Ch 3 Flashcards
What does community-based care focus on?
Community-based care focuses on health promotion, disease prevention, and restorative care.
What is community-based healthcare?
-a collaborative, patient-centered approach to provide culturally appropriate health care within a community.
-occurs outside traditional health care institutions such as hospitals.
-provides services to individuals and families in nontraditional settings such as ambulatory care clinics, community hospice centers, senior centers, parishes, and schools.
What are social determinants of health?
-Social determinants of health are biological, socioeconomic, psychosocial, behavioral, or social factors that contribute to a person’s current state of health.
-economic stability; education access and quality; health care access and quality; neighborhood and built environment; and social and community context.
What are health disparities?
-preventable differences in a population’s ability to achieve optimal health.
-negatively affect groups of people who have systematically experienced social or economic obstacles to health.
-obstacles stem from characteristics historically linked to discrimination or exclusion, such as race or ethnicity, religion, socioeconomic status, gender, mental health, sexual orientation, or geographic location.
-Other characteristics include cognitive, sensory, or physical disability.
What is community health nursing (also referred to as public health nursing)?
-Community health nursing is nursing practice in the community, with the primary focus on the health care of individuals, families, and groups within their communities.
-The goal is to preserve, protect, promote, or maintain health.
What is public health nursing?
-Public health nursing is a nursing specialty that requires understanding the needs of a population.
-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 that affect public policy.
What does the term population refer to?
-a collection of individuals who have one or more personal or environmental characteristics in common.
-Examples of populations include high-risk infants, older adults, or an ethnic group such as Native Americans.
What is the focus of community-oriented nursing?
The focus of community-oriented nursing is on health promotion, disease prevention, and improving quality of life of the population.
What is community-based nursing?
-takes place in community settings such as a home or clinic, where nurses focus on the needs of an indi- vidual or family.
-It involves the safety needs and acute and chronic care of individuals and families, enhances their capacity for self-care, and promotes autonomy in decision making.
What are 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, work, and socialize.
-These centers offer direct access to nurses and comprehensive patient-centered health services and readily incorporate the patient and the patient’s family or friends into a plan of care.
What are vulnerable populations?
-groups of patients who are more likely to develop health problems because of excess health risks, who are limited in their access to health care services, or who depend on others for care.
Guidelines for Assessing Members of Vulnerable Population Groups
Box 3.1
Global Health and WHO
-The global health issues identified by WHO for the next decade impact your community.
-Examples of priorities in global health issues for WHO include: equitable access to safe and effective vaccines, air pollution and climate change, infectious diseases, health care equality, affordable and available medications for all, shortages of health care workers, the use of new technologies to dissemi- nate accurate information, and clean water and sanitation
Guidelines for Assessing Members of Vulnerable Population Groups:
Box 3.1
What is a change-agent?
-A community-based nurse is also a change agent.
-involves identifying and implementing new and more effective approaches to problems.
-You act as a change agent within a family system or as a mediator for problems within a patient’s community.
- You identify any number of problems (e.g., quality of community childcare services, availability of older-adult day care services, or the status of neighborhood violence).
-As a change agent you empower individuals and their families to creatively solve problems or become instrumental in creating change within a health care agency.
Major Health Problems in Older Adults and Community-Based Nursing Roles and Interventions
Table 3.1
Community Assessment
Box 3.2
QSEN Building Competency in Safety Maria Perez is a 74-year- old widow with heart failure (HF) who has been referred to the Home Care Agency for services. Maria has been admitted to the hospital three times in the past two months. Two admissions were for HF exacerbation and the other was for a fractured wrist after falling in the bathroom. Maria lives alone in a senior housing apartment building that has an elevator. The hospitalist requests a home safety evaluation, along with assessment of medication management. What information does the nurse need to begin this assessment?
What population in the community do you see most frequently in your clinical setting? What are some nursing assessments, skills, or tasks you can perform with this population?
Evidence-Based Practice
Box 3.3
- The public health nurse is working with the local city/county health department during a pandemic that has created a crisis within the community. What are responsibilities of the public health nurse during the pandemic? (Select all that apply.)
