C228 – WGU

Community health nurses
promote the health and welfare of clients across the lifespan and from diverse populations.
Nightingale’s Theory of Environment
›› the relationship between an individual’s environment and health
›› Depicts health as a continuum
›› Emphasizes preventive care
Health Belief Model
›› to predict or explain health behaviors
›› preventive health behaviors are taken primarily for the purpose of avoiding disease
›› Emphasizes change at the individual level
›› Describes the likelihood of taking an action to avoid disease based on:
»»Perceived susceptibility, seriousness, and threat of a disease
»»Modifying factors (e.g., demographics, knowledge level)
»»Cues to action (e.g., media campaigns, disease impact on family/friends, recommendations from health care professionals)
»»Perceived benefits minus perceived barriers to taking action
Milio’s Framework for Prevention
›› Complements the health belief model
›› Emphasizes change at the community level
›› Identifies relationship between health deficits and availability of health‑promoting resources
›› Theorizes that behavior changes within a large number of people can ultimately lead to social change
A community
a group of people and institutions that share geographic, civic, and/or social parameters.
Health indicators
*mortality rates, disease prevalence, levels of physical activity, obesity, tobacco use, substance use
*used to describe the health status of a community and serve as targets for the improvement of a community’s health.
population-focused nursing
Assessing to determine needs and intervening to protect and promote health, and preventing disease within a specific population
Community-Based Nursing
Focus of Care: Individuals & Families
Nursing Activities: Illness care: where individuals, families, and groups live, work, and “attend” (schools, camps, prisons)
Community-Oriented Nursing
Focus of Care: At-risk individuals, families, groups, & Community
Nursing Activities: Health care: Determining health needs to improve the collective health of the community
Community Health Nursing Practice
Nursing Activities: Promote, preserve, and maintain the health of populations by the delivery of health services to individuals, families, and groups in order to impact “community health.”
Public Health Nursing Practice
Nursing Activities: Promote, preserve, and maintain the health of populations through disease and disability prevention and health protection of the community as a whole.
Respect for Autonomy
ex: Respecting a client’s right to self‑determination (making a decision not to pursue chemotherapy)
Nonmaleficence
ex: Developing plans of care that include a system for monitoring and evaluating outcomes
Beneficence
ex: Assessing risks and benefits when planning interventions
Distributive Justice
Determining eligibility for health care services based on income and fiscal resources
Epidemiology
*study of health-related trends in populations for the purposes of disease prevention, health maintenance, and health protection.
*relies on statistical evidence to determine the rate of spread of disease and the proportion of people affected.
*used to evaluate the effectiveness of disease prevention and
health promotion and to determine which goals have been met.
epidemiological triangle
study of the relationships among an agent, a host, and an environment
web of causality
increases or decreases the risk for disease
agent
*animate or inanimate object that causes the disease
*Chemical
*Physical
*Infectious
host
the living being that is affected by the agent.
environment
*the setting or surrounding that sustains the host.
*Physical
*Social
Behavioral theory
Use of reinforcement methods to change learners’ behaviors.
Cognitive theory
Use of sensory input and repetition to change learners’ patterns of thought, thereby changing behaviors.
Susceptible Host
Age
Gender
Genetics
Ethicity
Immunological Status
Physiological State
Occupation
Critical theory
Use of ongoing discussion and inquiry to increase learners’ depth of knowledge, thereby changing thinking and behaviors.
Chemical Agents
Drugs
Toxins
Developmental theory
Use of techniques specific to learners’ developmental stages to determine readiness to learn, and to impart knowledge.
Physical Agents
Noise
Temp.
Humanistic theory
Assists learners to grow by emphasizing emotions and relationships and believing that free choice will prompt actions that are in their own best interest.
Infectious Agent
Viruses
Bacteria
Social learning theory
Links information to beliefs and values to change or shift the learners’ expectations.
Physical Enviroment
Geography
Water/ Food Supply
Presence of Reservoirs/ Vectors
Social Enviroment
Access to HC
High-Risk working conditions
Poverty
Public health nursing
the practice of protecting and promoting the health of populations using knowledge from nursing, social, and public health sciences
Public health
organized community efforts designed to prevent disease and promote health.
The federal agency most responsible for improving the health status of the American people is the:
U.S. Department of Health and Human Services.
Primary health care (PHC)
It includes a comprehensive range of services including public health; prevention; and diagnostic, therapeutic, and rehabilitative services.
PHC is essential care made universally accessible to individuals and families in a community.
PHC encourages self-care and self-management in health and the social welfare of daily life.
PHC does not provide a focus on incidence of disease, pathophysiology of disease, or individual orders for care.
Primary care
personal health care that provides first-contact and continuous, comprehensive, and coordinated care.
four major factors that affect health
*personal behavior (or lifestyle) – have the greatest effect
*environmental factors (including physical, social, and economic environments)
*human biology
**environment and biology accounting for the greatest effect on the development of all illnesses
*the health care system—medical services are said to have the least effect.
Health maintenance organization (HMO)
*a provider arrangement whereby comprehensive care is provided to plan members for a fixed, “per member per month” fee.
*Use of designated providers
Preferred provider organization (PPO)
*provider arrangement in which predetermined rates are established for services to be delivered to members.
The five phases of the educational process
identifying educational needs
establishing educational goals and objectives
selecting appropriate educational methods
implementing the educational plan
and evaluating the educational process and product
Pender’s Health Promotion Model
emphasizes how individual characteristics and experiences impact health promotion. Each person has personal characteristics, including biological, physical and psychological, and experiences that influence health choices and behaviors. These characteristics can be influenced by the nurse to achieve healthy outcomes.
The Health Belief Model
describes the individual’s perception of the threat of illness. The perception of benefits that any action might bring to the individual or barriers or problems to taking action. Population-based nurses can learn an individual’s beliefs and perceptions of illness to to modify health behaviors and choices.
