Chapter 3: Community Health Nursing in Canada: Settings, Functions, and Roles

Question 1

1. Which statement best describes the concept of public health?
   a. A population health approach designed to prevent disease, promote health, and
   protect populations
   b. Health care provision offered in primary and secondary institutions or in clients’
   homes
   c. Provision of health care services in institutions located in the community but
   outside the hospital
   d. Use of the nursing process and evidence-informed practice to meet the objectives
   for community health improvement

Answer 1

ANS: A
In Canada, public health takes a population health approach to protecting and promoting
health and preventing disease for all Canadians. Public health nurses (PHNs) work with many
partners, both within the public health unit or health authority (e.g., nutritionists,
epidemiologists, dental hygienists, health inspectors) and external to the health unit (e.g.,
community coalitions for heart health, cancer screening, diabetes, and obesity prevention;
school and hospital administrators; regional planners; social service and child-care workers;
lobbyists for health issues such as antismoking legislation and homelessness).

Question 2

2. The increasing complexity of societal needs and rapid changes in public health no longer
   allow for adequate time for on-the-job training and education. As a result, what is the current
   minimum level of educational preparation for a public health nurse?
   a. Training as a registered practical nurse
   b. Training as a registered nurse
   c. A baccalaureate degree in nursing
   d. A master of science degree in nursing

Answer 2

ANS: C
Educational preparation for public health nurses should be at least a baccalaureate degree

Question 3

3. What is a core competency required of PHNs?
   a. Advanced knowledge in the use of high-technology diagnostics
   b. Familiarity with current life-support technology
   c. Highly tuned skills for assessment of critically ill clients
   d. Skill in developing policy and planning programs to improve health

Answer 3

ANS: D
Skill in developing policy and planning programs to improve health is part of the set of core
public health competencies, which are divided into the following eight domains: (1) Public
Health and Nursing Sciences; (2) Assessment and Analysis; (3) Policy and Program Planning,
Implementation, and Evaluation; (4) Partnerships, Collaboration, and Advocacy; (5) Diversity
and Inclusiveness; (6) Communication; (7) Leadership and Professional Responsibility; and
(8) Accountability. The other competencies listed are better suited to nurses who work in
tertiary facilities, such as hospitals.

Question 4

4. A health centre administrator is in the process of hiring a new CHN. Which statement by a
   potential employee would raise the greatest concern for the employer?
   a. “I like to be the only person working on a project because individual team
   members have their own ideas and plans, and the resulting debate slows progress.”
   b. “I prefer to work in teams because no single person has too much responsibility
   and the burden is shared.”
   c. “Teamwork is better than work done by individuals because teamwork
   incorporates different perspectives.”
   d. “Whether teamwork is better than work done by individuals depends on the nature
   of the work being performed.”

Answer 4

ANS: A
Working in collaborative partnerships is an essential routine function of any community health
nurse. Partnerships and collaboration among groups are much more powerful in making
changes than are the individual client and the CHN working separately. Part of the reason for
this is that multiple perspectives are examined in the process of arriving at the best solution.

Question 5

5. Which one of the following is a primary prevention activity for decreasing the incidence of
   communicable diseases?
   a. Identifying and treating clients in a clinic for sexually transmitted infections (STIs)
   b. Partnering with school teachers to teach handwashing to elementary school
   children and observe their techniques
   c. Providing case management services that link clients with communicable diseases
   to health care and community support services
   d. Providing directly observed therapy (DOT) to clients with active tuberculosis (TB)

Answer 5

ANS: B
An example of primary prevention is to educate daycare centres, schools, and the general
community about the importance of hand hygiene to prevent transmission of communicable
diseases.

Question 6

6. What activity is the PHN participating in when tracing the sexual contacts of clients with STIs
   for potential screening purposes?
   a. Primary prevention
   b. Secondary prevention
   c. Tertiary prevention
   d. Secondary and tertiary prevention

Answer 6

ANS: B
Secondary prevention activities include contacting and tracing individuals exposed to a client
with an active case of TB or an STI. Once contact has been made, the actual screening is
another secondary prevention activity.

Question 7

7. Which community health nurse (CHN) activity demonstrates tertiary prevention related to
   mental health?
   a. Disseminating information about mental health to community organizations
   b. Partnering with PHNs for early identification of children with mental health
   challenges
   c. Providing case management services that link clients with serious mental illnesses
   to mental health and community support services
   d. Screening clients at high risk for mental disorders

Answer 7

ANS: C
An example of tertiary prevention is the provision of case management services that link
clients identified with serious mental illnesses to mental health and community support
services.

