Community Health Nursing and Public Health, Exams of Nursing

Download Community Health Nursing and Public Health and more Exams Nursing in PDF only on Docsity! NURSING 222 - Ch. 3.9. 10 & 20 Final Exam Questions with Answers Latest Update A nurse is working as a public health nurse. What will be the nurse's primary focus? A. The individual as one member of a group B. Individuals and families C. Needs of a population D. Health promotion - Correct Answers C. Needs of a population Public health nursing primary focus is understanding the needs of a population. Community-based care focuses on health promotion. Community health nursing focuses on health care of individuals, families, and groups within the community. A nurse wants to become a specialist in public health nursing. Which educational requirement will the nurse have to obtain? A. A baccalaureate degree in nursing B. Preparation at the basic entry level C. The same level of education as the community health nurse D. A graduate level education with a focus in public health science - Correct Answers D. A graduate level education with a focus in public health science A specialist in public health has a graduate level education with a focus in public health science. Public health nursing requires preparation at the basic entry level and sometimes requires a baccalaureate degree in nursing. A community health nurse is not the same thing as a public health nursing specialist. A nurse is working as a community health nurse. Which action is a priority for this nurse? A. Provide direct care to subpopulations. B. Focus on the needs of the ill individual. C. Provide first level of contact to health care systems. D. Focus on providing care in various community settings. - Correct Answers A. Provide direct care to subpopulations. Community health nursing is nursing practice in the community, with the primary focus on the health care of individuals, families, and groups within the community. In addition, the community health nurse provides direct care services to subpopulations within a community. Community-based nursing centers function as the first level of contact between members of a community and the health care system. Community-based nursing focuses on providing care in various community settings, such as the home or a clinic and involves acute and chronic care. A nurse is focusing on acute and chronic care of individuals and families within a community while enhancing patient autonomy. Which type of nursing care is the nurse providing? A. Public health B. Community health C. Community-based D. Community assessment - Correct Answers C. Community-based Community-based nursing involves acute and chronic care of individuals and families and enhances their capacity for self-care while promoting autonomy in decision making. Public health nursing focuses on the needs of a population. Community health nursing cares for the community as a whole and considers the individual or the family as only one member of a group at risk. Community assessment is the systematic data collection on the population, monitoring the health status of the population, and making information available about the health of the community. The community health nurse is administering flu shots to children at a local playground. What is the rationale for this nurse's action? A. To prevent individual illness B. To prevent community outbreak of illness C. To prevent outbreak of illness in the family D. To prevent needs of the local population groups - Correct Answers B. To prevent community outbreak of illness The nurse is trying to prevent a community outbreak of illness. By focusing on subpopulations (children), the community health nurse cares for the community as a whole and considers the individual or the family as only one member of a group at risk. Community-based nursing, as opposed to community health nursing, focuses on the needs of the individual or family. Public health nursing focuses on meeting the population groups' needs. A nurse attended a seminar on community-based health care. Which information indicates the nurse has a good understanding of community-based health care? A. It occurs in hospitals. B. Its focus is on ill individuals. C. Its priority is health promotion. D. It provides services primarily to the poor. - Correct Answers C. Its priority is health promotion. Community-based health care is a model of care that reaches everyone in the community (including the poor and underinsured), focuses on primary rather than institutional or acute care, and provides knowledge about health and health promotion and models of care to the community. Community-based health care occurs outside traditional health care institutions such as hospitals. Social systems include volunteer programs, education system, government, and health systems. Housing and economic status are included in the structure assessment. Predominant ethnic groups are a component of the population assessment. The nurse is working with a 16-year-old pregnant female who tells the nurse that she needs an abortion. The nurse, acting as a counselor, provides the patient with information on alternatives to abortion. After discussing the options, the patient still expresses an interest in an abortion. What should the nurse, in the counselor role, do next? A. Encourage the patient to speak