The Theory of Planned Behavior, or Theory of Reasoned Action
describes the individual’s attitude toward a behavior reflects the individual’s expected consequences of that behavior. According to this model, actions are influenced by people around the individual and the individual’s perception of the ability to control the behavior.
The Natural Helpers Model
emphasizes the importance of educational and motivational changes at the community level through utilizing community resources, such as a lay health advisor, peer education, or social networks. In this model, the nurse utilizes a natural helper—a member of the community or social network trained to provide information and social support.
The person or group can facilitate attitude and healthy behavior changes. Peer education is a type of natural helper intervention.
The Social Learning Theory
emphasizes the importance of interaction between personal factors, behavior, and the environment. According to the theory, people learn within a social context through concepts such as modeling and observational learning.
Applying this theory to health behavior, the nurse knows that learning takes place primarily by observing and imitating the actions of others. The behavior is also influenced by being rewarded and/or punished for these actions.
CIRCLE
Model of Spiritual Care – the foundation of Parish nursing
principlism
*dominant theory of ethical decision making
*comprised of respect for autonomy, nonmaleficence, beneficence, & distributive justice
examples of assurance
*collaborating with community agencies to improve services
*ensuring competence of health care workforce
functions of parish nurse
*holistic care of populations
*personal health counseling
*health ed
*liaison
*facilitate support groups, change, train volunteers
*ID spiritual strengths for coping
what is ACUTE CARE NURSING
(7 things)
1) Provider control

2)Predictable routine

3) Maintenance of hospital policy

4) Resource availability

5) Collegial collaboration and consultation

6) Controlled patient compliance

7) Standardization of care

what is UPSTREAM thinking
why treat people…w/o changing what makes them sick?
what is Sphere of Intimacy
(attribute of community health nurse)
– Greater awareness of the reality of client lives and situations than may be true in other areas of nursing.

ie: u see roaches in apt

what is Kauffman’s 5 Phases of gaining entry into the community
1) Impressing
2) Behaving
3) Swapping
4) Belonging
5) Chilling out
Community Diagnosis (pt of nursing process for the community)
Risk of (specific problem or health risk )

Among (specific group or population affected by the problem/risk)

Related to (strengths and weaknesses in the community that influence the specific problem or health risk in the community)

The goal of epidemiology is
to ID and understand the causal factors and mechanisms of disease, disability, and injuries so that effective interventions can be implemented to prevent the occurrence of these adverse processes before they begin or before they progress.
Primary prevention examples
– Discuss a low-fat diet and the need for regular physical exercise with clients.
– when a nurse provides health education and training for daycare workers about issues of health and hygiene, such as proper hand hygiene, diapering, and food preparation and storage
– Immunizations, importance of wearing seatbelts, taking folic acid supplementation at preconception to prevent neural tube defects, fluoridation of water supplies to prevent dental caries, and actions taken to reduce human exposure to agents that may cause cancer
– Implement a community level program like walking for exercise to assist citizens in improving health behaviors related to lifestyle.
– Use the Code of Ethics for Nurses to guide your nursing practice
– Use the information exchange process to increase the client’s understanding of how to use the health care system and the health promotion strategies that will maintain health.
– Complete a family genogram and assess health risks with the family to contract for family health activities to prevent diseases from developing
Secondary prevention examples
– Implement blood pressure and cholesterol screening; give a treadmill stress test.
– Health screenings
– teach an asthmatic client to recognize and avoid exposure to asthma triggers and assist the family to implement specific protection strategies such as replacing carpets, keeping air systems clean and free of mold, staying inside when the pollution level is high, and avoiding pets.
– mammography to detect breast cancer, Papanicolaou (Pap) smears to detect cervical cancer, colonoscopy for early detection of colon cancer, prenatal screening of pregnant women to screen for gestational diabetes
– Provide mental health interventions after stressful events.
– The public health nurse provides toxin screenings for migrant workers who may be exposed to pesticides.
– Implement a family-planning program to prevent unintended pregnancies for young couples who attend the local community health center.
– Encourage clients who are pregnant to participate in prenatal care and Special Supplemental Nutrition Program for Women, Infants and Children to increase the number of healthy babies and reduce the costs related to preterm baby care.
– Use case finding to identify existing health problems in your caseload and the population served by your agency. Timely, holistic assessments and interventions can slow disease trajectories and promote healing and health.
– Assess disaster victims and triage for care.
– Investigate an outbreak of flulike illness in a local school.
– Provide programs in child development and behavior management for families who have not yet abused their children but whose children are brought to the attention of social authorities for aggressive behavior problems.
– Develop a way for homeless individuals to read their TB skin test, if necessary, and to transfer the results back to the facility at which the skin test was administered.
– To prevent the spread of disease
– Notify partners and trace contacts (HIV)
Tertiary prevention examples
– enhance rehabilitation from disease, injury, or disability
– Provide cardiac rehabilitation, medication, and surgery.
– medical treatment
– physical and occupational therapy, and rehabilitation
– Monitor the use of prescription medications and adherence to treatment to reduce risk for illness complications
– Provide health promotion activities to persons with serious and persistent mental illness.
– Promote support group participation for those with mental health disabilities.
– The public health nurse provides a diabetes clinic for a defined population of adults in a low-income housing unit of the community.
– If blood pressure cannot be controlled by diet, refer the client to a physician or nurse practitioner for medication; advise the client to engage in a cardiac program that will oversee diet and exercise.
– Participate in home visits to mothers who are at risk for neglecting babies, to reduce the costs related to abuse
– Provide health care and treatment for those infected by H1N1 or the new strains of the virus.