- Educate the public on disease prevention
- Serve as liaison between patients and health care services and providers
- Investigate cases as they arise
- Monitor trends of the disease outbreak
- Assist with testing for identification of the disease
1, 2, 3, 4, 5
- A community health nurse is working in a clinic with a focus on asthma and allergies. What is the primary focus of the community health nurse in this clinic setting? (Select all that apply.)
- Decrease the incidence of asthma attacks in the community
- Increase patients’ ability to self-manage their asthma
- Treat acute asthma in the hospital
- Provide asthma education programs for the teachers in the local
schools - Provide scheduled immunizations to people who come to the clinic
1, 2, 4
- The nurse caring for a refugee community identifies that the children
are undervaccinated and the community is unaware of resources. The nurse assesses the community and determines that there is a health clinic within a 5-mile radius. The nurse meets with the community leaders and explains the need for immunizations, the location of the clinic, and the process of accessing health care resources. Which of the following practices is the nurse providing? (Select all that apply.) - Raising awareness about community resources for the children
- Teaching the community about health promotion and illness prevention
- Promoting autonomy in decision making about health practices
- Improving the health care of the community’s children
- Participating in professional development activities to maintain
nursing competency
1, 2, 4
- What factor results in vulnerable populations being more likely to develop health problems?
- The ability to use available resources to find housing
- Adequate transportation to the grocery store and community clinics
- Availability of others to help provide care
- Limited access to health care services
4
- Many older homes in a neighborhood are undergoing a lot of restora- tion. Lead paint was used to paint the homes when they were built. The community clinic in the neighborhood is initiating a lead screening program. This activity is based on which social determinant of health?
Physical environment
- A community health nurse conducts a community assessment focused on adolescent health behaviors. The nurse determines that a large number of adolescents smoke. Designing a smoking-cessation program at the youth community center is an example of which nursing role?
- Epidemiologist
- Counselor
- Collaborator
- Casemanager
2
7.A nurse in a community health clinic reviews screening results from students in a local high school during the most recent academic year. The nurse discovers a 10% increase in the number of positive tuberculosis (TB) skin tests when comparing these num-bers to the previous year. The nurse contacts the school nurse and the director of the health department. Together they begin to expand their assessment to all students and employees of the school district. The community nurse is acting in which nursing role(s)? (Select all that apply.)
1. Epidemiologist
2. Counselor
3. Collaborator
4. Casemanager
5. Caregiver
1, 3
- A nursing student is giving a presentation to a group of other nursing students about the needs of patients with mental illnesses in the community. Which statement by the student indicates that the nursing professor needs to provide further teaching?
- “Many patients with mental illness do not have a permanent home.”
- “Unemployment is a common problem experienced by people with a mental illness.”
- “The majority of patients with mental illnesses live in long-term care settings.”
- “Patients with mental illnesses are often at a higher risk for abuse and assault.”
3
- The nurse in a new community-based clinic is requested to complete a community assessment. Order the steps for completing this assessment.
- Structure or locale
- Social systems
- Population
1, 3, 2
- The public health nurse is working with the county health department on a task force to fully integrate the goals of Healthy People 2030. Most of the immigrant population do not have a primary care provider, nor do they participate in health promotion activities; the unemployment rate in the community is 25%. How does the nurse determine which goals need to be included or updated? (Select all that apply.)
- Assess the health care resources within the community.
- Assess the existing health care programs offered by the county
health department. - Compare existing resources and programs with Healthy People
2030 goals. - Initiate new programs to meet Healthy People 2030 goals.
- Implement educational sessions in the schools to focus on
nutritional needs of the children.
1, 2, 3
Summary
• The terms community health nursing and public health nursing are used interchangeably and fall under the umbrella term community- oriented nursing.
• The community-oriented nurse’s focus is on health promotion, disease prevention, and improving quality of life of the popula- tion, while the focus of the community-based nurse is to provide direct illness care to individuals and families within the commu- nity setting.
