Community-Based Nursing: An Introduction, 3rd Edition Test Bank

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McEwen: Community-Based Nursing, 3rdEditionTest BankChapter 1:Opportunities in Community-Based Nursing PracticeMULTIPLE CHOICE1.Over the past two decades, the health care delivery system has changed dramatically. Among thechanges are:1.Care is becoming more focused on acute health care rather than health promotionand illness prevention.2.Hospital-based health care delivery has received increasing emphasis.3.There has been a change in emphasis from treating illness tomaintaining health.4.There has been a move from focusing on aggregates or populations to focusing onthe individual.ANS:3DIF:Cognitive Level: ComprehensionREF:Page Reference: 4OBJ:1TOP:Introduction2.Factors that have served to produce the current nursing shortage in the United States include allof the followingexcept:1.Heavy workloads and inadequate staffing.2.Increasing age of the general population and growing need for long-termmanagement of chronic diseases.3.Perceived lack of opportunity for job placement and advancement.4.Relatively low wages.ANS:4DIF:ComprehensionREF:Page Reference: 5 (Box 1-1) OBJ:2TOP:Trends in Nursing Employment3.Currently, approximately what percentage of nurses in the United States donotwork in acutecare (hospital) settings?1.11%2.22%3.33%4.44%ANS:4DIF:KnowledgeREF:Page Reference: 7OBJ:2TOP:Trends in Nursing Employment

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4.The two broad goals ofHealthy People 2010focus on:1.Achieving access to preventive care for all Americans and increasing lifeexpectancy.2.Eliminating health disparities and increasing quality years of healthy life.3.Promoting public health core functions (assessment, assurance, and health policy)and decreasing mortality.4.Reducing mortality in infants, children, adolescents, adults, and elders andimproving health surveillance.ANS:2DIF:ComprehensionREF:Page Reference: 9OBJ:3TOP:Healthy People 20105.All of the following are “focus areas” described inHealthy People 2010except:1.Access to quality health services.2.Cancer.3.Oral health.4.Senior health.5.Tobacco use.ANS:4DIF:KnowledgeREF:PageReference: 10 (Healthy People 2010 box)OBJ:3TOP:Healthy People 20106.Health promotion and illness prevention activities, such as well-child checkups, routine physicalexaminations, and prenatal care are examples of:1.Comprehensive healthcare.2.Primary health care.3.Secondary health care.4.Tertiary health care.ANS:2DIF:ApplicationREF:Page Reference: 5OBJ:4TOP:Primary, Secondary, and Tertiary Health Care7.Secondary health care is becoming increasingly common incommunity-based settings.Examples of this are:1.Alcohol counseling for a homeless veteran and cardiac testing for an overweightbank executive.2.Care for a terminally ill elder and rehabilitation for a client with a spinal cordinjury.3.Home-based infusion therapy for a man with osteomyelitis and outpatientcholecystectomy for a middle-aged woman.4.Prenatal care for a pregnant teen and diagnostic testing for a man with chronicback pain.ANS:3DIF:ApplicationREF:Page Reference: 5OBJ:4TOP:Primary, Secondary, and Tertiary Health Care

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8.Tertiary health care refers to:1.Health care delivered in the home.2.Health promotion and illness prevention activities.3.Management of chronic, complicated, long-term healthproblems.4.Relatively serious or complicated care that has historically been provided to peoplewho are inpatients in hospitals.ANS:3DIF:ComprehensionREF:Page Reference: 5OBJ:4TOP:Primary, Secondary, and Tertiary Health Care9.There are differences in the scope of practice and foci between community-based nursingpractice and community health nursing. Which of the following is more descriptive ofcommunity-based nursing practice?1.Emphasis is on preservation and protection of health.2.Main objective is managing acute or chronic conditions in community settings.3.Primary focus is on populations or aggregates.4.Provision of both direct and indirect health services is common.ANS:2DIF:ApplicationREF:PageReference: 6OBJ:1TOP:Community-Based Nursing and Community Health Nursing10.According to the findings from the survey of RNs conducted by the Department of Health andHuman Services’ Division of Nursing, geographic maldistribution of nurses is a significantproblem. Regions with the lowest rates of nurses per capita are:1.The District of Columbia and Virginia.2.Midwestern states and the Dakotas.3.Mountain states (Nevada, Idaho) and the southwest (Oklahoma, Texas).4.New England states (Massachusetts, Rhode Island, Vermont).ANS:3DIF:KnowledgeREF:Page Reference: 7-8OBJ:2TOP:Current Trends in Nursing Employment11.It is anticipated that over the next decade, the number of nurses working incommunity-basedsettings will:1.Decrease dramatically.2.Decrease slightly.3.Increase somewhat.4.Remain the same.ANS:3DIF:ComprehensionREF:Page Reference: 8OBJ:2TOP:Current Trends in Nursing Employment12.Community-based nursing practice is characterized by all of the followingexcept:

