COMMUNITY EXAM QUESTIONS COMBINED
CH 2: COMMUNITY-BASED NURSING PRACTICE
1. A community health nurse has scheduled a HTN clinic. This service would be an example of which type of health care?
A) Tertiary prevention B) Secondary prevention C) Primary prevention D) Disease prevention
~ Secondary prevention centers on health maintenance are aimed at early detection & prevention. Disease prevention is not a form of health
care but is a focus w/primary prevention.
2. The nursing instructor is preparing her students for their home-care rotation. She discusses the Pts that they are likely to care for in the
home. Which of the following are the most frequent users of home care services?
A) Disabled Pts B) Chronically ill Pts C) Terminally ill Pts D) Elderly Pts
~ The elderly are the most frequent users of home care services. The Pt must be acutely ill, home bound, & in need of skilled nursing services
to be eligible for this service. The other answers are incorrect b/c it is the elderly who are seen most frequently in the home health setting.
3. Pts' lifestyles in the home may vary greatly from the nurse's own beliefs. To work successfully w/ the Pt, what must the nurse do?
A) Ask for another assignment if there is a conflict of interest
B) Ask the Pt to come to the agency to receive treatment
C) Convey respect for the Pt's beliefs
D) Adapt the Pt's home to a hospital-like environment
~ To work successfully w/Pts in any setting, nurse must be nonjudgmental & convey respect for Pts' beliefs, even if they differ sharply from
the nurse's. This can be difficult when a Pt's lifestyle involves activities that a nurse considers harmful or unacceptable, such as smoking, use
of alcohol, drug abuse, or overeating. The other answers incorrect b/c you do not request another assignment b/c of a difference in beliefs, nor
do you ask for Pt to come to you if you are a home health nurse. It also inappropriate to convert the Pt's home to a hospital-like environment.
4. Infection control important in every setting where nursing care provided. In home setting, how will nurse best implement infection control?
A) Cleanse the hands before & after giving direct Pt care B) Remove the Pt's wound dressings from the home
C) Dispose of Pt's syringes in the Pt's garbage D) Disinfect all work areas in the Pt's home
~ Infection control is as important in the home as it is in the hospital, but it can be more challenging in the home & requires creative
approaches. As in any situation, it is important to clean one's hands before & after giving direct Pt care, even in a home that does not have
running water. The other ans are incorrect b/c removing the wound dressings from the home & disinfecting all work areas in the home are not
the best implementation of infection control in the home. Disposing of syringes in the Pt's garbage is never done.
5. Your Pt is ready to be discharged from the hospital. When should your Pt's discharge planning begin?
A) The day prior to discharge B) The day of estimated discharge C) The day the Pt is admitted D) Once the nurse determines care needs
~ Discharge planning begins w/ the Pt's admission to the hospital & must consider the possible need for follow-up home care.
6. During the initial visit to a Pt's home, what information is it important to provide to the Pt & family?
A) Available community resources to meet their needs
B) Information on other Pts in the area w/ similar health care needs
C) The nurse's home address & phone number
D) Dates & times of all scheduled home care visits
~ The community-based nurse is responsible for informing Pt & family about community resources available to meet their needs. During
initial & subsequent home visits, nurse helps Pt & family identify these community services & encourages them to contact the appropriate
agencies. When appropriate, nurses may make the initial contact. The other ans incorrect b/c it is inappropriate to ever provide info on other
Pts to a Pt; it is equally inappropriate for a nurse to give her Pts her home address or phone number. Giving the Pt the dates & times of their
scheduled home visits is appropriate, but it is more important to provide them w/ resources available w/in the community to meet their needs.
7. The home health nurse receives a referral from the hospital for a Pt who needs a home visit. After reading the referral, what would be the
first action the nurse should take?
A) Identify community services to initiate for the Pt B) Obtain a physician's order for the visit
C) Call the Pt to obtain permission to visit D) Schedule a home health aide to visit the Pt
~ After receiving a referral, the first step is to call the Pt & obtain permission to make the visit. Then the nurse should schedule the visit &
verify the address. A physician's order is not necessary to schedule a visit w/ the Pt. The nurse may identify community services or the need
for a home health aide after she assesses the Pt & the home environment during the first visit w/ the Pt.
8. Why is it important for the nurse to inform the health care agency of her daily schedule?
A) Allows the agency to keep track for payment of the nurse
B) Supports suggested safety precautions for the nurse when making a home care visit
C) Allows easy accessibility of the nurse for changes in assignments
D) Allows the Pt to cancel appointments w/ minimal inconvenience
~ Whenever a nurse makes a home visit, the agency should know the nurse's schedule & the locations of the visits. The other answers are
incorrect b/c providing the agency w/ a copy of the daily schedule is not for the purpose of correctly paying the nurse or for the ease of the
nurse in changing assignments or for the Pt's ease in canceling appointments.
