Stanhope: Foundations of Nursing in the Community: Community-Oriented Practice, 3rd Edition

Chapter 1: Community-Oriented Nursing and Community-Based Nursing

Test Bank

MULTIPLE CHOICE

	1.	Which of the following best describes community-based nursing?
a.	A philosophy that guides family-centered illness care	
b.	Giving care with a focus on the group’s needs	
c.	Giving care with a focus on the aggregate’s needs	
d.	Having the goal of giving optimal care to all clients	

ANS:	A
By definition, community-based nursing is nursing that focuses on family-centered illness care to individuals and families in the community.

DIF:	Cognitive Level: Knowledge	REF:	p. 3

	2.	Which of the following best describes community-oriented nursing?
a.	A practice that focuses on individuals and families	
b.	Giving care to manage acute or chronic conditions	
c.	Giving direct care to ill individuals within their family setting	
d.	Having the goal of health promotion and disease prevention	

ANS:	D
By definition, community-oriented nursing has the goal of preserving, protecting, or maintaining health to promote the quality of life. All nurses may focus on individuals and families, give direct to care to ill persons within their family setting, and help manage acute or chronic conditions.

DIF:	Cognitive Level: Knowledge	REF:	p. 3

	3.	What is the unique primary focus of public health nursing?
a.	Families and groups	
b.	Illness-oriented care	
c.	Individuals in their families	
d.	Promotion of quality of life	

ANS:	D
The key difference between community-based and community-oriented nursing is that community-based nurses deal primarily with illness-oriented care, whereas community-oriented nurses—or public health nurses—provide health care to promote quality of life.

DIF:	Cognitive Level: Knowledge	REF:	p. 3

	4.	Life expectancy increased dramatically during the twentieth century, primarily because of:
a.	Findings from medical laboratory research	
b.	Incredible advances in surgical techniques and procedures	
c.	Sanitation and other public health activities	
d.	Use of antibiotics to fight infections	

ANS:	C
Improvement in control of infectious diseases through immunizations, sanitation, and other public health activities led to the increase in life expectancy from less than 50 years in 1900 to more than 77 years in 2002.

DIF:	Cognitive Level: Knowledge	REF:	p. 5

	5.	What is the preferred public health approach to avoid premature deaths in America?
a.	Increasing the public’s knowledge concerning hospice care	
b.	Influencing Americans’ lifestyle behavior choices	
c.	Requiring employers to have wellness centers in each industrial site	
d.	Requiring that all prospective parents receive appropriate prenatal care	
e.	Timely and effective medical intervention and treatment	

ANS:	B
Public health approaches could help prevent about 70% of early deaths through influencing the way people eat, drink, drive, engage in exercise, and treat the environment.

DIF:	Cognitive Level: Knowledge	REF:	p. 5

	6.	What action would be most typical of a public health nurse?
a.	The nurse asks community leaders what interventions should be chosen.	
b.	The nurse assesses the community and decides on appropriate interventions.	
c.	The nurse uses data from the main health care institutions in the community to determine needed health services.	
d.	The nurse works with community groups to create policies to improve the community’s environment.	

ANS:	D
Although the public health nurse might engage in any of the tasks listed, he or she primarily works with members of the community to carry out core public health functions, including assessment of the population as a whole and engaging in promoting health and improving the environment.

DIF:	Cognitive Level: Application	REF:	p. 5

	7.	How is an aggregate defined?
a.	A large group of persons	
b.	A collection of individuals and families	
c.	A group of persons who share one or more characteristics	
d.	Another name for demographic group	

ANS:	C
An aggregate is defined as a collection of people who share one or more personal or environmental characteristics, such as geography or special interest.

DIF:	Cognitive Level: Knowledge	REF:	p. 9

	8.	A registered nurse (RN) was just employed as a public health nurse. Which question might be very relevant as the nurse begins employment?
a.	“Which groups are at the greatest risk for problems?”	
b.	“Which patients should I see first as I begin my day?”	
c.	“With which physicians will I be most closely collaborating?”	
d.	“Who is the nursing assistant to whom I can refer patients?”	

ANS:	A
Asking which groups are at greatest risk reflects a community-oriented perspective. The other possible responses reflect a focus on individuals.

DIF:	Cognitive Level: Application	REF:	p. 9 (How To box)	

	9.	When an RN talked to the women at the senior citizens’ center, the nurse reminded them that the only way the center would be able to afford a driver and van service for those who could no longer drive themselves would be to continue to write letters to their local city council representatives requesting funding for such a service. What was the nurse trying to accomplish?
a.	Ensuring that the women did not expect the nurse to solve their problem	
b.	Demonstrating that the nurse understood the women’s concerns and needs	
c.	Expressing empathy, support, and concern	
d.	Helping the women engage in political action	

ANS:	D
Public health nurses engage themselves and others in policy development and encourage and assist persons with a need to communicate that need to those with the power to take action.

DIF:	Cognitive Level: Application	REF:	p. 5

	10.	What is a basic assumption of public health efforts?
a.	Any disparities among any groups are morally and legally wrong.	
b.	Health care is the most important priority in government planning and funding.	
c.	The health of individuals cannot be separated from the health of the community.	
d.	The government is responsible for lengthening the life span of Americans.	

ANS:	C
Public health can be described as what society collectively does to ensure that conditions exist in which people can be healthy.

DIF:	Cognitive Level: Knowledge	REF:	p. 5

	11.	Which public health nurse is most clearly fulfilling responsibilities?
a.	The nurse who met with several groups to discuss community recreation issues.	
b.	The nurse who spent the day attending meetings of various health agencies.	
c.	The nurse who talked to several people about their particular health concerns.	
d.	The nurse who watched the city council meeting on local cable television.	

