Community Based Nursing Practice

1. Public health nursing differs from community health nursing in that public health nursing

a.
Focuses on individuals and families.
b.
Understands the needs of a population.
c.
Ignores political processes.
d.
Considers the individual as one member of a group.

ANS: B

Public health nursing requires understanding the needs of a population. A public health nurse understands factors that influence the political processes used to affect public policy. The primary focus of community health nursing is the care of individuals, families, and groups in the community. By focusing on subpopulations, the community health nurse cares for the community as a whole and considers the individual or family as only one member of a group at risk.

DIF: Understand REF: 32

OBJ: Explain the relationship between public health and community health nursing.

TOP: Assessment MSC: Teaching/Learning

2. A specialist in public health nursing requires

a.
The same level of education as the community health nurse.
b.
Preparation at the basic entry level.
c.
An advanced degree regardless of public health experience.
d.
A graduate level education with a focus in public health science.

ANS: D

A specialist in public health has a graduate level education with a focus in public health science. Public health nursing requires preparation at the basic entry level and sometimes requires a baccalaureate degree in nursing. Not all hiring agencies require an advanced degree in community health nursing. However, nurses with a graduate degree in nursing who practice in community settings are considered community health nurse specialists, regardless of their public health experience.

DIF: Understand REF: 32

OBJ: Explain the relationship between public health and community health nursing.

TOP: Assessment MSC: Teaching/Learning

3. The community health nurse differs from the community-based nurse in that the community health nurse

a.
Understands the needs of the population.
b.
Focuses on the needs of the individual.
c.
Is the first level of contact in the health care system.
d.
Involves the family in decision making.

ANS: A

The community health nurse understands the needs of a population or community through experience with individual families in working through their social and health care issues. The community-based nurse focuses on the needs of the individual or family. Community-based nursing centers function as the first level of contact between members of a community and the health care system. The community-based nurse learns to partner with patients and families so that ultimately the patient and the family become involved in planning, decision making, implementation, and evaluation of health care approaches.

DIF: Understand REF: 32-33

OBJ: Differentiate community health nursing from community-based nursing.

TOP: Assessment MSC: Teaching/Learning

4. The type of nursing that focuses on acute and chronic care of individuals and families while enhancing patient autonomy is known as _____ nursing.

a.
Public health
b.
Community health
c.
Community-based
d.
Community-focused

ANS: C

Community-based nursing involves acute and chronic care of individuals and families and enhances their capacity for self-care while promoting autonomy in decision making. Public health nursing focuses on the needs of a population. Community health nursing cares for the community as a whole and considers the individual or the family as only one member of a group at risk. Community-focused nursing understands the needs of a population or community.

DIF: Understand REF: 32-33

OBJ: Differentiate community health nursing from community-based nursing.

TOP: Assessment MSC: Teaching/Learning

5. The community health nurse is administering flu shots to children at a local playground. In doing so, the nurse’s focus is on

a.
Preventing individual illness.
b.
Preventing community outbreak of illness.
c.
Preventing outbreak of illness in the family.
d.
The needs of the individual or family.

ANS: B

By focusing on subpopulations, the community health nurse cares for the community as a whole and considers the individual or the family as only one member of a group at risk. Community-based nursing, as opposed to community health nursing, focuses on the needs of the individual or family.

DIF: Understand REF: 33 OBJ: Discuss the role of the community health nurse.

TOP: Implementation MSC: Caring

6. The community health nurse is providing counseling to a group of teenage girls related to birth control and disease prevention. The nurse does this because

a.
Focusing on subpopulations leads to community health.
b.
Community health nursing focuses on individuals only.
c.
Community health nursing excludes direct care to subpopulations.
d.
The focus is on preventing illness and unwanted pregnancy.

ANS: A

By focusing on subpopulations, the community health nurse cares for the community as a whole and considers the individual or the family as only one member of a group at risk. Community health nursing is a nursing practice in the community, with the primary focus on the health care of individuals, families, and groups in a community. Subpopulations are often a clinical focus. The goal is to protect, promote, or maintain health, not to prevent illness.

DIF: Understand REF: 33 OBJ: Discuss the role of the community health nurse.

