Chapter 08: Health Promotion and the Community
Edelman: Health Promotion Throughout the Life Span, 8th Edition
1. A nurse is employed by a local health department. Which of the following would be one of her primary responsibilities?
a. Providing appropriate treatment for the flu to an elderly man
b. Providing education to the community about prevention of the flu
c. Ensuring that the family members of the man with the flu get tested for the flu
d. Ensuring that the family members of the man with the flu receive the flu vaccine
The role of the community health nurse is to promote the health of the population. It is not limited to any particular individual or group of individuals. It is important that the nurse view the community structure as a population and consider existing health services. Therefore, the primary responsibility of this nurse is to the community she serves by providing education about flu prevention.
DIF: Cognitive Level: Analyze (Analysis) REF: p. 179
2. A parish nurse is concerned about the number of parishioners who smoke. How would the parish nurse best address this issue?
a. Ban smoking on parish property.
b. Invite local experts to participate in a health fair at the parish.
c. Find literature about smoking cessation.
d. Hand out free nicotine-replacement systems.
Nurses interact with communities to promote health. They supply educational information to at-risk groups to develop health-oriented skills as well as encourage behavior change. As such, nurses act as advocates collaborating with other disciplines and agencies. The success of health promotion programs depends on support from prominent community members. Therefore, arranging for a health fair and inviting local experts to participate is the best way for the nurse to address the smoking issue at her parish.
DIF: Cognitive Level: Analyze (Analysis) REF: p. 180 | p. 183
3. Partnering with school-based clinics and local pediatric dentists so that children can have access to preventive dental care is an example of a(n):
a. codependent function.
b. independent function.
c. interdependent function.
d. dependent function.
Collaboration with community members and interdisciplinary teamwork functions crucial to effective community health are considered interdependent functions. Partnering with school-based clinics and local dentists is a collaborative effort to improve the community’s health.
DIF: Cognitive Level: Apply (Application) REF: p. 181
4. Which of the following health concerns should the nurse have as a priority when planning care for a community?
a. The limited recreational areas identified through a windshield survey
b. The high crime rate reported in the town records
c. The absence of health clinics on the local bus route
d. The lack of grocery stores within walking distance identified by the community
As a community liaison, the nurse establishes priorities for programming and matches resources with needs determined by a community-needs assessment. The goal is to maintain the community’s vision. Nurses’ concerns should be based on the community’s concerns. Therefore, the lack of grocery stores identified by the community should take first priority.
DIF: Cognitive Level: Analyze (Analysis) REF: pp. 181-182 | p. 184
5. A nurse who is new to the area wants to get a “feel for the community she will be working with.” Which of the following would be the best way for the nurse to start learning about the community?
a. Driving around the neighborhood
b. Going door to door asking people about the community
c. Searching online to obtain population statistics
d. Talking to the police captain at the local police department
Community nurses assess communities by observation, interview, and measurement. Driving around and observing the community uses one’s senses to obtain information about the community, its health problems, and its strengths. This type of assessment (driving around and observing) gives the nurse an idea of how the community functions.
DIF: Cognitive Level: Analyze (Analysis) REF: pp. 181-182
6. A community believes many people in that community lead sedentary lives because they lack safe areas in which to exercise. What action should the nurse take in order to confirm or reject these beliefs?
a. Walk around the neighborhood.
b. Interview members of the community.
c. Obtain town morbidity and mortality rates.
d. Go to the town hall to obtain the number of parks in the community.
The nurse has generated a hypothesis (people lead sedentary lives because of a lack of safe areas). To explore this hypothesis, the nurse should follow it up with interviews and measurement data. In this situation, town statistics would not be sufficient to address the hypothesis. The nurse needs to interview members of the community to determine how they perceive it.
DIF: Cognitive Level: Apply (Application) REF: pp. 181-182
7. A nurse is interviewing members of a substance abuse unit at a local Veterans Administration (VA) hospital. Which of the following parts of a community is the nurse assessing?
a. Structure of a community
b. Subsystem of a community
c. Supra system of a community
d. Interaction of a community
Structural parts of a community form subsystems within a larger supra system. A substance abuse unit of a local VA hospital is a subsystem of a larger system (the VA hospital and family of hospitals). The structure of a community system or subsystem forms a formal or informal arrangement of parts. As a result, because interviewing is a form of assessment, the nurse in this example is assessing the subsystem (substance abuse unit of a local VA hospital) of a community (the VA hospital and family of hospitals).