ANS:	B
Any of these descriptions might represent a nurse communicating, cooperating, or collaborating with community residents or groups about health concerns. However, the nurse who spent the day attending meetings of various health agencies is the most representative, because in public health, concerns are broader than recreation, individual concerns are not as important as aggregate priorities, and watching television (a one-way form of communication) is less effective than interacting with others.

DIF:	Cognitive Level: Synthesis	REF:	Entire chapter		

	12.	The nurse often has to make resource allocation decisions. What best describes the criterion the nurse should use in such cases?
a.	A specific moral or ethical principle	
b.	The cheapest, most economical approach	
c.	The most rational probable outcome	
d.	The needs of the aggregate rather than a few individuals	

ANS:	D
Although all of the choices represent components of a decision that the nurse might consider, the dominant needs of the population outweigh the expressed needs of one or a few people.

DIF:	Cognitive Level: Application	REF:	p. 9

	13.	Which action best represents public health nursing?
a.	Assessing the effectiveness of the large high school health clinic	
b.	Caring for clients in their home after their outpatient surgeries	
c.	Giving care to children and their families at the school clinic	
d.	Following up care for pediatric clients at an outpatient clinic	

ANS:	A
A public health or population-focused approach would look at the entire group of children being served to determine whether available services are effective in achieving the goal of improving the health of the school population.

DIF:	Cognitive Level: Application	REF:	p. 6

	14.	Which public health service represents secondary health prevention?
a.	Developing a health education program on the dangers of smoking	
b.	Providing a diabetes clinic for adults in low-income housing	
c.	Providing an influenza vaccination program in a community retirement village	
d.	Teaching school-age children about the positive effects of exercise	

ANS:	C
Although all of these services are appropriate and valuable, providing the flu vaccine to healthy adults is the only choice that represents a secondary health prevention action.

DIF:	Cognitive Level: Application	REF:	p. 12 (Levels of Prevention box)

	15.	It is very clear to the public health nurse what needs to be done and where to begin to improve the health of a certain community. So why does this nurse spend time meeting with community groups to discuss what is the most important task to be addressed first?
a.	To increase the group’s self-esteem	
b.	To maintain communication links with the groups	
c.	To make the groups feel good about their contribution	
d.	To work with the groups, not for the groups	

ANS:	D
Historically, health care providers have been accused of providing care for or to people without actually involving the recipients in the decisions. Public health nursing is a “with the people”—not a “to the people” or “for the people”—approach to planning.

DIF:	Cognitive Level: Knowledge	REF:	p. 10

	16.	Two nurses plan to walk under a huge downtown bridge where various homeless persons live. Why would the two nurses go to such an unsafe area?
a.	To assess needs of the homeless who live there	
b.	To demonstrate their courage and commitment	
c.	To distribute some of their own surplus clothes to those who can use them	
d.	To share with various churches and other charities what their members need to contribute	

ANS:	A
In most nursing practices, the client seeks out and requests assistance. In public health nursing, the nurse often reaches out to those who might benefit from a service or intervention, beginning with assessment of needs.

DIF:	Cognitive Level: Application	REF:	p. 11

MULTIPLE RESPONSE

	1.	What variables have led to a stronger commitment to population-focused services? Select all that apply.
a.	Economic turmoil and demand for high-technology care	
b.	Emergence of new or drug-resistant infectious diseases	
c.	Emphasis on overall health care needs rather than only on acute care treatment	
d.	Need to reduce constantly increasing costs of health care	
e.	Threat of bioterrorism and recent weather disasters	
f.	Widespread weather disasters (hurricanes, floods) with concurrent illnesses	

ANS:	B, C, D, E, F
As overall health needs become the focus of care in the United States, a stronger commitment to population-focused services is emerging. Threats of bioterrorism, anthrax scares, and the emergence of modern-day epidemics have drawn attention to population-focused safety and services. Although the textbook does not mention widespread weather disasters, the inevitability of these events, along with concurrent illnesses and the magnitude of need during such disasters, would clearly support a commitment to population-focused services.

DIF:	Cognitive Level: Application	REF:	p. 5

	2.	What actions would demonstrate effective public health nursing practice in the community? Select all that apply.
a.	Epidemiologic investigations examine the environment for health hazards.	
b.	New services are organized where particular vulnerable populations live.	
c.	Partnerships are established with community coalitions.	
d.	Staff members at the public health agency continue to increase in number.	
e.	The emergency department continues to see more patients each week.	
f.	The nurses continue to make presentations at the city council about health needs.	

ANS:	A, B, C, F
Evidence that public health nurses are practicing effectively in the community would include these: organizing services where people live, work, play, and learn; working in partnerships and with coalitions; participating in epidemiologic studies; and working with policymakers for policy change.

DIF:	Cognitive Level: Knowledge	REF:	p. 12

	3.	Why are nurses increasingly providing care in clients’ homes rather than in hospitals? Select all that apply.
a.	Home care is less expensive.	
b.	It is much more efficient to give care in the home.	
c.	Nurses prefer to give home care with individual attention.	
d.	People prefer to receive care in their homes rather than in hospitals.	
e.	People expect hospital staff to act like those in TV dramas and are invariably disappointed.	
f.	Physicians find it more convenient to visit in the home to educate families about client care.	

ANS:	A, D
Home care is growing because it is less expensive and because clients prefer to receive care in familiar and comfortable settings. It is not more efficient or more convenient, since travel time has to be considered. Nurses differ as to their preferred employment setting.

DIF:	Cognitive Level: Knowledge	REF:	pp. 12-13