Chapter 1: Responsibilities for Care in Community/Public Health Nursing

10. How would the actions of the community/public health nurse caring for a recently discharged client in his home differ from those of the acute care nurse? a. The community/public health nurse would assess the health and needs of all the family members. b. The community/public health nurse would be careful to be nonjudgmental about the family's living situation. c. The community/public health nurse would explain why each nursing intervention was being performed. d. The community/public health nurse would help the family understand the basis for the treatment.

ANS: A Although both nurses would give excellent care to the individual client, the acute care nurse would assess the client individually and adapt interventions accordingly. The community/public health nurse would seek to identify others in the family who might need intervention or referral as well. The community/public health nurse provides care from a family-focused model, being concerned not only with the health of the identified client but also with the health of other family members. DIF: Cognitive Level: Application REF: p. 13

15. A community/public health nurse may ignore an individual's wishes in which of the following circumstances? a. Caring for a client with tuberculosis who refuses treatment b. Educating a client who adds salt to food while following a cardiac diet c. Discovering that a client drinks wine before dinner every night d. Finding evidence that the client may be smoking marijuana

ANS: A Many states require treatment for patients whose diseases are contagious to persons around them. The other choices are unfortunate, but patients have the right to choose their lifestyle behaviors, and nurses are not police officers. DIF: Cognitive Level: Application REF: p. 17

17. Why is it necessary for public health nurses to attend community health planning meetings? a. To network with other community groups b. To protect the health of special interest groups c. To coordinate case management efforts d. To seek advice from others in the community

ANS: A Nurses must establish and maintain relationships with professionals in other agencies and create partnerships to address community problems. Through networking with other community groups, nurses may be able to improve the health of special interest groups and improve case management services. The purpose of community health planning meetings is not to receive advice from others. However, the increased networking may help nurses solve problems that they may be encountering. DIF: Cognitive Level: Application REF: p. 20

2. The only clear distinction between a community health nurse and a public health nurse is that a. The community health nurse gives care in community settings regardless of personal education, whereas public health nurses have specific educational preparation. b. Community health nurse is a title that has historically been used, whereas public health nurse is the new "in" title for the role. c. The community health nurse is employed to give care to families and groups, whereas the public health nurse works in public health departments. d. Community health nurse is the broader term that includes public health nursing, school nursing, and home health nursing.

ANS: A Public health nurses synthesize all their nursing expertise, as well as knowledge, from public health, whereas nurses with varied educational backgrounds may be employed in community settings. DIF: Cognitive Level: Knowledge REF: p. 3

2. What is the value of nurses' discussions of their vision for the health of the community? (Select all that apply.) a. Other persons are assisted in seeking possibilities that they may not have considered. b. Other persons are encouraged to become partners in a specific project. c. Other persons are forced to think about health issues and nurses' power. d. Other persons are coerced to become partners in the nurse's dream. e. Attention is drawn away from issues pushed by other professions. f. The vision becomes a source of energy and motivation for everyone involved in the discussion.

ANS: A, B, F Discussing the vision empowers nurses and helps them remember why they became nurses. It also allows other persons to become involved and to recognize new possibilities. Expressing the vision provides an opportunity for other persons to become partners in working for potential outcomes: not only the broader vision but also in relation to specific projects. Nurses do not force or coerce other persons, and they often work with members of other professions on issues related to health. DIF: Cognitive Level: Comprehension REF: p. 25

4. The nurse was caring for several single teenage mothers who desperately needed supplies such as diapers and cribs, but no resource in the community provided these specific items. Which of the following actions would be most helpful? (Select all that apply.) a. Asking churches and other community charities to donate such supplies b. Asking the local hospital to not bill the mothers for labor and delivery costs c. Empowering the mothers by helping them form a self-help group to share resources d. Engaging the community in recognizing the problem and implementing changes e. Holding fundraisers to give cash to the mothers to purchase such supplies f. Teaching a sex education course in all the schools for prepubescent students

ANS: A, C, D The immediate short-term need can be met by asking community resources such as churches to donate supplies. The young women themselves can be empowered by forming a group to share resources and pass them on to others when equipment (e.g., cribs) is no longer needed. However, in the long term, the community itself must recognize the problem and decide what actions might be appropriate. In a similar manner, in the long term, younger students need education on how to avoid the risks of early pregnancy. DIF: Cognitive Level: Synthesis REF: p. 11

