community questions
20 What terms are used to describe healthy families? (Select all that apply.) 1. Families with strengths 2. Dysfunctional 3. Functional families 4. Resilient families 5. Resistant families
1. Families with strengths 3. Functional families 4. Resilient families Families with strengths, functional families, and resilient families are terms often used to refer to healthy families. Research has been conducted about healthy families, but it is clear that the issues examined all relate to those of relational needs. This means that in healthy families, the basic survival needs are met. The traits ascribed to healthy families are based on attachment and are affectionate in nature. DIF: Cognitive Level: Knowledge REF: Page 309
10 Which of the following barriers are specific to the educator? (Select all that apply.) 1. Fear of public speaking 2. Low literacy 3. Limited experience with the topic 4. Lack of motivation 5. Lack of experience with gaining participation
1. Fear of public speaking 3. Limited experience with the topic 5. Lack of experience with gaining participation Barriers to learning fall into two broad categories: one concerning the educator and the other concerning the learner. Common educator-related barriers include a fear of public speaking, limited experience with the topic, and lack of experience with gaining participation in the group. Two of the most important learner-related barriers are low literacy and lack of motivation to learn information and make needed behavioral changes. DIF: Cognitive Level: Knowledge REF: Page 198
8 Which educational method has been shown to be most effective in fostering treatment adherence? 1. Internet based education 2. In-person counseling 3. Telephone counseling 4. Self-directed learning
1. Internet based education Educating people through the Internet has been shown to be more effective in fostering treatment adherence than in-person counseling, telephone counseling, or self-directed learning. It is important to be aware that people increasingly are using the Internet as a source of health information. Clients may ask nurses to provide them with information about ways to evaluate the quality and reliability of this information. DIF: Cognitive Level: Knowledge REF: 200
6 A nurse in community health integrates new slides into a presentation that will be given to a local elementary school group regarding the techniques of proper hand washing. The new slides will repeat essential points during the presentation. This demonstrates the nurse's understanding of what principle? 1. Repetition 2. Integration 3. Participation 4. Sequencing
1. Repetition Incorporating repetitive health behaviors into games helps children retain knowledge and acquire skills. When learners are dependent and entering a totally new content area, they may require more pedagogical experiences. Consider both the age of the learner population and their learning needs as you choose either the pedagogical and andragogical principles for the program. In educational programs for children, provide information that matches the developmental abilities of the group. DIF: Cognitive Level: Application REF: Page 197
16 In applying the developmental theory, a family nurse determines the developmental stage of the family based on: 1. age of the eldest child. 2. family strengths. 3. individual growth patterns. 4. overall tasks of the family.
1. age of the eldest child. Family developmental and life cycle theory provides a framework for understanding normal predicted stresses that families experience as they change and transition over time. The stages of family development are based on the age of the eldest child. Overall family tasks are identified that need to be accomplished for each stage of family development. DIF: Cognitive Level: Knowledge REF: Page 312
A nurse in community health is planning to begin a class to help mothers returning to work better cope with the stresses of multiple roles. The nurse would most likely use: 1. an andragogical approach. 2. a behavioral approach. 3.. an operational approach. 4. a pedagogical approach.
1. an andragogical approach. Andragogy is the art and science of teaching adults and individuals with some knowledge about a health-related topic. In the andragogical model, learners influence what they need and want to learn. Learning strategies for children and individuals with little knowledge about a health-related topic are characterized as pedagogy. Various approaches, methods, and tools can be used to evaluate health and behavioral changes. A behavioral or operational approach to educational classes would not be useful in this situation. DIF: Cognitive Level: Application REF: Page 197
A neighborhood association group has asked the local nurse in community health for a class on environmental hazards. The nurse in community health has seen good information in the community health text and thinks about getting permission to copy some of the information. The most important thing the nurse should do before using copies of this material is to: 1. assess the literacy level of the group. 2. see how many plan to attend. 3. see whether the group is ready to learn. 4. secure a good space for a group meeting.
1. assess the literacy level of the group. Two of the most important learner-related barriers are low literacy and lack of motivation to learn information and make needed behavioral changes. Nurses often deal with individuals and populations who are illiterate or who have low literacy levels. One out of every five Americans reads below the fifth-grade level, and one out of every three lacks the literacy needed to understand health care providers. Typically, individuals read three to five grade levels below the last year of school completed. It has been found that most health instructions continue to be written at the 10th grade reading level which is too difficult for almost half of the adult readers in the United States. DIF: Cognitive Level: Application REF: Page 198
12 The nurse in community health uses information about family structure, household composition, marriage, divorce, birth, death, adoption, and other family life events to forecast and predict stresses and developmental changes experienced by families and identify possible solutions to family challenges. This best describes the study of: 1. family demographics. 2. family functions. 3. family health. 4. family resilience.
1. family demographics. Family demographics is the study of the structure of families and households and the family-related events, such as marriage and divorce, that alter the structure through their number, timing, and sequencing. Nurses must be knowledgeable about family structures, functions, processes, and roles. In addition, nurses must be aware of and understand their own values and attitudes pertaining to their own families, as well as being open to different family structures and cultures. DIF: Cognitive Level: Application REF: Page 307
18 The family nurse conducts the family nursing assessment with the family as a unit. Using a systematic process, family problems are identified and family strengths are emphasized as building blocks for interventions. Which of the following best completes the statement to demonstrate the importance of assessment to outcomes? Integrating the extended families: 1. fosters equal family and provider commitment to success. 2. facilitates outcomes-oriented family nursing research. 3. decreases the need for nurse contact and intervention. 4. removes barriers to needed services to achieve success.