9. There are specific guidelines & regulations for documentation related to home care that the nurse must consider & follow. For those Pts w/
Medicaid, what is most important for the nurse to document to assure reimbursement for services?
A) The medical diagnosis & supplies needed to care for the Pt
B) Directions to the Pt's home
C) Quality of nursing care needed
D) The Pt's homebound status & the need for skilled professional nursing care
~ Medicare, Medicaid, & 3rd party payers require documentation of Pt's homebound status & the need for skilled professional nursing care.
The medical diagnosis & specific detailed information on the functional limitations of the Pt are usually part of the documentation. The other
answers are incorrect b/c nursing documentation does not include needed supplies, directions to the Pt's home, or the quality of care needed.
,10. Your Pt has had a total knee replacement & will need to walk w/ crutches for 6 weeks. He is being discharged home w/ a referral for home
health care. What will the home care nurse need to assess during her initial assessment?
A) Assistance of neighbors B) Previous health status C) Costs of the visits D) Home environment
~ The initial assessment includes evaluating the Pt, the home environment, the Pt's self-care abilities or the family's ability to provide care, &
the Pt's need for additional resources. There is no assessment made of assistance on part of neighbors, previous health status, or costs of visit.
11. RN w/an advanced degree in primary care for a pediatric population is employed in health clinic. In what role is this RN functioning?
A) Nurse practitioner B) Case cocoordinator C) Clinical nurse specialist D) Clinic supervisor
~ Nurse practitioners, educated in primary care, often practice in ambulatory care settings that focus on gerontology, pediatrics, family or
adult health, or women's health. Case cocoordinators & clinic supervisors do not require an advanced degree, & a clinical nurse specialist is
not educated in primary care.
12. A nurse working in a large meat-packaging plant sees Pts for work-related issues. What is the role of the nurse?
A) Occupational health nurse B) Staff nurse C) Nurse clinician D) Nurse educator
~ Occupational health nurses may provide direct care to Pts who are ill, conduct health education programs for the industry staff, or set up
health programs. The other ans incorrect b/c they are not consistent w/ a nurse's placement in a manufacturing setting.
13. A school nurse is concerned about a 4th grade student w/CF. Nurse is aware that children w/ health problems are at major risk for what?
A) Sports injuries
B) Attention disorders
C) Experiencing school-related stress due to a desire to overachieve
D) Underachieving or failing in school
~ School-aged children & adolescents w/ health problems are at major risk for underachieving or failing in school. The other answers are
incorrect b/c they are not at major risk for sports injuries, attention disorders, or a desire to overachieve.
14. Which Pts seek health care late in the course of their disease process & deteriorate more quickly than other Pts?
A) Homeless B) Immigrants C) Elderly D) Adolescents
~ B/c of numerous barriers, the homeless seek health care late in the course of a disease & deteriorate more quickly than Pts who are not
homeless. Many of their health problems are related in large part to their living situation. The other answers are incorrect b/c these
populations do not seek care late in the course of their disease process & deteriorate quicker than other populations.
15. What changes in the health care system have created an increased need for nurses to practice in community-based settings? (SATA)
A) Tighter insurance regulations
B) Younger population
C) Increased rural population
D) Changes in federal legislation
E) Decreasing hospital revenues
~ Changes in federal legislation, tighter insurance regulations, decreasing hospital revenues, & alternative health care delivery systems have
also affected the ways in which health care is delivered. Our country does not have an increased rural population nor is our population
younger so these answers are incorrect.
16. Nurses are now working in ambulatory health clinics, hospice settings, & homeless shelters & clinics. What has influenced this increase
in practice settings for nurses?
A) Population shift to more rural areas B) Shift of health care delivery into the community
C) Advent of primary care clinics D) Increased use of rehabilitation hospitals
~ As health care delivery shifts into the community, more nurses are working in a variety of community-based settings. These settings include
public health departments, ambulatory health clinics, long-term care facilities, hospice settings, industrial settings (as occupational nurses),
homeless shelters & clinics, nursing centers, home health agencies, urgent care centers, same-day surgical centers, short-stay facilities, & Pts'
homes. The other answers are incorrect b/c our population has not shifted to more rural area, & the use of primary care clinics has not
influenced an increase in practice settings or the use of rehabilitation hospitals.
17. What is the focus of community-based nursing?
A) Community health
B) Maintaining & improving the health of the community
C) Promoting & maintaining the health of individuals & families
D) Family health
~ This nursing practice focuses on promoting & maintaining health of individuals & fams, preventing & minimizing progression of disease,
& improving quality of life. Its focus not really community health, maintaining or improving health of a community, or family health per se.
