Free Chapter 03: Community-Based Nursing Practice

Chapter 03: Community-Based Nursing Practice

Potter et al.: Fundamentals of Nursing, 9th Edition

MULTIPLE CHOICE

1. A nurse is working as a public health nurse. What will be the nurse’s primary focus?

a.

The individual as one member of a group

b.

Individuals and families

c.

Needs of a population

d.

Health promotion

ANS: C

Public health nursing primary focus is understanding the needs of a population. Community-based care focuses on health promotion. Community health nursing focuses on health care of individuals, families, and groups within the community.

DIF:Understand (comprehension)REF:33

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

TOP:CaringMSC:Management of Care

2. A nurse wants to become a specialist in public health nursing. Which educational requirement will the nurse have to obtain?

a.

A baccalaureate degree in nursing

b.

Preparation at the basic entry level

c.

The same level of education as the community health nurse

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. A community health nurse is not the same thing as a public health nursing specialist.

DIF:Understand (comprehension)REF:33

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

TOP:Teaching/LearningMSC:Management of Care

3. A nurse is working as a community health nurse. Which action is a priority for this nurse?

a.

Provide direct care to subpopulations.

b.

Focus on the needs of the ill individual.

c.

Provide first level of contact to health care systems.

d.

Focus on providing care in various community settings.

ANS: A

Community health nursing is nursing practice in the community, with the primary focus on the health care of individuals, families, and groups within the community. In addition, the community health nurse provides direct care services to subpopulations within a community. Community-based nursing centers function as the first level of contact between members of a community and the health care system. Community-based nursing focuses on providing care in various community settings, such as the home or a clinic and involves acute and chronic care.

DIF:Apply (application)REF:33

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

TOP: Implementation MSC: Health Promotion and Maintenance

4. A nurse is focusing on acute and chronic care of individuals and families within a community while enhancing patient autonomy. Which type of nursing care is the nurse providing?

a.

Public health

b.

Community health

c.

Community-based

d.

Community assessment

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 assessment is the systematic data collection on the population, monitoring the health status of the population, and making information available about the health of the community.

DIF:Understand (comprehension)REF:33

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

TOP:ImplementationMSC:Management of Care

5. The community health nurse is administering flu shots to children at a local playground. What is the rationale for this nurse’s action?

a.

To prevent individual illness

b.

To prevent community outbreak of illness

c.

To prevent outbreak of illness in the family

d.

To prevent needs of the local population groups

ANS: B

The nurse is trying to prevent a community outbreak of illness. By focusing on subpopulations (children), 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. Public health nursing focuses on meeting the population groups’ needs.

DIF:Apply (application)REF:33

OBJ: Discuss the role of the community health nurse. TOP: Planning

MSC:Health Promotion and Maintenance

6. A nurse attended a seminar on community-based health care. Which information indicates the nurse has a good understanding of community-based health care?

a.

It occurs in hospitals.

b.

Its focus is on ill individuals.

c.

Its priority is health promotion.

d.

It provides services primarily to the poor.

ANS: C

Community-based health care is a model of care that reaches everyone in the community (including the poor and underinsured), focuses on primary rather than institutional or acute care, and provides knowledge about health and health promotion and models of care to the community. Community-based health care occurs outside traditional health care institutions such as hospitals.

DIF:Understand (comprehension)REF:31

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

TOP: Teaching/Learning MSC: Health Promotion and Maintenance

7. A nurse is using the Healthy People 2020 to establish goals for the community. Which goal is priority?

a.

Reduce health care costs.

b.

Increase life expectancy.

c.

Provide services close to where patients live.

d.

Isolate patients to prevent the spread of disease.

ANS: B

The overall goals of Healthy People 2020 are to increase life expectancy and quality of life and eliminate health disparities through an improved delivery of health care services. It does not focus on reducing health care costs, providing services close to where patients live, or isolating patients to prevent the spread of disease.

DIF:Understand (comprehension)REF:31

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

TOP:PlanningMSC:Health Promotion and Maintenance

8. A nurse is working in community-based nursing. Which competency is priority for this nurse?

a.

Caregiver

b.

