Chapter 01: Community Health Nursing
MacDonald/Jakubec: Stanhope and Lancaster's Community Health Nursing in Canada, 4th Edition

MULTIPLE CHOICE

	1.	Which of the following best describes community health nursing?
a.	Giving care with a focus on the aggregate’s needs	
b.	Giving care with a focus on the group’s needs	
c.	Focusing on the health care of individual clients in the community	
d.	Working with an approach of unique client care	

ANS:	C
By definition, community health nursing is the health care of individual clients in the community.

PTS:	1	DIF:	Cognitive Level: Knowledge/Remember	
REF:	Introduction	OBJ:	1.6	TOP:	Safe and Effective Care Environment

	2.	Which of the following best describes primary health care?
a.	A comprehensive way to address issues of social justice	
b.	Giving care to manage acute or chronic conditions	
c.	Giving direct care to ill individuals within their family setting	
d.	Having the goal of health promotion and disease prevention	

ANS:	A
By definition, primary health care is comprehensive and addresses issues of social justice and equity. Social justice in the context of health refers to ensuring fairness and equality in health services so that vulnerable individuals in society have easy access to health care.

PTS:	1	DIF:	Cognitive Level: Knowledge/Remember	
REF:	Primary Health Care		OBJ:	1.4	
TOP:	Health Promotion and Maintenance		

	3.	The health of which of the following is the primary focus of public health nurses (PHNs)?
a.	Families	
b.	Groups	
c.	Individuals	
d.	Populations	

ANS:	D
PHNs use knowledge of nursing, social sciences, and public health sciences for the promotion and protection of health and for the prevention of disease among populations.

PTS:	1	DIF:	Cognitive Level: Knowledge/Remember	
REF:	Public Health Practice	OBJ:	1.5	
TOP:	Health Promotion and Maintenance		

	4.	Which change is the primary explanation for life expectancy increasing so notably since the early 1900s?
a.	An increase in findings from medical laboratory research	
b.	Incredible advances in surgical techniques and procedures	
c.	Improved sanitation and other public health activities	
d.	Increased use of antibiotics to fight infections	

ANS:	C
Improvement in control of infectious diseases through immunizations, sanitation, and other public health activities led to the increase in life expectancy since the early 1900s.

PTS:	1	DIF:	Cognitive Level: Knowledge/Remember	
REF:	Public Health Practice	OBJ:	1.5	
TOP:	Health Promotion and Maintenance		

	5.	Which community health nursing practice area receives funding from the private sector?
a.	Telenurses	
b.	Corrections nurses	
c.	Nurse entrepreneurs	
d.	Street or outreach nurses	

ANS:	C
The nurse entrepreneur receives private funding, whereas all of the other community health nurse (CHN) roles are with provincially or federally funded positions.

PTS:	1	DIF:	Cognitive Level: Knowledge/Remember	
REF:	Community Health Nursing Roles and Functions	OBJ:	1.1 | 1.6
TOP:	Safe and Effective Care Environment	

	6.	A public health nurse (PHN) strives to prevent disease and disability, often in partnership with other community groups. Which statement is an appropriate summary of the PHN’s role?
a.	The PHN asks the political leaders what interventions should be chosen.	
b.	The PHN assesses the community and decides on appropriate interventions.	
c.	The PHN uses data from the main health care institutions in the community to determine needed health services.	
d.	The PHN works with community members to carry out public health functions.	

ANS:	D
It is crucial that the PHN work with members of the community to carry out core public health functions.

PTS:	1	DIF:	Cognitive Level: Application/Apply		
REF:	Public Health Practice	OBJ:	1.5	
TOP:	Health Promotion and Maintenance		

	7.	Which of the following is used as a measurement of population health?
a.	Health status indicators	
b.	The levels of prevention	
c.	The number of memberships at the local fitness centre	
d.	Reported provincial alcohol and tobacco sales in any given month	

ANS:	A
Population health refers to the health outcomes of a population as measured by determinants of health and health outcomes.