18. You are the community-based nurse who acts as case-manager for a small town about 60 miles from a major health care center. What is
the most important factor of community-based nursing you should be knowledgeable about?
A) Eligibility requirements for services
B) Community resources available to Pts
C) Transportation costs to the medical center
D) Possible charges for any services provided
~ A community-based nurse must be knowledgeable about community resources available to Pts as well as services provided by local
agencies, eligibility requirements, & any possible charges for the services. The other answers are incorrect b/c they are not the most important
factor for a community-based nurse to be knowledgeable about.
19. A new community-based nurse is looking for community resources for one of her Pts. Where would be the best place to look?
A) Hospital directories B) Telephone book C) Community directories D) Church directories
~ Most communities have directories of health & social service agencies that the nurse can consult. The other answers are incorrect b/c
hospital directories usually only include people affiliated w/ the hospital, & neither telephone books nor church directories are meant to be
directories of community resources.
,20. You are a community-based care manager in a community that does not have a resource directory available. One of your goals is to
compile such a directory. What would be important to include in this directory? (Mark all that apply.)
A) Nearby medical facilities
B) List of social service workers in the community
C) Eligibility requirements for services
D) Commonly used resources
E) Costs of services
~ If a community does not have a resource booklet, an agency may develop one for its staff. It should include the commonly used community
resources that Pts need, as well as the costs of the services & eligibility requirements. The other answers are incorrect b/c a community
resource booklet would not always include nearby medical facilities, & it would not identify specific social service workers, only agencies.
21. You are assessing new Pt & his home environment. What is a responsibility that you, a community-based nurse, have at this initial visit?
A) Encourage the Pt & his family to use local stores to support their community.
B) Encourage the Pt & his family to contact their church as a resource.
C) Encourage the Pt & his family to use the Internet to find local resources.
D) Encourage the Pt & his family to contact appropriate community resources.
~ During initial & subsequent home visits, nurse helps Pt & fam Id these community services & encourages them to contact the appropriate
agencies. When appropriate, nurses may make the initial contact. The other ans incorrect b/c a home-health nurse would not encourage the Pt
to support the community, nor would she necessarily encourage the Pt to use the church as a resource or to use the Internet to find his own
local resources. The nurse would provide the Pt w/ the applicable local resources.
22. What type of health care is most likely to be available in both community & hospital-based settings?
A) Dieticians B) Ambulatory health care C) Physical therapy D) Hospice care
~ Ambulatory health care is provided for Pts in community or hospital-based settings. The types of agencies that provide such care are
medical clinics, ambulatory care units, urgent care centers, cardiac rehabilitation programs, mental health centers, student health centers,
community outreach programs, & nursing centers. Dieticians are not generally community based, physical therapy is usually agency based, &
hospice care is not generally provided in hospital settings.
23. Every home health agency, based on the principle of due diligence, must inform its employees of what?
A) At-risk working environments
B) OSHA requirements
C) Available training for personal safety
D) Policies & procedures about clinical safety
~ Based on the principle of due diligence, agencies must inform employees of at-risk working environments. Agencies have policies &
procedures concerning the promotion of safety for clinical staff, & training is provided to facilitate personal safety. Home health agencies are
not required to inform their staff of OSHA requirements, available training, or the policies & procedures regarding personal safety. They are
required to inform someone before she is sent into a risky working environment.
24. A home health nurse is making a visit to a new Pt. During the visit, the Pt's husband arrives home in an intoxicated condition. He speaks
to both you & the Pt in an abusive & threatening manner. What should you do?
A) Ignore the husband & focus on the Pt
B) Return to your agency & notify your supervisor
C) Call the police from your cell phone
D) Remove the Pt from the home
~ If a dangerous situation is encountered during the visit, the nurse should return to the agency & contact his or her supervisor or law
enforcement officials, or both. The other answers are incorrect. Ignoring the husband or calling the police while in the home or attempting to
remove the Pt from the home could further endanger you & the Pt.
25. You have been notified by your agency of a new Pt in your community. The agency tells you that this Pt resides in a high-crime area.
What is the most important request you should make of the agency?
A) A cell phone
B) Directions to the home
C) Someone to accompany you on the visit
D) Someone to wait in the car while you make your visit
~ When making visits in high-crime areas, visit w/ another person rather than alone. Answer D incorrect b/c that possibly endangers both you
& the person waiting in the car. Answers A & B incorrect b/c they are not the most important request to the agency.