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1.An opportunity to provide holistic care in less structured settings.2.Emphasis on health promotion and illness prevention.3.Enhanced flexibility andautonomy.4.Immediate access to support from other nurses and health personnel.ANS:4DIF:AnalysisREF:Page Reference: 8OBJ:1TOP:Community-Based Nursing and Community Health Nursing13.Among the uses ofHealthy People 2010are all of the followingexceptto:1.Be used as a framework to promote healthy choices for individuals.2.Encourage increased fiscal allocations by state and federal legislative bodies.3.Incorporate objectives to guide health promotion activities and programs inschools, clinics, and worksites.4.Serve as a benchmark for health promotion activities.ANS:2DIF:ApplicationREF:Page Reference: 10OBJ:3TOP:Healthy People 2010

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McEwen: Community-Based Nursing, 3rdEditionTest BankChapter 2: Roles and Interventions in Community-Based Nursing PracticeMULTIPLE CHOICE1.Marianne Smith is a volunteer nurse at a homeless clinic. One Tuesday, Marianne worked withBen, a67-year-old alcoholic who has been homeless for 8 years. Marianne discussed Ben’ssituation with him for an hour, cared for blisters on his feet, and provided him with new socks.She then referred him to the social worker for exploration of benefits for which Ben may beeligible. When working with Ben, Marianne performed the roles of:1.Counselor, direct care provider, collaborator.2.Direct care provider, educator, advocate.3.Educator, coordinator, consultant.4.Facilitator,collaborator, counselor.ANS:1DIF:Cognitive Level: ApplicationREF:Page Reference: 14-18OBJ:1TOP:Nursing Roles2.To meet the needs of the employees of a textile mill, occupational health nurse Sandy Blackcirculated aquestionnaire soliciting information on what health issues or topics most employeeswould like covered in the company’s health promotion program. Sandy will use this input toprovide new information on the topics chosen. This is an example of what nursing rolecommonly seen in community-based practice?1.Advocate2.Care provider3.Counselor4.EducatorANS:4DIF:Cognitive Level: SynthesisREF:Page Reference: 15OBJ:1TOP:Nursing Roles3.In the role of direct care provider, a nurseworking in a clinic for senior adults might performinterventions such as:1.First aid for a broken wrist, calling adult protective services for a suspected case ofabuse, and providing emotional support for family members of an elder diagnosedwith a terminal illness.2.Instruction on hypertension medication, triage, and discussing ways to managesymptoms of depression.3.Referral to a diabetes educator, discharge planning for a stroke client, andidentification of risk factors of osteoporosis.4.Taking vital signs, administering flu injections, and phlebotomy.ANS:4DIF:Cognitive Level: AnalysisREF:Page Reference: 14OBJ:1TOP:Nursing Roles4.Which of the following is an example of the role of the nurse as counselor?

