Community-Based Nursing Practice(FREE)

1. The student nurse is investigating different types of practice settings. In looking at community health nursing, the student recognizes that it:

1.
Is the same as public health nursing
2.
Focuses on the incidence of disease
3.
Requires graduate-level educational preparation
4.
Includes direct care and services to subpopulations

ANS: 4

Community health nursing strives to safeguard and improve the health of populations in the community as well as providing direct care services to subpopulations within a community. Public health nursing is concerned with trends and patterns influencing the incidence of disease within populations. A community health nurse may be involved in direct client care for disease within a community. Public health nursing focuses on the needs of populations. Community health nursing has a broader focus, with an emphasis on the health of a community. The community health nurse merges public health knowledge with nursing theory. The community health nurse considers the needs of populations and is prepared to provide direct care services to subpopulations within a community. Nurses who become expert in community health practice may have advanced nursing degrees, yet the baccalaureate-prepared generalist also can become quite competent in formulating and applying population-focused assessments and interventions.

DIF: A REF: 34 OBJ: Comprehension

TOP: Nursing Process: Assessment

MSC: NCLEX® test plan designation: Safe, Effective Care Environment

2. As a community health nurse assisting the client and family with nutritional needs the nurse should first:

1.
Identify for the client the best foods to buy
2.
Purchase foods at the lowest cost for the client
3.
Ask the client and family what they think they should eat
4.
Provide information on stores with the most reasonable pricing

ANS: 3

With the goal of helping clients assume responsibility for their own health care, the community health nurse must assess a client’s learning needs and readiness to learn within the context of the individual, the systems the individual interacts with, and the resources available for support. Asking the client about what foods he or she thinks should be eaten may help the nurse assess the client’s level of knowledge regarding nutrition as well as the client’s food preferences. It also enables the client to become a participant in his or her care. Telling the client what foods to buy does not encourage the client to assume responsibility for managing his or her health care. The nurse should first assess the resources available, and then encourage the client to do his or her own shopping. Providing information on food sources and stores with reasonable pricing may be appropriate after the nurse has determined what information the client requires to meet nutritional needs.

DIF: C REF: 40 OBJ: Analysis

TOP: Nursing Process: Assessment

MSC: NCLEX® test plan designation: Health Promotion and Maintenance

3. Which one of the following clients from a vulnerable population currently appears to be at the greatest risk?

1.
A physically abused client in a shelter
2.
A schizophrenic client in outpatient therapy
3.
An older adult taking medication for hypertension
4.
A substance abuser who shares drug paraphernalia

ANS: 4

A client with substance abuse has health and socioeconomic problems. These clients frequently may avoid health care for fear of judgmental attitudes by health care providers and concern over being turned in to criminal authorities. An abused client in a shelter has sought protection so currently should be at less risk. Although considered to be a member of a vulnerable population, the older adult who takes medication for a chronic disease, such as hypertension, is taking measures to maintain health. A schizophrenic client in outpatient therapy is currently at less risk because he or she is receiving treatment.

DIF: C REF: 36 OBJ: Analysis

TOP: Nursing Process: Assessment

MSC: NCLEX® test plan designation: Health Promotion and Maintenance

4. A client with a history of a gastrointestinal disorder eats a well-balanced diet that keeps his GI symptoms suppressed. Which level of prevention corresponds to his dietary management?

1.
Health promotion
2.
Primary prevention
3.
Tertiary prevention
4.
Secondary prevention

ANS: 3

The goal of tertiary prevention is to preclude further deterioration of physical and mental function in a person who has an existing illness, and to have the client use whatever residual function is available for maximum enjoyment of and participation in life’s activities. Health promotion is aimed at reducing the incidence of disease and its impact on people. Primary prevention is aimed at general health promotion.

Secondary prevention is aimed at early recognition and treatment of disease.

DIF: A REF: 37 OBJ: Comprehension

TOP: Nursing Process: Evaluation

MSC: NCLEX® test plan designation: Health Promotion and Maintenance

5. Which of the following statements by the home health nurse best reflects client advocacy in response to the client’s concern over the expense of the therapy?

