Chapter 003

Potter & Perry: Fundamentals of Nursing, 7th Edition
Test Bank
Chapter 3: Community-Based Nursing Practice
MULTIPLE CHOICE
1. The student nurse is investigating different types of practice settings. In looking at
community health nursing, the student recognizes that it:
1. Is the same as public health nursing
2. Focuses on the incidence of disease
3. Requires graduate-level educational preparation
4. Includes direct care and services to subpopulations
ANS: 4
Community health nursing strives to safeguard and improve the health of populations in
the community as well as providing direct care services to subpopulations within a
community. Public health nursing is concerned with trends and patterns influencing the
incidence of disease within populations. A community health nurse may be involved in
direct client care for disease within a community. Public health nursing focuses on the
needs of populations. Community health nursing has a broader focus, with an emphasis
on the health of a community. The community health nurse merges public health
knowledge with nursing theory. The community health nurse considers the needs of
populations and is prepared to provide direct care services to subpopulations within a
community. Nurses who become expert in community health practice may have advanced
nursing degrees, yet the baccalaureate-prepared generalist also can become quite
competent in formulating and applying population-focused assessments and
interventions.
DIF: A
REF: 34
OBJ: Comprehension
TOP: Nursing Process: Assessment
MSC: NCLEX test plan designation: Safe, Effective Care Environment
2. As a community health nurse assisting the client and family with nutritional needs the
nurse should first:
1. Identify for the client the best foods to buy
2. Purchase foods at the lowest cost for the client
3. Ask the client and family what they think they should eat
4. Provide information on stores with the most reasonable pricing
ANS: 3
Mosby items and derived items 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc.
Test Bank
3-2
With the goal of helping clients assume responsibility for their own health care, the
community health nurse must assess a clients learning needs and readiness to learn
within the context of the individual, the systems the individual interacts with, and the
resources available for support. Asking the client about what foods he or she thinks
should be eaten may help the nurse assess the clients level of knowledge regarding
nutrition as well as the clients food preferences. It also enables the client to become a
participant in his or her care. Telling the client what foods to buy does not encourage the
client to assume responsibility for managing his or her health care. The nurse should first
assess the resources available, and then encourage the client to do his or her own
shopping. Providing information on food sources and stores with reasonable pricing may
be appropriate after the nurse has determined what information the client requires to meet
nutritional needs.
DIF: C
REF: 40
OBJ: Analysis
MSC: NCLEX test plan designation: Health Promotion and Maintenance
3. Which one of the following clients from a vulnerable population currently appears to be
at the greatest risk?
1. A physically abused client in a shelter
2. A schizophrenic client in outpatient therapy
3. An older adult taking medication for hypertension
4. A substance abuser who shares drug paraphernalia
ANS: 4
A client with substance abuse has health and socioeconomic problems. These clients
frequently may avoid health care for fear of judgmental attitudes by health care providers
and concern over being turned in to criminal authorities. An abused client in a shelter has
sought protection so currently should be at less risk. Although considered to be a member
of a vulnerable population, the older adult who takes medication for a chronic disease,
such as hypertension, is taking measures to maintain health. A schizophrenic client in
outpatient therapy is currently at less risk because he or she is receiving treatment.
DIF: C
REF: 36
OBJ: Analysis
4. A client with a history of a gastrointestinal disorder eats a well-balanced diet that keeps
his GI symptoms suppressed. Which level of prevention corresponds to his dietary
management?
1. Health promotion
2. Primary prevention
3. Tertiary prevention
4. Secondary prevention
ANS: 3
Test Bank
3-3
The goal of tertiary prevention is to preclude further deterioration of physical and mental
function in a person who has an existing illness, and to have the client use whatever
residual function is available for maximum enjoyment of and participation in lifes
activities. Health promotion is aimed at reducing the incidence of disease and its impact
on people. Primary prevention is aimed at general health promotion.
Secondary prevention is aimed at early recognition and treatment of disease.
DIF: A
REF: 37
OBJ: Comprehension
TOP: Nursing Process: Evaluation
5. Which of the following statements by the home health nurse best reflects client advocacy
in response to the clients concern over the expense of the therapy?
1. Have you considered the possibility of a renal transplant?
2. This peritoneal dialysis is less expensive than hemodialysis.
3. You must feel awful about this situation, but this is the best course of treatment for
you.
4. Lets call the regional dialysis center and explore options for reducing the cost of
your home dialysis.
ANS: 4
Calling the regional dialysis center and exploring options for reducing cost demonstrates
the nurse acting as client advocate by identifying and assisting the client in contacting the
appropriate agency for information and resources to meet the clients needs. Asking the
client whether he has considered renal transplantation does not demonstrate client
advocacy. Pointing out the difference in cost for dialysis in the home versus the hospital
does not meet the clients need to reduce the expenses of his therapy. The nurse is not
demonstrating patient advocacy. Telling the client that this is the best treatment for him
does not address his financial concerns. The nurse is not demonstrating patient advocacy
with this response.
