Public Health Nursing Ch 18
A nurse schedules an appointment with a physician who has a practice in the community to learn more about the community's beliefs regarding childhood immunizations. Which of the following is being demonstrated? a. Informant interview b. Participant observation c. Active participation d. Windshield survey
ANS: A An informant interview is a method of community data collection that involves directed conversation with selected community members. Participant observation refers to the deliberate sharing in the life of a community, such as participating in a local fair or festival, or attending a political or social event. Active partnerships are those in which all participants share leadership and decision making to some degree. Windshield surveys are a method of simple observation, providing a quick overview of a community. DIF: Cognitive level: Applying REF: p. 404 TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care
Change for the community as a client must often occur at several levels because: a. health problems caused by lifestyle are multidimensional. b. most individuals can change their habits alone. c. aggregates are responsible for social change. d. geographic areas often have health risks that the nurse must identify.
ANS: A Because health problems caused by lifestyle cannot be solved simply by asking individuals to choose healthy habits, change for the community client must often take place at several levels. Society must also be involved in the change by supporting individual choices. There may be certain geographic areas that have higher health risks than others, but this does not explain why care must occur at several levels. DIF: Cognitive level: Understanding REF: p. 398 TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care
A leader of a support group introduces a nurse to its members and discusses the professional relationship he has with the nurse for the past several years. Which of the functions is the leader performing? a. Gatekeeper b. Insider c. Community health workers d. Advocate
ANS: A Gatekeepers refer to formal or informal community leaders who create opportunities for nurses to meet diverse members of the community. Insiders are those who grew up in the community, have personal ties to the people there or comes from a similar cultural or ethnic background. Community health workers are not professional or licensed health care providers but are community members from diverse backgrounds who receive training to do health outreach work. An advocate is someone who speaks up for and supports the needs of the community. DIF: Cognitive level: Applying REF: p. 401 TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care
A nurse is completing a community assessment. Which of the following actions would be most likely for the nurse to complete? a. Identify community needs and clarify problems b. Determine the weaknesses of a community c. Perform the core functions of public health nursing d. Assess individual needs within a community
ANS: A In a community assessment, one of the core functions is a logical, systematic approach to identifying community needs, clarifying problems, and identifying community strengths and resources. The focus of the community assessment is on the needs of the community, not on individuals. The core functions of public health nursing are not all used during the community assessment process. The community assessment should identify both the strengths and weaknesses of the community. DIF: Cognitive level: Applying REF: p. 397 TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care
A nurse analyzes data from minutes at a community meeting when completing a community assessment. Which of the following methods of data collection is being used? a. Secondary data b. Informant interviews c. Primary data d. Windshield survey
ANS: A Secondary sources include published data about the community. The data is secondary because it is collected by someone else. An informant interview is a method of community data collection that involves directed conversation with selected community members. Primary data includes using informant interviews, focus groups, and participant observation in order to collect information about a community. Windshield surveys are a method of simple observation, providing a quick overview of a community. DIF: Cognitive level: Applying REF: p. 401 TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care
A nurse has identified the boundaries of the community. Which of the following steps should the nurse take next when completing a community assessment? a. Gather relevant existing data and generating missing data b. Plan interventions that benefit the entire community c. Formulate nursing diagnoses d. Evaluate the interventions that were used
ANS: A The first step of the community assessment is to define the community. In order to do this, geographic boundaries, the population within the boundaries, the purpose of the assessment, and a data collection plan will be identified. Those inhabiting the community are a primary focus of the assessment. A variety of strategies are used to identify this central core of the community. The next step involves gathering and generating data to learn more about the community. After the community has been completely assessed then nursing diagnoses can be formulated, interventions planned, and finally interventions evaluated. DIF: Cognitive level: Applying REF: pp. 408-411 TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care
The main characteristics of partnership are: a. awareness, flexibility, and distribution of power. b. rights, responsibilities, and consensus. c. commitment, participation, and articulation. d. collaboration, advocacy, and utility.