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1.A home health nurse contacts adult protective services for a client who is beingneglected.2.A nurse in a homeless clinic discusses the importance of good foot care with a manwith severe blisters.3.An occupational health nurse works with a client to examinestrategies on how tostop smoking.4.A school nurse holds a class on contraception for 10th grade girls.ANS:3DIF:Cognitive Level: ApplicationREF:Page Reference: 15-16OBJ:1TOP:Nursing Roles5.Which of the following is an example ofthe role of the nurse as an advocate?1.A home health nurse contacts adult protective services for a client who is beingneglected.2.A nurse in a homeless clinic discusses the importance of good foot care with a manwith severe blisters.3.An occupational health nurse works with a client to examine strategies on how tostop smoking.4.A school nurse holds a class on contraception for 10th grade girls.ANS:1DIF:Cognitive Level: ApplicationREF:Page Reference: 16OBJ:1TOP:Nursing Roles6.Someone who participates in the process of making decisions regarding health care managementwith individuals from various professions is a(n):1.Advocate.2.Collaborator.3.Counselor.4.Leader.5.Role model.ANS:2DIF:CognitiveLevel: ComprehensionREF:Page Reference: 17OBJ:1TOP:Nursing Roles7.Nurses should remain informed of new developments in their area of practice and should sharethose developments with other health care providers. This is stressed in the role of:1.Advocate.2.Collaborator.3.Leader.4.Researcher.5.Role model.ANS:4DIF:Cognitive Level: ComprehensionREF:Page Reference: 18OBJ:1TOP:Nursing Roles

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8.Which of the following isnotone of the “domains” of nursinginterventions detailed in theNursing Interventions Classification (NIC) System?1.Health system2.Lifestyle3.Physiologic: basic4.Physiologic: complex5.SafetyANS:2DIF:Cognitive Level: KnowledgeREF:Page Reference: 20OBJ:3TOP:Nursing Interventions9.In the role of manager, a home health nurse typically does all of the followingexcept:1.Coordinate scheduled visits considering client needs and services to be providedand other factors.2.Ensure that prescribedservices are provided by other team members.3.Use each client’s resources to help develop a plan of care.4.Work with family members to explore placement options for long-term care.ANS:4DIF:Cognitive Level: AnalysisREF:PageReference: 16-17OBJ:1TOP:Nursing Roles10.As an educator, a home health nurse might:1.Encourage the parents of a ventilator-dependent child to stop smoking byproviding statistics that correlate parent’s smoking with childhood respiratorydifficulties.2.Explain the importance of thorough documentation to a new home health nurse.3.Show family members or caregivers how to administer insulin to a bed-boundclient.4.Talk with a social worker to identify sources for funding formedications for anelder who cannot afford her seizure medication.ANS:3DIF:Cognitive Level: SynthesisREF:Page Reference: 15OBJ:1TOP:Nursing Roles11.Any treatment that a nurse performs to enhance client outcomes is a nursing:1.Arbitration.2.Intervention.3.Role.4.Therapy.ANS:2DIF:Cognitive Level: KnowledgeREF:Page Reference: 18OBJ:3TOP:Nursing Interventions

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12.Universal nursing interventions that are performed by most nurses in most settings include all ofthe followingexcept:1.Anticipatory guidance.2.Circulatory care.3.Documentation.4.Environmental management (safety).5.Client rightsprotection.ANS:2DIF:Cognitive Level: ComprehensionREF:Page Reference: 20OBJ:3TOP:Nursing Interventions13.Nursing interventions more commonly performed by nurses working in community-basedpractice than by nurses in hospital-based practice include all of the followingexcept:1.Anesthesia administration.2.Health screening.3.Health system guidance.4.Referral.5.Telephone consultation.ANS:1DIF:Cognitive Level: ComprehensionREF:Page Reference: 21OBJ:2TOP:NursingInterventions14.In comparing nursing practice in occupational health with nursing practice in the critical caresetting, occupational health nurses are more likely to:1.Act as a collaborator and less likely to act as a role model.2.Emphasize the role of counselor and less likely to emphasize the role of manager.3.Focus on the educator role and less likely to focus on the care provider role.4.Stress the importance of the role of caregiver and less likely to stress the role ofresearcher.ANS:3DIF:Cognitive Level: AnalysisREF:Page Reference: 19 (Figure 2-1)OBJ:2TOP:Nursing Roles15.Margaret Roberts, RN, recently changed positions, moving from working as a labor and deliverynurse to caring for high-risk perinatal clients for a home health agency. In her new role, Margarethas observed that she spends more time in the roles of:1.Advocate and manager and less time as a direct care provider.2.Counselor and educator and less time as a direct careprovider.3.Direct care provider and advocate and less time as a manager.4.Manager and counselor and less time as an educator.ANS:2DIF:Cognitive Level: ApplicationREF:Page Reference: 19 (Figure 2-1)OBJ:2TOP:Nursing Roles