1. fosters equal family and provider commitment to success. Building the interventions with family-identified problems and strengths allows for equal family and provider commitment to the solutions and ensures more successful interventions. The interactions between family members become the target for nursing interventions (e.g., the direct interactions between the parents, or the indirect interaction between the parents and the child). The systems approach to family always implies that when something happens to one family member, the other members of the family system are affected. DIF: Cognitive Level: Application REF: Page 310
7 A community-oriented nurse convenes a support group for teenage mothers. The nurse understands that this strategy fosters cohesiveness among members and allows the members to learn from one another. What other benefit specific to group teaching will be achieved? 1. Cultural sensitivity 2. Efficiency in client service 3. Learning of new skills 4. Distraction-free surroundings
2. Efficiency in client service In the education process, one of the important skills for educators to develop in selecting appropriate educational methods is realizing the benefits of group teaching, such as cohesiveness among members, increased number of clients seen, clients learning from one another, and cost effectiveness. Cohesive groups tend to be more productive and able to accomplish their goals; cohesion can be increased as members better understand the experiences of others and identify common ideas and reactions to various issues. Nurses facilitate this process by pointing out similarities, contrasting supportive differences, or helping members redefine differences in ways that make those dissimilarities compatible. DIF: Cognitive Level: Application REF: Page 203
4 A nursing student prepares a treatment plan for a client that draws upon the student's understanding of pathophysiology and nursing practice theory learned in the student's coursework. This application of new information used in a different way demonstrates the educational principle of: 1. affective domain. 2. cognitive domain. 3. events of instruction. 4. principles of effective education.
2. cognitive domain. The cognitive domain of learning includes memory, recognition, understanding, reasoning, application, and problem solving and is divided into hierarchical classifications of behaviors (i.e., knowledge, comprehension, application, analysis, synthesis, and evaluation). Learners master each level of recognition in order of difficulty. The level of application involves the use of new information in a different way. The affective domain includes changes in attitudes and the development of values. This situation does not demonstrate events of instruction or educational principles. DIF: Cognitive Level: Application REF: Pages 190-191
14 A family nurse is working with a married couple that has decided to remain child-free. The nurse recognizes this decision as a: 1. biological necessity. 2. contemporary family function. 3. religious belief decision. 4. threat to family survival.
2. contemporary family function. In contemporary times, the traditional functions of families have been modified and new functions added. One of the traditional family functions was to procreate to ensure the survival of the species. Many married couples are electing to be child-free rather than to reproduce. DIF: Cognitive Level: Application REF: Page 307
A nurse in community health is working with a single parent of three children, ages 4, 6, and 8. The 6-year-old has cerebral palsy. The 4-year-old has asthma. The maternal grandmother lives with the family and has diabetes. The nurse understands the importance of working within the context of the existing family structure and community resources because families are: 1. resistive to outside intervention or involvement. 2. responsible for providing/managing the care of their members. 3. unable to manage the stress of complex health needs. 4. restricted in their ability to identify interventions.
2. responsible for providing/managing the care of their members. Health care decisions are made within the family, the basic social unit of society. Families are responsible for providing and managing the care of family members. Families are significant members of health care teams because they are an ever-present force over the lifetime of care. Families are more responsible than ever for assisting in the health care of ill family members. DIF: Cognitive Level: Application REF: Page 307
13 The current-day definition of family refers to two or more individuals who depend on one another for emotional, physical, and/or financial support. Which of the following is the most important principle to support this broader definition? 1. Families are defined by genetic ties. 2. Family names are needed to confer status. 3. Members of a family are self-defined. 4. Traditional family functions have been redefined.
3. Members of a family are self-defined. The members of a family are self-defined. Nurses working with families should ask the people whom they consider to be their family and then include those members in health care planning. The family may range from traditional nuclear and extended family to "postmodern" family structures such as single-parent families, stepfamilies, same-gender families, and families consisting of friends. DIF: Cognitive Level: Application REF: Page 307
17 Which of the following social science theories is used by public health nursing to describe how environments and systems outside of the family influence the development of a child over time? 1. Life cycle theory 2. Family developmental theory 3. Family systems theory 4. Bioecological systems theory
4. Bioecological systems theory The bioecological systems theory describes how environments and systems outside of the family influence the development of a child over time. Family developmental and life cycle theory provides a framework for understanding normal predicted stresses that families experience as they change and transition over time. The stages of family development are based on the age of the eldest child. Overall family tasks are identified that need to be accomplished for each stage of family development. Nurses use family systems theory to understand how a family is an organized whole as well as composed of individuals. DIF: Cognitive Level: Knowledge REF: Page 314
15 The family systems theory encourages nurses to view both the individual clients as participating members of a whole family. What is the major weakness of the systems framework? 1. Views families from both a subsystem and a suprasystem approach 2. Defines the direction of interactions 3. Views the family as an agent of change 4. Focuses on the interaction of the family with other systems
4. Focuses on the interaction of the family with other systems The major strength of the systems framework is that it views families from both a subsystem and a suprasystem approach. That is, it views the interactions within and between family subsystems as well as the interaction between families and the larger supersystems, such as the community and the world. The major weakness of the systems framework is that the focus is on the interaction of the family with other systems rather than on the individual, which is sometimes more important. DIF: Cognitive Level: Knowledge REF: Page 312
5 A home health nurse receives a referral to educate an older adult client with diabetes in proper foot care. The nurse's assessment of the client determines that the client has poor eyesight that may affect the client's ability to learn and perform certain skills. Which educational principle is being examined? 1. Cognitive domain 2. Events of instruction 3. Principles of effective instruction 4. Psychomotor domain
4. Psychomotor domain The psychomotor domain includes the performance of skills that require some degree of neuromuscular coordination and emphasizes motor skills. The cognitive domain includes memory, recognition, understanding, reasoning, application, and problem solving and is divided into a hierarchical classification of behaviors. Education is the establishment and arrangement of events to facilitate learning. Principles that guide the effective educator include message, format, environment, experience, participation, and evaluation. DIF: Cognitive Level: Application REF: Page 191
19 Family health can be defined as a dynamic, changing, relative state of well-being that includes the biological, psychological, sociological, cultural, and spiritual factors of a family system. This family health approach would best include which of the following underlying principles? (Select all that apply.) 1. Assessment of the individual's health does not determine the overall family system's health. 2. Family functioning affects the health of individuals. 3. Family system assessment specifically addresses the individual's health. 4. The individual's health affects family functioning. 5. Simultaneous assessment of individual family members and the family system as a whole is important to family health. 2. Family functioning affects the health of individuals. 4. The individual's health affects family functioning.