ANS: A The main characteristics of partnership are awareness, flexibility, and negotiated distribution of power. Rights, responsibilities, and consensus are not the main characteristics of partnership. Commitment, participation, and articulation are not the main characteristics of partnership. Collaboration, advocacy, and utility are not the main characteristics of partnership. DIF: Cognitive level: Understanding REF: p. 400 (Box 18-1) TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care
A nurse is caring for the community as the client. Which of the following is most likely the focus of the nurse's care? a. Providing care for aggregates living in the community b. The collective good of the population c. The provision of care for families in the home setting d. Providing health education in the community
ANS: B The community is considered the client when the nursing focus is on the collective good of the population. Providing education is one way the nurse can care for the community as the client; however, the focus of nursing care is larger in scope than only education. Provision of care for aggregates and families does not address the larger scope of community as client. DIF: Cognitive level: Applying REF: p. 398 TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care
A nurse focuses intervention strategies on the structural dimension of community health. Which of the following best describes the focus of these strategies? a. Health services b. Primary prevention c. Health promotion d. Secondary prevention
ANS: A The structure of the community is defined in terms of services and resources. The subsystems of community structure consist of physical environment, health and social services, economy, transportation and safety, politics and government, communication, education, and recreation. Secondary prevention focuses on early detection and prompt treatment of disease, injury, or disability. Primary prevention attempts to promote health and provide specific protection from disease. Health promotion activities are interventions focused on improving one's health. DIF: Cognitive level: Applying REF: p. 407 TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care
A nurse is defining the community as part of the community assessment process. Which of the following best describes how the community may be defined? (Select all that apply.) a. Social group determined by geographic boundaries b. Group of people who share common values and interests c. Group of people defined by their interactions d. Individual with a specific health concern e. Individuals with certain interests
ANS: A, B, C Community can be defined as many things, including a social group determined by geographical boundaries, a group of people who share common values and interests, and a group of people defined by their interactions. Individuals comprise a community, but would not be an accurate definition of a community. DIF: Cognitive level: Applying REF: p. 398 TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care
A community has residents who provide information to the city council so that decisions can be made about the health of the community. Which of the following characteristics is being displayed? a. Active partnerships b. Passive partnerships c. Gatekeeping d. Focus groups
ANS: B Coalitions are active partnerships in which all participants share leadership and decision making to some degree. Unfortunately, some community health efforts view community residents only as sources of information and receivers of interventions; this limits residents to passive participation. Gatekeepers refer to formal or informal community leaders who create opportunities for nurses to meet diverse members of the community. A focus group is similar to an interview in that it collects data mainly through asking open-ended questions to participants but to a small group rather than an individual. DIF: Cognitive level: Applying REF: p. 400 TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care
A nurse is engaging in the evaluation phase of community health program planning. Which of the following would be part of effective completion of this phase? a. Demonstrate the ability to improve the health of the participants b. Develop measureable objectives and goals before implementation c. Encourage full participation by community members d. Improve the health of the population through the program
ANS: B 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 meeting of objectives and effects of the intervening activities have to be assessed. Participation by community members and improvement of the health of the population may be measured through the evaluation phase, but would not demonstrate completion of this phase. The evaluation phase may determine if the participants' health improved, but improvement of health is not part of the completion of this phase. DIF: Cognitive level: Analyzing REF: p. 419 TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care
A nurse is using health status indicators to complete a community assessment. Which of the following best explains what the nurse is doing? a. Interviewing key informants in the community b. Examining morbidity and mortality rates in the community c. Surveying local businesses in the community d. Observing community members
ANS: B Health indicators are numerical measures of health outcomes, such as morbidity and mortality, as well as determinants of health and population characteristics. Generally, these data are from secondary sources such as websites or printed materials. Interviewing key informants, surveying local businesses, and making observations are all methods of primary data collection. DIF: Cognitive level: Analyzing REF: pp. 403-404 TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care
A community health nurse is conducting informant interviews in a small community. Which of the following would the nurse most likely contact? a. The state department of health for death records b. A local priest for congregation information c. Surrounding communities for crime comparison d. The Centers for Disease Control and Prevention (CDC) for illnesses in the area
ANS: B Informant interviews are methods of directly collecting data. County health department nurses and church officials are often good key informants. Key informants need not hold any formal title, but are generally viewed as community leaders by other community members and often have a long history in the community. The state department of health, surrounding communities, and CDC do not meet the definition of an informant. DIF: Cognitive level: Applying REF: p. 404 TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care
A nurse collects data about seat belt usage by interviewing key informants and observing behaviors in the community. Which of the following types of data is being collected? a. Quantitative b. Qualitative c. Focus groups d. Participant observation
ANS: B Qualitative data is collected through interviews and observation. This data is the descriptions provided by these individuals through interviews. Quantitative data is the numbers that can be found about the community, such as crime statistics. A focus group is similar to an interview in that it collects data mainly through asking open-ended questions to participants, but to a small group rather than an individual. Participant observation refers to the deliberate sharing in the life of a community, such as participating in a local fair or festival, or attending a political or social event. DIF: Cognitive level: Applying REF: p. 412 TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care
A nurse has collected data about the services available in the community and is using the seven "A"s to evaluate these services. Which of the following questions will the nurse most likely ask? a. Can the community members allocate resources to support the service? b. Can the community members afford the service? c. Will the community members allow strategies to be implemented to improve the service? d. Will the community members approve of the services provided?