1. Which commitments are unique to community/public health nursing? (Select all that apply.) a. Advocacy for equitable distribution of health care b. Care of ill, disabled, and suffering persons c. Political action for a healthful physical environment d. Promotion of self-responsibility or self-care in relation to health e. Focus on a standard of living that supports health for all f. Support for human growth and development throughout the life span

ANS: A, C, E All nurses care for the ill, support human growth and development, and promote self-responsibility or self-care. Community/public health nurses promote equitable distribution of health care, a healthful physical environment, and a basic standard of living that supports the health and well-being of all persons. DIF: Cognitive Level: Comprehension REF: p. 25

21. Which action by home health nurses is crucial because of current national health care goals? a. Administer medications and treatments correctly and safely. b. Document the savings and benefits of home care services. c. Guide a group to an appropriate resource to best meet their needs. d. Teach an ill person's family how to promote self-care.

ANS: B Because cost containment in health care continues to be a national goal, it is important for community/public health nurses to continue to document the cost of nursing care and the savings that nursing care can provide (Deal, 1994). Home care expanded because nurses demonstrated that quality care can be provided for some clients in the home at a lower cost than in the hospital. DIF: Cognitive Level: Application REF: p. 21

12. What is the nurse's most appropriate action when it becomes apparent that another agency is needed to help a family best meet their health needs? a. Call the other agency to set up care for the family. b. Give the family information to initiate contact with the other agency. c. Report the need to the community/public health nurse's supervisor for action. d. Write a letter to the appropriate agency suggesting that it contact the family.

ANS: B Nurses usually encourage clients to initiate contact as one way of maintaining responsibility for their own care without encouraging dependency. Nurses work with clients with a specific difficulty or barrier, such as language, in a way that empowers them to follow up on the referral. DIF: Cognitive Level: Application REF: p. 15

19. What underlying values should be a part of a healthy community? a. Responsibility and respect b. Connectedness and caring c. Stability and safety d. Marketability and security

ANS: B The World Health Organization (WHO) points out that values underlying health for a community include equity, empowerment, and cooperation. As a balance to some of the values of efficiency, materialism, and hierarchic power structures, nurses are speaking for connectedness and caring. DIF: Cognitive Level: Comprehension REF: p. 19

6. In which situation would the community/public health nurse be applying the ethical principle of doing good for the greatest number of persons with the least amount of harm? a. Asking the agency supervisor how to approach an ethical dilemma b. Focusing on providing basic services for everyone in the community c. Following agency policies d. Delivering care to families who have health insurance

ANS: B To provide for the greatest good to the greatest number, it is often necessary to focus on basic services, such as immunization or prenatal care, because such care has the most effect on the whole community. DIF: Cognitive Level: Application REF: p. 10

6. Which nursing actions would help ensure a healthful environment? (Select all that apply.) a. Help an elderly couple obtain access to a health clinic that will accept Medicare. b. Help parents fight to get soda and candy vending machines out of the school. c. Help the high school student government establish a waste recycling program. d. Refer a single mother to a public assistance program. e. Recognize that individuals have a right to smoke if they so desire. f. Support members of Mothers Against Drunk Driving who testify to Congress.

ANS: B, C, F While all the options would be excellent interventions, finding a source of medical care or referring a single mother to a public assistance program, even recognizing the right to autonomy, does not change the environment. Improving the environment by having only healthy choices available, establishing waste recycling, and helping get drunk drivers off the road makes the world safer for everyone. DIF: Cognitive Level: Synthesis REF: p. 12

5. What would a new baccalaureate-prepared community/public health nurse be expected to do to improve personal competency and quality of care? (Select all that apply.) a. Apply the nursing process to a large aggregate. b. Be actively involved in peer review. c. Provide the best possible care to individuals and families. d. Participate in relevant continuing education programs. e. Integrate relevant research findings for evidence-based practice. f. Systematically evaluate personal professional practice performance.