with a Right-to-Life advocate. B. Refuse to provide a referral to an abortion service. C. Provide referral to an abortion service. D. Delay referral to an abortion service. - Correct Answers C. Provide referral to an abortion service. As a counselor, the nurse is responsible for providing information, listening objectively, and being supportive, caring, and trustworthy and providing a referral to an abortion service. The role of counselor should not be influenced by personal biases or values. The nurse does not make decisions, like going to a ―Right-to-Life‖ advocate, but rather helps the patient reach decisions that are best for him or her. To refuse to provide a referral or to delay referral would not be supportive of the patient's decision. Before a patient diagnosed in the beginning stage of Alzheimer's disease is discharged, the community-based nurse is making a visit to the patient's home. The patient's daughter and family live in the home with the patient. What is the major focus of this visit? A. Teaching the family how to monitor blood pressure. B. Demonstrating techniques for providing care. C. Stressing to the family how difficult it will be to provide care at home. D. Encouraging the family to send the patient to an extended care facility. - Correct Answers B. Demonstrating techniques for providing care. The role of the community health nurse, when dealing with patients with Alzheimer's disease, is to maintain the best possible functioning, protection, and safety for the patient. The nurse should demonstrate to the primary family caregiver techniques for dressing, feeding, and toileting the patient while providing encouragement and emotional support to the caregiver. Monitoring blood pressure is not necessary for an Alzheimer's patient; blood pressure would be for a patient with hypertension. The nurse should protect the patient's rights and maintain family stability, not encourage placement in an extended care facility. While conducting a community assessment, the nurse seeks data on the average household income and the number of residents on public assistance. In doing so, the nurse is evaluating which component of a community assessment? A. Structure B. Population C. Social system D. Welfare system - Correct Answers A. Structure 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 nurse uses statistics on increased incidence of communicable disease to influence legislatures to pass a bill for mandatory vaccinations to enroll in school. Which type of nursing will the nurse use in this process? A. Public health nursing B. Community-based nursing C. Community health nursing D. Vulnerable population nursing - Correct Answers A. Public health nursing A public health nurse understands factors that influence health promotion and health maintenance, the trends and patterns influencing the incidence of disease within populations, environmental factors contributing to health and illness, and the political processes used to affect public policy. Community health nursing is nursing practice in the community, with the primary focus on the health care of individuals, families, and groups within the community. Community-based nursing care takes place in community settings such as the home or a clinic, where the focus is on the needs of the individual or family. While there is no specific vulnerable population nursing, all types of nursing should care for these populations. A community-based nursing is working with a family. For which key areas will the nurse need a strong knowledge base? (Select all that apply.) A. Family theory B. Communication C. Group dynamics D. Cultural diversity E. Individual-centered care - Correct Answers A, B, C, D With the individual and family as the patients, the context of community-based nursing is family-centered care (not individual-centered care) within the community. This focus requires a strong knowledge base in family theory, principles of communication, group dynamics, and cultural diversity. The nurse leans to partner with patients and families, not just with Offering which community-based nursing activities indicates the nurse is working in the role of educator? (Select all that apply.) A. Prenatal classes B. A child safety program C. To defend patients' decisions D. Creative solutions to local problems To coordinate resources after discharge - Correct Answers A, B Prenatal classes, infant care, child safety, and cancer screening are just some of the health education programs provided in a community practice setting. Offers to defend patients’ decisions are the role of patient advocate. Offers creative solutions to local problems indicates a change agent. Collaborator will offer to coordinate resources after discharge. A nurse is caring for vulnerable populations in a local community. Which patients will the nurse care for in this community? (Select all that apply.) A. A 47-year-old immigrant who speaks only Spanish B. A 35-year-old living in own home C. A 22-year-old pregnant woman D. A 40-year-old schizophrenic E. A 15-year-old rape victim - Correct Answers A, D, E Individuals living in poverty, older adults, people who are homeless, immigrant populations, individuals in abusive relationships (rape), substance abusers, and people with severe mental illnesses (schizophrenic) are examples of vulnerable populations. Middle-aged people