ANS: B The seven "A"s include: Is the community aware of its needs and of the service? Is it accessible to community members? Is the service available when the community needs it? Can the community members afford the service? Does the community find the service acceptable? Is the service adequate to meet the needs of the community? And, are the services appropriate to meet the needs of the community? The following questions do not address the seven "A"s: Can the community members allocate resources to support the service? Will the community members allow strategies to be implemented to improve the service? And, will the community members approve of the services provided? DIF: Cognitive level: Applying REF: p. 414 (Box 18-4) TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care
A nurse is writing a nursing diagnosis at the community level using the North American Nursing Diagnosis Association (NANDA) system as a guide. Which of the following diagnoses would most likely be developed? a. Risk of hypertension related to poor diet and sedentary lifestyle b. Risk of obesity among school-age children related to lack of opportunities to engage in physical activity c. Risk of ineffective health maintenance among individuals who do not have access to a primary care provider d. Ineffective coping related to multiple stressors, as evidenced by client crying and stating she has no support system
ANS: B There are three parts of the NANDA system: (1) identification of the problem or potential problem; (2) its relation to factors, stressors, or health issues; and (3) supporting data that documents the problem. The "risk of" identifies a specific problem or health risk faced by the community. "Among" identifies the specific community client with whom the nurse will be working in relation to the identified problem or risk. "Related to" describes characteristics of the community. DIF: Cognitive level: Analyzing REF: p. 418 TOP: Nursing process: Diagnosis MSC: NCLEX: Safe and Effective Care Environment: Management of Care
A nurse centers his practice around the principle of doing the greatest good for the greatest number. Which of the following ethical principles is being applied? a. Distributive justice b. Utilitarianism c. Social justice d. Health disparities
ANS: B Utilitarianism means doing the greatest good for the greatest number. Distributive justice means treating people fairly, and distributing resources and burdens equitably among the members of a society. Social justice means ensuring that vulnerable groups are included in the equitable distribution of resources. Health disparities are the inequalities that exist among different populations. DIF: Cognitive level: Applying REF: p. 399 TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care
A nurse gathers information about the condition of homes, size of lots, neighborhood hangouts, road conditions, and modes of transportation. Which method of data collection is being used? a. Participant observation b. Windshield survey c. Focus group d. Informant interviews
ANS: B Windshield surveys are a method of simple observation, providing a quick overview of a community. By making observations of the community, the nurse is completing a windshield survey. Participant observation refers to the deliberate sharing in the life of a community, such as participating in a local fair or festival, or attending a political or social event. A focus group is similar to an interview in that it collects data mainly through asking open-ended questions to participants, but to a small group rather than an individual. An informant interview is a method of community data collection that involves directed conversation with selected community members. DIF: Cognitive level: Applying REF: p. 408 TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care
A nurse is assessing the safety in the community using primary data. Which of the following data would be useful for the nurse to collect? (Select all that apply.) a. Number of billboards in the area b. Interviews with health care providers who are familiar with the community c. Observation of community members d. Nurse's own observations e. Morbidity and mortality rates
ANS: B, C, D Other nurses, social workers, health care providers, community members, and the nurse's own observations are reliable sources of information about the safety of an area. The number of billboards would not be important data to collect when assessing for safety in the community. Morbidity and mortality rates would be considered secondary data. DIF: Cognitive level: Applying REF: p. 404 TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care
A nurse lives in a community that demonstrates commitment. Which of the following would most likely be supported within this community? a. Creation of a community club by the city council to facilitate community involvement b. Collaboration among area restaurant owners to develop healthier menus c. Collaboration with the health department to build a new recreation center d. Development of a cooperative agreement with a neighboring city to share needed services
ANS: C Commitment to the health of the community requires a process of change at each appropriate level on the continuum. The most successful change processes often arise from collaborative practice models that involve the community and nurses in joint decision making. Participants must see themselves as part of a group effort and share in the process, beginning with planning and including decision making. Collaboration by restaurant owners to develop healthier menus only addresses one population of the community and does not show involvement by nurses and the larger community. Creation of a community club by the city council does not engage the larger community in this decision. Developing a cooperative agreement with a neighboring city does not show commitment between the members of both communities. DIF: Cognitive level: Analyzing REF: p. 398 TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care
Which data source provides information about the function of the community? a. Local restaurant b. Elected officials c. County health department d. Civic groups
ANS: C Function refers to the aims and activities of the community. Civic groups and elected officials refer to people. Local restaurant refers to a place. DIF: Cognitive level: Understanding REF: p. 398 TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care
A nurse reads the local community newspaper to gather data about the community. Which method of data collection is being used? a. Informant interview b. Focus group c. Participant observation d. Windshield survey