5. Simultaneous assessment of individual family members and the family system as a whole is important to family health. The bio/psycho/socio/spiritual approach to family health refers to individual members as well as the family unit as a whole. An individual's health (wellness-illness continuum) affects the entire family's functioning and, in turn, the family's functioning affects the health of individuals. Thus assessments of family health involve simultaneous assessment of individual members and the family system as a whole. DIF: Cognitive Level: Knowledge REF: Page 309
19 Which of the following factors assisted such community-oriented nursing pioneers as Lillian Wald to develop approaches and programs to solve the health care and social problems of the late 1800s? (Select all that apply.) A. Community health's focus on teaching and prevention B. Establishment of settlement houses C. Establishment of the Town and Country Nursing Services in large cities D. Lack of public interest in limiting disease E. Middle and upper class fear of diseases
A. Community health's focus on teaching and prevention B. Establishment of settlement houses E. Middle and upper class fear of diseases In the 1890s the public was interested in limiting disease among all classes of people, partly for religious reasons, partly for charity, but also because the middle and upper classes were afraid of the diseases that seemed to be brought in by the large communities of European immigrants. Nurses began to establish settlement houses and neighborhood centers, which became hubs for health care and social welfare programs. From the beginning, community health nursing practice included teaching and prevention. Community-oriented interventions led to improved sanitation, economic improvements, and better nutrition. These interventions were credited with reducing the incidence of acute communicable diseases. Pioneers in public health nursing, such as Lillian Wald, took advantage of the public's concern and existing practice models to solve health care and social problems that reduced the incidence of acute communicable diseases in immigrant communities. DIF: Cognitive Level: Application REF: Page 18
10 Which of the following best supports the concept of community-oriented nursing practice? (Select all that apply.) A. Direct nursing care of individuals with tuberculosis (TB) B. Hospice home care for a terminally ill individual and family C. Nursing interventions to stop elder abuse D. Nutrition education programs for teenagers and their families E. Wound care for a homebound individual
A. Direct nursing care of individuals with tuberculosis (TB) C. Nursing interventions to stop elder abuse D. Nutrition education programs for teenagers and their families Nurses who have a community orientation are often considered unique because of their target of practice. When the location of practice is the community and the focus of practice is the individual or family, the client remains the individual or family, and the nurse is practicing in the community as the setting; this is an example of community based nursing practice. Community-oriented nursing interventions should result in changes that are intended to affect the whole community. DIF: Cognitive Level: Application REF: Page 223
18 Which of the following statements accurately reflects the current status of nursing in community health? A. Each type of nurse is needed in today's communities. B. Community health serves only clients with chronic conditions. C. Comprehensive reform of health care is required. D. People no longer believe they can protect themselves.
A. Each type of nurse is needed in today's communities. Many nurses work in the community. Some bring a public health population-based approach and have as their goal preventing illness and protecting health. Other nurses have a community-oriented approach and deal primarily with the health care of individuals, families, and groups in the community. Still other nurses bring a community-based approach that focuses on "illness care" of individuals and families in the community. Each type of nurse is needed in today's communities. The latter two groups are growing and will continue to do so, because so much health care is being provided in community rather than inpatient settings. What is necessary is the extension of public health services to prevent illness, promote health, and protect the public. Without this extension a large gap would exist in the design of a comprehensive program for health care. DIF: Cognitive Level: Application REF: Page 28
12 In the United States, the current system of the local government's responsibility for providing care for the disenfranchised emerged from: A. Elizabethan Poor Law B. Florence Nightingale C. Public Health Service (PHS) D. Federal Emergency Relief Administration (FERA)
A. Elizabethan Poor Law Colonial Americans established systems of care for the sick, poor, aged, mentally ill, and dependent based on the model of the Elizabethan Poor Law. Early county or township government was responsible for the care of all dependent residents, and they were strict about caring for their own residents. In 1918 the U.S. Public Health Service (USPHS) established a division of public health nursing to work in the war effort. The Federal Emergency Relief Administration (FERA) was established during the depression to support nurse employment through increased grants-in-aid for state programs of home medical care. DIF: Cognitive Level: Knowledge REF: Pages 15-16
15 The historical nursing figure who contributed to establishing the foundation for current community health and nursing in community health by working in military field hospitals using a population-based approach that improved nursing care and environmental conditions was: A. Florence Nightingale. B. Frances Root. C. Lillian Wald. D. Mary Breckinridge.
A. Florence Nightingale. During the Crimean War (1854-1856), the British military established hospitals for sick and wounded soldiers in Scutari in Asia Minor. The care of the soldiers was poor, with cramped quarters, poor sanitation, lice and rats, not enough food, and inadequate medical supplies. When the British public demanded improved conditions, Florence Nightingale asked to work in Scutari. Because of her wealth, social and political connections, and knowledge of hospitals, the government sent her with a contingent of ladies, hired nurses, and hired servants to Scutari. Using simple epidemiology measures, she documented decreased mortality rates from the beginning of the war to the end of the war. Florence Nightingale progressively improved the soldiers' health using a population-based approach that improved both environmental conditions and nursing care. DIF: Cognitive Level: Knowledge REF: Page 17
19 A nurse functioning in the role of a case manager performs which of the following functions in the care delivery process? (Select all that apply.) A. Risk analysis B. Data mapping C. Provision of illness care D. Epidemiologic investigation of unexpected illnesses E. Counseling and education
A. Risk analysis B. Data mapping D. Epidemiologic investigation of unexpected illnesses The case manager is the architect for the target group's health in the care management delivery process. The building blocks used by the manager include risk analysis, data mapping, data monitoring, epidemiologic investigation of unexpected illnesses, multidisciplinary development of action plans and programs, and identifying case management triggers or events that promote earlier referrals of high-risk clients when prevention can have dramatic results. The case manager builds on the basic functions of the traditional role and adapts new competencies for managing the transition from one part of the system to another or to home. DIF: Cognitive Level: Knowledge REF: Page 233
17 A nurse coordinating care for undocumented minority workers with a high incidence of tuberculosis (TB) conducts a presentation before the local community health board to focus attention on the magnitude of the problem and its potential impact on the local community. The presentation stimulates the community to explore innovative solutions to increase screening for and treatment of TB cases. This scenario is an example of the relationship between: A. advocacy and case management. B. advocacy and continuity of care. C. care management and case management. D. care management and continuity of care.