– Evaluate the incidence or prevalence of obesity among school children after the implementation of the program and provide programs to reduce complications from the condition.
– A review of the public health report card indicated that community incidence of complications from vaccine-preventable diseases have declined over a 2-year period after the implementation of the parent education program.
– Provide family therapy for abusive families; remove children from the home.
– Develop a contract with the family to change nutritional patterns to reduce further complications from the specified health problem.
– Provide directly observed medication therapy for people with active TB.
– Develop programs to help people reduce or end substance abuse
– Regular inspection of hands and feet, as well as using protective footwear and gloves to avoid trauma and infection for leprosy clients who have lost sensation in those areas- developing an individual education plan (IEP) for students with long-term health needs
– developing an individual education plan (IEP) for students with long-term health needs
CHARACTERISTICS OF A SUCCESSFUL SCREENING PROGRAM
1. Valid (accurate): A high probability of correct classification of persons tested
2. Reliable (precise): Results are consistent from place to place, time to time, and person to person
3. Capable of large group administration: A) Fast in both the administration of the test and the obtaining of results. B) Inexpensive in both personnel required and the materials and procedures used.
4. Innocuous: Few if any side effects, and the test is minimally invasive
5. High yield: Able to detect enough new cases to warrant the effort and expense (yield defined as the amount of previously unrecognized disease that is diagnosed and treated as a result of screening)
Basic epidemiological concepts include:
– the interrelationships among the agent, host, and environment (the epidemiologic triangle)
– the interactions of factors, exposures, and characteristics in a causal web affecting the risk for disease
– and the levels of prevention corresponding to stages in the natural history of disease.
Community health
the meeting of collective needs through identifying problems and managing interactions within the community itself and between the community and the larger society
Five methods of collecting data
1. informant interviews
2. participant observation
3. secondary analysis of existing data
4. surveys
5. windshield surveys
Assurance
makes sure that essential community-wide health services are available. This may include providing essential personal health services for those who would otherwise not receive them.
Population
a collection of individuals who share one or more personal or environmental characteristics
Case management is
a systematic process of assessment, planning, service coordination, referral, monitoring, and evaluation that meets the multiple service needs of clients.
Health teaching
Communicates facts, ideas, and skills that change knowledge, attitudes, values, beliefs, behaviors, and practices of individuals, families, systems, and/or communities.
Planning
selecting and carrying out a series of actions to achieve a stated goal.
Evaluation
the methods used to determine if a service is needed and will be used, whether a program to meet that need is carried out as planned, and whether the service actually helps the people it is intended to help.
deontology
Ethical theory that bases moral obligation on duty and claims that actions are obligatory irrespective of the good or bad consequences that they produce. Because humans are rational, they have absolute value. Therefore, persons should always be treated as ends in themselves and never only as means.
utilitarianism
Ethical theory based on the weighing of morally significant outcomes or consequences regarding the overall maximizing of good and minimizing of harm for the greatest number of people.
principlism
Approach to problem solving in bioethics that uses the principles of respect for autonomy, beneficence, nonmaleficence, and justice as the basis for organization and analysis
1. A nurse manager at a community agency is developing an orientation program for newly hired nurses.
When discussing the differences between community-based and community-oriented nursing, the nurse
should include which of the following as examples of community-based nursing? (Select all that apply.)
A. A home health nurse performing wound care for a client who is immobile
B. An occupational health nurse providing classes on body mechanics at a local industrial plant
C. A school nurse teaching a student who has asthma about medications
D. A parish nurse teaching a class on low-sodium cooking techniques
E. A mental health nurse discussing stress management techniques with a support group
A. CORRECT: This is an example of community-based nursing, which involves management of acute
and chronic conditions in a community setting.
B. INCORRECT: This is an example of community-oriented nursing, which involves health care of
individuals, families and groups to improve the collective health of the community.
C. CORRECT: This is an example of community-based nursing, which involves management of acute
and chronic conditions in a community setting.
D. INCORRECT: This is an example of community-oriented nursing, which involves health care of
individuals, families and groups to improve the collective health of the community.
E. INCORRECT: This is an example of community-oriented nursing, which involves health care of
individuals, families and groups to improve the collective health of the community.
2. A nurse is advocating for local leaders to place a newly approved community health clinic in an area of
the city that has fewer resources than other areas. The nurse is advocating for the leaders to uphold which
of the following ethical principles?
A. Distributive justice
B. Fidelity
C. Respect for autonomy
D. Veracity
A. CORRECT: The nurse is advocating for the leaders to uphold the ethical principle of distributive
justice, which is the fair distribution of benefits and burden in society.
B. INCORRECT: The nurse is not advocating for the leaders to uphold the ethical principle of fidelity,
which involves keeping commitments and following through with promises.
C. INCORRECT: The nurse is not advocating for the leaders to uphold the ethical principle of respect
for autonomy, which is supporting the rights of individuals to determine and pursue personal
health care goals.
D. INCORRECT: The nurse is not advocating for the leaders to uphold the ethical principle of veracity,
which is the concept of telling the truth.
3. A nurse is preparing an education program on disease transmission for employees at a local day care
facility. When discussing the epidemiological triangle, the nurse should include which of the following as
agents? (Select all that apply.)
A. Resource availability
B. Ethnicity
C. Toxins
D. Bacteria
E. Altered immunity
C. CORRECT
D. CORRECT
4. A nurse is developing a community health education program for a group of clients who have a new
diagnosis of diabetes mellitus. Which of the following learning strategies should the nurse include for
clients who are auditory learners?
A. Showing informational videos
B. Providing equipment to practice hands-on skills
C. Supplying outlines for note-taking
D. Facilitating small group discussions
A. INCORRECT: Showing informational videos is an appropriate learning strategy for clients who are
visual learners.