• Nurses play a critical role in community health during a pandemic through identification of cases, prevention of disease/illness spread, education, direct patient care, and managing supplies and equipment.
• Vulnerable populations are groups of patients who are more likely to develop health problems as a result of excess health risks, who have limited access to health care services, or who depend on oth- ers for care. Individuals living in poverty, older adults, people who are homeless, immigrant populations, individuals in abusive rela- tionships, people with substance abuse disorders, and people with severe mental illnesses are examples of vulnerable populations.
• The community-based nurse needs skills in health promotion, disease prevention, and relationship building to fill the role of care- giver, case manager, change agent, patient advocate, collaborator, counselor, educator, and epidemiologist.
• Community assessment is the systematic collection of data on the population, monitoring of the health status of the population, and making information available about the health of the community. Community assessment includes structure, population, and social system.
Nurse Epidemiologist
responsible for community surveillance for risk factors, protect the level of health of the community
Incident rates
Rate of new cases of a disease in a specified population over a defined period of time.
The nurse is working with the county health department on a task force to fully integrate the goals of Healthy People 2020. How does the nurse determine which goals need to be included or updated? (Select all that apply.)
1. Assesses the health care resources within the community
2. Assesses the existing health care programs offered by the county health department
3. Compares existing resources and programs with Healthy People 2020 goals
4. Initiates new programs to meet Healthy People 2020 goals
- Assesses the health care resources within the community
- Assesses the existing health care programs offered by the county health department
- Compares existing resources and programs with Healthy People 2020 goals
A patient is worried about her 76-year-old grandmother who is in very good health and wants to live at home. The patient’s concerns are related to her grandmother’s safety. The neighborhood
does not have a lot of crime. Using this scenario, which of the following are the most relevant to assess for safety?
1. Crime rate, locks, lighting, neighborhood traffic
2. Lighting, locks, clutter, medications
3. Crime rate, medications, support system, clutter
4. Locks, lighting, neighborhood traffic, crime rate
Lighting, locks, clutter, medications
On the basis of an assessment, the nurse identifies an increase in the immigrant population group in the community. How would he or she determine some of the health needs of this population? (Select all that apply.)
1. Identify which two health needs the immigrant population views as most important
2. Apply information from Healthy People 2020
3. Determine how the population uses available health care resources
4. Identify perceived barriers for health care
5. Implement an exercise program to help with weight loss
- Identify which two health needs the immigrant population views as most important
- Apply information from Healthy People 2020
- Determine how the population uses available health care resources
- Identify perceived barriers for health care
The nurse in a new community-based clinic is requested to complete a community assessment. Order the steps for completing this assessment.
1. Structure or locale
2. Social systems
3. Population
- Structure or locale
- Population
- Social systems
In the community clinic the nurse provides care for a 40-year old woman who takes insulin to manage her diabetes.
The patient is having increased difficulty managing her disease, and the nurse wants her to consider a new insulin pump to help her control it. Which of the following increases the likelihood that the patient will accept this new insulin pump? (Select all that apply.)
1. Supporting the patient as she tries the insulin pump on a limited basis
2. Identifying why the patient is reluctant to use the insulin pump
3. Telling the patient that many other patients you know use the insulin pump successfully
4. The patient’s perception that the insulin pump is more consistent with her health care goals than insulin administration
- Supporting the patient as she tries the insulin pump on a limited basis
- Identifying why the patient is reluctant to use the insulin pump
- The patient’s perception that the insulin pump is more consistent with her health care goals than insulin administration
The nurse in a community health clinic notices an increase in the number of positive tuberculosis skin tests from students in a local high school during the most recent academic year. After comparing these numbers to the previous years, a 10% increase in positive tests was found. The nurse contacts the school nurse and the director of the health department. Together they begin to expand their assessment to all students and employees of the school district. The community health nurse is acting in which nursing role(s)? (Select all that apply.)