1.
“Have you considered the possibility of a renal transplant?”
2.
“This peritoneal dialysis is less expensive than hemodialysis.”
3.
“You must feel awful about this situation, but this is the best course of treatment for you.”
4.
“Let’s call the regional dialysis center and explore options for reducing the cost of your home dialysis.”

ANS: 4

Calling the regional dialysis center and exploring options for reducing cost demonstrates the nurse acting as client advocate by identifying and assisting the client in contacting the appropriate agency for information and resources to meet the client’s needs. Asking the client whether he has considered renal transplantation does not demonstrate client advocacy. Pointing out the difference in cost for dialysis in the home versus the hospital does not meet the client’s need to reduce the expenses of his therapy. The nurse is not demonstrating patient advocacy. Telling the client that this is the best treatment for him does not address his financial concerns. The nurse is not demonstrating patient advocacy with this response.

DIF: C REF: 40 OBJ: Analysis

TOP: Nursing Process: Assessment

MSC: NCLEX® test plan designation: Health Promotion and Maintenance

6. In assessing the structure of the community in order to identify the needs of its population, the nurse will focus on:

1.
Collecting demographic data on age distribution
2.
Visiting neighborhood schools to review health records
3.
Interviewing clients to determine the cultural composition of the subgroups
4.
Observing locations where services, such as water sanitation, are provided

ANS: 4

When assessing the structure or locale of a community, the nurse should travel around the neighborhood or community and observe its design; the location of services, such as water and sanitation; and the locations where residents congregate. Collecting demographic data on age distribution would be an assessment of the community’s population. Visiting neighborhood schools to review health records is an example of assessing a social system within a community. Interviewing clients to determine the cultural composition of subgroups is an example of assessing the population within a community.

DIF: A REF: 41 OBJ: Comprehension

TOP: Nursing Process: Assessment

MSC: NCLEX® test plan designation: Health Promotion and Maintenance

7. To facilitate change within a community, the nurse working as an effective change agent should:

1.
Inform community members how to effectively manage their health needs
2.
Work with clients and groups to select alternative health care sites and treatments
3.
Formulate decisions for individual clients regarding their health care options
4.
Provide instruction in the way the community should address health issues

ANS: 2

As a change agent, the nurse seeks to implement new and more effective approaches to problems. The nurse creates change by working with and empowering individuals and their families to solve problems or to become instrumental in changing aspects affecting their health care. Telling community members how to manage their health care needs may meet resistance. It also does not enable clients and their families to take responsibility for their health care. Making decisions for clients does not enable individuals to assume responsibility for their health care decisions. The community-based nurse acting as a change agent may be an excellent resource for health information to members of the community. Ultimately; however, the community members will take an active role to create change for themselves and will assume responsibility for their health care decisions.

DIF: A REF: 39-40 OBJ: Comprehension

TOP: Nursing Process: Assessment

MSC: NCLEX® test plan designation: Health Promotion and Maintenance

8. The client is being discharged from an acute care facility following a total hip replacement. She will need follow-up for her rehabilitation and exercise plan. In addition to a home health care nurse, what referral should be discussed?

1.
Dietitian
2.
Social worker
3.
Physical therapist
4.
Respiratory therapist

ANS: 3

Directing clients to appropriate resources and improving continuity of care require the nurse to know those resources well. A physical therapist is responsible for the client’s movement system and is likely to be needed following hip replacement surgery.

A social worker may or may not be necessary. A dietitian may or may not be necessary.

A respiratory therapist would not be necessary unless the client experienced a respiratory complication or had a preexisting respiratory condition.

DIF: A OBJ: Comprehension

TOP: Nursing Process: Planning

MSC: NCLEX® test plan designation: Health Promotion and Maintenance

9. The nurse recognizes which of the following as the largest contributing factor for the rise in the need and use of home care?

1.
Government funding of the home care setting has increased greatly.
2.
Clients are more acutely ill when discharged from the acute care facility.
3.
There are 7 days/week services for the elderly in home care agencies.
4.
The existence of more single-income families has increased the need for their elderly relatives to receive care in the home.