A. advocacy and case management. Clients are a part of larger systems: the family, the work environment, and the community. Each system interacts with the client to shape available options through resources, needs, and desires. The practice of advocacy may entail the ability to focus attention on the magnitude of problems caused by diseases affecting a segment of the population. Advocacy often stimulates a community's self-determination to find innovative actions to correct gaps in service. DIF: Cognitive Level: Application REF: Page 241
7 The nurse in community health identifies an elder abuse problem because of caregiver stress among families in the local community resulting from lack of caregiver support services. The next step in the community-oriented nursing process would be to: A. analyze the community problem. B. establish priorities. C. establish goals and objectives. D. identify intervention activities.
A. analyze the community problem. After the identification of the community problem(s), the planning phase of the community-oriented nursing process should begin with an analysis of the problem to seek clarification on the nature of the problem, its origins and effects, intervention points, interested parties/change agents, direct and indirect contributing factors, outcomes of the problem, and relationships between problems. Once high-priority problems are identified, relevant goals and objectives are developed, followed by the identification of intervention activities. DIF: Cognitive Level: Application REF: Page 223
2 A community-oriented nurse has identified obesity as a problem in the middle school. The next step in a population-focused practice is to make information available about the health of the middle school students. This describes the public health core function of: A. assessment. B. assurance. C. policy development. D. research.
A. assessment. The three public health core functions are assessment, policy development, and assurance. 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. Assurance is making sure that essential community-oriented health services are available. These services might include providing essential personal health services for those who would otherwise not receive them. Assurance also includes making sure that a competent public health and personal health care workforce is available. DIF: Cognitive Level: Knowledge REF: Page 4
3 A state agency has received multiple complaints regarding the availability of elder transportation services to a specific county senior center. The state agency assigns a public health nurse to work with the community to evaluate its program for elder transportation services to publicly sponsored elder care programs. The public health core function applied is: A. assurance. B. policy development. C. primary prevention. D. public transportation.
A. assurance. The public health core function of assurance focuses on the responsibility of public health agencies to be sure that activities are appropriately carried out to meet public health goals and plans. This role requires skill in assessment, investigative functions, collaboration, consultation, and cooperation. Assurance also includes assisting communities to implement and evaluate plans and projects. 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. Primary prevention does not focus on provision of services and a part of assurance is assisting communities to obtain necessary services such as transportation. DIF: Cognitive Level: Application REF: Page 4
18 In case management, it is unlikely that any single professional has the expertise, knowledge, or skills required to achieve success. The synergy produced by all involved parties (client, providers, payers, family/significant others, and community organizations) can result in successful outcomes. This statement relates to the sequential process of: A. collaboration. B. communication. C. cooperation. D. negotiation.
A. collaboration. Collaboration is achieved through a developmental process that occurs in a sequence, yet it is reciprocal between those involved. Teamwork and collaboration require extensive skill sets to achieve successful outcomes. No single professional has the expertise required in all aspects. It requires the synergy of all parties involved. The goal of communication in the collaborative development process is to promote respect for, understanding of, and the accuracy of all team members' points of view. Cooperation is the ability to understand and meet the needs of others. Negotiation generally occurs in a situation involving conflict. DIF: Cognitive Level: Application REF: Page 242
29 A nurse in community health seeks a low-cost evaluation method to learn the perspectives of the largest number of persons regarding a proposed local safe haven program for unwanted infants. The best evaluation method to meet the criteria would be: A. community forums. B. focus groups. C. key informants. D. surveys.
A. community forums. Community forums have the advantage of being low in cost and capturing the perspectives of a large number of persons. Focus groups and key informant methods limit the number of persons expressing their perspectives. Surveys are expensive and technically demanding. DIF: Cognitive Level: Application REF: Page 280 (Table 16-1)
30 The major sources of information for program evaluation are: (select all that apply) A. community indicators. B. media reports. C. program clients. D. program providers. E. program records.
A. community indicators. C. program clients. E. program records. Major sources of information for program evaluation are program clients, program records, and community indicators. The program participants, or clients of the service, have a unique and valuable role in program evaluation. Whether the clients, for whom the program was designed, accept the services will determine to a large extent whether the program achieves its goal. Thus their reactions, feelings, and judgments about the program are important to the evaluation. DIF: Cognitive Level: Knowledge REF: Page 283
7 A school nurse teaches three middle school students with asthma conditions techniques to minimize their incidence of bronchial spasms. This is an application of: A. community-based nursing. B. community-oriented nursing. C. institutional nursing. D. public health nursing.
A. community-based nursing. The goal of community-based nursing (CBN) is to manage acute or chronic conditions while promoting self-care among individuals and families. In CBN the nursing care is family centered, which means that the nurse works to improve the competencies of families to enable them to take better care of themselves. The nurse pays particular attention to the uniqueness of each family and works to plan the most useful interventions. Nurses practicing in the community and many staff public health nurses focus on providing direct care services, including health education, to persons or families outside of institutional settings, either in the home or in a clinic. DIF: Cognitive Level: Knowledge REF: Pages 10-11
6 A nurse in a clinic that provides direct care services to clients with tuberculosis would be classified as practicing: A. community-based nursing. B. community-oriented nursing. C. institutional nursing. D. public health nursing.
A. community-based nursing. The nurse practicing as a community-based nurse is more likely to give direct care to people than are nurses who practice from a community-oriented framework. A community-oriented framework includes community-oriented nursing and public health nursing. Institutional nursing care is generally delivered in a hospital or nursing home setting. DIF: Cognitive Level: Knowledge REF: Page 11
4 A nurse planning a smoking cessation clinic for adolescents in the local middle schools and high schools is providing: A. community-oriented care. B. community-based care. C. secondary care. D. tertiary care.
A. community-oriented care. Community-oriented nurses emphasize health protection, maintenance, and promotion and disease prevention, as well as self-reliance among clients. Regardless of whether the client is a person, a family, or a group, the goal is to promote health through education about prevailing health problems, proper nutrition, beneficial forms of exercise, and environmental factors such as safe food, water, air, and buildings. Community-based care is nursing care that is provided in a setting. A smoking cessation clinic is an example of primary prevention, not secondary or tertiary. DIF: Cognitive Level: Application REF: Page 2
Migrant workers and their families who reside in a specific mobile home park during the summer months would best be classified as a: A. community. B. group. C. setting of practice. D. target population.
