Responsibilities for Care Public Health Nursing.docx

Community/Public Health Nursing Practice Responsibilities for Care in Community Public Health Nursing 1. A community/public health nurse is best defined as a nurse who: A. Applies concepts and knowledge from nursing and public health. B. Gives care to families in the community. C. Has a baccalaureate and previous experience in community health. D. Is employed outside an institution such as a hospital or care facility. ANS: A Community/public health nurses synthesize all their nursing expertise as well as knowledge from public health. 2. Sometimes persons try to distinguish between community health nursing and public health nursing. The only clear distinction is that the community health nurse: A. Gives care in community settings regardless of personal education, whereas public health nurses have specific educational preparation. B. Is a title that has historically been used, whereas public health nursing is the new “in” title for the role. C. Is employed to give care to families and groups, whereas the public health nurse works in public health departments. D. Is the broader term, which includes public health nursing, school nursing, home health nursing, etc. ANS: A Public health nurses synthesize all their nursing expertise as well as knowledge from public health, whereas nurses with varied educational backgrounds may be employed in community settings, a much broader classification. 3. Nurses do all of the following. Which is a unique function of community/public health nurses? A. Care for the sick and dying B. Committed to help clients C. Focus on the client as a member of the community D. Give holistic care to clients in the presence of their families ANS: C All of the above may be done by all nurses except focusing on the community environment. 4. What is the value of discussing our vision for health of the community? Select all that apply. A. Assists others in seeking possibilities they may not have thought possible. B. Encourages others to become partners in a specific project. C. Forces others to think about health issues and nurses’ power. D. Helps coerce others to become partners in the nurse’s dream. E. Helps divert attention from issues pushed by other professions. F. Such sharing when others agree can become a source of energy and motivation for all. ANS: A, B, F Discussing our dream or vision empowers us and helps us remember why we do what we do. It also allows others to become involved and to recognize new possibilities. Expressing our visions also provides an opportunity for others to become partners in working for what might be, not only the broader vision but also in relation to specific projects. Nurses do not force or coerce others and often work with other professions on issues related to health. 5. What is the appropriate approach for the community/public health nurse in balancing individual privacy and autonomy and the community’s needs for safety and security? A. Always fulfill agency policies first. B. Implement professional standards of nursing practice. C. Obey all legal mandates. D. Remember that group needs outrank individual needs. E. Seek a balance between individuals’ needs and the community’s needs. ANS: E While the nurse’s practice should be consistent with employing agency policies, legal mandates, and professional standards, the nurse must seek a balance between individual autonomy and other individual rights and the rights of all other community members. It is a delicate balance. 6. When caring for a family or community, what is one of the most important variables for the care to be acceptable to the recipients? A. According to the textbook or procedure manual B. Consistent with agency policies C. Consistent with legal rules and regulations D. Culturally congruent E. The least expensive option if all are equally effective ANS: D While the nurse should do all of the above, for recipients to accept the care, the care must be consistent with their cultural expectations and norms. 7. What is the meaning of the term aggregate as used in community health? A. A group of people who reside in a specific geographic area B. All of the people who live in a specific community C. A set of persons having some characteristic in common D. “The public” in professional terminology ANS: C By definition, an aggregate is a group of persons who have one or more characteristics in common, particularly a set of persons under statistical study with some common personal or environmental characteristic. Aggregate is a synonym for population. 8. In a situation in which there are not enough resources to care for everyone who wants and could benefit from care, what would an ethical community/public health nurse do? A. Ask the agency supervisor how to approach this problem. B. Focus on basic services such as immunization for everyone in the community. C. Give care to everyone who can pay the cost of whatever care they might need. D. Follow agency policies, whatever those policies might be. E. Give care to those workers and their families who have insurance to pay for their care. ANS: B To provide for the greatest good to the greatest number, it is often necessary to focus on basic services, such as immunization or prenatal care, because such care has the most effect on the whole community. 