living in their own home are not an example of a vulnerable population. Pregnancy is not an example of a vulnerable population. A nurse is discussing the changing demographics of the US population. What is expected to be the fastest growing racial ethnic group by 2060? A. Hispanic B. Asian C. Multiracial D. Non-Hispanic Blacks - Correct Answers C. Multiracial The changing demographics of the US population create challenges for the health care system and health care providers. By the year 2060, the percentage of racial and ethnic minority groups in the United States is expected to climb to 32% of the population. The fastest-growing racial ethnic group in the United States is people whose ancestry is from two or more races, and this group is projected to grow by 200%. The next fastest growing is the Asian population, which is projected to double, followed by the Hispanic population. A nurse is caring for an immigrant with low income. Which information should the nurse consider when planning care for this patient? A. There is a decreased frequency of morbidity. B. There is an increased incidence of disease. C. There is an increased level of health. D. There is a decreased mortality rate. - Correct Answers B. There is an increased incidence of disease. D. Provides care to surgical patients. - Correct Answers A. Provides care to transgender patients. Although cultural competence and patient-centered care both aim to improve health care quality, their focus is slightly different. The primary aim of cultural competence care is to reduce health disparities and increase health equity and fairness by concentrating on people of color and other marginalized groups, like transgender patients. Patient- centered care, rather than cultural competence care, provides individualized care and restores an emphasis on personal relationships; it aims to elevate quality for all patients. The nurse is caring for an Asian patient using the teach-back technique. Which action by the nurse indicates successful implementation of this technique? A. Asks, "Does this make sense?" B. Asks, "Do you think you can do this at home?" C. Asks, "What will you tell your spouse about changing the dressing?" D. Asks, "Would you tell me if you don't understand something, so we can go over it? - Correct Answers C. Asks, "What will you tell your spouse about changing the dressing?" The teach-back technique asks open-ended questions, like what will you tell your spouse about changing the dressing, to verify a patient's understanding. When using the teach-back technique, do not ask a patient, "Do you understand?" or "Do you have any questions?" "Does this make sense?", and "Do you think you can do this at home?" are closed-ended questions. "Would you tell me if you don't understand something, so we can go over it?" is not verifying a patient's understanding about the teaching? A nurse is using core measures to reduce health disparities. Which group should the nurse focus on to cause the most improvement in core measures? A. Caucasians B. Poor people C. Alaska Natives D. American Indians - Correct Answers B. Poor people To improve results, the nurse should focus on the highest disparity. Poor people consistently received inferior care compared to high-income people. American Indians and Alaska Natives received worse care than Caucasians. A nurse is assessing culturally diverse population groups for the risk of suicide. Which assessment question will provide the most culturally relevant information? A. "Is suicide common in your culture?" B. "How is suicide viewed in your culture?" C. "Has anyone here every considered suicide?" D. "Do you know anyone who as committed suicide?" - Correct Answers B. "How is suicide viewed in your culture?" Culturally congruent care or transcultural care emphasizes the need to provide cares based on the individual's cultural beliefs, practices, and values; therefore, effective communication is a critical skill in culturally competent care and helps you engage a patient and family in respectful, patient-centered dialogue. Asking how the act of suicide is viewed provides information on the cultural values, beliefs, and practices of a culture. None of the other options provide that insight. A nurse is caring for a patient with limited English-speaking skills. What intervention should be implemented to best assist in educating the patient about their disease process? A. Request a trained medical interpreter. B. Provide information in graphic form when possible. C. Use handouts prepared in the patient's native languages. D. Ask that a family member be present during educational teaching. - Correct Answers A. Request a trained medical interpreter. The National Culturally and Linguistically Appropriate Services (CLAS) Standards include standards for communication and language assistance. The standards apply when you are caring for patients who have limited English proficiency and/or other communication needs. All United States health care organizations must provide language assistance resources (e.g., trained medical interpreters, qualified translators, telecommunication devices for the deaf) for individuals who have limited English proficiency and/or other communication needs, at no cost to them, to facilitate timely access to all health care and services. None of the other options provides the