Canadian Community as Partner Theory & Multidisciplinary Practice 5th Edition Test Bank

Type:

Test Bank

Canadian Community as Resource: Partner Theory & Multidisciplinary Practice Edition:

5th Edition

Author(s):

Ardene Robinson Vollman Suzanne F. Jackson

Chapter 1, Population Health Promotion: Essentials and Essence of Practice 1. The 20th century saw numerous improvements in the health status of people in the developed world. This was primarily attributable to what phenomenon?

A. Steady declines in the rate of tobacco consumption B. The development of vaccines against many communicable diseases C. Eradication of microorganisms responsible for infectious diseases D. Government policies that prioritized health promotion over disease treatment ANS: B Rationale: Health status gains in the developed world during the 20th century were a result of (1) advances in knowledge about the causes of disease, (2) development of new technologies and pharmaceuticals to treat and cure many diseases, (3) creation of vaccines and environmental solutions to prevent disease transmission and acquisition, and (4) innovations in surveillance techniques to measure health status.

PTS: 1 DIF: Easy REF: Page and Header: 3, Introduction OBJ: 1 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 1: Population Health Promotion: Essentials and Essence of Practice KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand 2. What document is recognized as laying the foundation for the transition in the focus of Canadian health policy from disease to health?

A. The Ottawa Charter for Health Promotion B. The Epp Framework (A Framework for Health Promotion) C. The WHO Declaration of Alma-Ata D. The Lalonde Report (A New Perspectives on the Health of Canadians) ANS: D Rationale: The publication in 1974 of the Lalonde Report (A New Perspective on the Health of Canadians) heralded a change in the focus of health on disease to a focus on health. The Ottawa Charter, the WHO Declaration, and the Epp Framework were each subsequent to the Lalonde Report.

PTS: 1 DIF: Easy REF: Page and Header: 5, The Lalonde Report OBJ: 1 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 1: Population Health Promotion: Essentials and Essence of Practice KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand

3. The Lalonde Report of 1974 is recognized as one of the seminal publications that has shaped the character and direction of public health policy in Canada.

What change in policy is attributed to the Lalonde Report?

A. A shift from collective responsibility for the health of Canadians to an individual focus B. A change in focus from the treatment of illness to the promotion of health C. A change from private funding for health to a combination of provincial and federal funding D. A recognition of the importance of determinants of health ANS: B Rationale: The Lalonde Report is credited with initiating a change in the policy from a focus on disease to a focus on health. The report did not promote a change in funding, a change to individual responsibility, or a formal recognition of the determinants of health.

PTS: 1 DIF: Easy REF: Page and Header: 5, The Lalonde Report OBJ: 1 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 1: Population Health Promotion: Essentials and Essence of Practice KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand 4. The publication of the World Health Organization’s Declaration of Alma-Ata is acknowledged to be a key event in the development of contemporary public health policy. The Declaration prioritized: A. collaboration among individuals and health care providers to impact health decisions.

B. increased funding for the education of nurses, physicians, and allied health workers in member nations.

C. cooperation between developed nations and developing nations to eradicate global health inequities.

D. the removal of class-based barriers to health decision making.

ANS: A Rationale: The Declaration of Alma-Ata called for health providers to work with people to assist them in making decisions about their health and how to meet health challenges in ways that are affordable, acceptable, and sustainable in the long term. It did not specifically prioritize education funding, international cooperation, or the removal of class-based barriers to health.

PTS: 1 DIF: Easy REF: Page and Header: 5, Declaration of Alma-Ata OBJ: 1 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 1: Population Health Promotion: Essentials and Essence of Practice KEY: Integrated Process: Nursing Process

BLM: Cognitive Level: Understand 5. A public health worker is participating in the creation of a health promotion initiative that aims to address many of the poor health outcomes in a city’s homeless population. The success or failure of this initiative is likely to depend on what factor?

A. Accessibility and the perceived credibility of the planned initiative B. The provision of incentives and immediate benefits for participants in the program C. Providing safe and supportive housing for homeless people before addressing their health needs D. Redressing the disparities based on gender, socioeconomic status, and education ANS: A Rationale: The Declaration of Alma-Ata called for health providers to work with people to assist them in making decisions about their health and how to meet health challenges in ways that are affordable, acceptable, and sustainable in the long term. In facing the health challenges posed by homelessness, it is imperative that programs, policies, and interventions ensure accessibility by the members of this population. As well, it is necessary to present initiatives in a way that promotes their credibility. Short-term benefits are not a prerequisite and the resolution of disparities and lack of housing need not precede health promotion.

PTS: 1 DIF: Moderate REF: Page and Header: 5, Declaration of Alma-Ata OBJ: 1 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 1: Population Health Promotion: Essentials and Essence of Practice KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze 6. Which issue is recognized as being inadequately addressed by current Canadian health policy?

A. Canadians are not aware of the impact that their behaviours have on their health status.

B. Utilization of the health care system is insufficient to ensure the health of the population.

C. Members of disadvantaged groups are less healthy than other Canadians.

D. The interests of the health care industry are at odds with the long-term health of Canadians.

ANS: C

Rationale: Among the major issues that are not being adequately addressed by current health policies and practices is the fact that disadvantaged groups have significantly lower life expectancy, poorer health, and a higher prevalence of disability than the average Canadian. A knowledge deficit, underutilization, and the interests of the health care industry are not noted as core problems in Canadian public health.

PTS: 1 DIF: Moderate REF: Page and Header: 6, A Framework for Health Promotion in Canada OBJ: 3 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 1: Population Health Promotion: Essentials and Essence of Practice KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand 7. Which client typifies the health problems that began to predominate in Canada during the late 20th century?

A. A young man who incurred a spinal cord injury while playing sports B. An elementary school student who developed measles because she was not vaccinated C. An older adult client who had type 2 diabetes that resulted in vascular and cardiac complications D. A child who was born HIV-positive to a mother who was an intravenous substance user ANS: C Rationale: During the late 20th century, the effects of chronic conditions such as diabetes began to overshadow other health problems such as communicable diseases and injuries.

PTS: 1 DIF: Moderate REF: Page and Header: 7, A Framework for Health Promotion in Canada OBJ: 2 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 1: Population Health Promotion: Essentials and Essence of Practice KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze 8. Which statement best captures the concept of population health?

A. Population health is the median life expectancy within a defined group of people.

B. Population health is citizens’ subjective perceptions of their physical, mental, and spiritual well-being.

C. Population health is the health status of a group of individuals that is considered as a whole, coherent unit.

D. Population health is the relative risk of premature death that exists within a specified group of residents.

ANS: C Rationale: Population health focuses on the health status of populations, which are conceptualized as coherent entities that are not simply the sum of individuals. Components and considerations include measures such as life expectancy and health risks, but the concept supersedes these finite indicators.

PTS: 1 DIF: Moderate REF: Page and Header: 12, Population Health OBJ: 6 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 1: Population Health Promotion: Essentials and Essence of Practice KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand 9. A tobacco educator is working with a group of adults who have a history of cigarette smoking. The group comprises immigrants to Canada from an ethnic group whose members have a smoking rate higher than that of the Canadian population as a whole. Which determinant of health does not have a significant impact on the group members’ tobacco use?

A. Culture B. Social environment C. Personal health practices D. Physical environment ANS: D Rationale: The influence of client’s culture, social environment (peers), and personal health practices can be seen as factors that affect his tobacco use. The client’s physical environment does not have a clear and direct bearing on this health behaviour.

PTS: 1 DIF: Moderate REF: Page and Header: 12, Population Health OBJ: 5 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 1: Population Health Promotion: Essentials and Essence of Practice KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply 10. A community health worker is collaborating with educators and school administrators to spearhead a new program for elementary students that aims to prevent children from beginning to smoke in junior high. This effort most clearly exemplifies what element of the population health approach?

A. Focusing on the health of populations B. Addressing the determinants of health C. Increasing accountability for health outcomes D. Investing upstream ANS: D

Rationale: Investing upstream means directing attention at the root causes of illness and injury, rather than at the symptoms that are evident. Influencing tobacco use before it begins is an example of such upstream thinking. This does not preclude a focus on the health of populations, consideration of the determinants of health, or increased accountability, but the structure and timeline of the program is a clear example of investing upstream.

PTS: 1 DIF: Moderate REF: Page and Header: 13, Population Health OBJ: 6 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 1: Population Health Promotion: Essentials and Essence of Practice KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze 11. Which action best demonstrates the element of collaboration in the population health approach?

A. A community health worker liaises with municipal leaders and social services representatives during the planning of a program.

B. A community health worker adopts a multidisciplinary approach to the provision of care in a community.

C. A community health worker forms a committee of fellow community health workers when weighing the costs and benefits of a proposed program.

D. A community health worker consults published evidence when planning an intervention and integrates the evidence into practice.

ANS: A Rationale: Collaboration is the active engagement between and across levels and sectors. It is not synonymous with multidisciplinary care or evidence-based practice.

PTS: 1 DIF: Difficult REF: Page and Header: 14, Population Health OBJ: 6 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 1: Population Health Promotion: Essentials and Essence of Practice KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze 12. Knowing that health is a result of a complex interplay among numerous factors, the community health worker is careful to make a distinction between risk factors and risk conditions. What factor would be considered a risk condition?

A. A community hospital has been closed due to budgetary pressures and consolidation with a larger, more distant hospital.

B. The community’s alcohol purchases have increased to very high levels since the loss of a key employer in the community several months ago.

C. A group of local middle-aged factory workers have avoided going to their primary care providers for the past 4 years for the fear of digital rectal examinations.

D. A group of women attending a community centre art class has been encouraged to increase their activity level but most women continue to maintain a sedentary lifestyle.

ANS: A Rationale: Risk conditions, on the other hand, are general circumstances over which people have little or no control that are known to affect health status.

Examples include the specific delivery of health care and changes that have the potential to negatively impact health. Risk factors are elements, often behaviour patterns, that tend to dispose people to poorer health and are modifiable through strategies that create individual behaviour change.

PTS: 1 DIF: Moderate REF: Page and Header: 15, Population Health Promotion OBJ: 6 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 1: Population Health Promotion: Essentials and Essence of Practice KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze 13. Which population group is considered to be the most vulnerable in Canadian society?

A. The Aboriginal population B. People who are homeless C. Female lone parenting families D. Children with chronic diseases ANS: B Rationale: People who are homeless are one of the most vulnerable population groups in society, exposed to multiple hazards in a nonsupportive environment, diminishing their ability to stay healthy or to take the necessary steps to seek the services they need to become healthy. The threats to health of the homeless population exceed those faced by nearly every other group in Canadian society.

PTS: 1 DIF: Moderate REF: Page and Header: 14, Target Populations OBJ: 5 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 1: Population Health Promotion: Essentials and Essence of Practice KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Remember 14. The Epp Framework (A Framework for Health Promotion) of 1986 is acknowledged as a milestone in the development of public health policy in Canada. What was the primary goal in this framework?