DIF: C
REF: 40
OBJ: Analysis
6. In assessing the structure of the community in order to identify the needs of its
population, the nurse will focus on:
1. Collecting demographic data on age distribution
2. Visiting neighborhood schools to review health records
3. Interviewing clients to determine the cultural composition of the subgroups
4. Observing locations where services, such as water sanitation, are provided
ANS: 4
Test Bank
3-4
When assessing the structure or locale of a community, the nurse should travel around the
neighborhood or community and observe its design; the location of services, such as
water and sanitation; and the locations where residents congregate. Collecting
demographic data on age distribution would be an assessment of the communitys
population. Visiting neighborhood schools to review health records is an example of
assessing a social system within a community. Interviewing clients to determine the
cultural composition of subgroups is an example of assessing the population within a
community.
DIF: A
REF: 41
OBJ: Comprehension
7. To facilitate change within a community, the nurse working as an effective change agent
should:
1. Inform community members how to effectively manage their health needs
2. Work with clients and groups to select alternative health care sites and treatments
3. Formulate decisions for individual clients regarding their health care options
4. Provide instruction in the way the community should address health issues
ANS: 2
As a change agent, the nurse seeks to implement new and more effective approaches to
problems. The nurse creates change by working with and empowering individuals and
their families to solve problems or to become instrumental in changing aspects affecting
their health care. Telling community members how to manage their health care needs
may meet resistance. It also does not enable clients and their families to take
responsibility for their health care. Making decisions for clients does not enable
individuals to assume responsibility for their health care decisions. The community-based
nurse acting as a change agent may be an excellent resource for health information to
members of the community. Ultimately; however, the community members will take an
active role to create change for themselves and will assume responsibility for their health
care decisions.
DIF: A
REF: 39-40
OBJ: Comprehension
8. The client is being discharged from an acute care facility following a total hip
replacement. She will need follow-up for her rehabilitation and exercise plan. In addition
to a home health care nurse, what referral should be discussed?
1. Dietitian
2. Social worker
3. Physical therapist
4. Respiratory therapist
ANS: 3
Test Bank
3-5
Directing clients to appropriate resources and improving continuity of care require the
nurse to know those resources well. A physical therapist is responsible for the clients
movement system and is likely to be needed following hip replacement surgery.
A social worker may or may not be necessary. A dietitian may or may not be necessary.
A respiratory therapist would not be necessary unless the client experienced a respiratory
complication or had a preexisting respiratory condition.
DIF: A
OBJ: Comprehension
TOP: Nursing Process: Planning
9. The nurse recognizes which of the following as the largest contributing factor for the rise
in the need and use of home care?
1. Government funding of the home care setting has increased greatly.
2. Clients are more acutely ill when discharged from the acute care facility.
3. There are 7 days/week services for the elderly in home care agencies.
4. The existence of more single-income families has increased the need for their
elderly relatives to receive care in the home.
ANS: 2
Because hospital stays are being shortened to control health care costs, clients are
returning home more acutely ill. This is the largest contributing factor for the rise in the
need and use of home care. Government funding of home care is not the largest
contributing factor for the rise in the need and use of home care. There are 7 days/week
services for the elderly in a variety of settings, such as in acute care or long-term care, not
just in the home care setting. Being able to provide daily services for the elderly in the
home care setting is not the largest contributing factor for the rise in the need and use of
home care. The existence of more single-income families is not the largest contributing
factor for the rise in the need and use of home care.
DIF: C
REF: Chapter 2, 22
OBJ: Analysis
10. One of the overall goals of Healthy People 2010 is to:
1. Increase life expectancy
2. Decrease health care costs
3. Promote managed care organizations
4. Establish the credentials of service providers
ANS: 1
The overall goals of Healthy People 2010 are to increase the life expectancy and quality
of life and to eliminate health disparities. The initiative of Healthy People 2010 is to
improve the delivery of health care services to the general public. The overall goal did
not focus on reducing health care costs. Although managed care organizations may
increase in number, this was not a goal of the Healthy People 2010 initiative.
Establishing the credentials of care providers was not a goal of Healthy People 2010.
Test Bank
3-6
DIF: A
REF: 33
OBJ: Comprehension
11. When assessing members of a vulnerable population, the community health nurse should
realize that the primary need is to:
1. Provide culturally competent assessment.
2. Organize in your mind exactly what you need to ask.
3. Create a comfortable, nonthreatening environment.
4. Be alert for indications of mental and physical abuse.
ANS: 3
In order to be successful in assessing a member of a vulnerable population, the nurse
must first create an environment that is encourages the client to cooperate with and
actively participate in the assessment process While it is important that the nurse be
cultural considerate of the client, it is not the primary need of those offered as options.