best form of communication since they all are subject to misinterpretation and nursing evaluation. A nurse is assessing a patient's ethnic history. Which question should the nurse ask? A. What language do you speak at home? B. How different is your life here from back home? C. Which caregivers do you seek when you are sick? D. How different is what we do from what your family does when you are sick? - Correct Answers B. How different is your life here from back home? An ethno history question is the following: How different is your life here from back home? Caring beliefs and practice questions include the following: Which caregivers do you seek when you are sick and How different is what we do from what your family does when you are sick? The language and communication is the following: What language do you speak at home? A nurse is teaching patients about health care information. Which patient will the nurse assess closely for health literacy? A. A patient 35 years old B. A patient with a chronic illness C. A patient with a college degree D. A patient with a high-school diploma - Correct Answers B. A patient with a chronic illness Many people in the United States experience challenges in using health care information. Patients who are especially vulnerable are the elderly (age 65+), immigrants, persons with low incomes, persons who do not have a high-school diploma or GED, and persons with chronic mental and/or physical health conditions. A 35-year- old patient and patients with high-school and college education are not identified in the vulnerable populations. A nurse implementing the principles of Intersectionality will focus on what patient characteristic? A. Values B. Illness C. Health D. Experiences - Correct Answers D. Experiences Intersectionality is a research and policy model used to study the complexities of people's lives and experiences. Illness and health are outcomes viewed in respect to the patient's experiences. The patient's values and beliefs are formulated by their life experiences. A nurse is providing care to a culturally diverse population. Which action indicates the nurse is successful in the role of providing culturally congruent care? A. Provides care that fits the patient's valued life patterns and set of meanings. B. Provides care that is based on meanings generated by predetermined criteria. C. Provides care that makes the nurse the leader in determining what is needed. D. Provides care that is the same as the values of the professional health care system. - Correct Answers A. Provides care that fits the patient's valued life patterns and set of meanings. The goal of transcultural nursing is to provide culturally congruent care, or care that fits the person's life patterns, values, and system of meaning. Patterns and meanings are generated from people themselves, rather than from predetermined criteria. Discovering patients' cultural values, beliefs, and practices as they relate to nursing and health care requires you to assume the role of learner (not become the leader) and to partner with your patients and their families to determine what is needed to provide meaningful and beneficial nursing care. Culturally congruent care is sometimes different from the values and meanings of the professional health care system. A nurse is assessing the patient's meaning of illness. Which area of focus by the nurse is priority? A. On the way a patient reacts to disease B. On the malfunctioning of biological processes C. On the malfunctioning of psychological processes D. On the way a patient reacts to family/social interactions - Correct Answers A. On the way a patient reacts to disease The extended family includes relatives (aunts, uncles, grandparents, and cousins) in addition to the nuclear family. An emergency department nurse is assessing a child that lives in a car with family members. Which area should the nurse assess closely? A. Ears B. Eyes C. Head D. Hands - Correct Answers A. Ears Children of homeless families are often in fair or poor health and have higher rates of asthma, ear infections, stomach problems, and mental illness. Eyes, head, and hands are not as likely to be negatively affected as the ears. The nurse is interviewing a patient who is being admitted to the hospital. The patient's family went home before the nurse's interview. The nurse asks the patient, ―Who decides when to come to the hospital?‖ What is the rationale for the nurse's action? A. To assess the family form B. To assess the family function C. To assess the family structure D. To assess the family generalization - Correct Answers C. To assess the family structure To assess the family structure, the nurse asks questions that determine the power structure and patterning of roles and tasks A nurse is caring for a patient injured in a motor vehicle accident. Which action by the unlicensed assistive personnel will cause the nurse to intervene? A. Tells the family not to leave the bedside. B. Offers the family a sandwich. C. Gives the family a blanket. D. Sits with the family. - Correct Answers A. Tells the family not to leave the bedside. The action of telling the family not to leave is inappropriate and should be corrected. Sometimes telling the family that you will stay with their loved one while they are gone is all they need to feel comfortable in leaving. A nurse is