9. When faced with an ethical conflict about limited resources and unlimited need, which action is the most just? A. Give care to those patients whose needs most closely match the nurse’s abilities. B. Give care to whichever prospective clients ask for care first. C. Just work as hard as you can and do not worry about it. D. Follow personal clinical expertise and preferences. E. Try to achieve the outcome of the greatest good for the greatest number of people. ANS: E While option B fulfills the criteria of egalitarian (equal) justice, it is a short-term answer to an ongoing problem. Option E describes a utilitarian approach to justice, which is more helpful when dealing with large populations such as those seen by the community/public health nurse. 10. What document is helpful in describing competent and appropriate nursing care in the community? A. Community Health: Standards of Nursing B. Healthy People 2010 C. The Joint Commission: The Comprehensive Accreditation Manual D. Public Health Nursing: Scope and Standards of Practice ANS: D The document Public Health Nursing: Scope and Standards of Practice (2007) was developed in concert with the steps of the nursing process to help nurses promote the health of people. There is no such document as Community Health: Standards of Nursing. 11. In what ways do community/public health nurses give indirect care to clients in homes, clinics, senior citizen centers, schools, prisons, homeless shelters, etc.? A. By being employed in such settings as outpatient clinics B. By engaging in anticipatory guidance and health promotion C. By giving care in mobile vans to citizens in their own neighborhoods D. By such activities as political action to create new client services ANS: D Nurses give care directly as in all the answers given but provide care indirectly by trying to promote health and well-being through creating new resources, improving the environment, or using social and political mechanisms for solving problems. 12. Both an acute care nurse employed by a hospital and a community/public health nurse might give care to a recently discharged client in his or her home. How might the actions of the community/public health nurse differ from those of the acute care nurse? A. The community/public health nurse might assess the health and needs of all the family members. B. The community/public health nurse might be very careful to be nonjudgmental about the family’s living situation. C. The community/public health nurse might explain why each nursing intervention was being done. D. The community/public health nurse might help the family understand the basis for the treatment. ANS: A While both nurses would give excellent care to the individual client, the acute care nurse would assess the client and adapt interventions accordingly. The community/public health nurse would seek to identify others in the family who might need intervention or referral as well. The community/public health nurse provides care from a family-focused model, being concerned not only with the health of the identified client but also with the health of other family members. 13. When a community/public health nurse cannot meet a need of the client, it is most appropriate for the nurse to: A. Encourage the patient to pay someone to meet that need. B. Point out that insurance will not pay for that particular care. C. Refer the client to a person or agency that might help the patient. D. Suggest that the patient discuss the need with the physician. ANS: C Referral or directing someone to another source of assistance is an appropriate response when the nurse cannot fill the need. 14. What is the nurse’s most appropriate action when it becomes apparent that another agency is needed to help a family best meet their health needs? A. Call the other agency to set up care for the family. B. Give the family information to initiate contact with the other agency. C. Report the need to the community/public health nurse’s supervisor for action. D. Write a letter to the appropriate agency suggesting the agency get in touch with the family. ANS: B Nurses usually encourage the client to initiate contact as one way of maintaining responsibility for their own care without encouraging dependency. Nurses work with clients with a specific difficulty or barrier, such as language, in a way that empowers them to follow up on the referral. 15. The nurse was caring for a 17-year-old pregnant girl. Among other areas of discussion, the nurse reviewed the normal process of labor and delivery. What is sharing such information before the young woman is in labor called? A. Anticipatory guidance B. Obstetrical care C. Postpartum care D. Prenatal care ANS: A Providing information before the patient is expected to need and act upon that information is best termed anticipatory guidance. 16. A young man again entered the STD (sexually transmitted disease) clinic for a test for HIV on an anonymous basis. What might the clinic nurse do besides complete the testing? A. Determine if the young man is heterosexual or homosexual. B. Emphasize repeatedly the importance of abstinence. C. Find out what barriers he perceives to practicing safe sexual behaviors in order to avoid HIV. D. Teach again the importance of using protection if engaging in sexual acts. ANS: C Because the young man has presumably been taught the advantages of abstinence or protection if engaging in sex, yet continues to return for further testing, it is clear that information alone has not changed his behavior. Therefore the nurse should interview the client about his values and help him perceive how reducing his risks may help him achieve his goals. 