ANS: 2

Because hospital stays are being shortened to control health care costs, clients are returning home more acutely ill. This is the largest contributing factor for the rise in the need and use of home care. Government funding of home care is not the largest contributing factor for the rise in the need and use of home care. There are 7 days/week services for the elderly in a variety of settings, such as in acute care or long-term care, not just in the home care setting. Being able to provide daily services for the elderly in the home care setting is not the largest contributing factor for the rise in the need and use of home care. The existence of more single-income families is not the largest contributing factor for the rise in the need and use of home care.

DIF: C REF: Chapter 2, 22 OBJ: Analysis

TOP: Nursing Process: Assessment

MSC: NCLEX® test plan designation: Health Promotion and Maintenance

10. One of the overall goals of Healthy People 2010 is to:

1.
Increase life expectancy
2.
Decrease health care costs
3.
Promote managed care organizations
4.
Establish the credentials of service providers

ANS: 1

The overall goals of Healthy People 2010 are to increase the life expectancy and quality of life and to eliminate health disparities. The initiative of Healthy People 2010 is to improve the delivery of health care services to the general public. The overall goal did not focus on reducing health care costs. Although managed care organizations may increase in number, this was not a goal of the Healthy People 2010 initiative. Establishing the credentials of care providers was not a goal of Healthy People 2010.

DIF: A REF: 33 OBJ: Comprehension

TOP: Nursing Process: Assessment

MSC: NCLEX® test plan designation: Health Promotion and Maintenance

11. When assessing members of a vulnerable population, the community health nurse should realize that the primary need is to:

1.
Provide culturally competent assessment.
2.
Organize in your mind exactly what you need to ask.
3.
Create a comfortable, nonthreatening environment.
4.
Be alert for indications of mental and physical abuse.

ANS: 3

In order to be successful in assessing a member of a vulnerable population, the nurse must first create an environment that is encourages the client to cooperate with and actively participate in the assessment process While it is important that the nurse be cultural considerate of the client, it is not the primary need of those offered as options.

While organization to thought is important to the effective use of time needed for an assessment, it is not the primary need of those offered as options. While vulnerable populations may be more susceptible to both mental and physical abuse making observation for signs of abuse important, it is not the primary need of those offered as options

DIF: C REF: 35 OBJ: Analysis

TOP: Nursing Process: Assessment

MSC: NCLEX® test plan designation: Health Promotion and Maintenance

12. The nurse working in a free clinic often utilized by Hispanic immigrants is assessing a client who reports a cough and malaise. The client is hearing impaired, speaks very little English and is currently living in a homeless shelter. The nurse’s primary concerns should be the client’s:

1.
Language barrier
2.
Risk for tuberculosis
3.
Hearing impairment
4.
Lack of health care resources

ANS: 2

Risk for tuberculosis presents the greatest risk since it is supported by the physical signs, is highly contagious and a risk factor among the homeless and some immigrant populations. The language barrier is a concern since it impacts the communication between the nurse and the client but it is not the primary concern among the options offered. The client’s hearing impairment is a concern because it has an impact on the communication between the nurse and the client but it is not the primary concern among the options offered. The client’s lack of insurance is a concern because it affects the treatment plan necessary for the client’s recovery, but it is not the primary concern among the options offered.

DIF: C REF: 36 OBJ: Analysis

TOP: Nursing Process: Assessment

MSC: NCLEX® test plan designation: Health Promotion and Maintenance

13. A nurse is planning interventions for the clients of a homeless shelter. Which of the activities represents a primary level intervention regarding sexually transmitted diseases?

1.
HIV screening for all residents
2.
Sex education for teenage residents
3.
Treatment for residents diagnosed with AIDS
4.
Gynecological referrals for female residences

ANS: 2

Primary level interventions are directed a preventing the disease. Educational programming is generally considered a primary intervention. Screening a disease is generally considered a secondary level intervention. Treatment of the disease is generally considered a tertiary level intervention. Referrals are generally considered a secondary intervention.