DIF: Cognitive Level: Apply (Application) REF: p. 182
8. The study of a population is referred to as (a):
a. community pattern.
b. windshield survey.
d. community diagnosis.
Demography is defined as the study of a population.
DIF: Cognitive Level: Remember (Knowledge) REF: pp. 182-183
9. The process of dynamic change with adaptation in the system’s parts, and how community systems and subsystems interact is known as:
a. structure of a community.
b. community health promotion.
c. community diagnosis.
d. function of a community.
The function of a community is defined as the process of dynamic change with adaptation in the system’s parts and how community systems and subsystems interact.
DIF: Cognitive Level: Remember (Knowledge) REF: p. 183
10. A nurse is assessing a community from both a developmental and risk perspective. Which of the following characteristics would be of most interest to the nurse?
d. Socioeconomic level
Community nurses use a developmental-age-correlated approach to identify health promotion and health protection activities. Age is an indication of development. Additionally, community nurses assess those risk factors in a community that can cause adverse health outcomes. Risk factors can vary from person to person but include age, gender, race, geographical location, and lack of health services. Age can thus be used to assess a community from both a developmental and a risk perspective.
DIF: Cognitive Level: Apply (Application) REF: p. 183
11. Using developmental theory, a community nurse assesses the community and determines that the majority of residents who are 45 years of age or older lead sedentary lives. Which of the following would be the priority for this nurse to promote?
a. Health promotion activities
b. Accident prevention activities
c. Drug prevention activities
d. Pregnancy prevention activities
Developmental theory can be used to identify existing or potential health problems for a particular age group in the community. Age-related risk factors associated with individuals can be extended to the community. It is well known that physical activity decreases with age and chronic illnesses increase with age. Therefore, health promotion and disease prevention activities become a priority for the nurse serving this community.
DIF: Cognitive Level: Analyze (Analysis) REF: p. 183
12. Which of the following demonstrates the nurse using subjective data to indicate a health concern in the health-perception–health-management pattern?
a. Examining high sexually transmitted disease rates recorded by the health department
b. Listening to community members discuss the high smoking rate among teenagers
c. Analyzing the high infant mortality rate reported by state hospitals
d. Discussing the high rate of teenage motor vehicle crashes recorded by the local police department
Subjective data is based on the perceptions of individuals in the community. Interviewing provides a way to learn how members perceive their communities and their perceptions of health. Therefore, the high smoking rates among teenagers reported by community members indicates subjective data. The others are forms of objective data.
DIF: Cognitive Level: Analyze (Analysis) REF: p. 181 | p. 184
13. After assessing the community, the nurse concludes that the community is having difficulty meeting its nutritional-metabolic pattern. Which of the following findings would the nurse most likely have discovered during the assessment?
a. Decreased availability of grocery stores
b. Poor nutritional habits
c. Lack of subsidized food programs
d. Inadequate knowledge about proper nutrition
The nutritional-metabolic pattern identifies data relevant to community eating habits. These habits are the result of decreased availability of grocery stores, lack of subsidized food programs, and inadequate knowledge. The habits are also influenced by a community’’s culture. Therefore, the end results of health concerns in the nutritional-metabolic pattern of a community are poor nutritional habits.
DIF: Cognitive Level: Apply (Application) REF: p. 184
14. A nurse is assessing a community’s exposure to pollutants by examining contaminated soil, air, water, and food. Which functional health pattern is being assessed by the nurse?
a. Nutritional-metabolic pattern
b. Elimination pattern
c. Health-perception–health management pattern
d. Values-beliefs pattern
The elimination pattern identifies factors including exposure to pollutants in the community through contaminated soil, water, air, and food.
DIF: Cognitive Level: Apply (Application) REF: pp. 184-185
15. Which functional health pattern provides information about problem-solving and decision-making within communities?
a. Cognitive-perceptual pattern
b. Self-perception–self-concept pattern
c. Coping-stress tolerance pattern
d. Health-perception–health-management pattern
The cognitive-perceptual pattern provides information about problem-solving and decision making within communities.