1. Epidemiologist
2. Counselor
3. Collaborator
4. Case manager
- Epidemiologist
- Collaborator
The nurse in a community health clinic notices an increase in the number of positive tuberculosis skin tests from students in a local high school during the most recent academic year. After comparing these numbers to the previous years, a 10% increase in positive tests was found. The nurse contacts the school nurse and the director of the health department. Together they begin to expand their assessment to all students and employees of the school district. The community health nurse is acting in which nursing role(s)? (Select all that apply.)
1. Epidemiologist
2. Counselor
3. Collaborator
4. Case manager
2
A neighborhood with old homes is undergoing a lot of restoration. Lead paint was used in the buildings. The clinic is initiating a lead screening program. This activity is an example of which level of prevention?
Secondary intervention
The local health department received information from the Centers for Disease Control and Prevention that the flu was expected to be very contagious this season. The nurses set up flu vaccine clinics in local churches and senior citizen centers. This activity is an example of which level of prevention?
Tertiary Intervention
Which of the following are major public health problems commonly affecting older adults? (Select all that apply.)
1. Substance abuse
2. Dementia
3. Financial limitations
4. Communicable diseases
5. Chronic physical illnesses
- Substance abuse
- Dementia
- Financial limitations
- Chronic physical illnesses
Vulnerable populations of patients are those who are more likely to develop health problems as a result of:
1. Chronic diseases and homelessness
2. Poverty and acute illness
3. Lack of transportation, ability to perform self-care but are homeless
4. Excess health risks, limits in access to health care services, and dependency on others for care
Excess health risks, limits in access to health care services, and dependency on others for care
A nurse caring for a Bosnian community identifies that the children are undervaccinated and the community is unaware of resources. The nurse assesses the community and determines that there is a health clinic within a 5-mile
radius. The nurse meets with the community leaders and explains the need for immunizations, the location of the
clinic, and the process of accessing health care resources.
Which of the following practices is the nurse providing? (Select all that apply.)
1. Educating about community resources
2. Teaching the community about illness prevention
3. Promoting autonomy in decision making
4. Improving the health care of the children in the community
- Educating about community resources
- Teaching the community about illness prevention
4 Improving the health care of the children in the community
A nursing student in the last semester of the baccalaureate nursing program is beginning the community health practicum and will be working in a community-based clinic with a focus on asthma and allergies.
What is the focus of the community health nurse in this clinic setting? (Select all that apply.)
1. Decreasing the incidence of asthma attacks in the community
2. Increasing healthy food choices for school lunches
3. Assessing for factors that contribute to asthmatic attacks in the community
4. Providing asthma education programs for the teachers in the local schools
- Decreasing the incidence of asthma attacks in the community
- Increasing healthy food choices for school lunches
- Providing asthma education programs for the teachers in the local schools
Using Healthy People 2020 as a guide, which of the following would improve delivery of care to a community? (Select all that apply.)
1. Community assessment
2. Implementing public health policies
3. Increasing access to care
4. Determining rates of specific illnesses
5. Reducing the number of fast food restaurants in the community
- Community assessment
- Implementing public health policies
- Increasing access to care
- Determining rates of specific illnesses
A community nurse in a diverse community is working with health care professionals to provide prenatal care for underemployed and underinsured South African women.
Which overall goal of Healthy People 2020 does this represent?
1. Assess the health care needs of individuals, families, or communities
2. Develop and implement public health policies and improve access to care
3. Gather information on incident rates of certain diseases and social problems
4. Increase life expectancy and quality of life and eliminate health disparities
Increase life expectancy and quality of life and eliminate health disparities
The first step in community assessment is
determining the community’s:
1. Goals
2. Set factors
3. Boundaries
4. Throughputs
Boundaries
Rationale:
Observe the community’s design, location of services, and locations where the residents meet.
When the community health nurse refers patients to appropriate resources and monitors and coordinates the extent and adequacy of services to meet family health care needs, the nurse is functioning in the role of:
1. Advocate
2. Counselor
3. Collaborator
4. Case manager
Case manager
Rationale:
The coordinating of activities of multiple providers and payers in different settings throughout a patient’s continuum of care.
Which of the following is an example of an intrinsic risk factor for homelessness?