B. INCORRECT: Providing equipment to practice hands-on skills is an appropriate learning strategy
for clients who are tactile-kinesthetic learners.
C. INCORRECT: Supplying outlines for note-taking is an appropriate learning strategy for clients who
are visual learners.
D. CORRECT: Facilitating small group discussions is an appropriate learning strategy for clients who
are auditory learners.
5. A community health nurse is implementing health programs with several populations in the local area.
In which of the following situations is the nurse using primary prevention?
A. Performing a home safety check at a client’s home
B. Teaching healthy nutrition to clients who have hypertension
C. Providing influenza immunizations to employees at a local preschool
D. Implementing a program to notify individuals exposed to a communicable disease
A. INCORRECT: The nurse is using secondary prevention when performing a home safety check at a
client’s home.
B. INCORRECT: The nurse is using tertiary prevention when teaching healthy nutrition to clients who
have hypertension.
C. CORRECT: The nurse is using primary prevention when providing influenza immunizations to
employees at a local preschool.
D. INCORRECT: The nurse is using secondary prevention when implementing a program to notify
individuals exposed to a communicable disease.
6. A school nurse is planning prevention activities for students within the school system.
Nursing Interventions:
●● Two primary prevention activities the nurse should plan
●● Primary Prevention Activities
◯◯ Teaching healthy heart curriculum (nutrition, exercise, not smoking)
◯◯ Educating about dental health
◯◯ Discussing safety (seat belts, bicycle helmets, stranger safety)
◯◯ Administering immunizations
◯◯ Teaching about communicable disease transmission
◯◯ Sex education
◯◯ Advocating for safe playground equipment
◯◯ Substance use prevention education
6. A school nurse is planning prevention activities for students within the school system.
Nursing Interventions:
●● Two secondary prevention activities the nurse should plan
●● Secondary Prevention Activities
◯◯ Performing tuberculin skin tests
◯◯ Performing routine checks for pediculosis
◯◯ Taking measures to control communicable disease outbreaks
◯◯ Screening for lead exposure
◯◯ Implementing scoliosis screenings
◯◯ Identifying students at risk for suicide or self-harm
◯◯ Performing vision and hearing screenings
◯◯ Checking heights and weights
◯◯ Identifying child abuse or neglect
6. A school nurse is planning prevention activities for students within the school system.
Nursing Interventions:
●● Two tertiary prevention activities the nurse should plan
●● Tertiary Prevention Activities
◯◯ Teaching about allergic triggers for students with asthma
◯◯ Administering medications to treat chronic conditions (asthma, diabetes, seizure disorders)
◯◯ Monitoring glucose levels and administering insulin to students who have diabetes
◯◯ Discussing and planning for nutritional needs of students who have diabetes
◯◯ Developing communication methods for students with autism
1. A nurse is preparing an educational program on cultural perspectives in nursing. The nurse should
include that which of the following are influenced by an individual’s culture? (Select all that apply.)
A. Nutritional practices
B. Family structure
C. Health care interactions
D. Biological variations
E. Views about illness
A. CORRECT: Culture is the beliefs, values, attitudes, and behaviors shared by a group of people
and transmitted from generation to generation. Nutritional practices are influenced by an
individual’s culture.
B. CORRECT: Culture is the beliefs, values, attitudes, and behaviors shared by a group of people and
transmitted from generation to generation. Family structure is influenced by an individual’s culture.
C. CORRECT: Culture is the beliefs, values, attitudes, and behaviors shared by a group of people
and transmitted from generation to generation. Health care interactions are influenced by an
individual’s culture.
D. INCORRECT: Biological variations are physical, biological and physiological differences between races,
and are not influenced by the beliefs, values, and attitudes of an individual.
E. CORRECT: Culture is the beliefs, values, attitudes, and behaviors shared by a group of people and
transmitted from generation to generation. Views about illness are influenced by an individual’s culture.
2. A nurse is caring for a client who is from a different culture than himself. When beginning the cultural
assessment, which of the following actions should the nurse take first?
A. Determine the client’s perception of his current health status.
B. Gather data about the client’s cultural beliefs.
C. Determine how the client’s culture may impact the effectiveness of nursing actions.
D. Gather information about previous client interactions with the health care system.
A. INCORRECT: It is important for the nurse to determine the client’s perception of his current health status. However, when conducting a cultural assessment, the nurse should perform a different action first.
B. CORRECT: The nurse’s first action when beginning a cultural assessment is to collect self-identifying data about the client, including specific information about how the client’s cultural beliefs influence family structure, food patterns, religious preferences, and health practices.
C. INCORRECT: While it is important for the nurse to determine how the client’s culture may impact the effectiveness of nursing actions, the nurse must gather other information first.
D. INCORRECT: It is important for the nurse to gather information about previous client interactions with the health care system. However, when conducting a cultural assessment, the nurse should perform a different action first.
3. A nurse is using the I PREPARE mnemonic to assess a client’s potential environmental exposures. Which of the following is an appropriate question for the nurse to ask to assess for “A” in the mnemonic?
A. “What do you like to do for fun?”
B. “What year was your residence built?”
C. “What jobs have you had in the past?”
D. “What industries are near where you live?”
A. CORRECT: This is an appropriate question for the nurse to ask when assessing for “A,” which represents activities in the mnemonic.
B. INCORRECT: This is not an appropriate question for the nurse to ask when assessing for “A” in the mnemonic. This question is appropriate to assess the first “R,” which represents residence in
the mnemonic.
C. INCORRECT: This is not an appropriate question for the nurse to ask when assessing for “A” in the mnemonic. This question is appropriate to assess the second “P,” which represents past work in
the mnemonic.
D. INCORRECT: This is not an appropriate question for the nurse to ask when assessing for “A” in the mnemonic. This question is appropriate to assess the first “E,” which represents environmental
concerns in the mnemonic.