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McEwen: Community-Based Nursing, 3rdEditionTest BankChapter 3: Client Education and Health TeachingMULTIPLE CHOICE1.Evaluation of health education is measured through:1.Changes in values, attitudes, and health behaviors.2.Individual reports of improved health.3.Objective measures of morbidity and mortality.4.Program participation.ANS:1DIF:Cognitive Level: KnowledgeREF:Page Reference: 29OBJ:8TOP:Health Education2.Which of the following statements about literacy levels and reading skills isfalse?1.Almost half of all Americans are functionally illiterate.2.Elders are particularly at risk for suffering from health problems related to poorliteracy.3.People with low literacy skills are at an increased risk of poor health.4.Instructions are commonly written at a level that does not match the reading skillsof patients.ANS:1DIF:Cognitive Level: KnowledgeREF:Page Reference: 40-41OBJ:7TOP:LowLiteracy Learners3.In applying an understanding of the characteristics of adult learners to a group in a cardiacdisease risk-reduction program in a large software company, an occupational health nurse shouldconsider all of the followingexceptthe:1.Developmental and interest levels.2.Effect of personal experience that members of the group may have had with heartdisease.3.Knowledge level of the participants about coronary heart disease and risk factorreduction.4.Motivating factors foreach of the members to address cardiac disease risk factors.ANS:1DIF:Cognitive Level: ApplicationREF:Page Reference: 35OBJ:4TOP:Principles of Teaching and Learning

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4.In planning a health education program for her high school, Alice Adams has decided to use a varietyof approaches. Appropriate teaching techniques would include all of the following, althoughAlice knows that theleasteffective would probably be:1.Large group lectures on nutrition.2.Peer counseling by former substance abusers.3.Presentations by nurses from the local health department on STDs.4.Small group discussions on personal hygiene.5.Support groups for persons with eating disorders.ANS:1DIF:Cognitive Level: ApplicationREF:Page Reference: 39OBJ:6TOP:Principles of Teaching and Learning5.All of the following are variables in the Health Belief Modelexcept:1.Cues to action.2.Perceived barriers to action.3.Perceived benefits.4.Perceived health status.5.Perceived susceptibility.ANS:4DIF:Cognitive Level: KnowledgeREF:Page Reference: 30 (Table 3-1)OBJ:2TOP:Health Belief Model6.Kelly Means, RN, is teaching the Ross family about smoking cessation. The Ross family knowsthat smoking is bad for their health, and they are open to learning about smoking cessation, buthave no plans to stop smoking. The Ross family is in which stage of change?1.Action2.Contemplation3.Precontemplation4.PreparationANS:3DIF:Cognitive Level: KnowledgeREF:Page Reference: 31 (Table 3-2)OBJ:2TOP:Transtheoretical Model7.A home health nurse provides reading materials in largeprint and a magnifying glass for anelderly client to monitor her blood pressure. This is an example of considering the client’s:1.Developmental stage.2.Emotional readiness.3.Learning style.4.Physical readiness.ANS:4DIF:CognitiveLevel: ApplicationREF:Page Reference: 35 (Box 3-2)OBJ:6TOP:Principles of Teaching and Learning