DIF: Cognitive Level: Remember (Knowledge) REF: p. 185
16. Within a community there is an elevated high-school dropout rate and its high school students are experiencing a decreased sense of self-worth. Based on this data, the community is at highest risk to experience an alteration in which of the following functional health patterns?
a. Self-perception–self-concept pattern
b. Role-relationships pattern
c. Cognitive-perceptual pattern
d. Sexuality-reproduction pattern
The elevated high-school dropout rate is a risk factor in the values-beliefs pattern, and the decreased sense of self-worth is a risk factor in the self-perception–self-concept pattern. Risk factors from several pattern areas may form clusters of risks for certain groups. Elevated high-school dropout rates and a decreased sense of self-worth may lead to crimes that the community cannot adequately control or cope with.
DIF: Cognitive Level: Analyze (Analysis) REF: pp. 185-186
17. A nurse is working with a community that is experiencing an alteration in its values-beliefs pattern. Which of the following is most likely to result because of a disturbance in this functional health pattern?
a. Respiratory disorders
b. Hearing loss
c. Coronary artery disease
The values-beliefs pattern identifies the community values and beliefs. Values underlie decisions regarding prevention programs. A lack of primary prevention methods (e.g., exercise and a healthy diet) can lead to coronary artery disease.
DIF: Cognitive Level: Analyze (Analysis) REF: p. 186
18. A nurse is using the technique of mapping while implementing the nursing process in the community setting. The nurse is engaging in which aspect of the nursing process?
Analysis refers to data categorization and pattern determination. The organization of data is used to determine patterns. Mapping is an organizational technique used in data analysis.
DIF: Cognitive Level: Apply (Application) REF: pp. 186-187
19. A nurse is collecting data regarding the number of crosswalks within a community. Which perspective is being used to gather this data?
a. Developmental perspective
b. Functional perspective
c. Risk-factor perspective
d. Systems perspective
One way to assess a community is from a risk-factor perspective. Risk factors associated with community diseases, illness, and death rates play a role in predicting the likelihood of adverse health conditions. Risk factors include a combination of demographic, psychological, physiological, or environmental characteristics. Select groups may be at risk based on shared risks. Knowing which risk factors are present assists community nurses in developing action plans for health promotion and disease prevention.
DIF: Cognitive Level: Apply (Application) REF: p. 183 | p. 188
20. A community nurse has collected rates of alcohol-related motor vehicle accidents involving teenagers. Which action should the nurse take next?
a. Develop a plan to address the high rates of alcohol-related motor vehicle accidents.
b. Partner with high school nurses to educate students about the risks of drinking and driving.
c. Diagnose the community with ineffective health management patterns related to the high levels of drunk driving.
d. Establish support groups for teenagers with alcohol abuse.
The role of the community nurse includes the interaction of independent, interdependent, and dependent functions. Independent functions include assessing, analyzing, diagnosing, planning, implementing, and evaluating. In this case, once the nurse analyzes the alcohol-related motor vehicle accident rates, the next step is to diagnose the community. Therefore, the nurse would diagnose this community with ineffective health management patterns related to the high levels of drunk driving.
DIF: Cognitive Level: Analyze (Analysis) REF: p. 181 | pp. 188-189
21. Which of the following best describes the primary goal of community nurses?
a. Create charts/graphs of data collected.
b. Create plans for community health promotion programs.
c. Create evaluation tools for health promotion programs.
d. Create a culture of health promotion/health protection with the community.
Over the last 2 decades, several social trends in the United States have increased the public interest in health promotion and disease prevention. Community health nursing combines nursing practice and public health concepts to promote the health of populations. Community participation in health planning facilitates effective assignment of priorities. Additionally, change results from efforts by individuals or groups and involves fundamental shifts of behavior. It is important that the community nurse create a culture of health promotion and health protection within a community in order to facilitate positive change in health behaviors.
DIF: Cognitive Level: Analyze (Analysis) REF: p. 177 | p. 190
22. A community nurse develops a plan to address the problem of teenage pregnancies. Which of the following actions should the nurse take next?
a. Determine the rate of teenage pregnancies.
b. Evaluate the success of her plan.
c. Provide educational programs at local schools regarding pregnancy prevention.
d. Determine which factors related to teenage pregnancy require intervention.