4. A nurse is conducting health screenings at a statewide health fair and identifies several clients who require referral to a provider. Which of the following statements by a client indicates a barrier to accessing health care?
A. “I don’t drive, and my son is only available to take me places in the mornings.”
B. “I can’t take off during the day and the local after-hours clinic is no longer in operation.”
C. “Only one doctor in my town is a designated provider by my health maintenance organization.”
D. “I would like to schedule an appointment with the local doctor in my town who speaks Spanish and English.”
A. INCORRECT: The availability of a family member to provide transportation for a client in the morning is not a barrier to accessing health care. The follow-up appointment should be scheduled during this time frame.
B. CORRECT: Inconvenient hours make scheduling a follow-up appointment challenging, and indicates a barrier to accessing health care for this client.
C. INCORRECT: A single provider in the local community that is approved by the client’s health maintenance organization does not indicate a barrier to accessing health care. The follow-up appointment should be scheduled with this provider.
D. INCORRECT: A provider who is bilingual does not indicate a barrier to accessing health care. This increases accessibility for clients who may speak a different language.
5. A nurse is interviewing for a position at the local health department. When preparing for the interview, the nurse should find that which of the following are responsibilities of this agency? (Select all that apply.)
A. Managing the Women, Infants, and Children program
B. Providing education to achieve community health goals
C. Coordinating directives from state personnel
D. Reporting communicable diseases to the CDC
E. Licensing of registered nurses
A. INCORRECT: Managing the Women, Infants, and Children program is a responsibility of state departments of health, not local health departments.
B. CORRECT: Providing education to achieve community health goals is a component of identifying and intervening to meet health needs of the local community, which is a responsibility of local
health departments.
C. CORRECT: Funding for local health departments come from local, state and federal monies, therefore; local health departments are responsible for coordinating directives issued from the state level.
D. INCORRECT: Reporting communicable diseases to the CDC is a responsibility of state departments of health, not local health departments. Local health department report communicable diseases to the
state department of health.
E. INCORRECT: Licensing of registered nurses is incorrect. Licensing of registered nurses is a responsibility of state boards of nursing, not local health departments.
“I PREPARE” mnemonic
◯◯ I = Investigate potential exposures
◯◯ P = Present work (exposures, use of personal protective equipment, location of material safety data sheets [MSDS], taking home exposures, trends)
◯◯ R = Residence (age of home, heating, recent remodeling, chemical storage, water)
◯◯ E = Environmental concerns (air, water, soil, industries in neighborhood, waste site or landfill nearby)
◯◯ P = Past work (exposures, farm work, military, volunteer, seasonal, length of work)
◯◯ A = Activities (hobbies, activities, gardening, fishing, hunting, soldering, melting, burning, eating, pesticides, alternative healing/medicines)
◯◯ R = Referrals and resources (Environmental Protection Agency, Agency for Toxic Substances & Disease Registry, Association of Occupational and Environmental Clinics, MSDS, OSHA, local
health department, environmental agency, poison control)
◯◯ E = Educate (risk reduction, prevention, follow-up)
1. A nurse is preparing to conduct a windshield survey. Which of the following data should the nurse collect as a component of this assessment? (Select all that apply.)
A. Ethnicity of community members
B. Individuals who hold power within the community
C. Natural community boundaries
D. Prevalence of disease
E. Presence of public protection
A. Correct: The nurse should identify the ethnicity of the people visible in the community as a component a windshield survey.
B. Incorrect: Individuals who hold power are identified through formal and informal observations of community activities, as a participant observer.
C. Correct: The nurse should identify natural community boundaries as a component a windshield survey.
D. Incorrect: Prevalence of disease is incorrect. Disease prevalence is a component of secondary data and is identified through morbidity rates of the community.
E. Correct: The nurse should identify the presence of public protection, such as police, fire, and animal control, as a component a windshield survey.
2. A nurse is completing a needs assessment and beginning analysis of data. Which of the following actions should the nurse take first?
A. Determine health patterns within collected data.
B. Compile collected data into a database.
C. Ensure data collection is complete.
D. Identify health needs of the local community.
A. Incorrect: This is not the first action the nurse should take. In order to determine health patterns within collected data the nurse must take another action first.
B. Correct: This is the first action the nurse should take. In order to adequately and appropriately analyze collected data the nurse must first compile collected data into a database.
C. Incorrect: This is not the first action the nurse should take. In order to ensure data collection is complete the nurse must take another action first.
D. Incorrect: This is not the first action the nurse should take. In order to identify health needs of the local community the nurse must take another action first.
3. A nurse is planning a community health program. Which of the following should the nurse include as part of the evaluation plan?
A. Determine availability of resources to initiate the plan.
B. Gain approval for the program from local leaders.
C. Establish a timeline for implementation of interventions.
D. Compare program impact to similar programs.
A. Incorrect: The nurse should not include determining availability of resources to initiate the program as part of the evaluation plan; this should be done during the assessment phase. However, when evaluating sustainability of the program, the nurse should determine whether resources are available for continuing the program.
B. Incorrect: The nurse should not include gaining approval for the program from local leaders as part of the evaluation plan. This approval should take place as part of the preplanning phase
because plans for the program should not move forward without adequate community support.
C. Incorrect: The nurse should not include establishing a timeline for implementation of interventions as part of the evaluation plan. Timeline development should occur after determining and selecting the best strategies for meeting the program’s goals and objectives.
D. Correct: The nurse should include comparing program impact to similar programs as part of the evaluation plan. This comparison assists with determining the efficiency of the program.
4. A nurse is conducting a community assessment. Which of the following data collection methods is the nurse using when having direct conversations with individual members of the community?