A. Encouraging Canadians to become more aware of international health disparities

B. Empowering Canadians to exercise control over and improve their own health C. Fostering a sense of pride in the health care system that Canadians created D. Promoting a reduction in known health risk factors ANS: B Rationale: The Epp Framework reaffirmed the WHO definition of health promotion as “the process of enabling people to increase control over, and to improve, their health.” The focus of the framework was not on international health disparities or promoting a sense of pride in the health care system. The framework went beyond narrow approaches such as reducing risk factors.

PTS: 1 DIF: Easy REF: Page and Header: 6, A Framework for Health Promotion in Canada OBJ: 1 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 1: Population Health Promotion: Essentials and Essence of Practice KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand 15. One of the key mechanisms of health promotion is self-care. What is an example of this mechanism in action?

A. A group of construction workers choose to pack healthy lunches to work rather than buying fast food each day.

B. A community centre resolves to increase the activity level of the children by purchasing outdoor toys.

C. A school participates in a regional tobacco prevention campaign.

D. The leadership of a church organizes a drop-in exercise program for parishioners.

ANS: A Rationale: Self-care refers to the decisions made and the behaviours practised by individuals specifically for the preservation of health. Decisions made in order to benefit others can improve public health but they are not considered to be self-care.

PTS: 1 DIF: Moderate REF: Page and Header: 7, A Framework for Health Promotion in Canada OBJ: 3 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 1: Population Health Promotion: Essentials and Essence of Practice KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze 16. Which is an example of a limitation of the 1974 Lalonde Report (A New Perspectives on the Health of Canadians)?

A. Blaming victims if they got sick or injured B. Not addressing the social conditions that affect health C. An overemphasis on lifestyle

D. Focus of attention on sectors other than health ANS: A Rationale: Lalonde’s approach was directed primarily toward individuals taking control of their health, and if people got sick or injured it was assumed they had not carried out recommended health behaviours (or did not do them enough).

PTS: 1 DIF: Moderate REF: Page and Header: 5, The Lalonde Report OBJ: 1 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 1: Population Health Promotion: Essentials and Essence of Practice KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand 17. One of the modes of collaboration is horizontal. What activity best demonstrates collaboration in action?

A. A public health clinical specialist partnering with the Board of Education and Health Canada to develop recommendations for gender-safe schools B. A school nurse, environmental health officer, and a teacher engaged together in a head lice program in a local elementary school C. A sexual health nurse, the head of the Boys and Girls Club, and the Chief of Police working on a bullying prevention program for transgendered high school students D. A Medical Officer of a health region partnering with a provincial Pharmacy Association and Public Health Agency to develop guidelines for influenza immunization ANS: B Rationale: Horizontal collaboration is when partnerships are formed at the same level. The other examples have different jurisdictions in policy and enforcement and are therefore examples of vertical collaboration.

PTS: 1 DIF: Moderate REF: Page and Header: 4, Introduction OBJ: 1 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 1: Population Health Promotion: Essentials and Essence of Practice KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze 18. The Declaration of Alma-Ata placed the greatest emphasis on: A. prevention.

B. expertise-driven programs.

C. low-technology options.

D. social justice.

ANS: D

Rationale: The Declaration focused on social justice and equity that was framed in the context of public participation and appropriate use of technology.

PTS: 1 DIF: Easy REF: Page and Header: 5, Declaration of Alma-Ata OBJ: 1 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 1: Population Health Promotion: Essentials and Essence of Practice KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Remember 19. The Epp Framework (A Framework for Health Promotion in Canada) of 1986 defines health promotion. Which best captures that definition?

A. A person who does not have a disease, illness, or injury B. The opportunity for people to exercise control over their health C. Education programs that inform people about how to be healthy D. Individual Canadians taking responsibility for their health ANS: B Rationale: Health promotion is the process of enabling people to increase control over, and to improve, their health.

PTS: 1 DIF: Moderate REF: Page and Header: 6, A Framework for Health Promotion in Canada OBJ: 1 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 1: Population Health Promotion: Essentials and Essence of Practice KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze

Chapter 2, Public Health in Canada 1. What is the best description of public health?

A. The organized efforts of society to promote health and prevent disease B. The development and delivery of vaccines to prevent communicable diseases C. The work of the government to ensure the health of youth and families D. Government policies that prioritize health promotion and injury prevention ANS: A Rationale: Public health is “the science and art of promoting health, preventing disease, prolonging life and improving quality of life through the organized efforts of society” (Last, 2001, p. 145). Public health transcends the use of vaccines, government efforts, and policies.

PTS: OBJ: NAT: TOP: KEY: BLM:

1 DIF: Easy REF: Page and Header: 18, Introduction 2 Client Needs: Safe and Effective Care Environment: Management of Care Chapter 2: Public Health in Canada Integrated Process: Nursing Process Cognitive Level: Understand

2. What is the best description of the mission of Canada’s public health system?

A. To organize societal efforts to promote health and prevent disease B. To create the societal conditions for all Canadians to be healthy C. To ensure the health of individuals such as youth D. To carry out actions that address the determinants of health ANS: B Rationale: The mission of the public health system is to help society to create the conditions in which all people can be healthy. The system does not directly create health. Addressing the determinants of health and organizing societal efforts are actions that take place within the public health system, but they are not the overall mission of the system.

PTS: OBJ: NAT: TOP: KEY: BLM:

1 DIF: Easy REF: Page and Header: 18, Introduction 2 Client Needs: Safe and Effective Care Environment: Management of Care Chapter 2: Public Health in Canada Integrated Process: Nursing Process Cognitive Level: Understand

3. What is the best description of the goal of Canada’s public health system?

A. To organize efforts to promote Canadians’ health and prevent disease B. To create the societal conditions for all Canadians to be healthy C. To minimize health disparity and preventable death and disability for all Canadians

D. To carry out actions that address the Canadian determinants of health ANS: C Rationale: The goal of public health—to minimize health disparity and preventable death and disability for all Canadians—is integral to social justice.

Actions such as health promotion and addressing the determinants of health take place within the system, but they are not the ultimate goal of the system.

PTS: OBJ: NAT: TOP: KEY: BLM:

1 DIF: Easy REF: Page and Header: 18, Introduction 2 Client Needs: Safe and Effective Care Environment: Management of Care Chapter 2: Public Health in Canada Integrated Process: Nursing Process Cognitive Level: Understand

4. How does the Canadian public health system ensure social justice in its various activities?

A. By making certain its programs are based on epidemiologic evidence B. By ensuring there is clean drinking water and safe workplaces for all Canadians C. By making sure those Canadians in the greatest need receive the most services D. By being certain that its programs address the Canadian determinants of health ANS: C Rationale: Public health is committed to social justice: the concept of a society that gives individuals and groups fair treatment and an equitable (fair) share of the benefits of society. Using a social justice perspective for public health interventions means ensuring that those in greatest need of public health services, or those most vulnerable or at risk, receive more attention.

PTS: OBJ: NAT: TOP: KEY: BLM:

1 DIF: Moderate REF: Page and Header: 18, Introduction 2 Client Needs: Safe and Effective Care Environment: Management of Care Chapter 2: Public Health in Canada Integrated Process: Nursing Process Cognitive Level: Understand

5. Canada’s public health history was affected by the fur trade that began in the 1600s. How did the introduction of European fur traders affect the health of the Indigenous peoples living in Canada during that time?

A. The fur trade brought economic growth and wealth to the Indigenous population.

B. European fur traders brought infectious diseases to Canada’s Indigenous people.

C. European fur traders married Indigenous women and improved their living conditions.

D. The Indigenous population began living on reserves and were protected by the government.

ANS: B Rationale: The North American continent was home to Indigenous peoples for thousands of years. Beginning in the 1600s, their health, economy, and social conditions were negatively affected by European immigration. The fur trade brought with it smallpox, measles, tuberculosis, and influenza that destroyed many Indigenous lives and in some cases wiped out entire villages. The Indian Act was not created until 1876.

PTS: REF: NAT: TOP: KEY: BLM:

1 DIF: Moderate Page and Header: 19, History of Public Health in Canada OBJ: 1 Client Needs: Safe and Effective Care Environment: Management of Care Chapter 2: Public Health in Canada Integrated Process: Nursing Process Cognitive Level: Understand

6. Canada’s public health history was affected by cholera that arrived on ships to what was then Upper and Lower Canada in the 1830s. What was the response to the epidemic this caused?

A. Over 6,000 people died from cholera in Montreal and Quebec City.

B. Local boards of health were established and medical officers appointed.

C. Immigrants were required to live in less crowded homes and keep the streets clean.

D. Sick immigrants were quarantined on islands outside of Canadian port cities.

ANS: B Rationale: Even though a quarantine station was established near Quebec City, immigrants that appeared healthy but were in fact infected with cholera had entered Lower Canada in the 1830s. The disease spread, and by the time the epidemic was over, cholera had killed about 2,300 people (10% of the population) in Quebec City and 4,000 (15% of the population) in Montreal. As cholera spread to Upper Canada, local boards of health were established and medical officers appointed to handle the epidemic; streets were cleaned of filth, pools of stagnant water were drained, and blocked sewers were cleared, particularly where poor immigrants lived in crowded housing conditions.

PTS: REF: NAT: TOP: KEY: BLM:

1 DIF: Easy Page and Header: 19, History of Public Health in Canada OBJ: 1 Client Needs: Safe and Effective Care Environment: Management of Care Chapter 2: Public Health in Canada Integrated Process: Nursing Process Cognitive Level: Understand

7. By the early 1860s, vaccination against smallpox became available and mandatory vaccination was introduced. How was this vaccine delivered to the Indigenous people for whom smallpox had been devastating in terms of lives lost and entire villages wiped out?

A. The priests and nuns went from village to village to vaccinate children.

B. The gold rush in coastal British Columbia required all miners be vaccinated.

C. The Hudson’s Bay Company provided vaccinations to Indigenous people.

D. Vaccinations were provided to children and families at residential schools.

ANS: C Rationale: By the early 1860s, vaccination against smallpox became available, and mandatory vaccination was introduced in the colonies. In the West, the Hudson’s Bay Company provided vaccinations in an effort to protect Indigenous communities. The Gold Rush in British Columbia, however, imported smallpox that devastated the coastal people.

PTS: REF: NAT: TOP: KEY: BLM:

1 DIF: Moderate Page and Header: 19, History of Public Health in Canada OBJ: 1 Client Needs: Safe and Effective Care Environment: Management of Care Chapter 2: Public Health in Canada Integrated Process: Nursing Process Cognitive Level: Remember

8. By the mid-1950s, the public health system was well developed in Canada.

Nevertheless, there are still concerns about the health of Canadians. What are the biggest challenges that the public health system is facing today?

