources and risks d. To determine financial assets available to the family in case of serious need

C The question by the nurse indicates that she is trying to obtain an ecomap. Ecomaps can provide information about relationships that the family has with others (such as relatives and neighbors), the family's connections with other social units (such as church, school, work, clubs, and organizations), and the flow of energy, positive or negative, in the family. An ecomap represents the family's interactions with other groups and organizations. Environmental or social risk and resources can be assessed from an ecomap. An ecomap does not assess extended family relationships or financial assets. An ecomap is not used as a communication method.

During a family assessment, the community health nurse must examine both the internal and external structure of the family. What factors will be assessed to determine the internal structure of the family? (Select all that apply.) a. What religion the individuals observe b. Where individuals work c. The family composition d. Each member's gender e. Where the family goes to exercise

C D

Which grand nursing theory presents the goal of identifying family health patterns for the purpose of making positive changes? a. Roy adaptation model b. Self-care agency c. Health as expanding consciousness d. Science of unitary beings

D

Which of the following families is at high risk for health problems? a. man knows that his grandfather, father, and older brother all died of cardiac disease. b. A man agrees that he needs to eat better and exercise more but also expresses how busy he is at his job. c. A man expresses disappointment that, having been laid off as an executive, his new position pays only about two thirds of his original salary. d. A man is currently unemployed and despairs about finding a position.

D A person who is unemployed and despairing of finding employment is at serious economic risk, which is one of the foremost predictors of health problems. Economic risk is determined by the relationship between family financial resources and the demands on those resources. Having adequate financial resources means that a family is able to purchase the necessary services and goods related to health, such as adequate housing, clothing, food, education, and health or illness care. A man who says he needs to eat better and exercixe more appears to have adequate resources as he is employed. The man who has a family history of cardiac disease is not displaying any known risk factors related to income. The man who has been laid off stil is receiving an income which should assist him in being able to afford the necessary goods and services he needs in the immediate future.

A nurse is assessing persons arriving at a shelter following a disaster. Which of the following would be the first action the nurse should take? a. Determine if the person has a psychological condition requiring special attention. b. Provide medical care for persons as if they were in a hospital. c. Limit the amount of equipment and medications brought into the shelter. d. Assess if this type of facility is appropriate for the person.

D Any person who comes to a special needs shelter must be assessed by a nurse to determine whether this type of facility is appropriate. After it has been determined if the facility is appropriate for these people, the nurse can work with them as needed to limit equipment if there is limited space. Assessment of the physical concerns of the people, not the psychological conditions, should be the priamry concern of the nurse. The nurse would not be providing medical care at the shelter, rather, the nurse would provide assessments, referrals, assist the client to meet health care needs, keep client records, ensure emergency communications, and provide a safe environment.

Which of the following best describes countries that bear the greatest burden of disasters? a. Arid regions that are prone to drought b. Water-boundary regions that are prone to floods and hurricanes c. Industrialized countries with much to lose d. Developing countries with limited resources

D Disasters create the most devastation in developing countries. The people of low socioeconomic status suffer the most because their houses are less sturdy and they have fewer resources and less means of social security. The climate and location of the country does not relate to its risk of bearing the burden of disasters. Industrialized countries have a higher socioeconomic status and can better address disasters if they occur.

What does the term family assessment imply? (Select all that apply.) a. Focus directed on health protection behaviors b. Assistance with the management of uncontrollable health risks c. Recognition of health risks that are controllable d. Examination of cultural, spiritual, and developmental needs e. Holistic appraisal of health care needs

D E

A nurse has been successful in creating improvement in a family's health. Which of the following characteristics is most likely displayed by the nurse? a. Skilled at obtaining referrals and resources for the family b. Skilled at communication and interpersonal relationships c. Skilled at assessing the family's main problems d. Skilled at recognizing and strengthening the family's competencies

D The nurse's approach to the family should be positive and focused on competencies rather than on problems or deficits. The incorrect responses do not address the strengths of the family, rather they focus on obtaining necessary resources, improving relationships, and assessing for problems.

Structural Family Assessment

Involve two factors 1. internal- family composition, rand of members, gender, subsystems (clustering), boundaries (clear, diffuse)

Health Responsibilities of family

development of members' sense of personal identity and self-worth emotional support and guidance during life cycle transitions socialization of family members to value and maintain health education about when and how to use the health care system care provision and management for chronically ill, disabled, and aging family members

Family

two or more individuals who ID themselves as family and who manifest some degree of interdependence with each other and their environment in meeting basic needs