PTS:	1	DIF:	Cognitive Level: Knowledge/Remember	
REF:	Populations and Aggregates	OBJ:	1.2	
TOP:	Health Promotion and Maintenance		

	8.	A registered nurse (RN), has just been employed as a community health nurse (CHN). Which question would be most relevant to practice as the nurse begins her position?
a.	“Which community groups are at greatest risk for problems?”	
b.	“Which patients should I see first as I begin my day?”	
c.	“With which physicians will I be collaborating most closely?”	
d.	“Who is the nursing assistant to whom I can refer patients?”	

ANS:	A
CHNs apply the nursing process to the entire community; asking which groups are at greatest risk reflects a community-oriented perspective. The other possible responses focus on particular individuals.

PTS:	1	DIF:	Cognitive Level: Application/Apply		
REF:	Populations and Aggregates	OBJ:	1.6	
TOP:	Health Promotion and Maintenance		

	9.	The community health nurse (CHN) who is working with women at the senior citizens’ centre reminds them that the only way the centre will be able to afford a driver and a van service for those who cannot drive themselves is to continue to write letters to their local city council representatives, requesting funding for such a service. What is the CHN doing?
a.	Ensuring that the women do not expect the CHN herself to do anything about their problem	
b.	Demonstrating that she understands the women’s concerns and needs	
c.	Expressing empathy, support, and concern	
d.	Helping the women engage in political action locally	

ANS:	D
CHNs have an imperative to work with the members of the community to carry out public health functions such as political action.

PTS:	1	DIF:	Cognitive Level: Application/Apply		
REF:	Public Health Practice	OBJ:	1.5 | 1.6	
TOP:	Safe and Effective Care Environment	

	10.	Which activity is an example of the “advocate” role of the community health nurse?
a.	Organizing home care support for a newly discharged older client	
b.	Acting as a member of a community action group for provision of accessible transit choices	
c.	Doing prenatal assessments	
d.	Facilitating a self-help group for smoking cessation	

ANS:	B
An advocate provides a voice to client concerns when acting as a member of a community action group for provision of accessible transit choices.

PTS:	1	DIF:	Cognitive Level: Application/Apply		
REF:	Community Health Nursing Roles and Functions	OBJ:	1.6
TOP:	Safe and Effective Care Environment	

	11.	In which scenario is the public health nurse (PHN) most comprehensively practising interprofessional collaboration?
a.	The PHN meets with several groups about community recreation issues.	
b.	The PHN spends the day attending meetings at various health agencies.	
c.	The PHN talks to several people about their particular health concerns.	
d.	The PHN watches television, including a telecast of a city council meeting on the local cable station.	

ANS:	B
Any of these might represent a public health nurse (PHN) communicating, cooperating, or collaborating with community residents or groups about health concerns. However, the PHN who spends the day attending meetings at various health agencies is most comprehensively fulfilling requirements effectively, since health is broader than recreation, individual concerns are not as important as aggregate priorities, and watching television is only one-way communication.

PTS:	1	DIF:	Cognitive Level: Synthesis/Synthesize	
REF:	Collaborating in Interprofessional Teams		OBJ:	1.5
TOP:	Safe and Effective Care Environment	

	12.	A community health nurse (CHN) often has to make resource allocation decisions. In such cases, which approach will most help the CHN to arrive at the decision?
a.	Choosing a moral or ethical principle	
b.	Choosing the cheapest, most economical approach	
c.	Choosing the most rational outcome	
d.	Choosing the needs of the aggregate, rather than the needs of a few individuals	

ANS:	D
Although all of the answers represent components of the CHN’s decision-making process, the predominant needs of the population outweigh the expressed needs of one person or a few people.

PTS:	1	DIF:	Cognitive Level: Application/Apply		
REF:	Social Justice			OBJ:	1.3	
TOP:	Safe and Effective Care Environment	

	13.	Which situation most closely represents the focus of public health nursing?
a.	Assessing the services and effectiveness of the school health clinic	
b.	Caring for patients after their outpatient surgeries	
c.	Giving care to schoolchildren at the school clinic and to the children’s families	
d.	Treating pediatric patients at an outpatient clinic	

ANS:	A
A public health or population-focused approach would consider the entire group of children receiving care, to see if services are effective in achieving the goal of improving the health of the school population.