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8.Mr. Gage believes that exercise is important to maintaining his health and is interested in takingan exercise class for beginners tolearn how to exercise safely. Mr. Gage is in what learningdomain?1.Affective2.Cognitive3.Psychomotor4.VisualANS:1DIF:Cognitive Level: ApplicationREF:Page Reference: 34OBJ:6TOP:Principles of Teaching and Learning9.A nurse isinstructing a middle-aged man regarding diet and exercise to lower cholesterol levelsand to improve fitness. In what way is this client empowered by education?1.He will be able to respond to external circumstances.2.He will be compliant with the prescribed exercise and diet program.3.He will have the knowledge and skills necessary to make decisions regarding hishealth.4.He will use the knowledge and skills to improve his health.ANS:3DIF:Cognitive Level: AnalysisREF:PageReference: 28OBJ:1TOP:Introduction to Health Education10.Mrs. Jones, a smoker, has early chronic obstructive pulmonary disease. Mrs. Jones realizes thatsmoking is harming her health, but she cannot get motivated to initiate change. Her nurse, MarkAimes, sets aside time during a clinic appointment to discuss the pros and cons of smokingcessation and to offer support. This encounter is a:1.Developmental assessment.2.Motivational interview.3.Needs assessment.4.Teachable moment.ANS:2DIF:Cognitive Level: ApplicationREF:Page Reference: 33OBJ:4TOP:Motivational Interviewing11.What is the most effective way of moving a client out of the precontemplation phase of change?1.Assessment of the client’s need for change2.Educating the client regarding health issues3.Motivational interviewing4.Referring the client to a support groupANS:2DIF:Cognitive Level: ApplicationREF:Page Reference: 33OBJ:2TOP:Principles of Teaching and Learning

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12.Whenasked how he learns best, Mr. Brown responds that he is better with written informationand remembers most of what he sees in videos or on TV. Mr. Brown is what type of learner?1.Auditory2.Kinesthetic3.Tactile4.VisualANS:4DIF:Cognitive Level: ApplicationREF:Page Reference: 34 (Table 3-3)OBJ:3TOP:Learning styles13.Sherri Montgomery, RN, is an elementary school nurse. As she designs a learningmodule for thestudents in her school (ages 5 to 10 years), she must consider their developmental level. Whatstrategies would be most effective for presenting material to the children?1.Brightly colored books, posters, and videos2.Computer games, manipulatives, and field trips3.Lectures, diagrams, and experiments4.Presentations by role models, movies, and field tripsANS:2DIF:Cognitive Level: ApplicationREF:Page Reference: 34OBJ:6TOP:Principles of Teaching and Learning14.Barriers to learning that health care professionals should consider when planning diabeteseducation for the Gonzales family include all of the followingexceptthe family’s:1.Context of needed change.2.Cosmopolitan view.3.Literacy level.4.Perceived seriousness of diabetes.5.Self-efficacy in managing diabetes.ANS:2DIF:Cognitive Level: SynthesisREF:Page Reference: 33OBJ:2, 4, 7TOP:Health Teaching15.Learning objectives should be SMART, indicating that they should be:1.Salient, maintenance-focused, active, repetitive, and teaching-oriented.2.Sensitive, meaningful, active, relevant, and testable.3.Specific, measurable, achievable, related to goals, and time-limited.4.Systematic, motivating, accurate, reasonable, and time-limited.ANS:2DIF:Cognitive Level: KnowledgeREF:Page Reference: 38OBJ:5TOP:Writing Goals

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McEwen: Community-Based Nursing, 3rdEditionTest BankChapter 4: Case ManagementMULTIPLE CHOICE1.Which of the following statements about the origin of case management istrue?1.Case management began in the mid-1980s as a component ofhealth carefinancing’s prospective payment system.2.Case management dates back to the early 20th century when the concepts wereused by visiting nurses and insurance companies.3.Case management started in the 1960s as a legislated mandatecomponent ofMedicare and Medicaid.4.Case management is a new concept beginning in the late 1990s in an effort tolower spiraling health care costs.ANS:2DIF:Cognitive Level: KnowledgeREF:Page Reference: 45OBJ:1TOP:Background of CaseManagement2.Case management is most accurately described as:1.A process of care coordination.2.A type of managed care.3.Enhanced utilization review.4.Prospective payment system compliance.ANS:1DIF:Cognitive Level: KnowledgeREF:Page Reference: 46OBJ:1TOP:Overview of Case Management3.Which of the following isnota goal of case management?1.Decrease fragmentation of care across settings2.Enhance appropriate use of resources3.Contain costs associated with health care4.Ensure appropriate use of services5.Reduce the provider’s reliance on insurersANS:5DIF:Cognitive Level: ComprehensionREF:Page Reference: 46OBJ:1TOP:Overview of Case Management