ANS: B, D, E, F Performing tasks such as applying the nursing process or providing the best care possible is not maintaining competence. Competency is maintained by ongoing professional development such as attending educational programs, becoming involved in peer review, reading and integrating relevant research findings, and continually evaluating one's personal practice. DIF: Cognitive Level: Application REF: p. 6

13. A young man has repeatedly visited the sexually transmitted disease (STD) clinic for human immunodeficiency virus (HIV) testing. What should the nurse do in addition to completing the testing? a. Determine whether the young man is heterosexual or homosexual. b. Emphasize repeatedly the importance of abstinence. c. Discuss his perceived barriers to practicing safe sexual behaviors. d. Teach the importance of using protection for engaging in sexual acts.

ANS: C Because the young man has presumably been taught the advantages of abstinence or protection for engaging in sex, and yet continues to return for further testing, it is clear that information alone has not changed his behavior. Therefore, the nurse should interview the client about his values and help him perceive how reducing his risks may help him achieve his goals. DIF: Cognitive Level: Application REF: pp. 15-16

22. Which nursing activity is unique to community/public health nurses? a. Care for the sick and dying b. Commitment to promote health of individuals and families c. Focus on vulnerable groups in the community d. Provide holistic care to clients in the presence of their families

ANS: C Beliefs of the nursing profession in general are to care for the sick and dying, promote the health of individuals and families, and provide holistic care to clients. One difference between community/public health nurses and other nurses is that they pay special attention to vulnerable and at-risk populations, especially elderly persons; infants; and disabled, ill, and poor persons. DIF: Cognitive Level: Knowledge REF: p. 21

4. What is the meaning of the term aggregate as used in community health? a. A group of persons who reside in a specific geographic area b. All the persons who live in a specific community c. A set of persons who have some characteristic in common d. "The public" in professional terminology

ANS: C By definition, an aggregate is a group of persons who have one or more characteristics in common, particularly a set of persons under statistical study with some common personal or environmental characteristic. Aggregate is a synonym for population. DIF: Cognitive Level: Knowledge REF: p. 5

16. How might case management be defined? a. An incident that necessitates intervention b. A synonym for cost containment c. Developing and coordinating a plan of care for a client d. Advocating for groups of clients who have a specific illness

ANS: C Case management is defined as the development and coordination of a plan of care for a selected client. DIF: Cognitive Level: Knowledge REF: p. 17

20. What is the significance of the credentials APHN, BC? a. A special professional development program for community/public health nurses b. A special title given to nurses who join the American Nurses Association c. A voluntary process that demonstrates knowledge, education, and experience d. A title given to a nurse who has a special master's degree

ANS: C Certification is a voluntary process that validates an individual registered nurse's qualifications in a specified area of nursing. A community health nurse who completes educational preparation in community health or public health at the graduate level may choose to seek certification in this specialty area. After passing the certification exam, the credentials APHN, BC may be used. DIF: Cognitive Level: Comprehension REF: p. 20

18. Why would a nurse choose to be an active member of several professional associations? a. To be able to spend time with friends and colleagues b. To be part to the organization's annual convention/conference c. To be part of the decision-making and political action activities d. To be able to have professional development opportunities

ANS: C Community/public health nurses obtain membership in decision-making groups as another way to increase their influence and contribute to health planning. DIF: Cognitive Level: Comprehension REF: p. 18

11. When a community/public health nurse cannot meet a need of the client, it is most appropriate for the nurse to a. Encourage the client to pay someone to meet that need. b. Inform the client that insurance will not pay for the care. c. Refer the client to a person or agency that may be able to provide assistance. d. Suggest that the client discuss the need with the physician.

ANS: C Referral or directing someone to another source of assistance is an appropriate response when the nurse cannot fulfill the need. DIF: Cognitive Level: Application REF: p. 14

23. Which ethical principle might be difficult for the community/public health nurse to implement? a. Nonmaleficence b. Beneficence c. Justice d. Respect for autonomy

ANS: C The ethical principle of justice is defined as treating all people fairly. One way that community/public health nurses would exhibit justice is by providing nursing services to all, regardless of their ability to pay. Community/public health nurses can give care only within the limitations of third-party payer requirements. A difficulty for community/public health nurses is coping with the disparities in our current health care system. DIF: Cognitive Level: Analysis REF: pp. 20-21

5. What is the appropriate approach for the community/public health nurse in balancing individual privacy and autonomy and the community's needs for safety and security? a. Fulfill agency policies first. b. Implement professional standards of nursing practice. c. Seek a balance between individuals' needs and the community's needs. d. Remember that group needs outrank individual needs.