PTS:	1	DIF:	Cognitive Level: Application/Apply		
REF:	Community Health Nursing Roles and Functions	OBJ:	1.5
TOP:	Health Promotion and Maintenance		

	14.	Which public health service best represents primary prevention?
a.	Developing a health education program about the dangers of smoking	
b.	Providing a diabetes clinic for adults in low-income neighbourhoods	
c.	Providing an influenza vaccination program in a community retirement village	
d.	Teaching school-aged children about the positive effects of exercise	

ANS:	C
Although all the services listed are appropriate and valuable, providing influenza vaccines to healthy adults represents the primary level of health prevention.

PTS:	1	DIF:	Cognitive Level: Application/Apply		
REF:	Principles of Public Health Practice: Levels of Intervention and Prevention
OBJ:	1.5	TOP:	Health Promotion and Maintenance		

	15.	What term is used interchangeably with the term subpopulations?
a.	Groups	
b.	Aggregates	
c.	Clients	
d.	Communities	

ANS:	B
Generally, subpopulations are referred to as aggregates within the larger community population.

PTS:	1	DIF:	Cognitive Level: Knowledge/Remember	
REF:	Populations and Aggregates	OBJ:	1.2	
TOP:	Health Promotion and Maintenance		

	16.	Which public health service best represents secondary prevention?
a.	Administering the influenza vaccine to a community of seniors	
b.	Initiating an infant car seat safety screening program for parents in low-income housing	
c.	Starting a rehabilitation clinic for middle-aged adults residing in low-income housing	
d.	Setting up a support group for teenage mothers of infants with Down syndrome	

ANS:	B
Secondary prevention seeks to detect disease early in its progression—for example, through mass screening programs.

PTS:	1	DIF:	Cognitive Level: Application/Apply		
REF:	Principles of Public Health Practice: Levels of Intervention and Prevention
OBJ:	1.5	TOP:	Health Promotion and Maintenance		

	17.	Which type of thinking is most reflective of looking at a macroscopic, big-picture population focus?
a.	Collaborative thinking	
b.	Upstream thinking	
c.	Holistic thinking	
d.	Downstream thinking	

ANS:	B
Upstream thinking uses a macroscopic, big-picture population focus, whereas downstream thinking is a microscopic, individual curative focus.

PTS:	1	DIF:	Cognitive Level: Knowledge/Remember	
REF:	Principles of Public Health Practice: Levels of Intervention and Prevention
OBJ:	1.5	TOP:	Health Promotion and Maintenance		

	18.	Which is a requirement for reaching the goal of “health for all”?
a.	Self-actualization	
b.	A system for health	
c.	Elimination of lower- and upper-class categories	
d.	Total compliance with immunizations and vaccines with all groups	

ANS:	B
The requirements identified to reach the “health for all” goal include (1) basic needs, (2) belonging and engagement, (3) healthy living, and (4) a system for health.

PTS:	1	DIF:	Cognitive Level: Knowledge/Remember	
REF:	Public Health Practice	OBJ:	1.2	
TOP:	Safe and Effective Care Environment	

	19.	Which is the simplest definition of primary health care?
a.	It is based on a multidisciplinary group of health care providers working as a team.	
b.	It provides essential care that is universally accessible to persons in a community and encourages self-management, self-reliance, and competence.	
c.	It focuses on health promotion and disease prevention among those who can afford to engage in behaviours that facilitate them.	
d.	It is based on local efforts to meet the Declaration of Alma-Ata, known as Health for All.	

ANS:	B
Primary health care is generally defined as essential care made universally accessible to individuals and families in a community with their full participation and at a cost that the community can afford.

PTS:	1	DIF:	Cognitive Level: Knowledge/Remember	
REF:	Primary Health Care		OBJ:	1.4	
TOP:	Safe and Effective Care Environment	

	20.	Which public health service best represents primary prevention?
a.	Administering the influenza vaccine to a group of seniors	
b.	Initiating an infant car seat safety screening program for parents in low-income housing	
c.	Starting a rehabilitation clinic for middle-aged adults who reside in low-income housing	
d.	Setting up a blood pressure screening clinic at the local mall	

ANS:	A
Primary prevention activities seek to prevent the occurrence of a disease (based on the natural history of a disease) or an injury.

PTS:	1	DIF:	Cognitive Level: Application/Apply		
REF:	Principles of Public Health Practice: Levels of Intervention and Prevention
OBJ:	1.5	TOP:	Health Promotion and Maintenance