A. community. In most definitions the concept of community includes people, place/time, and function. Nurses in community health practice regularly need to examine how the personal, geographic, and functional dimensions of community shape their nursing practice with individuals, families, and groups. They can use both a conceptual definition and a set of indicators for the concept of community in their practice. The community is first the setting for practice for the nurse practicing health-promotion and disease-prevention interventions with individuals, families, and groups. Second, the community is the target of practice for the public health nurse whose practice is focused on the broader community rather than on individuals. DIF: Cognitive Level: Application REF: Page 212
24 The nurse engaging in formative program evaluation would most likely: A. conduct medical record audits for quality assurance. B. make a home visit before a client is discharged from the program. C. participate in new client evaluation. D. write policy for risk management.
A. conduct medical record audits for quality assurance. Quality assurance audits are prime examples of formative program evaluation in health care delivery. The monitoring of program activities—such as hours of services, number of providers used, number of referrals made, and amount of money spent to meet the program objectives—provides an evaluation of the progress of the program. This type of evaluation is an example of formative evaluation of processes, which occurs on an ongoing basis while the program exists. Progress evaluation occurs primarily while implementing the program. The nurse who completes a daily or weekly log of clinical activities (e.g., number of clients seen in the clinic or visited at home, number of phone contacts, number of referrals made, number of community health-promotion activities) is contributing to progress evaluation of the nursing service. DIF: Cognitive Level: Application REF: Page 282
Local officials have requested a program evaluation of a comprehensive teen sex education program offered in the local schools in preparation for potential budget discussions. A nurse in community health conducts a program evaluation and determines that the teen pregnancy rate has gradually declined over the years that the program has been in place. The community is measuring the program's: A. efficiency. B. progress. C. relevance. D. sustainability.
A. efficiency. A program evaluation may be able to determine whether a program provides better benefits at a lower cost than does a similar program or whether the benefits to the clients or number of clients served justifies the costs of the program. This is a measure of the efficiency of a program. A reduction in teen pregnancies can represent significant cost savings to the overall health of the community. The monitoring of program activities—such as hours of services, number of providers used, number of referrals made, and amount of money spent to meet the program objectives—provides an evaluation of the progress of the program. Evaluation of relevance is an important component of the initial planning phase. As money, providers, facilities, and supplies for delivering health care services are more closely monitored, the needs assessment done by the nurse will determine whether the program is needed. Sustainability is the continuation of a program when resources are adequate. DIF: Cognitive Level: Application REF: Pages 284-285
9 The nurse in community health defines goals and measurable objectives during the planning phase of a community health intervention. This also marks the beginning of the: A. evaluation phase. B. implementation phase. C. needs assessment. D. problem analysis.
A. evaluation phase. Evaluation begins in the planning phase, when goals and measurable objectives are established and goal-attaining activities are identified. After implementing the intervention, only the accomplishment of objectives and the effects of the intervention activities have to be assessed. The nurse will evaluate whether the objectives were met and whether the intervention activities were effective. DIF: Cognitive Level: Application REF: Page 227
11 The term "instructive district nursing" was coined in the nineteenth century to describe the relationship of nursing to: A. health education. B. home health care. C. settlement houses. D. visiting nurse services.
A. health education. In 1886 in Boston, two women, to improve their chances of gaining financial support for their cause, coined the term "instructive district nursing" to emphasize the relationship of nursing to health education. Other nurses established settlement houses and neighborhood centers, which became hubs for health care and social welfare programs. Home health and visiting nursing evolved at a later time. DIF: Cognitive Level: Knowledge REF: Page 18
9 In a federally funded preschool program such as Head Start, nursing services that include conducting developmental-level screening for cognitive and psychomotor development of individual children would most likely be considered community-oriented nursing care when: A. individual results are compared with established standards for children of the same age group. B. program characteristics are assessed for their effectiveness in making the school population healthier. C. referral is provided for a child identified with delayed psychomotor development. D. treatment is initiated for a child with an identified learning disability.
A. individual results are compared with established standards for children of the same age group.\ Within federally funded programs for preschool children, from a community-oriented nursing care perspective, nursing services could be provided to individual children by conducting developmental-level screening tests to evaluate each child's level of cognitive and psychomotor development in comparison with established standards for children of the same age. This is population-focused service. A community-based nurse may deliver illness care or direct services to individual children. A public health nurse may assess the program's ability to achieve the overall goal of making its population of children healthier by evaluating the characteristics of the facility, program, and environment for their effectiveness in achieving the goal. DIF: Cognitive Level: Knowledge REF: Page 10
9 A nurse is conducting an in-service education session on the Centers for Disease Control and Prevention's (CDC's) updates for preventive services for a group of nurses in community health. The nurse would demonstrate the best understanding of the educational process by integrating which planning strategies? (Select all that apply.) 1. Use of films 2. Small group interaction 3. Use of games 4. Session timing 5. Session space
All of the above Many factors influence a person's learning needs and the ability to learn, including the learners' demographic, physical, geographical, economic, psychological, social, and spiritual characteristics. Also consider the learner's knowledge, skills, and motivation to learn, as well as what resources are available to support and possibly prevent learning. Resources include printed, audio or visual materials, equipment, agencies, and other individuals. Barriers for the presenter include lack of time, skill and/or confidence, money, space, energy, and organizational support. DIF: Cognitive Level: Application REF: Pages 192-193
17 Congress-supported categorical funding has produced what negative effect on the delivery of health care services? A. Beginning of 2-year associate's degree programs in nursing. B. A reduction in comprehensive community health programs C. End of insurance company support for visiting nurses. D. Rise in hospital-based care.
B. A reduction in comprehensive community health programs The shift in Congress to categorical funding provides federal money for priority diseases or groups rather than for a comprehensive community health program. Thus local health departments design programs to fit the funding priorities. This has included maternal and child health services and crippled children (1935), venereal disease control (1938), tuberculosis (1944), mental health (1947), industrial hygiene (1947), and dental health (1947). This type of funding pattern continues today. DIF: Cognitive Level: Knowledge REF: Page 23
12 When acting as a mediator, the nurse advocate would: A. choose a new health plan for a client with limited funds. B. assist new parents in communicating with their health plan regarding well-baby coverage. C. provide health education to teens who need knowledge about sexually transmitted diseases. D. set up a doctor's appointment for an illiterate adult.