TOP: Implementation MSC: Caring

7. Community-based nursing care takes place in community settings such as the home or a clinic. Ideally, this is done to

a.
Exert greater control over individual or family decisions.
b.
Provide services close to where patients live.
c.
Isolate patients and prevent the spread of disease.
d.
Reduce the need for self-care.

ANS: B

The ideal is to provide health care services close to where patients live. This lessens the cost of care as well as the stress associated with the financial burdens of care. The focus is on the needs of the individual or family. The nurse learns to partner with patients and families so they assume responsibility for their health care decisions.

DIF: Understand REF: 33

OBJ: Discuss the role of the nurse in community-based practice.

TOP: Planning MSC: Caring

8. The community-based nurse is caring for a patient who is home bound by arthritis and chronic lung problems. The patient, however, receives many visitors from the neighborhood and from former coworkers, as well as frequent phone calls from extended family. When concerned about how the large number of visitors may be fatiguing the patient, the nurse should

a.
Restrict the number of visitors for the patient’s welfare.
b.
Voice concerns to the patient and proceed according to the patient’s wishes.
c.
Allow visitors to come and go freely as they have been.
d.
Create visiting hours when the patient may see non–family members.

ANS: B

With the individual and the family as patients, the context of community-based nursing is family-centered care within the community. This focus requires a strong knowledge base in family theory, principles of communication, group dynamics, and cultural diversity. The nurse learns to partner with patients and families, so ultimately the patient and the family assume responsibility for their health care decisions.

DIF: Apply REF: 33

OBJ: Discuss the role of the nurse in community-based practice.

TOP: Implementation MSC: Caring

9. The student nurse is trying to determine what type of nurse she wants to be after graduation. In class, she states that community health nursing is probably not for her because community nursing focuses only on community issues such as preventing epidemics. The instructor’s most appropriate response would be that community health nursing

a.
Focuses on the health care of individuals, families, and groups in a community.
b.
Focuses only on the health of a specific subgroup in a community.
c.
Requires an advanced nursing degree, so the student need not worry.
d.
Focuses only on maintaining the health of the community.

ANS: A

Community health nursing is a nursing practice with the primary focus on the health care of individuals, families, and groups in a community. The goal is to preserve, protect, promote, or maintain health. Not all hiring agencies require an advanced degree.

DIF: Apply REF: 33 OBJ: Discuss the role of the community health nurse.

TOP: Implementation MSC: Caring

10. Vulnerable populations include those patients who are more likely to develop health problems as a result of

a.
Pregnancy.
b.
Nontraditional healing practices.
c.
Excessive risk.
d.
Unlimited access to health care.

ANS: C

Vulnerable populations are those patients who are more likely to develop health problems as a result of excess risks or limits in access to health care services, or who are dependent on others for care. Pregnancy is not a cause of vulnerability, except in cases where the mother is an adolescent, is addicted to drugs, or is at high risk for other reasons. Frequently, the immigrant population practices nontraditional healing practices. Many of these healing practices are effective and complement traditional therapies.

DIF: Knowledge REF: 33-34

OBJ: Identify characteristics of patients from vulnerable populations that influence the community-based nurse’s approach to care. TOP: Assessment

MSC: Nursing Process

11. The instructor is teaching student nurses about identifying members of vulnerable populations when the nursing student asks, “Why is it that not all poor people are considered members of vulnerable populations?” The instructor’s best answer would be

a.
“All poor people are members of a vulnerable population.”
b.
“Poor people are members of a vulnerable population only if they take drugs.”
c.
“Poor people are members of a vulnerable population only if they are homeless.”
d.
“Members of vulnerable groups frequently have a combination of risk factors.”

ANS: D

Members of vulnerable groups frequently have many risks or a combination of risk factors that make them more sensitive to the negative effects of individual risk factors. Individual risk factors are not always overwhelming, depending on the patient’s beliefs and values and sources of social support.