A. Viral infections related to injectable substance abuse B. Chronic diseases and mental health issues C. Immigration and refugee health conditions D. Families who do not vaccinate their children ANS: B Rationale: New infections emerged in the form of HIV/AIDS, and the incidence of other viral infections (e.g., hepatitis C) grew along with the increasing injectable substance use in the country. Today, much as in the early days of Canada, we remain concerned about immigrant health, Aboriginal health, and the health of people living in poverty. While much of our history is linked to infectious diseases (Brunham, 2009), current and future challenges relate to chronic disease, mental health, and the determinants of health.

PTS: 1 DIF: Moderate REF: Page and Header: 19 History of Public Health in Canada | Page and Header: 20, History of Public Health in Canada OBJ: 1 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 2: Public Health in Canada KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand 9. The last century brought many achievements in public health in Canada in addition to vaccination and control of infectious diseases. Of these achievements, which ones best protected the health of Canadians?

A. Family planning and safer workplaces B. Motor-vehicle policies and tobacco reduction

C. Healthy eating and physical activity D. Universal health insurance ANS: B Rationale: Policies about drinking and driving, seat belts and child restraints, vehicle emission standards, and speed control policies have decreased motorvehicle--related deaths. Once tobacco was recognized as a health hazard, public health initiatives to reduce smoking, prevent second-hand smoke in public places, and prevent youth from starting to smoke have significantly reduced tobacco-related morbidity and mortality in Canada.

PTS: 1 DIF: Moderate REF: Page and Header: 20, Public Health Achievements in the Past Century (Table 2.1) OBJ: 1 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 2: Public Health in Canada KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand 10. The programs, services, and institutions within Canada’s public health system are focused on prevention and promotion, and consideration of the health status and needs of the whole population. What essential functions of public health are needed to achieve these?

A. Epidemiology and clinical assessment and risk assessments B. Coordination and collaboration with other sectors C. Health assessment, surveillance, disease prevention, and health promotion D. Advocacy and social marketing ANS: C Rationale: The essential functions of the public health system are population and community health assessment, surveillance, injury and disease prevention, health promotion, health protection, and emergency and disaster preparedness.

PTS: 1 DIF: Moderate REF: Page and Header: 21, Public Health Achievements in the Past Century (Table 2.2) OBJ: 2 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 2: Public Health in Canada KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand 11. Which represents a function of emergency and disaster preparedness?

A. Safe housing for people who are homeless B. Coordinating an HPV immunization program in local schools C. Advocating for the legalization of marijuana D. Influenza pandemic planning and preparation ANS: D

Rationale: The essential functions of the public health system are population and community health assessment, surveillance, injury and disease prevention, health promotion, health protection, and emergency and disaster preparedness.

PTS: 1 DIF: Moderate REF: Page and Header: 21, Public Health Achievements in the Past Century (Table 2.2) OBJ: 2 NAT: Client Needs: Safe and Effective Care Environment: Safety and Infection Control TOP: Chapter 2: Public Health in Canada KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand 12. While Canadians today are healthier than ever and have a longer life expectancy than previously, the risks to health have changed over the past decades. What is today’s special public health concern?

A. New and reemerging infectious diseases B. The battle against youth obesity and diabetes C. Falls and other injuries in the elderly and children D. Health disparity and inequity ANS: D Rationale: Today the leading causes of disability and death for all ages are injuries and chronic diseases. Today the health system battles obesity, tobacco, diabetes, mental illness, falls in the elderly, and childhood injuries. The challenge of infectious diseases remains, however, as old foes reemerge (e.g., syphilis, tuberculosis, community waterborne disease, influenza) and new ones appear (e.g., West Nile virus, Middle Eastern respiratory syndrome [MERS], bioterrorism). Of special concern are the inequalities in life circumstances that lead certain population groups to have poorer health status than those with more advantages—this is termed health disparity.

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1 DIF: Moderate Page and Header: 21, Emerging Threats to the Health of Canadians 2 NAT: Client Needs: Health Promotion and Maintenance Chapter 2: Public Health in Canada Integrated Process: Nursing Process Cognitive Level: Understand

13. Following Canada’s Severe Acute Respiratory Syndrome (SARS) outbreak in 2002, there were a number of recommendations made to improve public health capacity. Which recommendation was acted upon by the federal government?

A. Create more opportunities for public health education in professional curricula.

B. Create a public health agency with a chief public health officer for Canada.

C. Increase funding of public health initiatives to 11.6% of Canada’s gross domestic product.

D. Integrate all components of the Canadian health care system---public health, acute care, and long-term care.

ANS: B Rationale: In 2004, Canada created the Public Health Agency of Canada (PHAC) separate from Health Canada and named the nation’s first Chief Public Health Officer. Masters of Public Health Schools and programs emerged after 2006.

The health care system as a whole accounts for 11.6% of GDP. Health care organization is in provincial/territorial jurisdiction so only they can integrate their systems, not the federal government.

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1 DIF: Moderate Page and Header: 23, Key Players in Public Health in Canada 3 NAT: Client Needs: Health Promotion and Maintenance Chapter 2: Public Health in Canada Integrated Process: Nursing Process Cognitive Level: Remember

14. The Public Health Agency of Canada has recognized seven common health professionals in public health by developing discipline-specific competencies for each of them. These seven disciplines include: A. Nursing, Inspection, and Health Promotion.

B. Social Work, Lactation Specialist, and Library Technician.

C. Medicine, Engineering, and Waste Management.

D. Nursing, Social Work, and Health Education Specialist.

ANS: A Rationale: There are many other valued professionals in public health departments, including those with expertise in information management and technology, social marketing, speech--language pathology, lactation, health education, among others. In addition, many public health agencies hire others (e.g., data analysts, social workers, toxicologists, program evaluators, librarians, research coordinators) who have specific public health expertise in addition to their discipline knowledge.

PTS: 1 DIF: Moderate REF: Page and Header: 25, The Intersection of Public Health and Primary Care (Tables 2.4 and 2.5) OBJ: 4 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 2: Public Health in Canada KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand 15. The importance of a strong primary care system to support public health practice is well recognized. The primary care system is characterized as the key to manage public health service demand. What is the primary care system’s contribution to the health of Canadians?

A. Direct and continuing care for clients B. Responding to unmet public health service needs C. Integration with home care, long-term care, and acute care facilities D. Twenty-four hour, seven days a week access to care for clients

ANS: A Rationale: Two key general characteristics of the public health contributions are provision of the systems or programmatic elements and response to unmet service needs, while for primary care it is the direct and continuing contact with clients.

PTS: 1 DIF: Moderate REF: Page and Header: 26, The Intersection of Public Health and Primary Care (Table 2.6) OBJ: 3 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 2: Public Health in Canada KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply 16. Thoughtful collaboration between the public health system and primary care has potential benefit across which area?

A. Maternal--child health and communicable disease prevention B. Improvements in public health system efficiency and effectiveness C. Reduction of injectable substance abuse and prevention of blood-borne diseases D. Decline in morbidity and mortality due to cardiovascular disease and stroke ANS: A Rationale: Valaitis (2012) found evidence of benefit across a number of areas including maternal--child programs, communicable disease prevention and control, health promotion and health protection, chronic disease prevention and management, youth health, women’s health, and working with vulnerable populations. Primary care and public health collaboration is an emerging area of research that should bear fruit in terms of improvements in overall health system efficiency and health equity.

PTS: 1 DIF: Moderate REF: Page and Header: 26, The Intersection of Public Health and Primary Care (Table 2.6) OBJ: 3 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 2: Public Health in Canada KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply 17. There are six key functions of the public health system. Which describes the specific outcomes of population and community health assessment?

A. Surveillance reports B. Targeted services C. Safe environments D. Strong communities ANS: B

Rationale: Population and community health assessment involves describing and understanding people, factors that determine health, and the distribution of wealth, health, and risk factors across geographic areas and population segments. The outcomes of this include better targeted services and healthy public policies.

PTS: 1 DIF: Moderate REF: Page and Header: 21, Public Health Achievements in the Past Century (Table 2.2) OBJ: 2 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 2: Public Health in Canada KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand 18. There are six key functions of the public health system. Which describes the outcomes of surveillance?

A. Program planning and support B. Healthy public policies C. Healthy lifestyle promotion D. Intersectoral collaboration ANS: A Rationale: Surveillance provides the basis for program support and anticipatory planning. Healthy public policies come from assessment and health promotion actions. Injury and disease prevention promote healthy lifestyle choices.

Intersectoral collaboration is required to plan effectively for disaster and emergency response.

PTS: 1 DIF: Moderate REF: Page and Header: 21, Public Health Achievements in the Past Century (Table 2.2) OBJ: 2 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 2: Public Health in Canada KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand 19. Universal programs for income maintenance, social welfare services, and health care services have helped Canadians maintain a high standard of living and of health. What describes a universal program?

A. Benefits awarded to certain Canadian seniors, for example, Guaranteed Income Supplement B. Benefits awarded to all Canadian children in the form of social welfare assistance C. Benefits awarded to low-income Canadian Armed Forces veterans who are disabled D. Benefits awarded to Canadians without reference to their assets or income level

ANS: D Rationale: The term “universal” generally applies to benefits that are awarded without reference to the recipient’s income or assets.

PTS: 1 DIF: Moderate REF: Page and Header: 20, Public Health Achievements in the Past Century (Table 2.1) OBJ: 2 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 2: Public Health in Canada KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand 20. Universal programs for income maintenance, social welfare services, and health care services have helped Canadians maintain a high standard of living and of health. What describes a targeted program?

A. A social housing project to shelter vulnerable people who do not have a place to live B. A program to prevent exposure to second-hand smoke in public places C. Annual immunization against influenza free to all Canadians D. Speed restrictions for transport trucks on the Trans-Canada Highway ANS: A Rationale: The term “universal” generally applies to benefits that are awarded without reference to the recipient’s income or assets. Social housing is targeted to people who cannot afford housing and are experiencing homelessness.

Second-hand smoke prevention is universal in that it is in public places. Annual flu shots are available universally free of charge to all Canadians across the country. The Trans-Canada Highway crosses all of Canada and speed levels are universally applied.

PTS: 1 DIF: Moderate REF: Page and Header: 20, Public Health Achievements in the Past Century (Table 2.1) OBJ: 2 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 2: Public Health in Canada KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand 21. Women’s health advocates had long been calling for legal access to contraception and sexual health education, and in 1969 contraceptives were legalized in Canada. How did access to contraception contribute to maternal and child health?

A. Allowed women to space births a healthy 2 years apart.

B. Allowed teens to engage in sex without fear of becoming pregnant.

C. Prevented women from feeling guilty when they used contraceptive devices illegally.

D. Using contraceptive devices prevented sexually transmitted infections.

ANS: A Rationale: Waiting until the mother is at least 18 years old before trying to have a child improves maternal and child health and it is healthier to wait at least 2 years after a previous birth before conceiving the next child.