using the family as context approach to provide care to a patient. What should the nurse do next? A. Assess family patterns versus individual characteristics. B. Assess how much the family provides the patient's basic needs. C. Use family as patient and family as context approaches simultaneously. D. Plan care to meet not only the patient's needs but also those of the family as well. - Correct Answers B. Assess how much the family provides the patient's basic needs. When the nurse views the family as context, the primary focus is on the health and development of an individual member existing within a specific environment (i.e., the patient's family). The nurse, caring for a patient in hospice, notes that while the patient is getting adequate care, the caregiver is not sleeping well. The nurse also assesses the need for better family nutrition and meals assistance. The nurse discusses these needs with the patient and family and develops a plan of care with them using community resources. Which approach is the nurse using? A. Family as context B. Family as patient C. Family as system D. Family as caregiver - Correct Answers C. Family as system When you care for the family as a system, you are caring for each family member (family as context) and the family unit (family as patient), using all available environmental, social, psychological, and community resources. The nurse is caring for an older-adult patient who has no apparent family. When questioned about family and the definition of family, the patient states, "I have no family. They're all gone." When asked, "Who prepares your meals?" the patient states, "I do, or I go out." Which approach should the nurse use for this patient? A. Family as context B. Family as patient C. Family as system D. Family as caregiver - Correct Answers A. Family as context If only one family member receives nursing care, it is realistic and practical to use the approach family as context. Although family nursing is based on the assumption that all people regardless of age are a member of some type of family form, the patient insists that there is no family. The nurse should investigate further. The nurse is caring for an older-adult patient at home who requires teaching for dressing changes. The spouse and adult child are also involved in changing the dressing. Which statement by the nurse will most likely elicit a positive response from the patient and family? A. "You're doing that all wrong. Let me show you how to do it. B. "I don't know who showed you how to change a dressing, but you're not doing it right. Let me show you again." C. "You're hesitant about changing the dressing like I was before I was shown an easier way; would you like to see?" D. "I used to change the dressing the same way you are doing it: the wrong way. I'll show you the right way to do it." - Correct Answers C. "You're hesitant about changing the dressing like I was before I was shown an easier way; would you like to see?" The nurse is providing discharge teaching for an older-adult patient who will need tube feedings at home. The spouse is the only source of care and states "I will not be able to perform the feedings due to arthritis." Which action should the nurse take? A. Obtain extra feeding supplies. B. Arrange for home care. C. Cancel the discharge. D. Teach the spouse. - Correct Answers B. Arrange for home care. Discharge planning with a family involves an accurate assessment of what will be needed for care at the time of discharge, along with any shortcomings in the home setting. If no one can do the feedings properly, the nurse will need to arrange for a home care service referral. A nurse is assessing for factors influencing family form. Which areas will the nurse include in the assessment? (Select all that apply.) A. Homelessness B. Domestic violence C. Presence of illness D. Changing economic status E. Rise of homosexual families - Correct Answers A, B, C, D In addition to providing physical care, what roles does a caregiver assure when caring for a family member? (Select all that apply.) A. Emotional supporter B. Health care decision maker C. Financial monitor D. Advocate E. Family leader - Correct Answers A, B, C, D Family caregivers also provide ongoing emotional support for their loved ones, making decisions about care options, being a patient advocate, and monitoring finances. A nurse determines that the patient's condition has improved and has met expected outcomes. Which step of the nursing process is the nurse exhibiting? a. Assessment b. Planning c. Implementation d. Evaluation - Correct Answers d. Evaluation A nurse completes a thorough database and carries out nursing interventions based on priority diagnoses. Which action will the nurse take next? a. Assessment b. Planning c. Implementation d. Evaluation - Correct Answers d. Evaluation D. Leaving the dressing off the wound for easier access and more frequent assessments - Correct Answers C. Measuring the wound and observe for redness, swelling, or drainage The nurse is caring for a patient whose plan of care states that a change of dressing is to occur twice a day, at 0600 and 1800. At 1400, the nurse notices that the dressing is saturated and leaking. What is the nurse's next action? A. Wait and change the dressing at 1800 as ordered. B. Revise the plan of care and change the dressing