1. Severe anxiety disorders
2. Psychotic mental disorders
3. Living below the poverty line
4. Progressive chronic alcoholism
Living below the poverty line
Rationale:
They are usually jobless and do not have the advantage of shelter and cope with finding a place to sleep at night and finding food.
There are three components of a community that need to be assessed.
Identify them and give an example of each.
a. Structure (geographical boundaries, emergency services, housing, economic status)
b. Population (age and sex distribution, growth trends, education level, ethnic and religious groups)
c. Social (education and communication systems, government, volunteer programs, welfare system)
Briefly explain the competencies the nurse needs in the epidimiologist role.
May be involved in case finding, health teaching, and tracking incident rates.
Briefly explain the competencies the nurse needs in the educator role.
Establishes relationships with community service organizations and assesses patients’ learning needs and readiness to learn within the context of the individual, the systems with which the individual interacts, and the resources available for support.
Briefly explain the competencies the nurse needs in the counselor role.
Assists patients in identifying and clarifying health problems and in choosing appropriate courses of action.
Briefly explain the competencies the nurse needs in the collaborator role.
Mutual trust and respect for each professional’s abilities and contributions, clarifying roles, and developing a plan of care.
Briefly explain the competencies the nurse needs in the patient advocate role.
Often is the one who presents the patient’s point of view to obtain appropriate resources.
Briefly explain the competencies the nurse needs in the change agent role.
Acts to empower individuals and their families to creatively solve problems or become instrumental in creating change within a health care agency.
Briefly explain the competencies the nurse needs in the case manager role.
The ability to establish an appropriate plan of care based on assessment of patients and families and to coordinate needed resources and services for the patient’s well-being across a continuum of care.
Briefly explain the competencies the nurse needs in the caregiver role.
Together with the family, you develop a caring partnership to recognize actual and potential health care needs and identify community resources.
Vulnerable populations are those patients who:
a. Patients who are more likely to develop health problems as a result of excess risks
b. Patients who have limits in access to health care services
c. Patients who are dependent on others for care
Briefly describe the differences between:
a. Public health nursing focus:
b. Community health nursing focus:
a. Focus requires understanding the needs of a population (e.g., high-risk infants, older adults, or cultural groups).
b. It is a nursing practice in the community, with the primary focus on the health care of individuals, families, and groups in the community.
- 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.
- 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 practicein community settings are considered community health nurse specialists, regardless of their public health experience
- 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. Thecommunity-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 thehealth care system. The community-based nurse learns to partner with patients and families sothat ultimately the patient and the family become involved in planning, decision making, implementation, and evaluation of health care approaches
- 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.
- 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.
- 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.
- 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
- The community-based nurse is caring for a patient who is homebound 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.
- 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.
- Vulnerable populations include those patients who are more likely to develop health problems
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 aresult 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
- 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.
- 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, non threatening 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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 nurseleans to partner with patients and families, not just with individuals.
- 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.
- 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.
A community-based nurse encounters a college student addicted to cocaine. What are the various assessments that the nurse must perform to assist this student?
Assess the nature of use.
Assess the amount of consumption
What is evidence-based practice?
- Nursing care based on tradition
- Scholarly inquiry of nursing and biomedical research literature
- Optimal patient care based on current research
- Quality nursing care provided in an efficient and economically sound manner
- Optimal patient care based on current research
Evidence-based practice integrates the best current evidence with clinical expertise, patient/family preferences, and values for delivery of optimal health care. It is based on research, not tradition. It is a patient care, not a type of literature. Quality care provided in an efficient and economically sound manner is a standard of nursing care.
The nurse is being appointed as nurse educator in a nursing school. What are the responsibilities of the nurse educator?
- Manage patient care and delivery of special nursing services.
- Provide students with practical and theoretical knowledge.
- Provide care to patients using a holistic approach.
- Provide surgical anesthesia under the guidance and supervision of an anesthesiologist.