PTS: 1 DIF: Moderate REF: Page and Header: 20, Public Health Achievements in the Past Century (Table 2.1) OBJ: 2 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 2: Public Health in Canada KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand 22. The community health worker who works with the residents of a low-income neighbourhood with few recreational amenities and difficult access to health and social services compared to another neighbourhood with a higher average income, good access to amenities, and understands that the residents might live with some: A. wellness disadvantages.

B. health disparities.

C. health flaws.

D. wellness deficits.

ANS: B Rationale: Inequalities in life circumstances lead certain population groups to have poorer health status than those with more advantages—this situation is termed health disparity.

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Chapter 3, Ethical Practice in Community Health 1. Which statement best reflects the ethical principle of autonomy?

A. The avoidance of harm B. The desire to act in the best interest of others C. The right of individuals to self-determination D. The recognition that every person and community has intrinsic value ANS: C Rationale: Autonomy is the right of individuals to self-determination.

Nonmaleficence is the avoidance of harm. Beneficence is the desire to act in the best interest of others. Respect for people is the recognition that every person and community has intrinsic value.

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2. Which statement best describes distributive justice?

A. The commitment to tell the truth B. The arena of reward and punishment C. The fair allocation of rights and resources D. Making promises and being steadfast in keeping them ANS: C Rationale: Distributive justice is the fair distribution of potential benefits and burdens. Compensatory justice is the arena of reward and punishment. Veracity is the commitment to tell the truth. Fidelity is being faithful in making promises and steadfast in keeping them.

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3. A nurse is having difficulty with the family decision for aggressive cancer therapy for an individual with metastatic lung cancer. The nurse is wondering whether the cancer treatments might be more harmful than the progression of the disease because of the dangerous side effects of chemotherapy. What ethical principle is the nurse struggling with in this situation?

A. Autonomy

B. Beneficence C. Justice D. Nonmaleficence ANS: D Rationale: Nonmaleficence is the avoidance of harm. Autonomy is the right of individuals to self-determination. Beneficence is the desire to act in the best interest of others. Justice is the fair distribution of rights and resources.

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4. A community health nurse has to start an IV for antibiotics on a client at home.

The client has never had an IV or been in a hospital. The client asks the community health nurse whether this will be a painful procedure. The nurse tells the client the truth that it will be uncomfortable while the needle is being inserted. What ethical principle is the nurse practicing?

A. Autonomy B. Fidelity C. Justice D. Veracity ANS: D Rationale: Veracity is the commitment to tell the truth. Autonomy is the right of individuals to self-determination. Fidelity is being faithful in making promises and steadfast in keeping them. Justice is the fair distribution of rights and resources.

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5. When an ethical issue arises for the community health professional, the nurse should prioritize: A. being able to analyze the ethical principles at stake at any given decisionmaking point.

B. following the request of the community members exactly as they have verbalized what they want to be done in the situation.

C. ensuring the community health care team takes ultimate responsibility for deciding the solution to the situation.

D. remaining neutral and detaching all present beliefs when making ethical decisions.

ANS: A Rationale: Conscious awareness of the risk and application of the principles of justice, both retributive and distributive, veracity, and fidelity will assist community health professionals to analyze the ethical principles at stake at any given decision-making point in their work within communities. By considering a variety of ethical theories and perspectives, including those of the community members, the health care team, and personal knowledge and beliefs, the nurse will be able to promote the overall health of the community.

PTS: 1 DIF: Moderate REF: Page and Header: 31, Theoretical Foundations | Page and Header: 32, Theoretical Foundations OBJ: 6 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 3: Ethical Practice in Community Health KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply 6. Following a motor vehicle accident, the wife of the victim requests that life support be continued in the absence of any brain function and that the client be allowed to go home on life support. The health care team believes that life support should be immediately discontinued and the client’s organs be donated.

Which ethical principle most applies to this situation?

A. Autonomy B. Fidelity C. Justice D. Veracity ANS: A Rationale: Autonomy is the right of individuals to self-determination. Fidelity is being faithful in making promises and steadfast in keeping them. Justice is the fair distribution of rights and resources. Veracity is the commitment to tell the truth.

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7. Which best describes Kantianism?

A. Decisions are made on the basis of the greatest good for the greatest number.

B. Actions are morally right when they are in accord with our nature and end as human beings.

C. A system that allows social and economic positions to be for everyone’s advantage and open to all.

D. A rule-based approach in which decisions are made by applying a set of rules of good conduct.

ANS: D Rationale: Kantianism is an ethical perspective based on respect for persons and action based on moral duty or good will. Morality is ensured by following the rules and acting from good intentions. Kant’s work explored the relationship between morality and human reason, arguing that individuals can understand what is morally right through study. Therefore, Kantian theory is not concerned with human nature. Decisions made based on what will be of most benefit to the most people is characteristic of utilitarianism, which involves predicting the possible impact of one’s actions. Conversely, Kantian principles are based on universal laws, which must be applied regardless of the consequences. Social justice is the concept which strives to make social and economic opportunities open to all, and is ideologically neutral, not exclusive to any one theory or value system.

PTS: 1 DIF: Easy REF: Page and Header: 32, Kantian Ethics OBJ: 3 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 3: Ethical Practice in Community Health KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand 8. Which is an example of utilitarianism?

A. All health professionals need to follow personal moral codes in their personal and professional life.

B. Health professionals should subscribe to professional codes of ethics in their daily practice.

C. All individuals in a research study have a complete understanding and informed consent of the study.

D. Preventing communicable disease benefits many more people in the community than does caring for individual illnesses.

ANS: D Rationale: The theory of utilitarianism maintains that one should strive to achieve the greatest good for the greatest number of people when making ethical decisions. A proponent of this theory might indeed argue that communicable disease prevention would be of greater benefit to more members of the community than caring for individual illnesses. Informed consent, as is given by the participants of the research study, is based on the principle of autonomy. Health professionals should consider a variety of ethical theories and practices when making decisions, and engage in critical thinking when examining personal moral codes or values. This is known as applied ethics.

Many organizations have professional codes of ethics that outline expectations for members, which may or may not incorporate principles of utilitarianism.

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Utilitarianism OBJ: 3 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 3: Ethical Practice in Community Health KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand 9. Which statement best describes applied ethics?

A. The creation and examination of ethical principles in isolation from specific scenarios B. Providing a lens for assessing the willingness and ability of individuals for change C. Addressing the moral character and professional identity of the health professional D. Utilizing ethical principles and theories in practice situations ANS: D Rationale: Applied ethics involve the use of ethical theory and methods of analysis to examine moral problems, practices, and policies. It is thus in contrast to ethical theory, which is detached from real-life scenarios. Applied ethics does not provide a framework for appraising an individual’s moral character or readiness to change.

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10. Which phenomenon most contributes to the need for ethical pluralism?

A. The decreasing emphasis placed on traditional concepts of moral character B. Social diversity and the presence of numerous ethnic and cultural groups in Canada C. Increasing numbers and varieties of treatment options in acute care settings D. Conflicts within the field of Canadian population health ANS: B Rationale: Diversity or pluralism of moral values and beliefs is characteristic of multicultural countries such as Canada. Ethical pluralism or moral diversity maintains the position that culturally diverse societies display multiple moral standards that may lead to conflicting moral realities. This position is not exclusive to any one field, but rather is applicable to the lived experiences of all people in a society. Emphasis on traditional concepts of moral character is a position of virtue ethics, which has in fact seen a resurgence in recent years.

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11. The health care managers of a community outreach clinic are faced with some difficult decisions around potential service cutbacks in light of a reduction in provincial funding. Within the framework of utilitarian rule ethics, which consideration will be prioritized?

A. Which socioeconomic groups will be most affected by any proposed change in service?

B. What ethical principles are best adhered to in light of any potential program changes?

C. Which of the existing programs provides the most benefit to the greatest number of residents?

D. How many members of the community support or oppose any particular change in programs?

ANS: C Rationale: Utilitarianism is a moral perspective based on the goal of achieving the greatest good for the greatest number of people. Weighing consequences, benefits, or detriments that result from one’s actions is instrumental in determining moral conduct and course of action.

PTS: 1 DIF: Difficult REF: Page and Header: 33, Utilitarianism OBJ: 4 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 3: Ethical Practice in Community Health KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply 12. A nurse who provides wound care for an older adult client in her home is faced with a conflict between the client’s autonomy and the client’s son’s belief that “someone needs to take charge to get her to take better care of herself.” In this nurse’s response to this ethical conflict, the theory of virtue ethics would prioritize what consideration?

A. The nurse’s moral character B. The application of the recognized principles of ethics C. The potential impact of the client’s decisions on taxpayers and other members of the community D. The dictates of the law and the nurse’s standards of practice ANS: A Rationale: While virtue ethics does not wholly reject the significance of laws, standards of practice, and principles of ethics, the primary focus in the theory is on the moral character of the individual.

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13. The health professionals who have organized a new screening program identified a feminist ethical perspective during the conceptualization and proposal of the program. This ethical theory is premised on what key consideration?

A. The moral inferiority of masculinity B. The need to promote maternalism over paternalism C. The fact that conflict is unnecessary and that peace is a realizable goal D. The importance of human connectedness and personal relationships ANS: D Rationale: Feminist ethics emphasizes an ethics of care that involves human connectedness and the importance of interpersonal relationships. It is not founded on a belief that masculinity is necessarily inferior or that maternalism is more desirable than paternalism. Feminism does not deny the reality of conflict in human relationships or in nursing practice.

PTS: 1 DIF: Moderate REF: Page and Header: 37, Feminist Ethics OBJ: 6 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 3: Ethical Practice in Community Health KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand 14. A teenage client has confided in the community health professional that she is engaging in high-risk behaviours. This knowledge has created an ethical conflict for the health professional. An application of feminist ethics to this problem should begin with: A. identifying key community stakeholders who may assist with solutions for the problem.

B. enlisting community women to inform the ethical decision-making process.

C. examining the social beliefs and practices that may underlie the ethical problem.

D. providing client education geared to empowering the client in her health behaviours.

ANS: C

Rationale: As a discipline, nursing has evolved largely from feminist ethics.

Feminist ethics aim to examine the moral experience of women and advocate for social change. When health care professionals apply the theories during decision making, they first must consider the client’s social beliefs and practices to properly empathize. By considering the client’s relationships and individual, group, community, and societal levels, the health care professional in this situation may better understand the reason the client engages in these behaviors. The health care professional may then determine how best to educate the client. Seeking the help of outside parties such as community stakeholders or women in the community before fully understanding the context of the ethical problem is less likely to be helpful to the client.

PTS: 1 DIF: Difficult REF: Page and Header: 36, Feminist Ethics and Ethics of Care | Page and Header: 37, Feminist Ethics and Ethics of Care OBJ: 6 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 3: Ethical Practice in Community Health KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply 15. In the provision of care, a community health professional considers whether entrenched, oppressive practices may contribute to the health realities of individuals or communities. In doing so, the health professional enacts the principles of which ethical theory?