A. Key informant interviews
B. Participant observation
C. Focus groups
D. Health surveys
A. Correct: Informant interviews are direct conversations with individual community members for the purpose of obtaining ideas and opinions.
B. Incorrect: Participant observation is observing formal or informal community activities and does not involve direct conversations with individual community members.
C. Incorrect: Focus groups are directed talks with a representative sample of a community, and do not involve direct conversations with individual community members.
D. Incorrect: Surveys are specific questions asked in a written format and do not involve direct conversations with individual community members.
5. A nurse is collecting data to identify health needs in the local community. Which of the following are examples of secondary data the nurse should review? (Select all that apply.)
A. Birth statistics
B. Previous health survey results
C. Windshield survey
D. Community forum
E. Health records
A. Correct: Birth statistics are an example of secondary data the nurse should review.
B. Correct: Previous health survey results are an example of secondary data the nurse
should review.
C. Incorrect: Windshield surveys are a method of collecting direct data.
D. Incorrect: Community forums are a method of collecting direct data.
E. Correct: Health records are an example of secondary data the nurse should review.
1. A nurse is talking to a client who asks for additional information about hospice. Which of the following is an appropriate statement by the nurse?
A. “Clients who require skilled nursing care at home qualify for hospice care.”
B. “One function of hospice is to provide teaching to clients about life-sustaining measures.”
C. “Hospice assists clients to develop the skills needed to care for themselves independently.”
D. “A component of hospice care is to control the client’s symptoms.”
A. INCORRECT: Clients who require skilled nursing care at home qualify for home health.
B. INCORRECT: Home health may provide teaching to clients about life-sustaining measures, but this
is not a function of hospice.
C. INCORRECT: Home health assists clients to develop the skills needed to care for
themselves independently.
D. CORRECT: Controlling the client’s symptoms is a component of hospice care.
2. An occupational health nurse is consulting with senior management of a local industrial facility. When
discussing work-related illness and injury, the nurse should include which of the following as physical
agents? (Select all that apply.)
A. Noise
B. Age
C. Lighting
D. Viruses
E. Stress
A. CORRECT: The nurse manager should include noise as a physical agent when discussing
work‑related illness and injury.
B. INCORRECT: The nurse manager should include age as a host factor when discussing work-related
illness and injury.
C. CORRECT: The nurse manager should include lighting as a physical agent when discussing
work‑related illness and injury.
D. INCORRECT: The nurse manager should include viruses as a biological agent when discussing
work-related illness and injury.
E. INCORRECT: The nurse manager should include stress as an outcome of psychological agents when
discussing work-related illness and injury.
3. A newly hired occupational health nurse at an industrial facility is performing an initial workplace assessment. Which of the following should the nurse determine when conducting a work site survey?
A. Work practices of employees
B. Past exposure to specific agents
C. Past jobs of individual employees
D. Length of time working in current role
A. CORRECT: The nurse should determine the work practices of employees when conducting a work
site survey.
B. INCORRECT: The nurse should determine past exposure to specific agents when conducting an
occupational health history on individual workers, not a work site survey.
C. INCORRECT: The nurse should determine past jobs of individual employees when conducting an
occupational health history on individual workers, not a work site survey.
D. INCORRECT: The nurse should determine the length of time working in current role when
conducting an occupational health history on individual workers, not a work site survey.
4. A school nurse is scheduling visits with a physical therapist for a child who has cerebral palsy. In which of the following roles is the nurse functioning?
A. Direct caregiver
B. Consultant
C. Case manager
D. Counselor
A. INCORRECT: The nurse is not functioning in the role of direct caregiver. As a direct caregiver, a
nurse provides illness or injury care to children at school.
B. INCORRECT: The nurse is not functioning in the role of consultant. As a consultant, a nurse
provides information to families, administrators, teachers, and parent-teacher groups to encourage
decisions that promote the health of the students.
C. CORRECT: The nurse is functioning in the role of case manager. As a case manager, the nurse
coordinates comprehensive services for students with complex health needs.
D. INCORRECT: The nurse is not functioning in the role of counselor. As a counselor, a nurse develops
a trusting relationship with students and provides support on issues affecting their lives.
5. A school nurse is planning health promotion and disease prevention activities for the upcoming school
year. In which of the following situations is the nurse planning a secondary prevention strategy?
A. Placing posters with images of appropriate hand hygiene near restrooms
B. Routinely checking students for pediculosis throughout the school year
C. Implementing age-appropriate injury prevention programs for each grade level
D. Working with a dietician to determine carbohydrate counts for students who have diabetes mellitus
A. INCORRECT: Placing posters with images of appropriate hand hygiene near restrooms is a primary
prevention strategy.
B. CORRECT: Routinely checking students for pediculosis throughout the school year is a secondary
prevention strategy.
C. INCORRECT: Implementing age-appropriate injury prevention programs for each grade level is a
primary prevention activity.
D. INCORRECT: Working with the dietitian to determine carbohydrate counts for students with
diabetes is a tertiary prevention activity.
6. A nurse is developing programs to promote the health of families in the local community.
Related Content: Three characteristics of families.
●● Family characteristics
◯◯ Members communicate well and listen to each other.
◯◯ There is affirmation and support for all members.
◯◯ Members teach respect for others.
◯◯ There is a sense of trust.
◯◯ Members play and share humor together.
◯◯ Members interact with one another.
◯◯ There is a shared sense of responsibility.
◯◯ There are traditions and rituals.
◯◯ Members seek help for their problems.
6. A nurse is developing programs to promote the health of families in the local community.
Underlying Principles:
●● Two times families experience transition.
●● Times of transition
◯◯ Birth of a child
◯◯ Adoption of a child
◯◯ Death of a family member
◯◯ Child moving from the home
◯◯ Child getting married
◯◯ Major illness of a family member
◯◯ Divorce of a family member
◯◯ Loss of the main source of family income
6. A nurse is developing programs to promote the health of families in the local community.
Underlying Principles:
●● Two national health goals that apply to families.