- Provide students with practical and theoretical knowledge
The nurse educator is responsible for educational activities conducted in schools of nursing. If they are educators in clinical care institutions, they often participate in the development of nursing policies and procedures. In schools of nursing, the nurse educator imparts practical and theoretical knowledge to students. The nurse educator is not responsible for managing patient care, proving holistic care, or providing surgical anesthesia. The nurse administrator manages patient care. The nurse practitioner provides holistic care to patients. The certified registered nurse anesthetist provides surgical anesthesia.
The nursing mentor observes that a nursing student is deficient in communication skills but is good at understanding nursing theories. How should the mentor intervene with respect to this student?
- Help the student build communication skills.
- Utilize the student’s services for patient education and rehabilitation.
- Utilize the student’s services for coordinating and managing patient care.
- Consider the lack of communication skills unimportant, because sound knowledge ensures a good patient-nurse relationship.
- Help the student build communication skills.
Communication is an important skill for nurses, so the mentor should help the student build communication skills. This student cannot be utilized for patient education, rehabilitation, or coordinating and managing patient care, because all these activities require good communication skills. Communication skills, not subject knowledge, ensure a good patient-nurse relationship.
A patient in the emergency department has developed wheezing and shortness of breath. The nurse gives the ordered medicated nebulizer treatment now and in 4 hours. Which standard of practice is performed?
- Planning
- Evaluation
- Assessment
- Implementation
- Implementation
Implementation is coordinating care and completing the prescribed plan of care.
The health care provider asks the certified registered nurse anesthetist (CRNA) to provide spinal anesthesia to a patient who is scheduled for a hernia operation. What is the CRNA’s next step?
- Provide the anesthesia under the supervision of a senior nurse.
- Inform the health care provider that the CRNA has the right to provide spinal anesthesia only in a tertiary setup.
- Provide the anesthesia under the supervision of a primary health care provider with knowledge of surgical anesthesia.
- Inform the health care provider that the CRNA’s services are restricted to nonsurgical procedures.
- Provide the anesthesia under the supervision of a primary health care provider with knowledge of surgical anesthesia.
A certified registered nurse anesthetist (CRNA) is trained at an anesthesia-accredited program. The nurse has the right to provide surgical anesthesia under the supervision of a primary health care provider with knowledge of surgical anesthesia. The CRNA should provide anesthesia only under the supervision of a primary health care provider. The CRNA can provide anesthesia even in a primary set-up, under supervision. CNRA services may be utilized even for surgical procedures.
The nurse usually is assigned multiple patients at one time. What should the nurse do to ensure individual patient satisfaction? Select all that apply.
- Provide quality care to each patient.
- Ensure that patients leave with a positive image of nursing.
- Provide quick and hurried treatment to the less needy.
- Manage time and approach all patients with compassion.
- Minimize contact time with each patient to ensure care for all.
- Provide quality care to each patient.
- Ensure that patients leave with a positive image of nursing
- Manage time and approach all patients with compassion.
The nurse caring for multiple patients at a time should understand that all patients are equally important. All should receive quality care, so they leave the health care setting with a positive image of nursing. Time management and a compassionate approach are keys to achieving these goals. However, the nurse should not cut down contact time with each patient; rather, the nurse should optimize contact time so all can be cared for and should deliver care in an organized manner, rather than in a hurried or rushed manner.
A patient sprained her ankle. The nurse instructs the patient to keep the leg elevated and applies cold compresses on the affected ankle. Which standard of practice is the nurse performing?
- Assessment
- Diagnosis
- Evaluation
- Implementation
- Implementation
The nurse is delivering care to the patient; therefore the standard practiced by the nurse is implementation. Assessment is the process of collecting data related to the health and illness of the patient. Nursing diagnosis involves analyzing the assessed data. Evaluation refers to determining the effectiveness of the implemented patient care in meeting the patient goals.
Nurses are responsible for the quality of care provided to patients. Which will help nurses practice safe nursing? Select all that apply.
- Acquiring knowledge
- Minimizing documentation
- Improving competencies
- Acquiring technical skills
- Exhibiting complete dependence
- Acquiring knowledge
- Improving competencies
- Acquiring technical skills
The nursing profession is accountable for the type and quality of care delivered to patients, so nurses should prepare by acquiring and updating knowledge, improving competencies, and acquiring technical skills. Avoiding documentation may generate more complications, such as legal issues. Nurses are given autonomy for various nursing practices, so they should be dependent only in aspects of care beyond their scope of practice.