A. Feminist ethics B. Rule ethics C. Virtue ethics D. Kantianism ANS: A Rationale: A primary component of feminist ethics is identifying and responding to oppressive practices. This is not a central consideration of the rule ethics schools of utilitarianism and Kantianism, nor is it a core component of virtue ethics.

PTS: 1 DIF: Moderate REF: Page and Header: 37, Feminist Ethics OBJ: 6 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 3: Ethical Practice in Community Health KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand 16. In the process of overhauling a community health policy, the health professionals who participated in the process were conscious of the need to ensure participation and input from individuals and groups who might not otherwise participate in high-level decision making. What concept in public health and community practice have these health professionals enacted?

A. Advocacy B. Empowerment

C. Autonomy D. Inclusion ANS: D Rationale: The practice of inclusion ensures an opportunity for as many people and groups as possible to fully participate in the social and economic benefits of the community or the society. Empowerment may come as a result of inclusion as a community practice, when individuals gain mastery over decisions that effect them and are motivated to participate. Advocacy is the pursuit of influencing outcomes, which the health professionals might do to influence public opinion or policy in favor of the practice of inclusion. In community practice, personal autonomy may be limited when individual choices endanger the community’s well-being. In this instance, the health professionals will seek to promote individuals’ right to self-determination as much as possible, unless their actions encroach upon the needs of others.

PTS: 1 DIF: Moderate REF: Page and Header: 37, Ethical Foundations of Public Health and Community Practice OBJ: 5 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 3: Ethical Practice in Community Health KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze 17. A health professional who provides care in a low-income, inner-city neighbourhood is engaged in an effort to increase the public visibility and government funding of programs that have the potential to improve health outcomes for the residents. The health professional’s efforts exemplify: A. diversity.

B. advocacy.

C. inclusion.

D. interdependence.

ANS: B Rationale: Advocacy can be defined as the act of disseminating information to influence opinion, conduct, public policy, or legislation. Diversity acknowledges the heterogeneity of communities and inclusion prioritizes high proportions of participation. Interdependence as a concept in public health relates to the recognition that the health of individuals is tied to the life of the community.

The health professional might advocate for the public and the government to consider the values of diversity, inclusivity, and interdependence during these efforts.

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TOP: Chapter 3: Ethical Practice in Community Health KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand 18. A community practitioner is seeing a group of parents who have chosen not to vaccinate their children against measles. Knowing that the community has seen a recent outbreak of measles, the practitioner expresses concern. What ethical principles are in direct conflict in this situation?

A. Beneficence and nonmaleficence B. Beneficence and justice C. Beneficence and autonomy D. Beneficence and fidelity ANS: C Rationale: Beneficence is the duty to do good (in this case, the nurse knows that vaccinations are supported by empirical evidence to prevent disease).

Autonomy is the right of individuals to self-determination. The other principles (justice, fidelity, and nonmaleficence) are less relevant to this particular case.

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19. Which statement best illustrates the foundational concept of interdependence A. Community workers represent the interest of the community.

B. The health of individuals is tied to the life of the community.

C. Public involvement strategies should be planned to facilitate meaningful participation.

D. People must be able to predict, control, and participate in their environment.

ANS: B Rationale: The concept of interdependence relates to the interdependence among human beings, and the idea that the health of individuals is tied to the life and health of the community in which they live. Community workers are present to work with a community and help the community recognize and represent their own issues. Public involvement strategies should take interdependence into account but are not a central concept of interdependence.

People’s ability to control and participate is more closely related to empowerment.

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TOP: Chapter 3: Ethical Practice in Community Health KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand 20. Which statement best reflects the value of ethical pluralism over ethical relativism?

A. Pluralism asserts that morality is a function of cultural norms.

B. Pluralism leads to uniformity of moral codes.

C. Pluralism allows for different views of right and wrong.

D. Pluralism emphasizes the understanding of differences.

ANS: D Rationale: Ethical Relativism is the position that morality is a function of cultural norms and allows for variation of understanding of right and wrong. Ethical pluralism, on the other hand, rejects that position. Instead, it emphasizes as understanding of differences, though not going so far as to suggest uniform morality.

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Chapter 4, Patterns of Health and Disease: The Role of Epidemiology in Population Health 1. The incidence and seasonal patterns of two diseases are similar, but the prevalence of Disease A is higher than the prevalence of Disease B. Which explanation is most consistent with this observation?

A. Disease A is more likely to be infectious in nature.

B. Clients die quickly from Disease A, but not from Disease B. C. Clients recover more quickly from Disease A than from Disease B. D. Clients recover more quickly from Disease B than from Disease A. ANS: D Rationale: Prevalence reflects not only the incidence of a disease but the duration of a disease as well, whether that be related to the natural history of the disease, treatment, and/or access to health care. In the above situation, given that the incidence and seasonal patterns are similar, the major reason for the higher prevalence of Disease A has to be related to the duration of the disease.

PTS: 1 DIF: Moderate REF: Page and Header: 50, Interpretation of Incidence and Prevalence OBJ: 1 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 4: Patterns of Health and Disease: The Role of Epidemiology in Population Health KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze 2. The concept of prevention is a key component of modern community health practice. Which is an example of secondary prevention?

A. Wearing of protective devices to prevent injury B. Phenylalanine testing for phenylketonuria in infancy C. Physical therapy for stroke victims D. Exercise programs for heart attack victims ANS: B Rationale: Examples of secondary prevention include blood pressure screening for hypertension, audiometric testing for hearing impairment, skin testing for tuberculosis, and phenylalanine testing for phenylketonuria in infancy.

Examples of tertiary prevention include physical therapy for stroke victims, social support programs for recovering alcoholics, exercise programs for heart attack victims, and mental health counselling for rape victims. Protective devices are a primary prevention measure.

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Population Health KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze 3. The concept of prevention is a key component of modern community health practice. What is the goal of tertiary prevention?

A. General health promotion, such as nutrition, hygiene, exercise, and environmental protection B. Specific health promotion, such as immunizations and the wearing of protective devices to prevent injuries C. Detection and treatment of a problem at the earliest possible stage when disease or impairment already exists D. Limit disability and rehabilitate or restore affected people to their maximum possible capacities ANS: D Rationale: Primary prevention goals include general health promotion, such as nutrition, hygiene, exercise, and environmental protection; and specific health promotion, such as immunizations and the wearing of protective devices to prevent injuries. The goal of secondary prevention is to detect and treat a problem at the earliest possible stage when disease or impairment already exists. The goal of tertiary prevention is to limit disability and rehabilitate or restore affected people to their maximum possible capacities.

PTS: 1 DIF: Easy REF: Page and Header: 50, Interpretation of Incidence and Prevalence OBJ: 2 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 4: Patterns of Health and Disease: The Role of Epidemiology in Population Health KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand 4. Which is not considered to be part of the criteria for determining causality?

A. Nonrandom aggregation B. Dose--response relationship C. Strength of the association D. Temporally correct association ANS: A Rationale: Causation is difficult to establish; numerous criteria are assessed to determine if causation is plausible, including dose--response relationship, strength of an association, and temporality. Nonrandom aggregation has no bearing on causality.

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5. What classification would be given to the goal of reducing the incidence of mental illness in a population?

A. Rehabilitation B. Primary prevention C. Secondary prevention D. Tertiary prevention ANS: B Rationale: Primary prevention goals include general health promotion, such as nutrition, hygiene, exercise, and environmental protection; and specific health promotion, such as immunizations. The enhancement of general well-being to prevent mental illness in a population is primary prevention.

PTS: 1 DIF: Moderate REF: Page and Header: 50, Interpretation of Incidence and Prevalence OBJ: 2 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 4: Patterns of Health and Disease: The Role of Epidemiology in Population Health KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand 6. There are several commonly used rates when applying epidemiology and demography to the practice of community health. How is the prevalence rate calculated?

A. (Number of new cases of specified health condition during time interval/Estimated midinterval population at risk) 1,000 B. (Number of people experiencing a health condition at a given point in time/Estimated population at risk at same point) 1,000 C. (Number of deaths of infants aged <1 year during time interval/Total live births during time interval) 1,000 D. (Number of deaths from puerperal cases during 1 year/Number of live births during same year) 100,000 ANS: B Rationale: Prevalence is calculated by dividing the number of people with a condition by the number of people at risk. K is a constant that is normally 1,000.

PTS: 1 DIF: Easy REF: Page and Header: 53, Commonly Used Rates (Table 4.2) OBJ: 1 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 4: Patterns of Health and Disease: The Role of Epidemiology in Population Health KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand 7. To be valid, a screening test must distinguish correctly between those people who have the condition and those who do not. This ability to distinguish is measured by the test’s sensitivity and specificity. What is specificity of a screening test?

A. True positives/Total diseased B. True negatives/Total not diseased C. False negatives/Total diseased or 1 ?2- Sensitivity D. False positives/Total not diseased or 1 ?2- Specificity ANS: B Rationale: Specificity = True negatives/Total not diseased PTS: 1 DIF: Easy REF: Page and Header: 61, Sensitivity and Specificity of a Screening Test (Table 4.5) OBJ: 1 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 4: Patterns of Health and Disease: The Role of Epidemiology in Population Health KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand 8. In a case-control study of diabetes as a risk factor for chronic renal failure (CRF), the odds ratio was 3.0 (95% CI, 1.9--3.6). What does this mean?

A. Clients with CRF were 3% more likely to have diabetes.

B. Thirty percent more clients with CRF had a history of diabetes than controls.

C. There is a 10% possibility that any association occurred by chance alone.

D. Clients with CRF had a significant three-times greater odds of having diabetes than controls.

ANS: D Rationale: The OR = 3.0 is significant as the 95% confidence interval does not include 1.0, and denotes a three-times greater odds of having diabetes as a risk factor (or exposure) than controls.

PTS: 1 DIF: Moderate REF: Page and Header: 55, Odds Ratio OBJ: 1 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 4: Patterns of Health and Disease: The Role of Epidemiology in Population Health KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze 9. At current, which condition meets the criteria for establishing a screening program?

A. Lung carcinoma B. Alzheimer disease C. Rheumatoid arthritis D. Developmental delay ANS: D

Rationale: Population-based screening programs require that there is good evidence that: early diagnosis and treatment can favourably alter the course of the illness; definitive diagnosis and treatment facilities are available; the group is likely to have a high prevalence of the illness; and screening procedures are reliable and valid. At this time, only developmental delay meets these criteria.

PTS: 1 DIF: Easy REF: Page and Header: 60, Considerations in Deciding to Screen OBJ: 2 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 4: Patterns of Health and Disease: The Role of Epidemiology in Population Health KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand 10. In epidemiologic studies, data and statistics make comparison possible among populations. Which is an example of proportion?