While organization to thought is important to the effective use of time needed for an
assessment, it is not the primary need of those offered as options. While vulnerable
populations may be more susceptible to both mental and physical abuse making
observation for signs of abuse important, it is not the primary need of those offered as
options
DIF: C
REF: 35
OBJ: Analysis
12. The nurse working in a free clinic often utilized by Hispanic immigrants is assessing a
client who reports a cough and malaise. The client is hearing impaired, speaks very little
English and is currently living in a homeless shelter. The nurses primary concerns should
be the clients:
1. Language barrier
2. Risk for tuberculosis
3. Hearing impairment
4. Lack of health care resources
ANS: 2
Risk for tuberculosis presents the greatest risk since it is supported by the physical signs,
is highly contagious and a risk factor among the homeless and some immigrant
populations. The language barrier is a concern since it impacts the communication
between the nurse and the client but it is not the primary concern among the options
offered. The clients hearing impairment is a concern because it has an impact on the
communication between the nurse and the client but it is not the primary concern among
the options offered. The clients lack of insurance is a concern because it affects the
treatment plan necessary for the clients recovery, but it is not the primary concern among
the options offered.
Test Bank
3-7
DIF: C
REF: 36
OBJ: Analysis
13. A nurse is planning interventions for the clients of a homeless shelter. Which of the
activities represents a primary level intervention regarding sexually transmitted diseases?
1. HIV screening for all residents
2. Sex education for teenage residents
3. Treatment for residents diagnosed with AIDS
4. Gynecological referrals for female residences
ANS: 2
Primary level interventions are directed a preventing the disease. Educational
programming is generally considered a primary intervention. Screening a disease is
generally considered a secondary level intervention. Treatment of the disease is generally
considered a tertiary level intervention. Referrals are generally considered a secondary
intervention.
DIF: A
REF: 36
OBJ: Comprehension
TOP: Nursing Process: Planning
14. The nurse working in a free clinic is caring for a homeless client diagnosed with paranoid
schizophrenia who has reported that, I hurt my foot running away from them. It hurts so
bad I can hardly walk now. On assessment the nurse notices bruising on the clients
back, arms, and thighs, a red rash on both neck and face, and poor personal hygiene, in
addition to edema of the left ankle. The nurse should first realize that this client is at risk
for:
1. Physical abuse and assault
2. Drug addiction relating to pain
3. Communicable immune disorders
4. Hospitalization due to mental disorder
ANS: 1
When a client has a severe mental illness such as schizophrenia there are multiple health
and socioeconomic problems you will need to explore. Many clients with pervasive
mental illnesses are homeless or live in poverty. In addition, mentally ill clients are at
greater risk of abuse and assault. This clients reported foot injury and observable
bruising support the possibility of abuse/assault. While drug abuse may be a
consideration, it does not represent the best option offered for this item because there is
not indication that the client is drug seeking. Contacting communicable diseases is a risk
factor for such a client but it does not represent the best option offered for this item
because there are several factors that may indicate abuse/assault. Hospitalization may be
required but it does not represent the best option offered for this item because there is no
indication that the client is experiencing a psychiatric crisis.
DIF:
REF: 37
OBJ: Analysis
Test Bank
3-8

15. A community nurse has identified a need for educational programming among the
residents of an assistive living facility dealing with osteoarthritis. The best example of
such programming is:
1. Planning the best exercise program for you.
2. Recognizing how arthritis has affected your life.
3. Proper self administration of antiinflammatory medication
4. Be an informed consumerdont fall for false arthritis cures.
ANS: 4
Thorough assessment and appropriate community based interventions provide an
opportunity to improve the lifestyle and quality of life of older adults in general. The
focus is on broad-based needs not specific client needs. Answer 4 offers information
applicable to the entire resident population diagnoses with osteoarthritis.
DIF: C
REF: Chapter 2, 19
OBJ: Analysis
TOP: Nursing Process: Planning/Implementation
16. A homeless client has presented in the ED with a bacterial infection in a hand wound. The
nurse has cleansed and dressed the wound, and an initial dose of an antibiotic has been
administered. The client will need the antibiotic prescription filled and a dressing change
in 3 days. In order to ensure that the client will receive the appropriate follow-up care, the
nurse must first act as the clients:
1. Educator
2. Advocate
3. Caregiver
4. Counselor
ANS: 2
Client advocacy perhaps is more important today because of the confusion surrounding
access to health care services. Your clients often need someone to help them walk through
the system, identify where to go for services and tell them how to reach the individuals
with the appropriate authority, what services to request, and how to follow through with
the information they received. The role of the educator is to help the client assume
responsibility for his or her own health care. This client has been educated to the needs
related to caring for the infection but needs the nurse advocate to assist with facilitating
the care. As caregiver, the nurse manages and cares for the clients health. You apply the
nursing process (see Unit III) in a critical thinking approach to ensure appropriate,
individualized nursing care for specific clients and their families. This clients nursing
care has been appropriated delivered and so that nursing role has been fulfilled. A
counselor assists clients in identifying and clarifying health problems and in choosing
appropriate courses of action to solve those problems. The client is first in need of
assistance in dealing with the obstacles to the care of the identified probleminfection.