●● Reductions in
◯◯ Barriers to access
◯◯ Allergic content within the home
◯◯ Families that are unable to have a child or maintain a pregnancy
◯◯ Exposure to secondhand smoke
◯◯ Household hunger
●●Increases in
◯◯ Health education provided by an agency
◯◯ Home testing for radon
◯◯ Health insurance coverage
◯◯ Individuals with a usual primary care provider
1. A nurse at a community clinic is conducting a well-child visit with a preschool-age child. The nurse should identify which of the following as a manifestation of child neglect? (Select all that apply.)
A. Underweight
B. Healing spiral fracture of the arm
C. Genital irritation
D. Burns on the palms of the hands
E. Poor hygiene
A. CORRECT: An underweight child is a manifestation of child neglect.
B. INCORRECT: A healing spiral fracture is a manifestation of physical abuse.
C. INCORRECT: Genital irritation is a manifestation of sexual abuse.
D. INCORRECT: Burns on the palms of the hands are a manifestation of physical abuse.
E. CORRECT: Poor hygiene is manifestation of child neglect.
2. A nurse is caring for a client who is experiencing alcohol withdrawal. Which of the following findings is a manifestation of withdrawal?
A. Decreased blood pressure
B. Diaphoresis
C. Pin-point pupils
D. Bradycardia
A. INCORRECT: Increased, not decreased, blood pressure is a manifestation of alcohol withdrawal.
B. CORRECT: Diaphoresis is a manifestation of alcohol withdrawal.
C. INCORRECT: Dilated, not pin-point, pupils are a manifestation of alcohol withdrawal.
D. INCORRECT: Tachycardia, not bradycardia, is a manifestation of alcohol withdrawal.
3. A community health nurse is developing an education program on substance use disorders for a group of adolescents. Which of the following should the nurse include when discussing nicotine and smoking?
A. Smoking is the fifth-most preventable cause of death in the United States.
B. Nicotine is a central nervous system depressant.
C. Withdrawal effects from smoking are minimal.
D. Tolerance to nicotine develops quickly.
A. INCORRECT: Smoking is the first-most, not fifth-most, preventable cause of death in the United States.
B. INCORRECT: Nicotine is a central nervous system stimulant, not depressant.
C. INCORRECT: Withdrawal effects from smoking are substantial, not minimal, and increase
physical dependence.
D. CORRECT: Tolerance to nicotine does develop quickly.
4. A community health nurse is developing strategies to prevent or improve mental health issues in the local area. In which of the following situations is the nurse implementing a tertiary prevention strategy?
A. Providing support programs for new parents
B. Screening a client whose spouse recently died for suicide risk
C. Teaching a client who has schizophrenia about medication interactions
D. Discussing stress reduction techniques with employees at an industrial site
A. INCORRECT: Providing support programs for new parents is a primary prevention strategy.
B. INCORRECT: Screening a client whose spouse recently died for suicide risk is a secondary
prevention strategy.
C. CORRECT: Teaching a client who has schizophrenia about medication interactions is a tertiary
prevention strategy.
D. INCORRECT: Discussing stress reduction techniques with employees at an industrial site is a
primary prevention strategy.
5. A nurse at an urban community health agency is developing an education program for city leaders about homelessness. Which of the following should the nurse include as the fastest-growing segment of the homeless population?
A. Families with children
B. Adolescent runaways
C. Intimate partner abuse victims
D. Older adults
A. CORRECT
6. A nurse is reviewing data that will assist with the development of a program to improve health outcomes of vulnerable populations.
Underlying Principles: At least three issues that affect vulnerable populations
●● Violence
●● Substance use disorders
●● Homelessness
●● Mental health issues
●● Poverty
●● Chronic stress
●● Poor self-esteem
●● Access to health care services
1. A nurse is preparing a community health program on communicable diseases. When discussing modes of transmission, the nurse should include which of the following as an airborne illness?
A. Cholera
B. Malaria
C. Influenza
D. Salmonellosis
A. Incorrect: Cholera is waterborne illness.
B. Incorrect: Malaria is a vector-borne illness.
C. Correct: When discussing modes transmission, the nurse should include influenza as an airborne illness.
D. Incorrect: Salmonellosis is a foodborne illness.
2. A home health nurse is discussing portals of entry with a group of newly hired assistive personnel. Which of the following are portals of entry the nurse should discuss? (Select all that apply.)
A. Respiratory secretions
B. Skin
C. Genitourinary tract
D. Saliva
E. Mucous membranes
A. Incorrect: Respiratory secretions are a portal of exit.
B. Correct: Skin is a portal of entry the nurse should discuss.
C. Correct: The genitourinary tract is a portal of entry the nurse should discuss.
D. Incorrect: Saliva is a portal of exit.
E. Correct: Mucous membranes are a portal of entry the nurse should discuss.
3. A newly hired public health nurse is familiarizing himself with the levels of disaster management. Which of the following actions is a component of disaster prevention?
A. Outlining specific roles of community agencies
B. Identifying community vulnerabilities
C. Prioritizing care of individuals
D. Providing stress counseling
A. Incorrect: Outlining specific roles of community agencies is a component of disaster preparedness.
B. Correct: Identifying community vulnerabilities is a component of disaster prevention.
C. Incorrect: Prioritizing care of individuals is a component of disaster response.
D. Incorrect: Providing stress counseling is a component of disaster recovery.
4. A community health nurse is educating the public on the agents of bioterrorism. Which of the following
are Category A biological agents? (Select all that apply.)