- Acquiring knowledge
- Improving competencies
- Acquiring technical skills
The nursing profession is accountable for the type and quality of care delivered to patients, so nurses should prepare by acquiring and updating knowledge, improving competencies, and acquiring technical skills. Avoiding documentation may generate more complications, such as legal issues. Nurses are given autonomy for various nursing practices, so they should be dependent only in aspects of care beyond their scope of practice.
- Provide information so the patient can decide whether to accept the treatment or refuse.
The patient has been put on a potentially toxic drug. Because the patient is elderly, the nurse should act as an advocate and take measures to protect the patient’s rights. Therefore, the nurse may provide information that will help the patient decide whether to take the treatment. The nurse should not give the drug in a low dose, because that may not serve the purpose of administering it. The nurse should obey the instructions by the health care providers only after ensuring that the patient’s concerns are addressed. At times, in order to protect human rights, the nurse needs to speak out against policies.
In a hospital there is an acute shortage of nurses due to retirement. What should the remaining nurses do? Select all that apply.
- Hurry through the patient care assignments.
- Use patient contact time efficiently.
- Utilize the patient contact time professionally.
- Only treat the same number of patients as treated before the retirements.
- Eliminate assessment aspects of patient care to make more time.
- Use patient contact time efficiently.
- Utilize the patient contact time professionally.
Nurses should learn time management skills and use patient contact time efficiently and professionally. They should not hurry through patient care, as studies have proven that hurrying does not save time in the long run and increases the possibility of errors. Nurses should not compromise the quality of care they deliver; in the long run, that will not save time.
An 18-year-old patient is in the emergency department with fever and cough. The nurse obtains vital signs, auscultates lung sounds, listens to heart sounds, determines patient’s level of comfort, and collects blood and sputum samples for analysis. Which standard of practice is performed?
- Diagnosis
- Evaluation
- Assessment
- Implementation
- Assessment
Assessment is the collection of comprehensive data pertinent to the patient’s health and/or the situation.
The senior nurse is explaining to the nurse who holds an associate degree about immediate future options in advanced nursing education. Which educational options should be included? Select all that apply.
- Doctor of Nursing Practice (DNP)
- A master’s degree in nursing
- Doctor of Philosophy (PhD) in Nursing
- Bachelor of Science in Nursing (BScN)
- Bachelor in Nursing (BN)
- Bachelor of Science in Nursing (BScN)
- Bachelor in Nursing (BN)
The higher education opportunities available for the nurse with an associate degree include baccalaureate programs in nursing, such as Bachelor of Science in Nursing (BScN) and Bachelor in Nursing (BN). A Doctor of Nursing Practice (DNP) degree can be pursued only after a master’s degree. A Doctor of Philosophy (PhD) in Nursing also requires a master’s degree. The nurse must hold a baccalaureate degree before enrolling in a master’s degree program.
The community health nurse is conducting a program on health and fitness awareness for medically underserved people. Who would be categorized as medically underserved?
- People belonging to a different culture
- People of a poor socioeconomic status
- People who are not willing to be treated for their illnesses
- People who use complementary and alternative treatments for their illnesses
- People of a poor socioeconomic status
Medically underserved people are those who lack the financial resources required for proper health care. Unemployment, low-paying jobs, and rising health care costs have all increased the population of medically underserved people in the United States. People not belonging to the dominant culture are not necessarily poor or unable to bear health care costs. People who prefer not to be treated and those who opt for alternate treatment methods are not categorized as medically underserved.
The nurse is caring for a patient with end-stage lung disease. The patient wants to go home on oxygen and be comfortable. The family wants the patient to have a new surgical procedure. The nurse explains the risk and benefits of the surgery to the family and discusses the patient’s wishes with the family. Which role is the nurse playing for the patient?