Question 8

8. Which of the following represents the main difference between parish nursing and all other
   fields of nursing?
   a. Affiliation with a church or congregation
   b. Incorporation of spiritual aspects into nursing care
   c. Provision of holistic nursing care
   d. Residence within the community of service

Answer 8

ANS: A
Parish nurses are found in faith congregations, including communities that serve diverse
cultures. Parish nurses also serve faith communities in other countries

Question 9

9. Which statement by a parish nurse exhibits a misunderstanding of the concept of pastoral
   care?
   a. “By working with my clients to help them identify their spiritual strengths, I am
   drawing on the pastoral care aspects of practice.”
   b. “I incorporate pastoral care in my practice when I involve the pastor in ministering
   to the members of the congregation.”
   c. “I am practising pastoral care when I emphasize the spiritual dimension of nursing
   while providing care.”
   d. “Lending support to clients during their times of joy as well as times of sorrow is
   part of providing pastoral care.”

Answer 9

ANS: B
Pastoral care by a parish nurse implies providing care by stressing the spiritual dimension of
nursing, lending support during times of joy and sorrow, guiding the person through health
and illness throughout life, and helping identify the spiritual strengths that assist in coping
with particular events. The parish nurse is able to provide pastoral care; she or he does not
have to involve the pastor.

Question 10

10. What is the central difference between home health care and other types of health care?
    a. Home health care is individualized care for the client and family.
    b. Home health care is provided in the client’s environment.
    c. Reimbursement for home health care is different from that of care provided in
    institutions.
    d. Home health care focuses on community health.

Answer 10

ANS: B
Home health care differs from other types of health care in that home health care providers
practice in the client’s environment

Question 11

11. A CHN is part of a palliative consultation team that provides care for people living on the
    streets, in parks, or in shelters or who are unwilling or unable to come to the clinic, hospital,
    or hospice to receive end of life care. How can this type of nursing service be best classified?
    a. Community-oriented nursing
    b. Home health nursing
    c. Outpost nursing
    d. Private duty nursing

Answer 11

ANS: B
Home health nursing is provided in the client’s environment, wherever that may be. “Home”
may be a house, apartment, trailer, boarding and care home, shelter, car, makeshift shelter
under a bridge, or cardboard box.

Question 12

12. Which of the following is the best way for a home health nurse (HHN) to help a client who
    has right-sided paresis secondary to a stroke?
    a. Arranging for private duty nurses to assist the client with daily needs
    b. Assisting the client with activities of daily living (ADLs)
    c. Teaching self-care to the client
    d. Teaching the family to assist the client with ADLs

Answer 12

ANS: C
Because home health care is often intermittent, a primary objective for the HHN is to facilitate
self-care. This allows clients to have some control over their lives and activities and can help
prevent hopelessness and a loss of self-esteem. Although assistance may be provided
occasionally, this comes after helping clients help themselves.

Question 13

13. An HHN in training states, “I don’t understand why we have to collaborate with so many
    other disciplines. Doesn’t this conflict with the concept of holistic nursing practice?” What
    would be the best response by an experienced colleague?
    a. “The nurse still functions holistically; however, interdisciplinary collaboration is
    necessary to prevent fragmentation of care.”
    b. “Holistic nursing is a concept applied to care in tertiary facilities such as hospitals,
    where materials are centrally located in one facility. In home health, this is not
    possible.”
    c. “Even though home health nursing is not as holistic as other areas of community
    health nursing, each discipline contributes to client needs from its special
    knowledge base.”
    d. “Yes, it does create conflict, but we as nurses are mandated to practise
    interdisciplinary collaboration.”

Answer 13

ANS: A
Home health nursing involves interdisciplinary care. Coordination of care provided by an
interdisciplinary team is an essential indirect function of the HHN. Team conferences are an
ideal time for enhancing collaboration and continuity of services for optimal client care and
use of resources and services. Without effective collaboration, there would be no continuity of
care and the client’s home care program would be fragmented. This does not conflict with the
concept of holism, however. Holism does not require that the HHN provide all services (i.e.,
direct client care). Many services, such as coordination of care, provide indirect care and
contribute to holistic nursing care provision.