Test Bank
3-9
DIF: C
REF: 37-38
OBJ: Analysis
TOP: Nursing Process: Implementation
17. A nurse is discussing the need to use a specific cleansing agent when redressing an
infected hand. The client prefers using, plain old soap and water. The nurse knows that
the primary factor that will affect client compliance is:
1. The ease with which the client can use the special agent
2. The clients acceptance of the need for the specialized care
3. The availability and cost of the prescribed cleansing agent
4. The introduction of an incentive to prompt client to comply
ANS: 2
Client must perceive the innovation or change as more advantageous than other
alternatives or they will not make the change. Client education is essential in bringing
about the change in attitude necessary for change. While the client is more likely to adapt
the change if it is perceived as being easy, it is not the primary factor in achieving client
compliance provided among the options available because client compliance is primarily
a result of the clients understanding of the need for change. While cost to the client is a
factor, it is not the primary factor in achieving client compliance provided among the
options available since client compliance is primarily a result of the clients
understanding of the need for change. An incentive is sometimes necessary, but it is not
the primary factor in achieving client compliance provided among the options available,
because client compliance is primarily a result of the clients understanding of the need
for change.
DIF: C
REF: 39
OBJ: Analysis
TOP: Nursing Process: Planning/Implementation
18. The nurse is assessing a client diagnosed with chronic bronchitis who has been
experiencing an increase in dyspnea. The client lives within 2 blocks of a factory that
emits pollution into the air. In light of this information, the nurse is primarily concerned
with:
1. Performing a complete client health history and physical assessment
2. Providing the client with assess to all the required breathing treatments
3. Identifying a correlation between the pollution and the clients increased dyspnea
4. Determining the availability of alternate housing for the client away from the
factory
ANS: 3
There may be many factors that are affecting the clients breathing. Determining the
clients exposure to the pollution and its affects of the clients breathing would be the
nurses primary concern for this client. The assessment and history is important but is not
the best option available regarding the effects of air pollution on the clients respirations.
Test Bank
3-10
The availability of required breathing treatments is important but it is not the best option
regarding the effects of air pollution of the clients respirations. It may be necessary for
the client to consider moving but only if it is determined that the pollution is responsible
of the increase in the dyspnea.
DIF: A
REF: 40
OBJ: Analysis
MULTIPLE RESPONSE
1. Which of the following clients is a concern for the community health nurse? (Select all
that apply.)
1. The homeless woman with a history of congestive heart failure
2. The elderly gentleman who fell while disembarking from a bus
3. The child of itinerant workers who has a developed asthma
4. A client diagnosed with HIV who recently lost her insurance
5. A 15-year-old who was injured while at a public swimming pool
6. A retired service veteran who has a chronic psychiatric disorder
ANS: 1, 3, 4
Community-based health care occurs outside traditional health care institutions, such as
hospitals. It provides services for acute and chronic conditions to individuals and families
with in the community (Stanhope and Lancaster, 2006). Some of these problems include
an increase in homeless and immigrant populations, an increase in sexually transmitted
diseases, underimmunization of infants and children, and life-threatening diseases (e.g.,
clients living with HIV and other emerging infections). All of these clients possess risk
factors that are community based
DIF: C
REF: 40
OBJ: Analysis
2. A nurse working with clients at or below the poverty level recognizes that the life
expectancy of these clients is lower than the general population because of: (select all that
apply.)
1. Inadequate nutritional diets
2. High-risk work environments
3. Hazardous living environments
4. Addictive and abusive lifestyles
5. Predisposition to chronic diseases
6. Ineffective decision making abilities
ANS: 1, 2, 3, 4
Test Bank
3-11
People who live in poverty are more likely to live in hazardous environments, work at
high-risk jobs, eat less nutritious diets, abuse substances, and have multiple stressors in
their life. When researchers compared the life expectancies of European Americans and
African-Americans, the causes of the differences were related to low socioeconomic
status rather than ethnicity (Decker and others, 2006; Hwang, 2000). Predisposition to
chronic disease in part is genetic in nature and research has confirmed no such link
between poverty and chronic disease. Decision-making ability is not the only factor
affecting decision making. Poverty negatively affects the individuals ability to access
recourses and adds stressors such as finding shelter that can alter the decision-making
process.
DIF: A
REF: 41
OBJ: Comprehension

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TOP: Nursing Process: Assessment

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