B. assist new parents in communicating with their health plan regarding well-baby coverage. Mediation is an activity in which a third party attempts to provide assistance to those who may be experiencing a conflict in obtaining what they desire. The goal of the nurse advocate as mediator is to help parties understand each other on many levels so that agreement on an action is possible. DIF: Cognitive Level: Application REF: Page 239
15 A community health nurse is working with an uninsured family with two children. The nurse assists the parents in applying for SCHIP benefits and securing an appointment for the children with a community pediatrician that participates in SCHIP. The intervention can best be described as: A. care management. B. case management. C. continuity of care. D. disease management.
B. case management. Case management is identified as one of the 17 interventions in the scope of practice in community health nursing. Case management is defined as the ability to optimize self-care capabilities of individuals and families and the capacity of systems and communities to coordinate and provide services. Case management, in contrast to the definition of care management, refers to activities implemented with individual clients in a system. Care management includes the concept of disease management. DIF: Cognitive Level: Application REF: Page 233
8 A nurse in community health is invited to work with a coalition of churches to address safety concerns for children in the local community. The nurse provides training in problem-solving skills, manages conflict, facilitates the process, and provides expertise in interpreting data. This nurse has chosen the implementation role of: A. change agent. B. change partner. C. group leader. D. data collector.
B. change partner. Content-focused roles often are considered change agent roles, whereas process roles are change partner roles. Change partner roles include enabler-catalyst, teacher of problem-solving skills, and activist advocate. Different roles may be required if the community lacks problem-solving skills or has a history of unsuccessful change efforts. The nurse may have to focus on developing problem-solving capabilities or on making one successful change so that the community becomes empowered to take on the job of promoting change on its own behalf. DIF: Cognitive Level: Application REF: Page 226
2 A nurse in community health contacts three individuals who have had sexual encounters with an individual recently diagnosed with syphilis. The concept basic to community-oriented nursing practice that is best described by this intervention is: A. community. B. community as client. C. individual as client. D. partnership.
B. community as client. When the community is the client, the results of nursing interventions should produce changes that affect the community as a whole, such as reducing the spread of sexually transmitted diseases (STDs). Although the nurse may work with individuals, families or other interacting groups, aggregates, institutions, or communities, or within a population, the resulting changes are intended to affect the whole community. The community health nurse is not providing care to an individual in this circumstance. It would be ideal if there were some form of partnership in this intervention. DIF: Cognitive Level: Application REF: Pages 213-214
5 While conducting a community health assessment, a nurse in community health meets with local religious leaders to understand the values, norms, perceived needs, and influence structures within the community. This process of data collection can best be described as: A. data gathering. B. data generation. C. data interpretation. D. problem identification.
B. data generation. Data generation in a community health assessment is the process of developing data that do not already exist through interaction with community members, individuals, families, and groups, such as community knowledge and beliefs, values, goals, perceived needs, norms, problem-solving processes, power, leadership, and influence structures. This activity parallels the assessment phase of the nursing process. Data gathering is the process of obtaining existing, readily available data. Data interpretation is conducted in the analysis phase. All of the steps will assist the nurse in problem identification. DIF: Cognitive Level: Application REF: Page 219
25 A major evaluation source for a nurse to use to determine the effectiveness of a teen driver safety program is: A. Centers for Disease Control and Prevention (CDC) reports. B. epidemiologic data. C. recent census data. D. voter registration records.
B. epidemiologic data. A major source of evaluation is epidemiologic data. Mortality and morbidity data measuring health and illness indicators are probably cited more frequently than any other single index for program evaluation. Incidence and prevalence are valuable indexes used to measure program effectiveness and impact, and these data are readily available on the Internet. Major sources of information for program evaluation are program clients, program records, and community indexes. DIF: Cognitive Level: Knowledge REF: Page 284
16 Mary Breckinridge established the Frontier Nursing Service (FNS) in 1925. One of Breckinridge's primary contributions to health care in the United States was: A. the Federal Emergency Relief Administration (FERA). B. introduction of the first nurse-midwives. C. the nursing process. D. occupational health nursing.
B. introduction of the first nurse-midwives. The unique pioneering spirit of the Frontier Nursing Service (FNS) influenced the development of public health programs to improve the health care of the rural and often inaccessible populations in the Appalachian sections of southeastern Kentucky. FNS nurses were trained in nursing, public health, and midwifery. Breckinridge, the founder of the FNS, introduced the first nurse-midwives into the United States. DIF: Cognitive Level: Knowledge REF: Pages 21-22
5 Public health nursing is a specialty with a distinct focus and scope of practice and requires a special knowledge base different from other specialty areas of nursing. A public health nurse would first be interested in: A. drug treatments for diabetes. B. populations with the highest rate of diabetes. C. educational materials for individuals with diabetes. D. new technology for diabetic care.
B. populations with the highest rate of diabetes. The primary focus that has differentiated public health nursing from other specialties has been the emphasis on the population rather than on individuals or families. The primary goal of public health—the prevention of disease and disability—is achieved by ensuring that conditions exist in which people can remain healthy. Diabetes care and educational materials are provided to individuals and families by a nurse in the community or institutional setting. DIF: Cognitive Level: Knowledge REF: Pages 4-5
10 The public health nurse deals with the examination of a community setting to determine the community's health status. Which of the following activities should be considered in the assessment phase? (Select all that apply.) A. Assisting communities to implement and evaluate plans and projects B. Building constituencies to work with the community C. Collecting, analyzing, and disseminating information D. Evaluating the social, economic, and environmental characteristics of the population E. Questioning the availability of health services to the community
C. Collecting, analyzing, and disseminating information D. Evaluating the social, economic, and environmental characteristics of the population E. Questioning the availability of health services to the community The core public health function of assessment includes the following: · Engaging in activities that involve the collection, analysis, and dissemination of information on both the health and health-relevant aspects of a community or specific population · Questioning, for example, whether the health services of the community are available to the population and are adequate to address needs · Monitoring the health status of the community or population and the services provided over time · Evaluating the social, economic, environmental, and lifestyle characteristics and practices of a population as well as the health services and capability available within the community to support good health for the population DIF: Cognitive Level: Knowledge REF: Page 8
28 A nurse in community health is participating in a community service board strategic team that is currently assessing the community's strengths, the local public mental health system, the community's mental health status, and other variables. This best describes what strategic program planning model used today in the public health arena? A. Assessment Protocol for Excellence in Public Health (APEXPH) B. Health Evaluation Data Information System (HEDIS) C. Mobilizing for Action Through Planning and Partnership (MAPP) D. Planning Approach to Community Health (PATCH)
C. Mobilizing for Action Through Planning and Partnership (MAPP) MAPP is the newer approach to program planning in the public health arena. It is a strategic planning model that helps the community health workers be facilitators, as communities establish priorities in their public health issues and identify resources to address the issues. APEXPH addresses the three core competencies of public health: assessment, assurance, and policy development. PATCH is a health education model and HEDIS is not associated with program planning. DIF: Cognitive Level: Application REF: Page 282
13 A parent involved in conflict resolution with her teenager says, "I know that some of your friends stay out until midnight, but I think it is best if you are in at 10 o'clock." This statement, a behavior seen in conflict situations, is an example of: A. negotiation. B. cooperation. C. assertiveness. D. aggressiveness.