A. 2,000 motorcycle fatalities, 1,900 are male and 100 are female. The number of males compared to number of females (1,900/100 or 19 males to 1 female).

B. 2,000 motorcycle fatalities, 1,900 are male and 100 are female; the percentage of males to females would be 1,900/2,000 multiplied by 100, which equals 95%.

C. Crude death rates for heart disease in Manitoba and Saskatchewan were 288.0 and 190.0 per 100,000 persons, respectively.

D. 20,000 people experience seasonal influenza/the total population of New Brunswick residents younger than 20 years of age 100,000.

ANS: B Rationale: A ratio is simply one number divided by another in which there is no specified relationship between the numerator and the denominator. A proportion is one number divided by another in which the numerator is a subset of the denominator (i.e., included in the denominator) and is expressed as a percentage (e.g., 95%). Rates measure the amount of disease, injury, disability, or death within a unit of the population and within a unit of time.

PTS: 1 DIF: Moderate REF: Page and Header: 50, Rates OBJ: 2 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 4: Patterns of Health and Disease: The Role of Epidemiology in Population Health KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand 11. Rates enable researchers to compare different populations in terms of health problems or conditions. What is an adjusted rate?

A. Rates computed for a population as a whole B. Rates related to demographic factors C. (Number of people who experience a condition/Population at risk experiencing a condition) 1,000 D. Summary measure in which statistical procedures remove the effect of differences in the composition of the various populations ANS: D

Rationale: Rates computed for a population as a whole are crude rates. Rates calculated for subgroups are specific rates. The calculation (Number of people experiencing a condition/population at risk for experiencing condition) K is the general formula for calculating rates. An adjusted rate is a summary measure in which statistical procedures remove the effect of differences in the composition of the various populations.

PTS: 1 DIF: Easy REF: Page and Header: 52, Crude, Specific, and Adjusted Rates OBJ: 1 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 4: Patterns of Health and Disease: The Role of Epidemiology in Population Health KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand 12. To investigate potential relationships between health conditions and other factors, analytic measures of community health are required. What is relative risk?

A. Incidence among those exposed/Incidence rate among those not exposed B. Odds of having the condition when the suspected factor is present/Odds of having the condition when not exposed to the factor C. Measures the difference between the incidence rates for those exposed and those not exposed to the risk factor D. Identifies whether those in the exposed group will develop the disease or condition when compared with those not exposed ANS: A Rationale: The relative risk expresses the ratio of the incidence rate of those exposed and those not exposed to the suspected factor. Odds ratio is a simple mathematical ratio of the odds in favour of having a specific health condition when the suspected factor is present and the odds in favour of having the condition when the factor is absent. Another measure of risk is attributable risk (AR), which measures the difference between the incidence rates for those exposed and those not exposed to the risk factor. Relative risks and odds ratios provide a point estimate (a number) that identifies whether those in the exposed group will develop the disease or condition when compared with those not exposed.

PTS: 1 DIF: Moderate REF: Page and Header: 54, Relative Risk OBJ: 1 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 4: Patterns of Health and Disease: The Role of Epidemiology in Population Health KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand 13. A rapid screening test for streptococcal disease was completed on a 4-year-old child who presented with a sore throat. The test was reactive, suggesting the presence of streptococcal infection. Additional testing by culture and sensitivity indicated that the child did not have strep throat. The original screening test is described as a: A. true positive.

B. false positive.

C. true negative.

D. false negative.

ANS: B Rationale: When a positive screening test is followed up with more sensitive diagnostic testing that determines that the diagnosis is negative, the inaccurate screening test is labelled a false-positive result.

PTS: 1 DIF: Moderate REF: Page and Header: 61, Decision Making in Screening: Practical and Ethical Considerations OBJ: 2 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 4: Patterns of Health and Disease: The Role of Epidemiology in Population Health KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze 14. An investigator knows that relationships between variables must be interpreted with great caution. Which is a widely used criterion for evaluating causation?

A. Association is not strong.

B. Association is not specific.

C. Association is temporally correct.

D. Association is the result of a confounding variable.

ANS: C Rationale: Six widely used criteria for evaluating causation are as follows: the association is strong, the association is consistent, the association is temporally correct, the association is specific, the association is not the result of a confounding variable, and the association is plausible and consistent with current knowledge.

PTS: 1 DIF: Easy REF: Page and Header: 58, Criteria for Determining Causation OBJ: 1 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 4: Patterns of Health and Disease: The Role of Epidemiology in Population Health KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand 15. Suppose a highly effective new drug is discovered for treating a form of cancer that previously had been rapidly fatal. What rate for this cancer will be least affected by the widespread use of the drug?

A. Incidence rate B. Mortality rate C. Prevalence rate D. 5-year survival rate ANS: A

Rationale: Prevalence is affected by incidence, treatment (e.g., survival), and mortality. New, effective treatment will alter the prevalence of disease by affecting mortality and thus the 5-year survival rate. Incidence will remain unaffected by new treatment.

PTS: 1 DIF: Moderate REF: Page and Header: 50, Interpretation of Incidence and Prevalence OBJ: 2 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 4: Patterns of Health and Disease: The Role of Epidemiology in Population Health KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply 16. The strength of an association between a factor and a disease is best measured by: A. attack rate.

B. alpha level.

C. prevalence.

D. relative risk.

ANS: D Rationale: The strength of the relationship may be evaluated statistically by a variety of measures, including the RR or OR. Attack rate refers to the incidence of infection, the alpha level is used to set the level of significance of a statistical test, and prevalence refers to the burden of disease in a population.

PTS: 1 DIF: Moderate REF: Page and Header: 56, Relative Risk and Odds Ratio: Caution in Interpretation OBJ: 1 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 4: Patterns of Health and Disease: The Role of Epidemiology in Population Health KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Remember 17. Interpreting and using data from various sources is essential for being an effective community health practitioner. What is the most comprehensive source of population data for Canada?

A. Census data B. Reportable disease reports C. Surveillance data D. Vital statistics ANS: A Rationale: The census is the most comprehensive source of population data for Canada. Every 5 years, under the Statistics Act, the government of Canada enumerates the population and surveys it for basic demographics such as age, sex, marital status, and mother tongue as well as numerous other factors such as employment, ethnicity, housing, income, migration, and education.

PTS: 1

DIF:

Easy

REF: Page and Header: 59, Census

OBJ: 2 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 4: Patterns of Health and Disease: The Role of Epidemiology in Population Health KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Remember 18. The person–place–time model examines the characteristics of the people affected, place or location, and the time period involved. In studying infant mortality, what is considered an example of the person in the model?

A. Rural community B. Urban community C. Infant and maternal factors D. Trends in mortality ANS: C Rationale: In studying infant mortality according to this model, infant and maternal factors are considered traits of “person.” Aspects of “place” are such factors as whether the community is rural or urban and affluent or poor.

Aspects of “time” include seasonal or age-specific patterns or trends in mortality.

PTS: 1 DIF: Moderate REF: Page and Header: 47, The Person–Place–Time Model OBJ: 2 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 4: Patterns of Health and Disease: The Role of Epidemiology in Population Health KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand

Chapter 5, Strengthening Community Action: Public Engagement for Social Innovation and Collective Impact 1. A community health worker is part of an interdisciplinary team charged with planning and carrying out a new community health initiative. What factor is most likely to have the greatest bearing on the success or failure of this initiative?

A. The presence of a valid, reliable, and current evidence base supporting the initiative B. Representation from a variety of health disciplines in the planning and execution of the initiative C. Logistical support from municipal, provincial, and federal levels of government D. Appropriate, contextualized engagement of community members in all aspects of the initiative ANS: D Rationale: Increasingly, health professionals, researchers, policy makers, and the public have acknowledged that meaningful participation of stakeholders in conceptualizing, developing, and implementing health interventions is vital to the success of such initiatives. The importance of this factor supersedes that of the evidence base, multidisciplinary cooperation, and logistics.

PTS: 1 DIF: Moderate REF: Page and Header: 66, Introduction OBJ: 1 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 5: Strengthening Community Action: Public Engagement for Social Innovation and Collective Impact KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand 2. A population health promotion program will soon be launched in a rural region.

To design and implement a program, what would an effective community development approach require?

A. Funding support, community leaders, and access to experts B. Learning opportunities for health, information technology, and funding support C. Continuous access to information, learning opportunities for health, and funding support D. Continuous access to information, information technology, and access to experts ANS: C

Rationale: Comprehensive action strategies to improve health are embedded within the Ottawa Charter. Community development is one of the cornerstones.

Effective community development requires access to information, regardless of the medium, engagement of a broad constituency of stakeholders (not just experts), and embedded learning opportunities to ensure improvement and progress.

PTS: 1 DIF: Moderate REF: Page and Header: 65, Ottawa Charter quote OBJ: 1 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 5: Strengthening Community Action: Public Engagement for Social Innovation and Collective Impact KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand 3. In the process of publicizing a health promotion program, organizers have realized that members of the community and caregivers alike have varying notions of what constitutes a community. How is the term community best defined?

A. The people who reside in a place that shares a common municipal government B. Groups of individuals who share a common culture, language, or religion C. Residents of a defined geographic region whose borders and limits are widely accepted D. Collectives of people who share common values and concerns ANS: D Rationale: Thinking of communities as collectives of people who share common values and concerns provides a broad definition of community that accurately reflects the way that people think about and organize their social relationships.

PTS: 1 DIF: Easy REF: Page and Header: 67, Community Development OBJ: 1 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 5: Strengthening Community Action: Public Engagement for Social Innovation and Collective Impact KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Understand 4. Organizers and community members are pleased with the outcomes of a recent community development program. Which action is fundamental to all community development efforts?

A. Focus on the dominant perspectives in the community B. Incorporate the diverse interests and cultures of the community C. Prioritize incorporation of vulnerable populations in the community D. Use external experts to lead the community development process ANS: B

Rationale: Many actions are fundamental to all community development initiatives. These actions extend the values and principles underpinning community development. Incorporating the diverse interests and cultures of the community is one such action. Focusing on expertise or a single perspective limits the power of the solution.

PTS: 1 DIF: Moderate REF: Page and Header: 69, Community Development Practice OBJ: 2 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 5: Strengthening Community Action: Public Engagement for Social Innovation and Collective Impact KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand 5. An inner-city community has been identified by a government ministry as the desired site for a population health promotion initiative. How would recognition of the social trend of democratization of knowledge influence ministry interactions with this inner-city community?

A. Ministry personnel and public health professionals present to the community a detailed description of the evidence that led to the identification of this community.

B. Ministry personnel come to the community with a detailed plan for the population health promotion initiative.

C. Before making the final decision, Ministry personnel and public health professionals engage with community members in ways that reflect respect for community members’ knowledge and expertise.

D. Public health professionals begin implementation of the population health promotion initiative as soon as possible to address the pressing needs in the community.