now. C. Reassess the dressing and the wound in 2 hours. D. Discontinue the plan of care for wound care. - Correct Answers B. Revise the plan of care and change the dressing now. A goal for a patient diagnosed with diabetes is to demonstrate effective coping skills. Which patient behavior will indicate to the nurse achievement of this outcome? A. States, "It really helps talking about my health with family and friends." B. Observed consuming high-carbohydrate foods when stressed. C. Expresses a dislikes with the support group meetings. D. Spends most of the day reading in bed. - Correct Answers A. States, "It really helps talking about my health with family and friends." A nurse is providing education to a patient about self-administering subcutaneous injections. The patient demonstrates the self-injection. Which type of indicator did the nurse evaluate? A. Health status B. Health behavior C. Psychological self-control D. Health service utilization - Correct Answers B. Health behavior Health behavior involves demonstrating a psychomotor skill such as self-injection. Health status is a clinical indicator such as exercise tolerance or blood pressure control. The skill is psychomotor, not psychological self-control. Health service utilization is readmission within 30 days or emergency department use. A nurse is evaluating the goal of acceptance of body image in a young teenage girl. Which statement made by the patient is the best indicator of progress toward the goal? A. ―I'm worried about what those other girls will think of me.‖ B. ―I can't wear dresses that make my hips stick out.‖ C. ―I'll wear the blue dress. It matches my eyes.‖ D. ―I hope I can go to the pool next summer.‖ - Correct Answers C. ―I'll wear the blue dress. It matches my eyes.‖ A nurse is evaluating goals and expected outcomes for a confused patient. Which finding indicates positive progress toward resolving the confusion? A. Patient wanders halls only at night. B. Patient's side rails are up with bed alarm activated. C. Patient denies pain while ambulating with assistance. D. Patient correctly states names of family members in the room. - Correct Answers D. Patient correctly states names of family members in the room. A nurse identifies a fall risk when assessing a patient upon admission. The nurse and the patient agree that the goal is for the patient to remain free from falls. However, the patient fell just before shift change. Which action is the nurse's priority when evaluating the patient after the fall? A. Identifying factors interfering with goal achievement B. Counseling the nursing assistive personnel on duty when the patient fell C. Removing the fall risk sign from the patient's door because the patient has suffered a fall D. Requesting that the more experienced charge nurse complete the documentation about the fall - Correct Answers A. Identifying factors interfering with goal achievement A patient was recently diagnosed with pneumonia. The nurse and the patient have established a goal that the patient will not experience shortness of breath with activity in 3 days with an expected outcome of having no secretions present in the lungs in 48 hours. Which evaluative measure will the nurse use to demonstrate progress toward this goal? A. No sputum or cough present in 4 days B. Congestion throughout all lung fields in 2 days C. Shallow, fast respirations 30 breaths per minute in 1 day D. Lungs clear to auscultation following use of inhaler - Correct Answers D. Lungs clear to auscultation following use of inhaler In this case, the patient's goal is to not experience shortness of breath with activity in 3 days. If the lung sounds are clear following use of inhaler, the nurse can determine that the patient is making progress toward achieving the expected outcome. A nurse is evaluating an expected outcome for a patient that states heart rate will be less than 80 beats/min by 12/3. Which finding will alert the nurse that the goal has been met? A. Heart rate 78 beats/min on 12/3 B. Heart rate 78 beats/min on 12/4 C. Heart rate 80 beats/min on 12/3 D. Heart rate 80 beats/min on 12/4 - Correct Answers A. Heart rate 78 beats/min on 12/3 A nurse is modifying a patient's care plan after evaluation of patient care. In which order, starting with the first step, will the nurse perform the tasks? 1. Revise nursing diagnosis. 2. Reassess blood pressure reading. 3. Retake blood pressure after medication. 4. Administer new blood pressure medication. 5. Change goal to blood pressure less than 140/90. a. 1, 5, 2, 4, 3 b. 2, 1, 5, 4, 3 c. 4, 3, 1, 5, 2 d. 5, 4, 5, 1, 2 - Correct Answers b. 2, 1, 5, 4, 3 Which evaluative measures will the nurse use to determine a patient's responses to nursing care? (Select all that apply.) a. Observations of wound healing b. Daily blood pressure measurements c. Findings of respiratory rate and depth d. Completion of nursing interventions e. Patient's subjective report of feelings about a new diagnosis of cancer - Correct Answers A, B, C, E Which nursing actions will the nurse perform in the evaluation phase of the nursing process? (Select all that apply.) A. Set priorities for patient care. B. Determine whether outcomes or standards are met. C. Ambulate patient 25 feet in the hallway. D. Document results of goal achievement. E. Use self-reflection and correct errors. - Correct Answers B, D, E