Collaborator

c.

Change agent

d.

Case manager

ANS: A

First and foremost is the role of caregiver. While collaborator, change agent, and case manager are important, they are not the priority.

DIF:Apply (application)REF:35

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

TOP:ImplementationMSC:Management of Care

9. A nurse observes an outbreak of lice in a certain school district. The nurse collects data and identifies a common practice of sharing lockers, caps, and hair brushes. The nurse shares the information with the school. Which community-based nursing competency did the nurse use?

a.

Educator

b.

Caregiver

c.

Case manager

d.

Epidemiologist

ANS: D

As an epidemiologist, you are involved in case finding, health teaching, and tracking incident rates of an illness (outbreak of lice). The nurse did not teach the students about lice. The nurse did not provide care for the lice. The nurse did not coordinate needed resources and services for a group of patient’s well-being (case manager).

DIF:Apply (application)REF:37

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

TOP: Implementation MSC: Safety and Infection Control

10. A nurse is providing screening at a health fair. Which finding indicates the person may be a vulnerable patient who is most likely to develop health problems?

a.

One who is pregnant

b.

One who has excessive risks

c.

One who has unlimited access to health care

d.

One who uses nontraditional healing practices

ANS: B

Vulnerable populations are the 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. A person who has unlimited access to health care is not vulnerable. Frequently, the immigrant population practices nontraditional healing practices. Many of these healing practices are effective and complement traditional therapies.

DIF:Understand (comprehension)REF:34

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

MSC:Health Promotion and Maintenance

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?” How should the nurse respond?

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:Apply (application)REF:34

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

MSC:Health Promotion and Maintenance

12. The nurse is making a home visit to a Korean mother after the birth of girl. The spouse is pressing different parts of the patient’s hand and lower arm to relieve a headache. What is the nurse’s next action?

a.

Tell the spouse to stop and give the mother acetaminophen.

b.

Let the spouse finish and then give the mother medication.

c.

Ask the mother and/or spouse to explain the procedure.

d.

Explain to the spouse that it will not work.

ANS: C

The nurse should not judge the patient’s/family’s beliefs and values about health. The nurse needs to understand cultural beliefs, values, and practices to determine their specific needs. Acetaminophen may not be an acceptable alternative for this family. Criticizing the family’s beliefs and practices or saying they will not work may only create a barrier to care.

DIF:Analyze (analysis)REF:34

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

MSC: Psychosocial Integrity

13. A nurse is assessing the social system of a community. Which area should the nurse assess?

a.

Housing

b.

Economic status

c.

Volunteer programs

d.

Predominant ethnic groups

ANS: C

Social systems include volunteer programs, education system, government, and health systems. Housing and economic status are included in the structure assessment. Predominant ethnic groups are a component of the population assessment.

DIF:Understand (comprehension)REF:37-38

OBJ: Describe elements of a community assessment. TOP: Assessment

MSC: Psychosocial Integrity

14. The nurse is working with a 16-year-old pregnant female who tells the nurse that she needs an abortion. The nurse, acting as a counselor, provides the patient with information on alternatives to abortion, but after several sessions, the patient still insists on having the abortion. What should the nurse, in the counselor role, do next?

a.

Encourage the patient to speak with a “Right-to-Life” advocate.

b.

Refuse to provide a referral to an abortion service.

c.

Provide referral to an abortion service.

d.

Delay referral to an abortion service.

ANS: C

As a counselor, the nurse is responsible for providing information, listening objectively, and being supportive, caring, and trustworthy and providing a referral to an abortion service. The nurse does not make decisions, like going to a “Right-to-Life” advocate, 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.

DIF:Apply (application)REF:37

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

TOP: Implementation MSC: Psychosocial Integrity

15. Before a patient with beginning stage of Alzheimer’s disease is discharged, the community-based nurse is making a visit to the patient’s home. The patient’s daughter and family live in the home with the patient. What is the major focus of this visit?

a.

Teach the family how to monitor blood pressure.

b.

Demonstrate techniques for providing care.

c.

Stress to the family how difficult it will be to provide care at home.

d.

Encourage the family to send the patient to an extended care facility.