DIF: A REF: 36 OBJ: Comprehension

TOP: Nursing Process: Planning

MSC: NCLEX® test plan designation: Health Promotion and Maintenance

14. The nurse working in a free clinic is caring for a homeless client diagnosed with paranoid schizophrenia who has reported that, “I hurt my foot running away from them. It hurts so bad I can hardly walk now.” On assessment the nurse notices bruising on the client’s back, arms, and thighs, a red rash on both neck and face, and poor personal hygiene, in addition to edema of the left ankle. The nurse should first realize that this client is at risk for:

1.
Physical abuse and assault
2.
Drug addiction relating to pain
3.
Communicable immune disorders
4.
Hospitalization due to mental disorder

ANS: 1

When a client has a severe mental illness such as schizophrenia there are multiple health and socioeconomic problems you will need to explore. Many clients with pervasive mental illnesses are homeless or live in poverty. In addition, mentally ill clients are at greater risk of abuse and assault. This client’s reported foot injury and observable bruising support the possibility of abuse/assault. While drug abuse may be a consideration, it does not represent the best option offered for this item because there is not indication that the client is drug seeking. Contacting communicable diseases is a risk factor for such a client but it does not represent the best option offered for this item because there are several factors that may indicate abuse/assault. Hospitalization may be required but it does not represent the best option offered for this item because there is no indication that the client is experiencing a psychiatric crisis.

DIF: C REF: 37 OBJ: Analysis

TOP: Nursing Process: Assessment

MSC: NCLEX® test plan designation: Health Promotion and Maintenance

15. A community nurse has identified a need for educational programming among the residents of an assistive living facility dealing with osteoarthritis. The best example of such programming is:

1.
“Planning the best exercise program for you.”
2.
“Recognizing how arthritis has affected your life.”
3.
“Proper self administration of antiinflammatory medication”
4.
“Be an informed consumer—don’t fall for false arthritis cures.”

ANS: 4

Thorough assessment and appropriate community based interventions provide an opportunity to improve the lifestyle and quality of life of older adults in general. The focus is on broad-based needs not specific client needs. Answer 4 offers information applicable to the entire resident population diagnoses with osteoarthritis.

DIF: C REF: Chapter 2, 19 OBJ: Analysis

TOP: Nursing Process: Planning/Implementation

MSC: NCLEX® test plan designation: Health Promotion and Maintenance

16. A homeless client has presented in the ED with a bacterial infection in a hand wound. The nurse has cleansed and dressed the wound, and an initial dose of an antibiotic has been administered. The client will need the antibiotic prescription filled and a dressing change in 3 days. In order to ensure that the client will receive the appropriate follow-up care, the nurse must first act as the client’s:

1.
Educator
2.
Advocate
3.
Caregiver
4.
Counselor

ANS: 2

Client advocacy perhaps is more important today because of the confusion surrounding access to health care services. Your clients often need someone to help them walk through the system, identify where to go for services and tell them how to reach the individuals with the appropriate authority, what services to request, and how to follow through with the information they received. The role of the educator is to help the client assume responsibility for his or her own health care. This client has been educated to the needs related to caring for the infection but needs the nurse advocate to assist with facilitating the care. As caregiver, the nurse manages and cares for the client’s health. You apply the nursing process (see Unit III) in a critical thinking approach to ensure appropriate, individualized nursing care for specific clients and their families. This client’s nursing care has been appropriated delivered and so that nursing role has been fulfilled. A counselor assists clients in identifying and clarifying health problems and in choosing appropriate courses of action to solve those problems. The client is first in need of assistance in dealing with the obstacles to the care of the identified problem—infection.

DIF: C REF: 37-38 OBJ: Analysis

TOP: Nursing Process: Implementation

MSC: NCLEX® test plan designation: Health Promotion and Maintenance

17. A nurse is discussing the need to use a specific cleansing agent when redressing an infected hand. The client prefers using, “plain old soap and water.” The nurse knows that the primary factor that will affect client compliance is:

1.
The ease with which the client can use the special agent
2.
The client’s acceptance of the need for the specialized care
3.
The availability and cost of the prescribed cleansing agent
4.
The introduction of an incentive to prompt client to comply

ANS: 2

Client must perceive the innovation or change as more advantageous than other alternatives or they will not make the change. Client education is essential in bringing about the change in attitude necessary for change. While the client is more likely to adapt the change if it is perceived as being easy, it is not the primary factor in achieving client compliance provided among the options available because client compliance is primarily a result of the client’s understanding of the need for change. While cost to the client is a factor, it is not the primary factor in achieving client compliance provided among the options available since client compliance is primarily a result of the client’s understanding of the need for change. An incentive is sometimes necessary, but it is not the primary factor in achieving client compliance provided among the options available, because client compliance is primarily a result of the client’s understanding of the need for change.