C. assertiveness. Assertiveness is the ability to present one's own needs and is a behavior often seen in conflict situations. Negotiating is a strategic process used to move conflicting parties toward an outcome. Cooperation is the ability to understand and meet the needs of others. Aggressiveness is a behavior which may be exhibited in a conflict situation. DIF: Cognitive Level: Application REF: Page 242
Community-oriented nursing in the twenty-first century has been influenced by historical events and government initiatives that support the approach of: A. caring for the disenfranchised. B. illness care. C. keeping the public healthy. D. preventing acute illness.
C. keeping the public healthy. The Healthy People program, recent disasters and acts of terrorism, and most recently the Patient Protection and Affordable Care Act of 2010 have brought renewed emphasis on prevention to public and community health nursing. During the late twentieth and early twenty-first century, challenges have continued to trigger growth and change in nursing in the community. Nurses continue to care for the vulnerable populations, provide illness care, and prevent acute illness while delivering care that is safe and high in quality. DIF: Cognitive Level: Application REF: Pages 27-28
21 A nurse in community health has determined that there is a need for a program for teenage fathers who want to learn about child care. The next step in the program management process would be to: A. conduct a survey to determine how many children the fathers have. B. determine whether the fathers have benefited from this type of program before. C. meet with community members to form a planning body. D. provide the fathers with community resources.
C. meet with community members to form a planning body. The program management process is like the nursing process. Program management consists of assessing, planning, implementing, and evaluating a program. One is applied to a program, whereas the other is applied to clients. Following the assessment, planning for the program should occur. DIF: Cognitive Level: Application REF: Page 276
11 A community health nurse involved in care management would most likely: A. develop, conduct, and evaluate health teaching programs in primary care. B. manage the staff at a free clinic. C. monitor the health status, resources, and outcomes for an aggregate. D. provide immunizations to migrant workers.
C. monitor the health status, resources, and outcomes for an aggregate. Care management is an enduring process in which a care manager establishes systems and monitors the health status, resources, and outcomes for an aggregate or a targeted segment of the population or a group. Care management strategies include use management, critical paths, disease management, demand management, and case management. DIF: Cognitive Level: Knowledge REF: Page 233
14 In 1902 Lillian Wald introduced the concept of school nursing to address the problem of student absenteeism by: A. enforcing the Department of Health's rules and regulations. B. excluding infectious children from the school environment. C. providing and obtaining medical treatment for absent students. D. providing shoes and clothing for absent students.
C. providing and obtaining medical treatment for absent students. In New York City in 1897, school medical examination focused on excluding infectious children from school. By 1902, more than 20% of children might be absent from school on any given day because no one was focused on providing or obtaining medical treatment so that absent children could return to school. Lillian Wald introduced an English innovation by providing nurses for schools. The first school nurses made home visits to teach parents and provide follow-up care to children absent from schools. DIF: Cognitive Level: Knowledge REF: Page 19
20 A nurse performing home hospice case management notes the increasing number of hospice clients that lack caregivers in the home environment. The nurse identifies the potential need for a hospice house facility to meet the needs of these clients. The case management process frequently reveals such larger picture issues as: (select all that apply) A. Community cost concerns B. Community conflict-resolution skills C. Community satisfaction D. Community weaknesses in quality of services E. Community weaknesses in quantity of services
D. Community weaknesses in quality of services E. Community weaknesses in quantity of services Case management activities with individual clients and families will reveal the larger picture of health services and health status of a community. Through a nurse's case management activities, general community weaknesses in quality and quantity of services often are discovered. DIF: Cognitive Level: Application REF: Page 234
23 A 3-year smoking cessation program for teens has just concluded. The type of evaluation the staff will conduct is: A. a formative evaluation. B. an informal evaluation. C. an ongoing evaluation. D. a summative evaluation.
D. a summative evaluation. Summative evaluations assess program outcomes or are a follow-up of the results of the program activities and look at the end result. Formative evaluations are used to evaluate the progress of a program. An evaluation of program effectiveness may help the nurse evaluator determine both client and provider satisfaction with the program activities, as well as whether the program met its stated objectives. DIF: Cognitive Level: Application REF: Pages 284-285
14 A case manager is concerned that some of the clients at the neighborhood clinic are getting fewer services because of their financial situations. The case manager is confronting the ethical principle of: A. justice. B. veracity. C. deontology. D. beneficence.
D. beneficence. Beneficence can be influenced when excessive attention to cost supersedes or impairs the nurse's duty to provide measures to improve health or relieve suffering. Justice, as an ethical principle for case managers, considers equal distribution of health care with reasonable quality. Veracity, or truth telling, is absolutely necessary to the practice of advocacy and building a trusting relationship with a client. Deontology is not an ethical principle that applies to this situation. DIF: Cognitive Level: Application REF: Page 245
4 A Hispanic outreach program works with the nurse in community health to train Hispanic health care workers in providing basic services and education within the local Hispanic community. The concept basic to community-oriented nursing practice that is best described by this intervention is: A. community. B. community client. C. community health. D. community partnerships.