17. If a nurse considers health to include well-being, then what will be the nurse’s focus when giving care to a family confronting the imminent death of a family member? A. Doing everything possible to postpone the client’s death B. Giving pain medication so the patient can be kept comfortable C. Reinforcing the need for the whole family to adapt to the impending death D. Sharing the nurse’s knowledge of the physiology behind the patient’s symptoms and the appropriate interventions for comfort E. Using discussions to help both the dying person and the person’s family perceive meaning in their lives ANS: E Well-being requires learning to create meaning and a sense of belonging in life while recognizing that control (i.e., preventing the death) is not always possible. 18. A community/public health nurse may ignore an individual’s wishes in which of the following circumstances? A. A client with tuberculosis refusing treatment B. A client who continues to put salt on food although educated about a cardiac diet C. Discovers the client drinks wine before dinner every night D. Finds evidence that the client may be smoking marijuana ANS: A Many states require treatment for patients who are contagious to those around them. The other choices are unfortunate, but people have the right to choose their lifestyle behaviors and nurses are not police officers. 19. How might case management be defined? A. An incident needing intervention B. Another term for cost containment C. Development and coordination of a plan of care for a client D. Managing groups of cases of patients having a specific illness ANS: C Case management is defined as the development and coordination of a plan of care for a selected client. 20. Why is it necessary for nurses to attend meetings such as health planning council meetings? A. To be able to sit and catch up on documenting care given B. To get a rest from all the physical effort expended in the morning C. To have a chance to see friends and catch up on their news D. To have a nice break from direct patient care E. To network with other community groups ANS: E Nurses must establish and maintain relationships with professionals in other agencies and create partnerships to address community problems. 21. Why would a nurse choose to be an active member of several professional associations? A. To be able to spend time with friends and colleagues B. To be invited to the organization’s annual convention/conference C. To be part of the decision-making and political action activities D. To have a rationale for paid professional development time for their meetings E. To obtain free copies of the organization’s journal or magazine ANS: C Community/public health nurses obtain membership in decision-making groups as another way to increase their influence and have input into health planning. 22. What do human communities require in order to be healthy communities? A. Award-winning schools with ambitious educational programs B. Connectedness and caring C. Excellent transportation systems throughout D. Full employment opportunities beginning with adolescents E. Fully staffed hospitals with the latest technologies ANS: B The WHO points out that values underlying health for a community include equity, empowerment, and cooperation. As a balance to some of the values of efficiency, materialism, and hierarchic power structures, nurses are speaking for connectedness and caring. 23. The nurse was caring for quite a number of single teenage mothers who desperately needed such common supplies as diapers and cribs but there was no resource for obtaining such things in the nurse’s community. Which of the following actions would be most helpful? Select all that apply. A. Ask churches and other community charities to donate such supplies. B. Ask the local hospital to not bill the young women for labor and delivery costs. C. Empower the women by helping them form a self-help group to share resources. D. Engage the community in recognizing the problem and considering change. E. Hold fundraisers to give cash to the teenagers to purchase such supplies. F. Teach a sex education course in all the schools for pre-pubescent students. ANS: A, C, D, F The immediate short-term need can be met by asking community resources such as churches to donate supplies. The young women themselves can be empowered by forming a group to share resources and pass them on to others when equipment (e.g., cribs) is no longer needed. However, in the long term, the community itself must recognize the problem and decide what actions might be appropriate. In similar fashion, in the long term, younger students need education on how to avoid the risks of early pregnancy. 