Community-Based Nursing Practice

1.A student nurse is beginning the community-based primary care rotation. The student nurse anticipates that the assignment in community-based health care will most likely be at which organization?

a.
An acute care hospital
b.
A rehabilitation hospital
c.
A nursing home
d.
A high school

ANS: D

High schools focus on primary rather than acute care and provide knowledge about health and health promotion that occurs outside traditional health care institutions, such as hospitals, rehabilitation hospitals, and nursing homes.

PTS:1DIF:Cognitive Level: Applying (Application)

REF:50 | 51

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

TOP:Nursing Process: Planning

MSC: NCLEX: Health Promotion and Maintenance

2.A nurse is practicing as a community health nurse. What is the primary focus of care for this nurse?

a.
Providing care to subpopulations
b.
Practicing care in existing services
c.
Being a specialist in public health science
d.
Having a case management certification

ANS: A

The community health nurse provides direct care services to subpopulations within that community. Community health nursing is nursing care provided in the community, with the primary focus on the health care of individuals, families, and groups in the community. A community health nurse is not the same thing as a specialist in public health nursing. A community health nurse does not have to have case management certification. Although the community health nurse may practice care in existing services, the primary focus is on the subpopulation’s care.

PTS:1DIF:Cognitive Level: Applying (Application)

REF:52

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

TOP:Nursing Process: Implementation

MSC: NCLEX: Health Promotion and Maintenance

3.A community health nurse is using the goals of the Healthy People 2020 to focus care. Which goal is the priority?

a.
To increase the life expectancy of people in the United States
b.
To increase the health status of people throughout the world
c.
To eradicate the human immunodeficiency virus (HIV)
d.
To reduce health care costs

ANS: A

The overall goals of Healthy People 2020 are to increase the life expectancy and quality of life and to eliminate health disparities through an improved delivery of health care services to people in the United States. The focus is on the United States, not the world. It does not focus on one disease or on reducing health care costs.

PTS:1DIF:Cognitive Level: Applying (Application)

REF: 51 OBJ: Describe the role of the community health nurse.

TOP:Nursing Process: Planning

MSC: NCLEX: Health Promotion and Maintenance

4.The teen pregnancy rate in one community significantly increased; as a result, the school system was seeing an increase in the dropout rate of teenage mothers. A nurse recently worked with the local school system to develop a day care program for the children of high school students so that they could return to school. Which technique did the nurse use?

a.
Incorporating immunizations for the infants and mothers
b.
Responding to changes within the community
c.
Influencing chronic environmental factors
d.
Managing disease

ANS: B

Successful community health nursing practice involves building relationships with the community and responding to changes within the community. No immunizations were given. There was no mention of managing disease in this scenario. The nurse did not influence chronic factors.

PTS:1DIF:Cognitive Level: Analyzing (Analysis)

REF: 53 OBJ: Describe the role of the community health nurse.

TOP:Nursing Process: Evaluation

MSC: NCLEX: Health Promotion and Maintenance

5.A nurse notices that a particular area of the community had food poisoning. The nurse collected data from the people who were affected, identified a local restaurant that served all the people, and determined it was the chicken dish that caused the poisoning. Which community health nurse competency did the nurse demonstrate?

a.
Public health
b.
Educator
c.
Epidemiologist
d.
Case manager

ANS: C

As epidemiologist, community health nurses use basic principles of epidemiology such as tracking health problems; collecting and analyzing data to identify disease trends, outbreaks of illnesses, and disease incidence rates; and planning strategies to prevent or contain outbreaks. With the goal of helping patients assume responsibility for their own health care, the role of educator is important in a community-based setting. Case management means making an appropriate plan of care based on assessment of patients and families and coordinating needed resources and services for the patient’s well-being across a continuum of care. A community health nurse is not the same thing as a public health nurse and is not a competency of community health nursing.

PTS:1DIF:Cognitive Level: Applying (Application)

REF:58

OBJ:Describe selected competencies important for success in community-based nursing practice.TOP:Nursing Process: Evaluation

MSC:NCLEX: Safety and Infection Control

6.Upon assessment the nurse finds the following: a 46-year-old immigrant patient from the Czech Republic has diabetes and hypertension and just recently moved in to live with a family member who must travel frequently. The patient speaks English very well. The community health nurse knows that this patient may be vulnerable because of which assessment finding?

a.
Age
b.
Immigration status
c.
Diabetes
d.
Language

ANS: B

Vulnerable populations include individuals living in poverty, elderly people, homeless individuals, those in abusive relationships, people with substance abuse problems and/or mental illnesses, and new immigrants. For some immigrants access to health care is limited because of legal status, language barriers and lack of benefits, resources, and transportation. Being 46 years old does not place the patient in the elderly category. Diabetes does not make the patient vulnerable. The patient speaks English, so that is not an issue.