D. community partnerships. Community partnership is necessary because when there is community partnership lay community members have a vested interest in the success of efforts to improve the health of their community. Most changes must aim at improving community health through active partnerships between community residents and health workers from a variety of disciplines. Partnership, as defined here, is a concept that is as essential for nurses to know and use as are the concepts of community, community as client, and community health. DIF: Cognitive Level: Application REF: Pages 215-216
22 The nurse in community health is meeting with staff to systematically plan for a new outreach program. Doing so helps them to: A. assess the needs of potential outreach clients. B. recognize the special needs of vulnerable people in the area. C. identify how the problems of similar programs will not be repeated. D. identify the resources and activities that will help them meet their program objectives.
D. identify the resources and activities that will help them meet their program objectives. Systematic planning for meeting client needs assists in identifying the resources and activities that are needed to meet the objectives of client services. Today this type of planning is referred to as strategic planning and it involves the successful matching of client needs with specific provider strengths and competencies and agency resources. DIF: Cognitive Level: Application REF: Page 277
16 A nurse working with a Hispanic client explains the referral options available for the client to receive a mammogram. One option is free and has limited Spanish language resources. The other option has a nominal fee and comprehensive Spanish language resources. The nurse supports the client's decision to choose the provider that the client feels would best meet her needs. This advocacy role is best described as: A. intercessor. B. mediator. C. obstructer. D. promoter.
D. promoter. The nurse advocate makes the client's rights the priority. The goal of promoter for the client's autonomy and self-determination may result in a high degree of client independence in decision making. Mediation is an activity in which a third party attempts to provide assistance to those who may be experiencing a conflict in obtaining what they desire. The nurse advocate does not exhibit roles of intercessor or obstructer in this situation. DIF: Cognitive Level: Application REF: Page 239
3 The nurse in community health reviews the monthly and year-to-date health service use report for the local community to monitor trends as correlates of the community's health. The nurse is viewing community health through the dimension of: A. partnership. B. process. C. status. D. structure.
D. structure. Community health has three dimensions: status, structure, and process. The dimension of structure would define the community's health in terms of community characteristics such as services and resources. Community health in terms of status, or outcome, is the most well-known and accepted approach; it involves biological, emotional, and social parts. The view of community health as the process of effective community functioning or problem solving is well established. In population-centered practice, the nurse and community seek healthful change together. DIF: Cognitive Level: Application REF: Page 215
26 A nurse in community health becomes aware that a teen smoking cessation program offered at the health department is a demonstration project. In evaluating this program, the nurse would be concerned with the program's: A. efficiency. B. impact. C. relevance. D. sustainability.
D. sustainability. A program can be continued if there are resources for it. Programs funded as a demonstration project or through outside sources require ongoing funding to survive after the initial funding or timeframe for the demonstration project has ended. If the reason for the evaluation is to examine the efficiency of a program, it may occur on an ongoing basis as a formative evaluation. If the evaluation of impact is the goal, long-term effects such as changes in morbidity and mortality must be investigated. Evaluation of relevance is an important component of the initial planning phase. As money, providers, facilities, and supplies for delivering health care services are more closely monitored, the needs assessment done by the nurse will determine whether the program is needed. DIF: Cognitive Level: Application REF: Page 285
8 In a community clinic that screens and treats individuals for cardiovascular disorders, the nurse practicing public health/population-focused nursing would most likely ascertain: A. a holistic treatment plan. B. a specific clinical diagnosis. C. individual dietary interventions for cardiovascular disorders. D. the prevalence rate of cardiovascular disorders among various groups.
D. the prevalence rate of cardiovascular disorders among various groups. A public health nurse in a community clinic engaged in population-focused practice would ask the following questions: · What is the prevalence rate of the diagnosis or condition among various age, race, and gender groups? · Which subpopulations have the highest rates of untreated diagnosis or condition? · What programs could reduce the problem of untreated diagnosis/condition and decrease the risk for further morbidity and mortality? Public health nurses are typically concerned with more than one subpopulation, and they often deal with the health of the entire community. Assessment, one of the public health core functions, is a logical first step in examining a community setting to determine its health status. DIF: Cognitive Level: Knowledge REF: Pages 7-8
6 Two nurses in community health schedule a day to ride through a low-income community to better understand the community and its boundaries, trends, rhythm, stability, and changes that can affect the health of that community. This direct data collection method is often referred to as: A. composite database. B. participant observation. C. secondary analysis. D. windshield survey.
D. windshield survey. Five useful methods of data collection are informant interviews, participation observation, windshield survey, secondary analysis of existing data, and surveys. Windshield surveys are the motorized equivalent of simple observation. While driving a car or riding public transportation, the nurse can observe many dimensions of a community's life and environment through the windshield. A basic method is participant observation, the deliberate sharing, if conditions permit, in the life of a community. In secondary analysis, the nurse uses previously gathered data, such as minutes from community meetings. DIF: Cognitive Level: Application REF: Page 220
Jennifer is a nurse in a family medicine clinic. Today she is assessing Jose, a 4-year-old who is being seen for an earache. The type of nursing Jennifer practices is: A. community-oriented nursing. B. community-based nursing. C. public health nursing. D. tertiary health nursing. B. community-based nursing.
In community-based nursing, the nurse focuses on "illness care" of individuals and families across the life span. The aim is to manage acute and chronic health conditions in the community, and the practice is family-centered illness care. Community-based nursing is not a specialty in nursing but, rather, a philosophy that guides care in all nursing specialties. Community-oriented nursing has as its primary focus the health care either of the community or populations as in public health nursing (PHN) or of individuals, families, and groups in a community. DIF: Cognitive Level: Knowledge REF: Page 2
3 The nurse has just taught a client newly diagnosed with diabetes how to administer sliding-scale insulin. The most effective way to evaluate learning is to: a. provide an online test module. b. ask whether there are any questions. c. ask for a return demonstration. d. give a short paper-and-pencil quiz.
c. ask for a return demonstration. Evaluation is important in the educational process and the nursing process. You will need to evaluate the educator, the process, and the product. Feedback to the educator provides the educator an opportunity to modify the teaching process and to better meet the learner's needs. The educator may ask for verbal feedback, as well as get nonverbal feedback by using return demonstrations to see what learners have mastered and by observing facial expressions when feedback is being given. DIF: Cognitive Level: Application REF: Page 201