- Educator
- Advocate
- Caregiver
- Case manager
- Advocate
An advocate protects the patient’s human and legal right to make choices about care. An advocate may also provide additional information to help a patient decide whether or not to accept a treatment or find an interpreter to help family members communicate their concerns.
Nurses at a community hospital are in an education program to learn how to use a new pressure-relieving device for patients at risk for bed sores. This is an example of which type of education?
- Continuing prerequisite education
- Graduate education
- Inservice education
- Professional registered nurse education
- Inservice education
Inservice education programs provide instruction or training by a health care agency or institution. An inservice program is held in the institution and is designed to increase the knowledge, skills, and competencies of nurses and other health care professionals employed by the institution. Prerequisite education is course work required prior to the nursing program. Graduate education is a formal program following a Bachelor of Science in Nursing (BSN) and professional registered nurse education is an undergraduate nursing education program.
A 40-year-old patient is diagnosed with colon cancer. While interacting with the patient, the nurse learns that he has a twin brother. Which nursing actions are appropriate for the patient’s brother? Select all that apply.
1 . Motivate the patient’s brother to get a colonoscopy.
2. Conclude that the patient’s brother does not require intervention.
3. Encourage the patient’s brother to get an annual stool test.
4. Avoid doing anything, because that is a responsibility of the health care provider.
5. Avoid doing anything, because the nurse is responsible for the patient and not for the brother.
- Motivate the patient’s brother to get a colonoscopy.
- Encourage the patient’s brother to get an annual stool test.
Because the patient is suffering from colon cancer before the age of 50, it is likely that the patient’s siblings have a higher risk of developing colon cancer. Therefore, the nurse should motivate the twin brother to also get a colonoscopy or other screening test, as recommended by current guidelines for higher-risk patients. If the patient had developed colon cancer after age 50, screening for the brother would be less urgent. However, early onset in the patient means the risk of colon cancer is higher for the brother. The nurse is as responsible as the primary health care provider for screening for family members who are at risk of colon cancer. The nurse should provide care to both the patient and his brother.
The nurse is participating in a clinical care coordination conference for a patient with terminal cancer. The nurse talks with colleagues about using the nursing code of ethics for professional registered nurses to guide care decisions. A nonnursing colleague asks about this code. What does this code do?
- Improves self-health care
- Protects the patient’s confidentiality
- Ensures identical care to all patients
- Defines the principles of right and wrong when providing patient care
- Defines the principles of right and wrong when providing patient care
The code of ethics identifies the philosophical ideals of right and wrong that define the principles that nurses follow when providing care for patients. The code serves as a guide for carrying out nursing responsibilities to provide quality nursing care and describes the ethical obligations of the profession. The code of ethics does not include methods to improve self-health care. Protecting the patient’s confidentiality is a standard of care and is covered in the language of the Health Insurance Portability and Accountability Act (HIPAA). Care must be provided based on differing patient needs. When giving care, it is essential to provide a specified service according to standards of practice and to follow a code of ethics.
The nurse educator is delivering a lecture on nursing as a profession to a group of nursing students who have recently joined the baccalaureate nursing degree course. Which statements are true? Select all that apply.
- “The nurse is responsible to provide specific health care to patients.”
- “The nurse is responsible and accountable to the patients.”
- “Nurses have to follow a specific code of ethics while delivering care.”
- “Care delivery by nurses is only based on orders given by the health care provider.”
- “Nursing education involves learning the caregiving techniques without any theoretical body of knowledge.”
- “The nurse is responsible to provide specific health care to patients.”
- “The nurse is responsible and accountable to the patients.”
- “Nurses have to follow a specific code of ethics while delivering care.”
Nursing is a profession that involves administering quality patient-centered care in a safe and knowledgeable manner. The nurse provides a specific kind of health care to patients. The nurse is responsible for the care delivered to the patient and is accountable to the patients. Ethical health care delivery is a very important characteristic of the nursing profession. Nurses have the right to participate in the decision-making process for the patient, so they need not always rely on the prescription given by the health care provider for delivering care. Nursing education includes a theoretical body of knowledge leading to defined skills, abilities, and norms.