26. What level of care do home health nurses often focus on?
A) Preventative care B) Primary prevention C) Secondary prevention D) Tertiary prevention
~ Nurses in community-based practice provide preventive care at three levels — primary, secondary, & tertiary. Tertiary prevention focuses
on minimizing deterioration & improving quality of life, including rehabilitation to assist Pts in achieving their maximum potential by
working through their physical or psychological challenges. Home care nurses often focus on tertiary preventive nursing care, although
primary & secondary prevention are also addressed. Answers B & C are incorrect b/c, while addressed, they are not usually the focus of
home care nurses, & preventive care is an umbrella for all three levels of care.
27. You are admitting two new Pts to your home health care service. These Pts live w/in two blocks of each other, & both homes are in a
high-crime area. What is recommended for your personal safety?
A) Drive a car that is hard to break into. B) Keep your purse close to you at all times.
C) Don't leave anything in the car that might be stolen. D) Do not wear expensive jewelry.
~ Do not drive an expensive car or wear expensive jewelry when making visits. While all of these answers might be wise precautions to take,
the only recommendation for your personal safety is answer D.
, 28. In two days you are scheduled to discharge a Pt home status post left hip replacement. You have initiated a home health referral & you
have met w/ a team of people who have been involved w/ this Pt's discharge planning. Who would be appropriate people to be on the
discharge planning team? (Mark all that apply.)
A) Home health nurse
B) Physical therapist
C) Pt's pastor
D) Social service worker
E) Meal-on-Wheels provider
~ The development of a comprehensive discharge plan requires collaboration w/ professionals at both the referring agency & the home care
agency, as well as other community agencies that provide specific resources upon discharge. The Pt's pastor & the Meals-on-Wheels provider
are not appropriate people to be part of a discharge-planning team.
29. Which type of agencies provides documented home health care services? (Mark all that apply.)
A) Unofficial neighborhood groups
B) Private businesses
C) Proprietary chains
D) Off-duty neighborhood nurses
E) Hospital-based agencies
~ Home health care services are provided by official, publicly funded agencies; nonprofit agencies; private businesses; proprietary chains; &
hospital-based agencies. Unofficial neighborhood groups & off-duty neighborhood nurses are not agencies that provide documented home
health services.
30. Discharge planning begins w/ the Pt's admission to the hospital. What is involved in the discharge-planning process?
A) Identifying the Pt's needs
B) Making a social services referral
C) Getting physical therapy involved
D) Notifying the speech therapist of the discharge date
~ The process involves identifying the Pt's needs & developing a thorough plan to meet them. Answers B, C & D might be appropriate for
some Pts, but they are not all appropriate for every Pt; therefore, these answers are wrong.
31. W/in the public health system there has been an increased demand for medical, nursing, & social services. What is the basis for this
increased demand?
A) A shift from hospital to community-based health care
B) The growing number of older adults in the United States
C) The rise in poverty in the United States
D) The decreasing revenues in health care
~ The growing number of older adults in the United States increases the demand for medical, nursing, & social services w/in the public health
system. While there has been a shift from hospital-based to community-based health care, it is not the main reason for the increased need for
public health services. Answers C & D are incorrect b/c they are not used as the basis for the increased demand for professionals w/in the
public health system.
32. Nursing care, no matter where it is delivered, has many consistencies. One of these consistencies is the need for what?
A) Advanced education
B) Certification in a specialty
C) Cultural competence
D) Independent practice
~ Nurses in community settings must be culturally competent, as culture plays a role in the delivery of care. Culture can be structured w/in
the context of care through the utilization of a theoretical framework involving cultural competence. The other answers are incorrect b/c an
advanced education, specialty certification, & the ability to practice independently are not consistencies btwn nursing care delivery settings.
33. Medicare finances many home health care expenses. What does this allow nurses to do?
A) Provide care w/out the oversight of a physician
B) Write necessary medication orders for the Pt
C) Order physical, occupational, & speech therapy if needed
D) Manage & evaluate Pt care for seriously ill Pts
~ Many home health care expenditures are financed by Medicare, which allows nurses to manage & evaluate Pt care for seriously ill Pts who
have complex, labile conditions & are at high risk for rehospitalization. Home health nurses, despite who funds their visits, do not provide
care w/out the oversight of a physician; they do not write medication orders; nor do they order the services of ancillary specialists such as
physical, occupational, or speech therapists.
34. You are a school nurse who is concerned about an incoming kindergartner w/ muscular dystrophy. Why would you make a home visit
before school starts?
A) To provide anticipatory guidance to the family
B) To measure the child's wheelchair to make sure it fits through the school doors
C) To set up home teachers for the child
D) To provide follow-up care after the child's clinic visit
~ Public health, parish, & school nurses may make visits to provide anticipatory guidance to high-risk families & follow-up care to Pts w/
communicable diseases. The other answers are incorrect b/c they are not functions of the school nurse.