Plans guide nursing actions. Implementation of the nursing process begins based on the health promotion/health protection plan. Providing education is an action item in a plan and thus should be the next step. Determining the rate occurs before diagnosis. Determining which factors require intervention occurs during the planning phase.
DIF: Cognitive Level: Apply (Application) REF: p. 190
23. A nurse has implemented a smoking cessation program for teenagers and is now evaluating the rate of teenage smoking in the community. Which of the following functions is being demonstrated by the nurse?
a. Codependent function
b. Independent function
c. Interdependent function
d. Dependent function
Evaluating nursing activities such as health promotion and health education is an independent function. In this case, the nurse is evaluating the nursing activity (smoking cessation program), and therefore it is an independent function.
DIF: Cognitive Level: Apply (Application) REF: p. 181 | p. 192
24. Which factor has the greatest implication for a community nurse when developing a health promotion program for church members?
a. The majority of members live within a 3-mile radius.
b. The majority of members are African American.
c. The majority of members are high school graduates.
d. The majority of members are employed.
Demographic data provides the basis for analysis and a means to identify groups that may be at high risk for health concerns. Age, gender, race, geographical location, consumption pattern, or lack of health services may be considered risk factors because one or more may contribute to disease or death and place the population sharing them at risk. Such information also provides clues for the direction of health strategies. It is known that poverty rates among African Americans are rising, placing them at risk for health disparities. Additionally, African Americans are at high risk of developing Type 2 diabetes mellitus and hypertension. As a result, knowing that a majority of church members are African American has great implications for a community nurse when developing health promotion programs.
DIF: Cognitive Level: Analyze (Analysis) REF: p. 183 | p. 188 (Box 8-4)
25. A community is in the maintenance stage of change. Which of the following would be an appropriate intervention for the community health nurse?
a. Highlight past successes
b. Discuss the benefits of changing
c. Develop strategies to prevent relapse
d. Provide information
In the maintenance stage of change, a community nurse should highlight past successes and future benefits. During the contemplation phase, the benefits of changing should be discussed. Developing strategies to prevent relapse should happen during the action phase. Providing information should occur during the precontemplation stage.
DIF: Cognitive Level: Analyze (Analysis) REF: p. 187 (Table 8-2)
26. A community is considering banning smoking in all schools. Based on the community’s current stage of change, which action should the nurse take next?
a. Provide the community with statistics regarding childhood smoking rates.
b. Point out positive outcomes associated with banning smoking such as maintenance of lung function.
c. Help the community develop a plan to implement the ban.
d. Praise the members of the community for their actions.
A community that is considering implementing a smoking ban is in the contemplation stage of change. In this stage, interventions should be focused on discussing the risks of not changing and the benefits of changing. Maintaining the lung function of children is a benefit of the ban the community members are considering and thus an appropriate intervention for the nurse to utilize.
DIF: Cognitive Level: Analyze (Analysis) REF: p. 187 (Table 8-2)
1. In response to the growing elderly population, community health nurses should do which of the following? (select all that apply)
a. Work with the board of education to emphasize the importance of adequate physical activity for children and the importance of healthy meals.
b. Work with local nursing schools to emphasize the importance of geriatric training in the curriculum.
c. Work with the state and local departments of health to devise a plan to increase nursing home beds.
d. Work with local health departments to increase recreational activities for elderly members of the community.
ANS: A, B, C, D
Community leadership provides direction for health promotion and health protection. The change in age distribution indicates that people will be living longer and thus have more chronic illness issues. Services need to be made available for this population. Health promotion services need to be made available to the younger population as well to decrease their risk factors for future illnesses such as obesity and heart disease. Therefore, all responses are correct.
DIF: Cognitive Level: Analyze (Analysis) REF: p. 177 | p. 182
2. Which of the following is a stage of change? (select all that apply)
ANS: B, C
According to Pender, the five stages of change include precontemplation, contemplation, planning, action, and maintenance.
DIF: Cognitive Level: Remember (Knowledge) REF: p. 187 (Table 8-2)