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4.All of the following statements about case management are trueexcept:1.Case management is time intensive.2.Case management can be used cost-effectively for most patients in the health caresystem.3.Even when used appropriately, case management can add to the cost of a client’shealth care bill.4.Clients with serious, severe, and chronic conditions benefit most from casemanagement services.ANS:2DIF:Cognitive Level: KnowledgeREF:Page Reference: 47OBJ:1TOP:Overview of CaseManagement5.Nursing case management can be described as all of the followingexcept:1.A process that extends care across settings and along a continuum.2.A service in which case managers help clients and their caregivers make informeddecisions.3.A system involving planning, coordination, and monitoring of services.4.A strategy for reimbursement synthesis for health care payers and providers.ANS:4DIF:Cognitive Level: ComprehensionREF:Page Reference: 47OBJ:2TOP:Nursing Case Management6.Which of the following patients wouldleastlikely benefit from case management?1.Gary Green is a 41-year-old businessman who cannot keep a job because of severebipolar disorder and substance abuse.2.Hannah Henderson is a42-year-old mother of two teens who recently received aliver transplant.3.Inez Irving, a 39-year-old schoolteacher, is pregnant with quadruplets.4.John Jennings, a 28-year-old policeman, broke both legs—one a compoundfracture—during an on-the-job motorcycle accident.ANS:4DIF:Cognitive Level: ApplicationREF:Page Reference: 47OBJ:3TOP:Appropriate Use of Case Management7.Which of the following isnotone of the “knowledge domains” necessary for case managers?1.Clinical protocols and tactics—developing and implementing unidirectionalclinical protocols for care delivery2.Health care management and delivery—focusing on understanding the roles andfunctions of the various health care providers and using them appropriately3.Health care reimbursement—understanding the principles and strategies related tohealth insurance, the prospective payment system, and other mechanisms forpayment for health care4.Vocational concepts and strategies—understanding ergonomics, life care planning,and modifications of homes and workplaces to accommodate disabilitiesANS:1DIF:Cognitive Level: ApplicationREF:Page Reference: 48OBJ:1TOP:KnowledgeDomains for Case Managers8.Essential skills necessary for case managers include:

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1.Communication, teaching, and advocacy.2.Economic reasoning, lobbying, and fiscal responsibility.3.Information manager, intensivist, and technologyutilization.4.Principles of pharmacodynamics, physical assessment, and laboratory analysis.ANS:1DIF:Cognitive Level: ComprehensionREF:Page Reference: 49-50OBJ:2TOP:Skills Needed by Case Managers9.In her role as case manager for alarge home care agency, Sally Randall, RN, worked with one ofher clients, Mr. Benson, who is diagnosed with ALS. Among many interventions that sheprovided, Sally did the following for Mr. Benson: wrote a letter to the insurance companysupporting the need for a motorized wheelchair, set up and monitored care provided by otherprofessionals and paraprofessionals, and monitored and evaluated the outcomes and quality ofcare for her client. These are examples of which case manager roles?1.Advocate, manager of care, outcome and quality manager2.Counselor, holistic care provider, risk manager3.Educator, coordinator of care, change agent4.Ethicist, discharge planner, utilization manager5.Negotiator/broker, clinical expert, consultantANS:1DIF:Cognitive Level: ApplicationREF:Page Reference: 49 (Box 4-2)OBJ:2TOP:Case Manager Roles10.Disease management is best described as a:1.Collaborative care strategy in which a team, headed by a disease specialist,determines a plan of care for a patient based on evidence-based protocols.2.Process for care of seriously ill or disabled clients using clinical pathways or caremaps.3.Specialized aspect of Workers’ Compensation in which case management ismandated for severe occupational disease or serious occupational injury.4.Type of case management that promotes quality while controlling costs of care forpersons with chronic health conditions (e.g. AIDS, diabetes).ANS:4DIF:Cognitive Level: ComprehensionREF:PageReference: 52OBJ:1TOP:Disease Management11.A tool or strategy used by case managers that uses protocols to organize services is:1.A clinical pathway.2.A variance indicator.3.Clinical resource management.4.Utilizationmanagement.ANS:1DIF:Cognitive Level: ComprehensionREF:Page Reference: 53-54OBJ:4TOP:Clinical Pathways12.Which of the following isnota setting where one would practice external case management?1.Home health agency

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