PTS:1DIF:Cognitive Level: Applying (Application)

REF:54

OBJ: Explain the characteristics of patients from selected vulnerable populations that influence a nurse’s approach to care. TOP: Nursing Process: Assessment

MSC: NCLEX: Management of Care

7.A nurse wants to use the most important competency in community nursing. Which competency should the nurse use?

a.
Caregiver
b.
Case manager
c.
Educator
d.
Epidemiologist

ANS: A

The most important role is caregiving. Using the nursing process and critical thinking skills, a nurse develops appropriate, individualized nursing care for specific patients and their families. Case management means making an appropriate plan of care based on assessment of patients and families and coordinating needed resources and services for the patient’s well-being across a continuum of care. Community-based nurses teach their patients individually or in groups. Community health nurses use basic principles of epidemiology, such as tracking health problems; collecting and analyzing data to identify disease trends, outbreaks of illnesses, and disease incidence rates; and planning strategies to prevent or contain outbreaks.

PTS:1DIF:Cognitive Level: Applying (Application)

REF:56

OBJ:Describe selected competencies important for success in community-based nursing practice.TOP:Nursing Process: Implementation

MSC: NCLEX: Management of Care

8.A community health nurse is assessing the structure of a community. Which component will the nurse assess?

a.
Available health systems
b.
Available colleges and schools
c.
Geographical boundaries
d.
Predominant religious groups

ANS: C

Geographical boundaries are a component of the structure of a community. Health systems, and available colleges and schools are social systems. Predominant religious groups are a component of the population of a community.

PTS:1DIF:Cognitive Level: Analyzing (Analysis)

REF: 58 OBJ: Describe elements of a community assessment.

TOP:Nursing Process: Assessment

MSC: NCLEX: Health Promotion and Maintenance

MULTIPLE RESPONSE

1.A nurse in community-based practice needs a variety of skills and talents while rendering care to patients in the community. Which are competencies of the community health nurse? (Select all that apply.)

a.
Case manager
b.
Care giver
c.
Educator
d.
Advocate
e.
Counselor

ANS: A, B, C

Selected competencies, such as caregiver, case manager, epidemiologist, and educator, are used in the community-based setting. Advocate and counselor are not competencies.

PTS:1DIF:Cognitive Level: Applying (Application)

REF:56 | 58

OBJ:Describe selected competencies important for success in community-based nursing practice.TOP:Nursing Process: Implementation

MSC: NCLEX: Management of Care

2.A community health nurse is caring for vulnerable populations. The nurse is caring for which patients? (Select all that apply.)

a.
Patients living at home
b.
Patients with abusive habits
c.
Immigration patients
d.
Middle-aged patients
e.
Patients living in poverty

ANS: B, C, E

Individuals living in poverty, elderly people, homeless individuals, those in abusive relationships, people with substance abuse problems and/or mental illnesses, and new immigrants are examples of vulnerable populations. Living at home and being middle-aged are not examples of vulnerable populations.

PTS:1DIF:Cognitive Level: Analyzing (Analysis)

REF:54 | 56

OBJ: Explain the characteristics of patients from selected vulnerable populations that influence a nurse’s approach to care. TOP: Nursing Process: Implementation

MSC:NCLEX: Safety and Infection Control

3.A nurse is performing a community assessment. Which areas should the nurse include? (Select all that apply.)

a.
Structure
b.
Population
c.
Social systems
d.
Environment
e.
Vital signs

ANS: A, B, C

A complete assessment examines structure or locale, population or people, and social systems. The principles of public health practice aim at achieving a healthy environment in which all individuals may live. Environment and vital signs are not components of a community assessment.

PTS:1DIF:Cognitive Level: Analyzing (Analysis)

REF: 58 OBJ: Describe elements of a community assessment.

TOP:Nursing Process: Assessment

MSC: NCLEX: Health Promotion and Maintenance

4.A community-based nurse is working with a family. The nurse needs to be knowledgeable in what key areas? (Select all that apply.)

a.
Family theory
b.
Group dynamics
c.
Political affiliations
d.
Cultural diversity
e.
Communication principles

ANS: A, B, D, E

The context of community-based nursing is family-centered care within the community. This focus requires the nurse to be knowledgeable about family theory, principles of communication, and group dynamics and cultural diversity. Political affiliations are not a key component of family-centered care.

PTS:1DIF:Cognitive Level: Analyzing (Analysis)

REF: 54 OBJ: Discuss the role of the nurse in community-based practice.

TOP:Nursing Process: Implementation

MSC: NCLEX: Health Promotion and Maintenance