Question 14

14. A family member asks an HHN to explain the concept of hospice care. Which action would
    the HHN need to include as the fundamental underlying philosophy of hospice?
    a. Making it possible for the client to die at home
    b. Ensuring that the client’s living will is honoured
    c. Placing experts in the position of power of attorney
    d. Providing respite and comfort measures before death

Answer 14

ANS: D
Hospice care refers to the delivery of palliative care to the very ill and dying, offering both
respite and comfort. If the client and family agree, hospice care can be comfortably delivered
at home with family involvement under the direction and supervision of health care providers,
especially a home health nurse.

Question 15

15. In an effort to prevent drug abuse among junior high–school students, a PHN has enlisted the
    assistance of high-school role models in the areas of both sports and scholarship for an
    antidrug presentation. What is the level of prevention represented by this activity?
    a. Primary prevention
    b. Secondary prevention
    c. Tertiary prevention
    d. Both primary and secondary prevention

Answer 15

ANS: A
PHNs partner with the community to develop programs in response to identified needs.
Primary prevention interventions by the PHN include educating children and adolescents
about the effects of illegal drugs (e.g., marijuana, cocaine, and heroin) and alcohol abuse. By
educating students, the PHN helps them stay away from these harmful substances. It is not
both primary and secondary because secondary prevention involves screening, which would
not take place in this instance.

Question 16

16. The CHN has arranged for students in all classes at the local school to receive visual acuity
    testing to determine if they need glasses. What is the level of prevention represented by this
    activity?
    a. Primary
    b. Secondary
    c. Tertiary
    d. Both primary and secondary

Answer 16

ANS: B
CHNs implement screening programs for genetic disorders or metabolic deficiencies in
newborns; breast, cervical, and testicular cancers; diabetes; hypertension; and sensory
impairments in children. They also ensure follow-up services for clients with positive test
results. Secondary prevention involves screening children for illnesses or conditions. In this
instance, visual acuity testing is being used to screen for visual problems requiring corrective
lenses.

Question 17

17. A CHN is demonstrating the use of a peak flow meter to help children with chronic asthma
    recognize when they need to use a rescue inhaler. What is the level of prevention represented
    by this activity?
    a. Primary
    b. Secondary
    c. Tertiary
    d. Both primary and secondary

Answer 17

ANS: C
CHNs provide direct care and counselling as well as health education, and a variety of other
practices for people with chronic conditions living in the community. Tertiary prevention
includes caring for children with long-term health concerns, such as asthma, and disabling
conditions. At first glance, this appears to have elements of primary and secondary prevention,
but this is not the case because primary prevention aims at ensuring that a condition does not
develop (whereas these children already have the disease). Furthermore, although the children
are being taught techniques for recognizing respiratory danger, it is in the context of disease
management (i.e., when to use an inhaler).

Question 18

18. What practice is being implemented by the occupational health nurse (OHN) who removes a
    foreign body from a client’s eye?
    a. Primary care
    b. Primary prevention
    c. Secondary prevention
    d. Tertiary prevention

Answer 18

ANS: A
The nurse is implementing primary care of the client. This action does not meet the criteria for
injury prevention because the injury has already occurred and the OHN is providing treatment
for the injury. Prevention strategies will need to follow treatment to prevent recurrence and to
prevent development of secondary problems related to the foreign body.

Question 19

19. What practice is being implemented by the OHN who periodically conducts spirometry
    testing of employees working with hazardous gases?
    a. Primary prevention
    b. Secondary prevention
    c. Tertiary prevention
    d. Tertiary care

Answer 19

ANS: B
Secondary prevention involves health surveillance and periodic screening to identify an illness
at the earliest possible stage and elimination or modification of the hazard-producing
situation.

Question 20

20. An employee in a laboratory drops a flask, resulting in the chemical splashing into her eyes.
    What is the agent in this scenario?
    a. Chemical
    b. Employee
    c. Flask
    d. Laboratory

Answer 20

ANS: A
The agents, or factors associated with illness and injury, comprise occupational exposures that
are classified as biological and infectious, chemical, ergonomic, physical, or psychosocial
hazards.

Question 21

21. A hospital nurse working in employee health notes that several nurses from one unit are
    missing from work after having contracted a communicable disease from a client. In this
    scenario, what is considered to be the host?
    a. Each sick nurse
    b. The communicable disease
    c. The hospital
    d. The client

Answer 21

ANS: A
The host is described as any susceptible human being; each sick nurse represents a host within
the worker population group.