DIF: C REF: 39 OBJ: Analysis

TOP: Nursing Process: Planning/Implementation

MSC: NCLEX® test plan designation: Health Promotion and Maintenance

18. The nurse is assessing a client diagnosed with chronic bronchitis who has been experiencing an increase in dyspnea. The client lives within 2 blocks of a factory that emits pollution into the air. In light of this information, the nurse is primarily concerned with:

1.
Performing a complete client health history and physical assessment
2.
Providing the client with assess to all the required breathing treatments
3.
Identifying a correlation between the pollution and the client’s increased dyspnea
4.
Determining the availability of alternate housing for the client away from the factory

ANS: 3

There may be many factors that are affecting the client’s breathing. Determining the client’s exposure to the pollution and it’s affects of the client’s breathing would be the nurse’s primary concern for this client. The assessment and history is important but is not the best option available regarding the effects of air pollution on the client’s respirations.

The availability of required breathing treatments is important but it is not the best option regarding the effects of air pollution of the client’s respirations. It may be necessary for the client to consider moving but only if it is determined that the pollution is responsible of the increase in the dyspnea.

DIF: A REF: 40 OBJ: Analysis

TOP: Nursing Process: Assessment

MSC: NCLEX® test plan designation: Health Promotion and Maintenance

MULTIPLE RESPONSE

1. Which of the following clients is a concern for the community health nurse? (Select all that apply.)

1.
The homeless woman with a history of congestive heart failure
2.
The elderly gentleman who fell while disembarking from a bus
3.
The child of itinerant workers who has a developed asthma
4.
A client diagnosed with HIV who recently lost her insurance
5.
A 15-year-old who was injured while at a public swimming pool
6.
A retired service veteran who has a chronic psychiatric disorder

ANS: 1, 3, 4

Community-based health care occurs outside traditional health care institutions, such as hospitals. It provides services for acute and chronic conditions to individuals and families with in the community (Stanhope and Lancaster, 2006). Some of these problems include an increase in homeless and immigrant populations, an increase in sexually transmitted diseases, underimmunization of infants and children, and life-threatening diseases (e.g., clients living with HIV and other emerging infections). All of these clients possess risk factors that are community based

DIF: C REF: 40 OBJ: Analysis

TOP: Nursing Process: Assessment

MSC: NCLEX® test plan designation: Health Promotion and Maintenance

2. A nurse working with clients at or below the poverty level recognizes that the life expectancy of these clients is lower than the general population because of: (select all that apply.)

1.
Inadequate nutritional diets
2.
High-risk work environments
3.
Hazardous living environments
4.
Addictive and abusive lifestyles
5.
Predisposition to chronic diseases
6.
Ineffective decision making abilities

ANS: 1, 2, 3, 4

People who live in poverty are more likely to live in hazardous environments, work at high-risk jobs, eat less nutritious diets, abuse substances, and have multiple stressors in their life. When researchers compared the life expectancies of European Americans and African-Americans, the causes of the differences were related to low socioeconomic status rather than ethnicity (Decker and others, 2006; Hwang, 2000). Predisposition to chronic disease in part is genetic in nature and research has confirmed no such link between poverty and chronic disease. Decision-making ability is not the only factor affecting decision making. Poverty negatively affects the individual’s ability to access recourses and adds stressors such as finding shelter that can alter the decision-making process.

DIF: A REF: 41 OBJ: Comprehension

TOP: Nursing Process: Assessment

MSC: NCLEX® test plan designation: Health Promotion and Maintenance

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