24. What do the credentials RN, BC signify? A. A special professional development program only for community/public health nurses B. A special title given to nurses who join the American Nurses Association C. A voluntary process that demonstrates knowledge, education, and experience D. It means the nurse received the RN licensure from British Columbia. E. The nurse had a special master’s degree. ANS: C Certification is a voluntary process that validates an individual RN’s qualifications in a specified area of nursing. A nurse generalist with a BSN who becomes certified as a Community/Public Health Nurse can sign RN, BC. 25. Which nursing goals are unique to community/public health nursing? Select all that apply. A. Advocacy for equitable distribution of health care B. Care of the ill, disabled, and suffering C. Political action for a healthful physical environment D. Promotion of self-responsibility or self-care in relation to health E. Standard of living that supports health for all F. Support human growth and development throughout the life span ANS: A, C, E All nurses care for the ill, support human growth and development, and promote self-responsibility or self-care. Community/public health nurses promote equitable distribution of health care, a basic standard of living that supports the health and well-being of all persons, and a healthful physical environment. 26. Which nursing actions would help ensure a healthful environment? Select all that apply. A. Help an elderly couple get referred to a health clinic that will accept their Medicare card. B. Help parents fight to get soda and candy vending machines out of the school. C. Help the high school student government establish a waste recycling program. D. Refer a homeless person to an overnight shelter. E. Recognize that patient autonomy is crucial and individuals have a right to smoke if they so desire. F. Support members of Mothers Against Drunk Driving who testify to Congress. ANS: B, C, F While all of the above would be excellent interventions, finding a source of medical care or helping a homeless person have shelter for 1 night, even recognizing the right to autonomy, is not changing the environment. Improving the environment by having only healthy choices available, establishing waste recycling, and helping get drunk drivers off the road makes a safer world for everyone. 27. Which interventions are most commonly used by community/public health nurses caring for families? Select all that apply. A. Administer screening tools to all members. B. Apply the nursing process to the care of individuals. C. Collaborate and coordinate with referral as needed. D. Provide health teaching, including anticipatory guidance. E. Participate in collecting data on clients for clinical research. F. Resolve conflict among family members. ANS: C, D The predominant intervention strategies used with families are primary care, health teaching (including anticipatory guidance), referral, and collaborating and coordinating care. Screening can be done by various nurses, as can care of individuals. Nurses probably cannot resolve conflict, although they may help family members cope with conflict. Collecting data for research can only be done with client permission. 28. What would a new baccalaureate-prepared community/public health nurse be expected to do to maintain personal competency and quality of care? Select all that apply. A. Apply the nursing process to a large aggregate. B. Be actively involved in peer review. C. Continue to give the best possible care to individuals and families. D. Participate in relevant continuing education programs. E. Integrate relevant research findings for evidence-based practice. F. Systematically evaluate personal professional practice performance. ANS: B, D, E, F Doing tasks such as applying the nursing process or giving the best care possible is not maintaining competence. Competency is maintained by ongoing professional development such as attending educational programs, becoming involved in peer review, reading and integrating relevant research findings, and continually evaluating one’s personal practice. 29. Which action by home health nurses is crucial because of current national health care goals? A. Administer medications and treatments correctly and safely. B. Continue to document savings and benefits in long-term outcomes from community/public health nursing. C. Guide a group to an appropriate resource to best meet their needs. D. Teach an ill person’s family how to give self-care. ANS: B Because cost containment in health care continues to be a national goal, it is important for community/public health nurses to continue to document the cost of nursing care and the savings that nursing care can provide (Deal, 1994). Home care expanded because nurses demonstrated that quality care can be provided for some clients in the home at a lower cost than in the hospital. 30. Which ethical principle might be difficult for the community/public health nurse? A. Absence of malfeasance, or avoiding harm B. Beneficence, or doing good C. Justice or providing services when needed, regardless of cost D. Respect for autonomy or seeking informed consent E. Veracity or telling the truth ANS: C While all nurses clearly would try to fulfill all of the above principles, nurses working in institutions do not typically have to be concerned with the source of payment; health department nurses often do. Agency nurses can only give care within the limitations of third-party payer requirements. A difficulty for community/public health nurses is coping with the disparities in our current health care system.