ANS: B

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. Monitoring blood pressure is not necessary for an Alzheimer’s patient; blood pressure would be for a patient with hypertension. The nurse should protect the patient’s rights and maintain family stability, not encourage placement in an extended care facility.

DIF:Apply (application)REF:36

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

TOP:ImplementationMSC:Management of Care

16. While conducting 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 component of a community assessment?

a.

Structure

b.

Population

c.

Social system

d.

Welfare 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 (comprehension)REF:38

OBJ: Describe elements of a community assessment. TOP: Assessment

MSC:Health Promotion and Maintenance

17. The nurse uses statistics on increased incidence of communicable disease to influence legislatures to pass a bill for mandatory vaccinations to enroll in school. Which type of nursing will the nurse use in this process?

a.

Public health nursing

b.

Community-based nursing

c.

Community health nursing

d.

Vulnerable population nursing

ANS: A

A public health nurse understands factors that influence health promotion and health maintenance, the trends and patterns influencing the incidence of disease within populations, environmental factors contributing to health and illness, and the political processes used to affect public policy. Community health nursing is nursing practice in the community, with the primary focus on the health care of individuals, families, and groups within the community. Community-based nursing care takes place in community settings such as the home or a clinic, where the focus is on the needs of the individual or family. While there is no specific vulnerable population nursing, all types of nursing should care for these populations.

DIF:Analyze (analysis)REF:33

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

TOP:EvaluationMSC:Health Promotion and Maintenance

MULTIPLE RESPONSE

1. A community-based nursing is working with a family. For which key areas will the nurse need a strong knowledge base? (Select all that apply.)

a.

Family theory

b.

Communication

c.

Group dynamics

d.

Cultural diversity

e.

Individual-centered care

ANS: A, B, C, D

With the individual and family as the patients, the context of community-based nursing is family-centered care (not individual-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:Understand (comprehension)REF:34

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

TOP: Teaching/Learning MSC: Health Promotion and Maintenance

2. Which community-based nursing activities indicate the nurse is working in the role of educator? (Select all that apply.)

a.

Offers prenatal classes

b.

Offers a child safety program

c.

Offers to defend patients’ decisions

d.

Offers creative solutions to local problems

e.

Offers coordinate resources after discharge

ANS: A, B

Prenatal classes, infant care, child safety, and cancer screening are just some of the health education programs provided in a community practice setting. Offers to defend patients’ decisions is the role of patient advocate. Offers creative solutions to local problems indicates a change agent. Collaborator will offer to coordinate resources after discharge.

DIF:Apply (application)REF:37

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

TOP: Teaching/Learning MSC: Health Promotion and Maintenance

3. A nurse is caring for vulnerable populations in a local community. Which patients will the nurse care for in this community? (Select all that apply.)

a.

A 47-year-old immigrant who speaks only Spanish

b.

A 35-year-old living in own home

c.

A 22-year-old pregnant woman

d.

A 40-year-old schizophrenic

e.

A 15-year-old rape victim

ANS: A, D, E

Individuals living in poverty, older adults, people who are homeless, immigrant populations, individuals in abusive relationships (rape), substance abusers, and people with severe mental illnesses (schizophrenic) are examples of vulnerable populations. Middle-aged people living in their own home are not an example of a vulnerable population. Pregnancy is not an example of a vulnerable population.

DIF:Analyze (analysis)REF:34-35

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

MSC: Psychosocial Integrity

MATCHING

A nurse is assessing a community. Match each community element the nurse will assess with the correct example.

a.

Education level

b.

Housing

c.

Government

1. Structure

2. Population

3. Social system

1.ANS:BDIF:Understand (comprehension)REF:38

OBJ: Describe elements of a community assessment. TOP: Assessment

MSC:Health Promotion and Maintenance

2.ANS:ADIF:Understand (comprehension)REF:38

OBJ: Describe elements of a community assessment. TOP: Assessment

MSC:Health Promotion and Maintenance

3.ANS:CDIF:Understand (comprehension)REF:38

OBJ: Describe elements of a community assessment. TOP: Assessment

MSC:Health Promotion and Maintenance