ANS: C Rationale: One of the key social trends that has influenced public engagement in health decisions is democratization of knowledge. As people become more knowledgeable, they are less likely to automatically trust authority figures and experts. Community members expect to be part of the planning and decisionmaking process for any initiatives that directly affect their community.

PTS: 1 DIF: Moderate REF: Page and Header: 66, Introduction OBJ: 3 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 5: Strengthening Community Action: Public Engagement for Social Innovation and Collective Impact KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply 6. A community health team is developing a public engagement initiative with a vulnerable population. Several principles underpin effective engagement, community development, and collaboration. Which of these principles are particularly important when working with vulnerable populations?

A. Being sensitive to inherent power differences and embedding power-sharing strategies in the initiative

B. Jointly establishing goals, objectives, and principles C. Capacity-building to sustain the initiative beyond initial implementation D. Clear, fixed structures and processes to ensure a consistent approach to initiative, design, and delivery ANS: A Rationale: There are many common values and principles underlying effective and sustainable engagement, community development, and collaboration.

Some of these are particularly salient when working with vulnerable populations; these relate specifically to developing power-sharing strategized to enable authentic participation.

PTS: 1 DIF: Difficult REF: Page and Header: 67, Values and Principles OBJ: 3 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 5: Strengthening Community Action: Public Engagement for Social Innovation and Collective Impact KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand 7. Unanticipated issues have called into question certain aspects of the community development plan that is being carried out in a community. How should organizers best respond to this?

A. Postpone the remainder of the program until a new consensus is reached B. Cancel the remainder of the program and draft a new plan C. Make necessary changes to the program to ensure relevancy D. Carry out the program as planned and address the issues during the evaluation stage ANS: C Rationale: The successful implementation of a community development plan requires flexibility and responsiveness to unanticipated events and developments. It would be likely inappropriate to put the plan on hold, to cancel the plan, or to carry out the plan unchanged.

PTS: 1 DIF: Moderate REF: Page and Header: 67, Values and Principles OBJ: 2 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 5: Strengthening Community Action: Public Engagement for Social Innovation and Collective Impact KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply 8. A community development project has been proposed for an inner-city area of a Canadian city. What factor most often prompts the initial idea for a community development project?

A. Directives from international nongovernmental organizations B. The presence of a high-visibility problem or issue C. Excess municipal budget capacity that must be put to use

D. Spontaneous initiative by champions in the community ANS: B Rationale: Often, there is an external catalyst that brings people together against a common “foe.” In some instances, it has been reactions against crime (e.g., gangs, prostitution, violence); in others, it has been a result of externally imposed decisions (e.g., urban renewal, school closings, hospital relocations) or a common issue faced by many residents. It is less common for such projects to result from international directives, money that must be spent, or the spontaneous effort of residents.

PTS: 1 DIF: Moderate REF: Page and Header: 68, Community Development Drivers OBJ: 3 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 5: Strengthening Community Action: Public Engagement for Social Innovation and Collective Impact KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand 9. A community health team is trying to engage the members of a community in a community development process. Organizers should: A. focus primarily on members of the community who have the highest potential.

B. enlist the support of residents who are middle- and upper-income earners.

C. involve a group of residents who are demographically representative of the community.

D. engage primarily with members of the ethnic group most prevalent in the community.

ANS: C Rationale: In the process of community engagement, organizers should seek diversity in representation. Focusing on the wealthiest residents, members of the dominant ethnic group, or residents with the “highest potential” are inappropriate, and likely ineffective, strategies for engagement.

PTS: 1 DIF: Moderate REF: Page and Header: 69, Community Development Practice OBJ: 3 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 5: Strengthening Community Action: Public Engagement for Social Innovation and Collective Impact KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply 10. A team of community health workers recognizes the importance of developing partnerships with community members. What factor most often motivates the development of a partnership?

A. The awareness of a need B. A subservient relationship C. A government policy directive

D. A health disparity ANS: A Rationale: Development of partnerships usually commences with a few potential partners exploring issues of common interest and identification of a need, articulating a common vision, and developing a preliminary strategy before approaching other potential partners. This requires equitable relationships. The presence or absence of government policy is unlikely to influence the development of a partnership and a health disparity may or may not exist.

PTS: 1 DIF: Easy REF: Page and Header: 78, A Process Model of Partnership Development OBJ: 4 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 5: Strengthening Community Action: Public Engagement for Social Innovation and Collective Impact KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand 11. A community health worker has committed to developing collaborative partnerships with members of the community in the context of a health promotion initiative. Within the partnership framework, which is an example of the domain?

A. The local and provincial political climates B. The existing relationships that predate the initiative C. Current epidemiologic data for the community D. Prevention of sexually transmitted infections (STIs) ANS: D Rationale: The domain is the area of interest that is the focus of partnership activities, such as a specific health promotion or prevention activity. Political systems are examples of extralocal relations.

PTS: 1 DIF: Difficult REF: Page and Header: 74, Domain OBJ: 4 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 5: Strengthening Community Action: Public Engagement for Social Innovation and Collective Impact KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze 12. In an effort to create interest in a new population health promotion initiative, the nurse is aware of the need to identify and work within the economic realities of agencies and the community. This demonstrates that the nurse is prioritizing: A. extralocal relations.

B. domain.

C. communication.

D. the partnership configuration.

ANS: A

Rationale: Extralocal relations are described as the external influences on the partnership, including the social context and the political and economic systems within which the partnership is based. The domain is the area of interest that is the focus of partnership activities and partnership configuration denotes the categories, properties, and dimensions of the partnership.

PTS: 1 DIF: Moderate REF: Page and Header: 74, Extralocal Relations OBJ: 4 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 5: Strengthening Community Action: Public Engagement for Social Innovation and Collective Impact KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand 13. While meeting with a potential partner in the context of a proposed community development project, the community health worker senses that the partner has a different perception of the program’s benefits. How should the community health worker follow up on this observation?

A. Encourage the potential partner to collaborate on a revision of the program’s planned benefits B. Explain clearly to the potential partner that the project’s identified benefits will be exclusive of any other benefits C. Discuss the potential partner’s agenda with other existing partners in the community D. Have an open discussion with the potential partner about his or her understanding of the benefits of the program ANS: D Rationale: It is important to directly and clearly discuss potential partners’ perceptions of program benefits. Differing perceptions do not necessarily preclude participation, but these differences should be explored explicitly. A revision of the program would be inappropriate, as would discussing perceived differences with third parties rather than the individual in question.

PTS: 1 DIF: Moderate REF: Page and Header: 67, Values and Principles OBJ: 4 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 5: Strengthening Community Action: Public Engagement for Social Innovation and Collective Impact KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply 14. A community health worker has initiated contact with a potential partner in the community. The health worker’s reasons for seeking this partnership should be: A. identified once the partnership has been established.

B. explicitly discussed with the potential partner.

C. withheld until the worker has appraised the potential partner’s character and agenda.

D. identified by the potential partner himself or herself.

ANS: B Rationale: It is not possible to overemphasize the importance of clearly describing the reason for the partnership. It is essential to develop early agreement on definitions regarding the vision, goals, and objectives of the partnership.

PTS: 1 DIF: Easy REF: Page and Header: 76, Communication OBJ: 5 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 5: Strengthening Community Action: Public Engagement for Social Innovation and Collective Impact KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply 15. A group of community health nurses is evaluating a community development project. What outcome demonstrates that community capacity was enhanced by the project?

A. A majority of community members acknowledge the value of the project.

B. There was a steady progression in the number of residents participating and the depth of commitment to the project.

C. Community members mobilize new knowledge and skills to improve their health.

D. Community members express a desire to continue the project beyond its projected end date.

ANS: C Rationale: Community capacity exists when members of a community develop a positive difference in their capacity and skills, because they actively participate in activities directed toward meeting their needs in some way. Approval and support for a project do not necessarily denote increased community capacity.

PTS: 1 DIF: Moderate REF: Page and Header: 67, Values and Principles OBJ: 2 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 5: Strengthening Community Action: Public Engagement for Social Innovation and Collective Impact KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze 16. A community health team is undertaking a community development process with a community youth group. Such initiatives must take into account the social capital that exists in the community. Social capital consists primarily of: A. financial resources.

B. collective coping strategies.

C. lines of defence.

D. interpersonal relationships.

ANS: D

Rationale: Social capital refers to the networks of social relations that may provide individuals and groups with access to resources and supports. At its core, social capital does not consist of money, coping skills, or lines of defence that exist in the community.

PTS: 1 DIF: Easy REF: Page and Header: 79, Social Capital and Social Networks OBJ: 5 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 5: Strengthening Community Action: Public Engagement for Social Innovation and Collective Impact KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Understand 17. A community health nurse has taught a colleague that social capital involves both bridging and bonding. What is the clearest example of bridging?

A. A group of teenagers interacts with some of the older adults from a longterm care setting.

B. A group of coworkers increases its frequency and quality of communication and trust.

C. An elementary school class develops cohesion during a wilderness campout.

D. A university student finds support and connection in a campus political club.

ANS: A Rationale: Bridging social capital is the value generated from social networks that cut across groups, creating connections that have the potential to bring in resources that a group does not currently have, or to share information between groups. In contrast, bonding social capital relates to the value assigned to social networks that are quite dense, where most members have close connections with one another.

PTS: 1 DIF: Easy REF: Page and Header: 79, Social Capital and Social Networks OBJ: 4 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 5: Strengthening Community Action: Public Engagement for Social Innovation and Collective Impact KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Analyze 18. During the assessment of a mental health client, the client fondly describes her family as “tight.” This statement is suggestive of: A. the “bridging” form of social capital.

B. equity.

C. the settings approach to environmental health.

D. the “bonding” form of social capital.

ANS: D

Rationale: Bonding social capital relates to the value assigned to social networks that are quite dense, where most members have close connections with one another. Examples include families that consider themselves to be close-knit.

PTS: 1 DIF: Easy REF: Page and Header: 79, Social Capital and Social Networks OBJ: 4 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 5: Strengthening Community Action: Public Engagement for Social Innovation and Collective Impact KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Understand 19. A nurse is participating in a backbone organization supporting a partnership initiative. What sources of influence support guiding such collective impact initiatives?

A. Competence, commitment, vested interests, data and information, network, and visibility B. Competence, objectivity, data and information, network, and visibility C. Competence, commitment, objectivity, data and information, network, and visibility D. Competence, commitment, objectivity, funding, network, and visibility ANS: C Rationale: Backbone organizations are fundamental to collective impact initiatives. Six sources of influences that are important to backbone organizations have been identified to guide collective impact efforts. Vested interests and funding are not identified as one of the six sources of influence.

PTS: 1 DIF: Moderate REF: Page and Header: 73, Sources of Influence of Backbone Organizations (Box 5.2) OBJ: 4 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 5: Strengthening Community Action: Public Engagement for Social Innovation and Collective Impact KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand 20. An agency is applying the process model of partnership development to address the problem of teen suicide in a rural community. The partnership development process should begin by: A. assigning leadership of the initiative to young people in the community.