DIF: Understand REF: 33-34

OBJ: Identify characteristics of patients from vulnerable populations that influence the community-based nurse’s approach to care. TOP: Assessment

MSC: Nursing Process

12. The nurse is making a home visit to a Korean family whose daughter gave birth 6 weeks earlier. She finds the daughter in bed with a severe headache. The daughter’s father is holding her hand and is pressing different parts of the hand and lower arm. The mother explains that the father is trying to cure the headache by using pressure points. The nurse’s best response would be to

a.
Tell the father to stop and give the daughter Tylenol.
b.
Ask the mother and/or father to explain the procedure.
c.
Explain to the father that what he is doing will not work.
d.
Let the father finish and then give the daughter Tylenol.

ANS: B

The nurse should not judge the patient’s/family’s beliefs and values about health. The nurse needs to create a comfortable, nonthreatening environment and to learn as much as possible about the patient’s culture and values that influence his or her health care practices. Tylenol may not be an acceptable alternative for this family. Criticizing the family’s beliefs and practices will only create a barrier to care.

DIF: Apply REF: 34

OBJ: Identify characteristics of patients from vulnerable populations that influence the community-based nurse’s approach to care. TOP: Implementation

MSC: Teaching/Learning

13. The nurse is working in a community clinic when a man and woman bring a 12 year-old boy in, stating that the child fell down a flight of stairs and hurt his arm. The nurse notices several other bruises on the child’s body at varying stages of healing. The boy is placed on the stretcher. When asked how he hurt himself, he states that he does not remember. However, the nurse notices that the boy continuously avoids looking at the man, while the man stares at him constantly. The nurse should

a.
Ask the boy if the man hurt him.
b.
Confront the man directly.
c.
Ask the man and woman to step out.
d.
Ask the woman if the man hurt the boy.

ANS: C

Ask the man and woman to step out. When dealing with patients at risk for or who have suffered abuse, it is important to provide protection and to interview the patient at a time when he or she has privacy, and the individual suspected of being the abuser is not present. The boy may be less likely to be forthcoming with his attacker in the room. Confronting the man directly may lead to violence. The woman may also be a victim of abuse and may fear retribution if she discusses their problems with health care providers.

DIF: Apply REF: 34-35

OBJ: Identify characteristics of patients from vulnerable populations that influence the community-based nurse’s approach to care. TOP: Implementation

MSC: Nursing Process

14. The nurse is working with a 16-year-old pregnant female who tells the nurse that she needs an abortion. The nurse provides the patient with information on alternatives to abortion, but after several sessions, the patient still insists on having the abortion. The competency of the counselor requires the nurse to

a.
Insist that the patient speak with a “Right-to-Life” advocate.
b.
Provide a referral to an abortion service.
c.
Refuse to provide referral to an abortion service.
d.
Delay referral to an abortion service.

ANS: B

As a counselor, the nurse is responsible for providing information, listening objectively, and being supportive, caring, and trustworthy. The nurse does not make decisions but rather helps the patient reach decisions that are best for him or her. To refuse to provide a referral or to delay referral would not be supportive of the patient’s decision. Counselors usually suggest and rarely insist.

DIF: Apply REF: 36

OBJ: Describe the competencies important for success in community-based nursing practice.

TOP: Implementation MSC: Nursing Process

15. The patient is in the hospital with the diagnosis of early-onset Alzheimer’s disease. Before the patient is discharged, the community-based nurse is making a visit to the patient’s home, where he lives with his daughter and her family. A major focus of this visit will be to

a.
Demonstrate caregiver techniques for providing care.
b.
Stress to the family how difficult it will be to provide care at home.
c.
Encourage the family to send the patient to an extended care facility.
d.
Teach the family how to have the patient declared incompetent.

ANS: A

The role of the community health nurse, when dealing with patients with Alzheimer’s disease, is to maintain the best possible functioning, protection, and safety for the patient. The nurse should demonstrate to the primary family caregiver techniques for dressing, feeding, and toileting the patient while providing encouragement and emotional support to the caregiver. The nurse should protect the patient’s rights and maintain family stability.

DIF: Apply REF: 35

OBJ: Describe the competencies important for success in community-based nursing practice.