A. Hantavirus
B. Typhus
C. Plague
D. Tularemia
E. Botulism
A. Incorrect: Hantavirus is a Category C biological agent.
B. Incorrect: Typhus is a Category B biological agent.
C. Correct: Plague is a Category A biological agent.
D. Correct: Tularemia is a Category A biological agent.
E. Correct: Botulism is a Category A biological agent.
5. A community health nurse is determining available and needed supplies in the event of a bioterrorism attack. The nurse should be aware that community members exposed to anthrax will need access to which of the following medications?
A. Metronidazole (Flagyl)
B. Ciprofloxacin (Cipro)
C. Zanamivir (Relenza)
D. Fluconazole (Diflucan)
A. Incorrect: Metronidazole is used to treat trichomoniasis, skin infections, and septicemia.
B. Correct: Community members exposed to anthrax will need access to ciprofloxacin. This
medication is used for the prophylactic treatment of anthrax.
C. Incorrect: Zanamivir is used to treat influenza.
D. Incorrect: Fluconazole is used to treat candidiasis.
Category A biological agents are the highest priority agents, posing a risk to national security because they are easily transmitted and have high mortality rates.
smallpox (variola), botulism toxin, anthrax, tularemia, hemorrhagic viral fevers, and plague.
Category B biological agents are the second-highest priority because they are moderately easy to
disseminate and have high morbidity rates and low mortality rates.
typhus and cholera
Category C biological agents are the third-highest priority, comprising emerging pathogens that can be engineered for mass dissemination because they are easy to produce, and/or have a potential for high morbidity and mortality rates.
hantavirus
anthrax tx
›› IV ciprofloxacin (Cipro) prophylactically
for exposure or high risk of exposure
›› Antibiotics do not stop disease
progression.
anthrax manifestations
›› Headache
›› Fever
››Muscle aches
›› Chest discomfort
›› Severe dyspnea
›› Shock
Smallpox manifestations
›› High fever
›› Fatigue
›› Severe headache
›› Rash (begins on face and tongue, quickly spreading to the trunk, arms, and legs, then hands and feet) that turns to pus‑filled lesions
›› Vomiting
1. A nurse is creating partnerships to address health needs within the community. The nurse should be aware that which of the following characteristics must exist for partnerships to be successful? (Select all that apply.)
A. A leading partner with decision-making authority
B. Flexibility among partners when considering new ideas
C. Adherence of partners to ethical principles
D. Varying goals for the different partners
E. Willingness of partners to negotiate roles
A. INCORRECT: Shared power must exist for a partnership to be successful.
B. CORRECT: Flexibility must exist for a partnership to be successful.
C. CORRECT: Integrity must exist for a partnership to be successful.
D. INCORRECT: Shared goals must exist for a partnership to be successful.
E. CORRECT: Negotiation must exist for a partnership to be successful.
2. A nurse is reviewing the various roles of a community health nurse. Which of the following is an example of a nurse functioning as a consultant?
A. Advocating for federal funding of local health screening programs
B. Updating state officials about health needs of the local community
C. Facilitating discussion of a client’s ongoing needs with an interprofessional team
D. Performing health screenings for high blood pressure at a local health fair
A. INCORRECT: This is an example of a nurse functioning as a change agent.
B. CORRECT: This is an example of a nurse functioning as a consultant. Community health nurses serve as a consultant regarding the health care needs of individuals, families, and groups within the community served.
C. INCORRECT: This is an example of a nurse functioning as a case manager.
D. INCORRECT: This is an example of a nurse functioning as a caregiver.
3. A case management nurse at an acute care facility is conducting an initial visit with a client to identify needs prior to discharge home. After developing a working relationship with the client, the nurse is engaging in the referral process. Which of the following should be the first action by the nurse?
A. Monitor the client’s satisfaction with the referral.
B. Provide client information to referral agencies.
C. Review available resources with the client.
D. Identify referrals that the client needs.
A. INCORRECT: Monitoring the client’s satisfaction with the referral is an appropriate action by the nurse. However, another action must occur first in the referral process.
B. INCORRECT: Once the client agrees, providing client information to referral agencies is an appropriate action by the nurse. However, another action must occur first in the referral process.
C. INCORRECT: Reviewing available resources with the client is an appropriate action by the nurse. However, another action must occur first in the referral process.
D. CORRECT: Identifying referrals that the client needs is the first action the nurse should take in the referral process. Identifying the client’s needs then allows the nurse and client to focus on specific
needs while moving forward in the referral process.
4. A nurse developing a community health program is determining barriers to community resource referrals. Which of the following is an example of a resource barrier?
A. Costs associated with services
B. Decreased motivation
C. Inadequate knowledge of resources
D. Lack of transportation
A. CORRECT: Costs associated with services are an example of a resource barrier to community referrals.
B. INCORRECT: Decreased motivation is an example of a client barrier to community referrals.
C. INCORRECT: Inadequate knowledge of resources is an example of a client barrier to community referrals.
D. INCORRECT: Lack of transportation is an example of a client barrier to community referrals.
5. A nurse is working with a client who has systemic lupus erythematosus and recently lost her health insurance. Which of the following is an appropriate action by the nurse in the implementation phase of the case management process?
A. Coordinating services to meet the client’s needs
B. Comparing outcomes with original goals
C. Determining the client’s financial constraints
D. Clarifying roles of interprofessional team members
A. CORRECT: Coordinating services to meet the client’s needs is an appropriate action by the nurse in the implementation phase of the case management process.
B. INCORRECT: Comparing outcomes with original goals is an appropriate action by the nurse in the evaluation phase of the case management process.
C. INCORRECT: Determining the client’s financial constraints is an appropriate action by the nurse in the assessment phase of the case management process.
D. INCORRECT: Clarifying roles of interprofessional team members is an appropriate action by the nurse in the planning phase of the case management process.