ANS: C Participant observation refers to the deliberate sharing in the life of a community, such as participating in a local fair or festival, or attending a political or social event. The nurse is deliberately sharing in the life of the community by reading the newspaper. An informant interview is a method of community data collection that involves directed conversation with selected community members. A focus group is similar to an interview in that it collects data mainly through asking open-ended questions to participants, but to a small group rather than an individual. Windshield surveys are a method of simple observation, providing a quick overview of a community. DIF: Cognitive level: Applying REF: p. 404 TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care
What are the critical attributes in the definition of community? a. Families, groups, and health organizations b. Health needs, geographical boundaries, and target population c. People, place, and functions d. Populations and health resources
ANS: C People, place, and function are the critical attributes in the definition of community. These attributes are found in most definitions of community. The people are community members or residents; place refers to geographic and time dimensions; and function refers to the aims and activities of the community. DIF: Cognitive level: Understanding REF: p. 398 TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care
A nurse interviews the school nurses in a community to determine their roles in schools because this data is not available. Which of the following processes is the nurse using? a. Photovoice b. Spatial data c. Primary data d. Secondary data
ANS: C Primary data includes using informant interviews, focus groups, and participant observation in order to collect information about a community. Spatial data involves looking at the locations of places within the community. Photovoice, also called photo elicitation, is a community assessment technique in which community members take photos to represent a topic or theme about community health. Secondary sources include published data about the community, such as census data. DIF: Cognitive level: Applying REF: p. 407 TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care
What is the purpose of writing a community nursing diagnosis? a. To assist with developing the evaluation measures for program planning b. To clearly describe the strengths and weaknesses of the community c. To lead to the outcomes and strategies to address and improve the identified health problem d. To increase the likelihood that the problem will be solved
ANS: C The community nursing diagnosis, no matter which classification system is used, leads to expected outcomes and evidence-based health promotion strategies to address and improve the problem identified in the diagnosis. This becomes the nursing care plan. The expected outcomes and evaluations derived from the nursing diagnosis systems suggest subsequent evaluation measures for identified needs or problems. A community assessment describes the strengths and weaknesses of a community. The likelihood of solving a problem is not influenced by writing a community nursing diagnosis. DIF: Cognitive level: Understanding REF: p. 418 TOP: Nursing process: Diagnosis MSC: NCLEX: Safe and Effective Care Environment: Management of Care
A collection of individuals who have one or more personal or environmental characteristics in common is the definition of a(n): a. community. b. group. c. family. d. aggregate.
ANS: D An aggregate is a collection of individuals who have one or more personal or environmental characteristics in common. A community is a group of people that share something in common, such as geographic location, interests, or values. A group is people who are located close together. A family is considered parents and children living together in a household. DIF: Cognitive level: Understanding REF: p. 398 TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care
A nurse is trying to develop community partnerships. Which of the following interventions would be the most appropriate for the nurse to use? a. Involve the community residents b. Use nurses as the source of information and leadership c. Rely on the power of local officials d. Include a variety of disciplines
ANS: D Community partnerships occur when community residents and health workers come from a variety of disciplines. Partnerships should involve a variety of individuals from various backgrounds. There should be a balance of power and information sharing among all of the participants. DIF: Cognitive level: Analyzing REF: pp. 399-400 TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care
A nurse plans on implementing a community-wide influenza immunization program. Which of the following factors should the nurse consider when implementing this program? a. The number of community members who have already received the immunization b. The existence of formal groups in the community c. Public policy that mandates influenza immunization for certain populations d. The community's readiness to participate in the program
ANS: D The factors that influence implementation in the community are the nurse's chosen roles, the type of health problem selected as the focus for intervention, the community's readiness to take part in problem solving, and characteristics of the social change process. The community's readiness to participate is more important than public policy, the existence of formal groups in the community, and the number of community members who have already received the vaccine. DIF: Cognitive level: Analyzing REF: p. 419 TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care
A nurse is trying to increase participation in a free colorectal screening program for middle-aged adults who lack health insurance. Which of the following implementation mechanism would be most effective? a. Small interacting groups b. Health policy c. Lay advisors d. Mass media
ANS: D The mass media (newspapers, television, and radio) represent an impersonal and formal type of communication and are useful in providing information quickly to a large number of people. The other methods will take much longer for the information to spread to the community members. DIF: Cognitive level: Applying REF: p. 414 TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care
A nurse is investigating the structure of the community. Which of the following indicators would the nurse most likely collect data about? a. Infant mortality rate b. Effective communication c. Crime rate d. Emergency room utilization
ANS: D The structure of the community is defined in terms of services and resources. The subsystems of community structure consist of physical environment, health and social services, economy, transportation and safety, politics and government, communication, education, and recreation. DIF: Cognitive level: Applying REF: p. 407 TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care