TOP: Implementation MSC: Nursing Process

16. The community has three components: structure or locale, the people, and the social systems. While doing a community assessment, the nurse seeks data on the average household income and the number of residents on public assistance. In doing so, the nurse is evaluating which of the following?

a.
Structure
b.
Population
c.
Welfare system
d.
Social system

ANS: A

Economic status is part of the community structure. Population would involve age and gender distribution, growth trends, density, education level, and ethnic or religious groups. The welfare system is part of the social system that also includes the education, government, communication and health systems.

DIF: Understand REF: 37 OBJ: Describe elements of a community assessment.

TOP: Implementation MSC: Nursing Process

17. The patient is being readmitted to an inner city hospital for chest pain after being discharged 3 months earlier after having a heart attack. The patient was referred to the hospital’s cardiac rehabilitation program after her previous admission. The patient states that she began going to cardiac rehabilitation and liked it but stopped. When asked why, she states that, at the beginning, the classes were at 9 AM, but then got switched to 7 PM, when it’s dark. The cardiac rehabilitation program was within walking distance of the patient’s home. What is the most likely cause of the patient’s unwillingness to go to cardiac rehabilitation?

a.
Lack of transportation
b.
Fear of walking at night
c.
Reimbursement issues
d.
Noncompliance

ANS: B

A community assessment should be done to determine the level of community violence at night in the patient’s neighborhood. She claimed that she liked the program when it was at 9 AM. She did not mention finances as a reason for not going, and the program was within walking distance to her house. Noncompliance is a label given unfairly to patients. Most “noncompliance” is caused. The cause should be identified and dealt with, so the therapy will be successful.

DIF: Apply REF: 37 OBJ: Describe elements of a community assessment.

TOP: Implementation MSC: Nursing Process

MULTIPLE RESPONSE

1. Community-based nursing requires a strong knowledge base in which of the following? (Select all that apply.)

a.
Family theory
b.
Communication
c.
Group dynamics
d.
Focus on the individual
e.
Cultural diversity

ANS: A, B, C, E

With the individual and family as the patients, the context of community-based nursing is family-centered care within the community. This focus requires a strong knowledge base in family theory, principles of communication, group dynamics, and cultural diversity. The nurse leans to partner with patients and families, not just with individuals.

DIF: Knowledge REF: 33

OBJ: Discuss the role of the nurse in community-based practice.

TOP: Assessment MSC: Teaching/Learning

2. Community-based nursing centers function as the first level of contact between members of a community and the health care delivery system. Ideally, health care services (Select all that apply.)

a.
Are provided where patients live.
b.
Reduce the cost of health care for the patient.
c.
Provide direct access to nurses.
d.
Exclude interference from family or friends.

ANS: A, B, C

Community-based nursing centers function as the first level of contact between members of a community and the health care delivery system. Ideally, health care services are provided near where patients live. This approach helps to reduce the cost of health care for the patient and the stress associated with the financial burdens of care. In addition, these centers offer direct access to nurses and patient-centered health services and readily incorporate the patient and the patient’s family or friends into a plan of care.

DIF: Understand REF: 33

OBJ: Discuss the role of the nurse in community-based practice.

TOP: Planning MSC: Caring

3. Of the following list of patients, which would be considered at high risk to be members of a vulnerable population? (Select all that apply.)

a.
An immigrant who speaks only Chinese
b.
An Hispanic truck driver who speaks limited English
c.
A 22-year-old pregnant woman
d.
A 15-year-old rape victim
e.
A 40-year-old schizophrenic

ANS: A, B, D, E

For some immigrants, access to health care is limited because of language barriers and lack of benefits, resources, and transportation. Immigrant populations face multiple diverse health issues that cities, counties, and states need to address. These health care needs pose significant legal and policy issues. For some immigrants, access to health care is limited because of language barriers and lack of benefits, resources, and transportation. Low-risk mothers and babies usually are not considered vulnerable populations unless other factors are noted. Physical, emotional, and sexual abuse (such as rape), as well as neglect, is a major public health problem affecting older adults, women, and children. When a patient has a severe mental illness such as schizophrenia, multiple health and socioeconomic problems will need to be explored.

DIF: Evaluation REF: 33-35

OBJ: Identify characteristics of patients from vulnerable populations that influence the community-based nurse’s approach to care. TOP: Planning

MSC: Caring