Question 22

22. What hazard tends to particularly affect employees who work in 2-week shifts?
    a. Biological hazards
    b. Environmental hazards
    c. Physical hazards
    d. Psychosocial hazards

Answer 22

ANS: D
Psychosocial hazards are factors and situations encountered or associated with one’s job or
work environment that create or potentiate stress, emotional strain, or interpersonal problems.

Question 23

23. What is the primary role of the forensic nurse in Canada?
    a. Health promoter
    b. Disaster planner
    c. Sexual assault nurse examiner (SANE)
    d. Outreach worker

Answer 23

ANS: C
In Canada, forensic nurses primarily work as SANEs.

Question 24

24. From which health care professional is a rural resident with asthma more likely to receive
    health care services?
    a. Allergist
    b. Nurse practitioner
    c. Pediatrician
    d. Pulmonologist

Answer 24

ANS: B
In rural communities, often a health care professional may live and practice in a community
for decades, also providing care to people who live in several other communities. A limited
number of CHNs, such as PHNs or nurse practitioners, may offer a full range of services for
all residents in a specified area, which may span more than 150 km. Consequently, rural
physicians and CHNs provide care to individuals and families with all kinds of conditions, in
all stages of life, and across several generations. In urban communities, residents are more
likely to seek care from a medical specialist.

Question 25

25. In addition to the common barriers faced by most rural residents, what is an additional barrier
    to health care that a Mexican migrant farm worker is more likely to encounter?
    a. Absence of culturally appropriate care
    b. Availability of specialists
    c. Distance of health care facilities from the place of residence
    d. Lack of anonymity

Answer 25

ANS: A
Barriers to health care affecting all rural clients may be the availability, affordability, or
accessibility of services and professionals. Two pertinent identified barriers to health care in
rural areas are language barriers and lack of culturally appropriate care and services.

Question 26

26. For the CHN who plans to move from an urban centre to a rural region of the country, which
    one of the following statements should be included in the advice on preparing for role
    alterations?
    a. “Community members will probably hold you in higher regard and will look up to
    you.”
    b. “Expect to have less autonomy than you have working as a CHN in the city.”
    c. “You can expect more resources and supplies because there are fewer clinics.”
    d. “You will need to focus on developing specialized knowledge and skills.”

Answer 26

ANS: A
CHNs working in rural areas have a prestigious status in the community and are viewed as
role models. They have greater (not less) independence and autonomy as well as fewer (not
more) resources, and they need to have more generalist (not specialized) knowledge and
skills.

Question 27

27. Which of the following primarily distinguishes case management from managed care?
    a. Case management is a tool for health maintenance organizations.
    b. Case management is targeted toward a specific segment of the population.
    c. Case management is implemented with individual clients.
    d. Case management is used to monitor the health status, resources, and outcomes for
    an aggregate.

Answer 27

ANS: C
Case management, in contrast to managed care, comprises activities implemented with
individual clients in the system.

Question 28

28. For a CHN, which of the following describes the goal of advocacy?
    a. Gaining organizational and governmental support for the promotion of nursing
    objectives
    b. Improving community service needs identified by research findings
    c. Integrating evidence-informed practice guidelines in the provision of community
    nursing service
    d. Promoting self-determination in a client, family, group, or community

Answer 28

ANS: D
The goal of advocacy is to promote self-determination in a constituency or client group. The
constituency may be a client, family, group, or community. The advocate role includes the
following three major strategies: (1) interacting with clients and families, (2) interacting with
other health care providers, and (3) working through the system.

Question 29

29. Research demonstrates that exercise is important for general wellness and weight control. The
    CHN can use this information to implement primary prevention by doing which of the
    following?
    a. Developing individualized exercise programs for overweight children
    b. Drafting policy for increases in noncompetitive physical activity programs
    c. Monitoring body mass index in children to identify elevations before they become
    difficult to manage
    d. Notifying parents or guardians of their child’s height–weight scale in comparison
    with national norms

Answer 29

ANS: B
At the primary prevention level, campaigns to support regular exercise, greater emphasis on
school-based physical education programs, and environmental and policy initiatives to create
or enhance places for physical activity in communities can make significant contributions to
improving the lifestyle of sedentary children. Developing individualized exercise programs
for overweight children is an example of tertiary prevention. Monitoring body mass index in
children to identify elevations before they become difficult to manage is an example of
secondary prevention. Notifying parents or guardians of their child’s height–weight scale in
comparison with national norms increases family awareness but does not meet the definition
of a preventive measure