ANS: C While the nurse's practice should be consistent with employing agency policies, legal mandates, and professional standards, the nurse must seek a balance between individual autonomy and other individual rights and the rights of all other community members. It is a delicate balance. DIF: Cognitive Level: Knowledge REF: p. 7

3. Which interventions are most commonly used by community/public health nurses caring for families? (Select all that apply.) a. Administering screening tools to all family members b. Applying the nursing process to the care of individuals c. Collaborating and coordinating referrals as needed d. Providing health teaching, including anticipatory guidance e. Participating in collecting data on clients for clinical research f. Resolving conflict among family members

ANS: C, D The predominant intervention strategies used with families are primary care, health teaching (including anticipatory guidance), referral, and collaborating and coordinating care. Screening can be performed by various nurses, as can care of individuals. Nurses probably cannot resolve conflict, although they may help family members cope with conflict. Collecting data for research can be done only with a client's permission. DIF: Cognitive Level: Application REF: p. 26

7. When faced with an ethical conflict about limited resources and unlimited need, which action is the most just? a. Giving care to clients whose needs most closely match the nurse's abilities b. Giving care to whichever prospective clients ask for care first c. Working as hard as possible and not worrying about it d. Trying to achieve the outcome of the greatest good for the greatest number of persons

ANS: D Although option B fulfills the criteria of egalitarian (equal) justice, it is a short-term answer to an ongoing problem. Trying to achieve the outcome of the greatest good for the greatest number of persons is a utilitarian approach to justice, which is more helpful in dealing with large populations such as clients seen by the community/public health nurse. DIF: Cognitive Level: Synthesis REF: p. 12

3. When the nurse is caring for a family or a community, it is important that the nurse provide care that is a. Similar to that described in the textbook or procedure manual b. Consistent with agency policies c. Inexpensive d. Culturally congruent

ANS: D Although the nurse should provide care in all the ways described, for recipients to accept the care, the care must be consistent with their cultural expectations and norms. DIF: Cognitive Level: Application REF: p. 4

9. How does a community/public health nurse provide indirect care to clients in homes, clinics, senior citizen centers, schools, prisons, homeless shelters, and other living environments? a. Being employed in community settings such as outpatient clinics b. Providing anticipatory guidance and health promotion activities to community members c. Providing care in mobile vans to citizens in their own neighborhoods d. Being involved on a political action committee to create new client services

ANS: D Nurses give care directly, as in all the answers given, but provide care indirectly by trying to promote health and well-being through creating new resources, improving the environment, or using social and political mechanisms for solving problems. DIF: Cognitive Level: Application REF: p. 13

8. Which document is helpful in describing competent and appropriate nursing care in the community? a. Community Health: Standards of Nursing b. Healthy People 2020 c. The Joint Commission: The Comprehensive Accreditation Manual d. Public Health Nursing: Scope and Standards of Practice

ANS: D The document Public Health Nursing: Scope and Standards of Practice (2007) was developed in concert with the steps of the nursing process to help nurses promote the health of persons. Healthy People 2020 focuses on achieving health goals for persons living in the United States. The Joint Commission Manual is used by organizations pursuing accreditation from this organization. There is no such document as Community Health: Standards of Nursing. DIF: Cognitive Level: Knowledge REF: p. 12

1. A community/public health nurse is best defined as a nurse who a. Applies concepts and knowledge from nursing and public health. b. Gives care to families in the community. c. Has a baccalaureate and previous experience in community health. d. Is employed outside of an acute care setting.

ANS: D The term community health nursing is an umbrella term used for all nurses who work in a community. This term denotes the setting of practice for the nurse. DIF: Cognitive Level: Knowledge REF: p. 3

14. A nurse includes well-being in her definition of health. What will the focus be when the nurse provides care to a family confronting the imminent death of a family member? a. Sharing the nurse's knowledge of the physiology behind the client's symptoms and the appropriate interventions for comfort b. Administering pain medication so that the client can be kept comfortable c. Reinforcing the need for the whole family to adapt to the impending death d. Discussing the perceived meaning of life with the family

ANS: D Well-being requires learning to create meaning and a sense of belonging in life while recognizing that control (i.e., preventing the death) is not always possible. DIF: Cognitive Level: Application REF: pp. 15-17