B. determining a clear and unified vision for the community’s needs.

C. performing a detailed literature review of youth suicide.

D. consulting evidence-based guidelines for suicide prevention.

ANS: B

Rationale: Partnership development begins with the establishment of a shared vision. This vision must precede community interventions and should guide the subsequent research process.

PTS: 1 DIF: Moderate REF: Page and Header: 78, A Process Model of Partnership Development OBJ: 2 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 5: Strengthening Community Action: Public Engagement for Social Innovation and Collective Impact KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

Chapter 6, Developing Individual Skills: Building Capacity for Individual, Collective, and Sociopolitical Empowerment 1. Modern health care tends to emphasize which type of health care?

A. Aggregate community-based health care B. Individual medical care C. Family-based health care D. Family- and community-based health care ANS: B Rationale: Modern health care emphasizes individualized medical care, as opposed to providing aggregate community-based health care. Our present “system” of health care has not served our profession well and has resulted in fragmented programs and limited return on improving the overall health in communities.

PTS: 1 DIF: Easy REF: Page and Header: 84, Introduction OBJ: 1 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 6: Developing Individual Skills: Building Capacity for Individual, Collective, and Sociopolitical Empowerment KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Remember 2. A community health nurse is aware of the importance of individual capacities and individual empowerment. What statement best describes the relationship between these two concepts?

A. Individual capacities are synonymous with individual empowerment.

B. Individual empowerment is an inherent personality trait that is present in those individuals who possess individual capacities.

C. Individual capacities and individual empowerment have a synergistic relationship, with each fostering the other.

D. Individual capacities are associated with a Western, biomedical view of health, but individual empowerment is a postmodern concept.

ANS: C Rationale: The notion of individual empowerment---the development of individual capacities and the mobilization of these toward health-promoting behaviours and increased control over health is emphasized in current health policy. It is known that individual capacities both influence and are influenced by individual empowerment.

PTS: 1 DIF: Difficult REF: Page and Header: 84, Introduction OBJ: 1 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 6: Developing Individual Skills: Building Capacity for Individual, Collective, and Sociopolitical Empowerment

KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Understand 3. A community health nurse understands that the development of individual empowerment takes place in a broad context that is profoundly influenced by the process of globalization. The phenomenon of globalization has a particularly large effect on which domains?

A. Biologic and individual B. Political and financial C. Sociologic and familial D. Economic and cultural ANS: D Rationale: Contemporary globalization describes an accelerated constellation of processes by which nations, businesses, and people are becoming more interconnected and interdependent. Globalization is especially significant to individual empowerment in the economic and cultural realms.

PTS: 1 DIF: Moderate REF: Page and Header: 84, Introduction OBJ: 2 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 6: Developing Individual Skills: Building Capacity for Individual, Collective, and Sociopolitical Empowerment KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Understand 4. A community health nurse is engaged in a health promotion program that will be implemented in the context of the local Indigenous community. How do Western conceptualizations of individual empowerment tend to differ from Indigenous conceptualizations?

A. Indigenous conceptualizations of empowerment place primary responsibility on the individual, whereas Western notions of empowerment emphasize cultural context.

B. Western conceptualizations emphasize the individual’s identity as a unit discrete from the whole, whereas Indigenous conceptualizations are more relational to people and the environment.

C. Aboriginal conceptualizations of empowerment emphasize biologic and natural factors, whereas Western conceptualizations focus on sociopolitical factors.

D. The Western idea of individual empowerment is linked to improved individual health outcomes, whereas the Indigenous notion emphasizes benefits to the group.

ANS: B

Rationale: Meanings of individual empowerment, on the whole, have been shaped within neocolonial contexts that privilege Western identities, biomedically oriented beliefs, and knowledge systems over others, including those of Indigenous peoples throughout the world and Canada. On the whole, such meanings have tended to view the individual as being a discrete entity--part of, but separate from, the environment. While to some extent individual empowerment occurs within the social context, the development of individual skills and capacities (often used as a proxy for individual empowerment, as in the Ottawa Charter) is often conveyed as occurring within the individual.

Indigenous conceptualizations of individual empowerment, on the other hand, are more anchored to ideas of having a secure cultural identity and are more relational with respect to extended family, land, and metaphysical realities.

PTS: 1 DIF: Moderate REF: Page and Header: 84, Introduction OBJ: 1 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 6: Developing Individual Skills: Building Capacity for Individual, Collective, and Sociopolitical Empowerment KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Understand 5. Empowerment work with Indigenous communities takes place within the context of contemporary dynamics of economic and cultural globalization, which build on previous forms of Western imperialism. Nurses undertaking empowerment efforts in this context need to recognize: A. the heterogeneity of Indigenous identities and worldviews.

B. the homogeneity of Indigenous identities and worldviews.

C. the totalizing dominance of Western globalization and therefore the very limited possibilities of empowerment work.

D. the outdatedness of traditional Indigenous worldviews and associated cultural identities.

ANS: A Rationale: Globalization (including sociohistoric and contemporary processes of colonization) has very real impacts on the subjectivities and the material realities of people. A critical postmodern view of globalization recognizes the constructed and plural nature of cultural identities and social realities, both within and between cultural communities, and the relevance of this for empowerment practice. First Nations communities, for example, are increasingly asserting their rights to combine traditional, locally based approaches with Western models. There is no singular client, as there is no singular Indigenous individual.

PTS: 1 DIF: Moderate REF: Page and Header: 92, A Health Promotion Example OBJ: 3 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 6: Developing Individual Skills: Building Capacity for Individual, Collective, and Sociopolitical Empowerment KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Remember

6. A nurse has expressed exasperation at a client’s perceived unwillingness to control his type 2 diabetes. Which should the nurse recognize?

A. Diabetes is a Western concept that may not be shared by the client.

B. The client’s culture may emphasize illness over health.

C. A knowledge deficit may not always be modifiable.

D. Significant external barriers exist to any change in behaviour.

ANS: D Rationale: Evidence abounds that the translation of an individual’s knowledge and skills into health-promoting behaviours and practices is undoubtedly strongly influenced by socioecologic influences such as income, housing quality, location, and social capital. While health is indeed a subjective notion, no culture emphasizes illness over health. Diabetes is a physiologic phenomenon that is not culturally constructed, though the understanding and meaningmaking of the disease is influenced by culture. A knowledge deficit is unlikely to underlie this situation.

PTS: 1 DIF: Moderate REF: Page and Header: 86, Individual Empowerment in Context OBJ: 2 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 6: Developing Individual Skills: Building Capacity for Individual, Collective, and Sociopolitical Empowerment KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply 7. Which goal should a community health nurse prioritize in a community health promotion program?

A. The transformation of environments into those that support health B. Changing individuals’ behaviours to create group identity C. Compliance with recognized health behaviours by community members D. Elimination of knowledge deficits in order to improve health ANS: A Rationale: Sustained changes in health-promoting behaviours require the transformation of risk environments to those that support healthy behaviours.

Group identity and compliance are not the appropriate goals and knowledge deficits are unlikely to be central to a community’s health.

PTS: 1 DIF: Difficult REF: Page and Header: 86, Individual Empowerment in Context OBJ: 1 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 6: Developing Individual Skills: Building Capacity for Individual, Collective, and Sociopolitical Empowerment KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply 8. A community health nurse has advocated an individualized, person-based approach to health promotion in a community. What is a significant downfall of such an approach?

A. Community health is independent of individual health.

B. People tend to revert to unhealthy behaviours over time.

C. Change is possible only collectively, not individually.

D. Health promotion efforts should focus on changing cultures, not people.

ANS: B Rationale: While individual change is possible, research shows that rates of recidivism are high. Individual health and community health are interconnected.

Culture profoundly affects community and population health, but it is inaccurate to state that health promotion should focus on actively changing a culture.

PTS: 1 DIF: Moderate REF: Page and Header: 85, Individual Empowerment in Context OBJ: 2 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 6: Developing Individual Skills: Building Capacity for Individual, Collective, and Sociopolitical Empowerment KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand 9. Individual and community empowerment are likely to exist and result in improved health outcomes when what circumstance exists?

A. There are tangible rewards and benefits available to community members who adopt healthy behaviours.

B. Health promotion activities are planned, implemented, and evaluated solely by members of the community rather than health professionals.

C. The principles of the Ottawa Charter are referenced in the planning stages of health promotion programs.

D. The provision of health care and the policies that underlie that care are aligned with community needs.

ANS: D Rationale: Both individual and collective forms of empowerment require health contexts to be aligned---that is, health-related systems and policy organizations are in accord with community needs and realities. A series of rewards, exclusive involvement of community members in health promotion, and references to the Ottawa Charter do not necessarily mark community empowerment.

PTS: 1 DIF: Easy REF: Page and Header: 86, Individual Empowerment in Context OBJ: 1 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 6: Developing Individual Skills: Building Capacity for Individual, Collective, and Sociopolitical Empowerment KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand 10. A community health nurse recognizes the importance of fostering community settings that are empowering. According to Maton, what is an aspect of empowering community settings that influence individuals, the surrounding community, and the larger society?

A. Empowerment creates an environment in which unhealthy behaviours are met with sanctions.

B. Empowered individuals create a critical mass that encourages compliance with the principles of health promotion.

C. Empowered individuals have the potential to create empowerment among others.

D. Empowerment results in knowledge, which underlies all changes in behaviour.

ANS: C Rationale: Maton cites the “radiating” effect of empowerment, in which empowerment begets empowerment (2008). This process is neither coercive nor punitive. Knowledge is a facet of empowerment, but it is not necessarily the central construct.

PTS: 1 DIF: Moderate REF: Page and Header: 86, Individual Empowerment in Context OBJ: 1 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 6: Developing Individual Skills: Building Capacity for Individual, Collective, and Sociopolitical Empowerment KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand 11. A nurse who provides care at a nursing outpost in Northern Canada understands the need to integrate Indigenous conceptualizations of health into care. Compared with Western notions of health, Indigenous understandings of health are known to be more: A. abstract.

B. unsophisticated.

C. individualistic.

D. holistic.

ANS: D Rationale: Indigenous approaches to health are distinct from Western constructions in that they emphasize wholeness, connection, balance, harmony, and growth. Such approaches are less individualistic than Western ideas of health, and it is erroneous to characterize them as unsophisticated.

PTS: 1 DIF: Easy REF: Page and Header: 87, Health and Empowerment OBJ: 2 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 6: Developing Individual Skills: Building Capacity for Individual, Collective, and Sociopolitical Empowerment KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Remember

12. A nurse has been posted to a Cree reserve to work with the community to plan and provide culturally appropriate health promotion projects. How are members of the community most likely to understand the concept of well-being and empowerment?

A. The empowerment and health of each member of the community are linked on many levels to the other members of the community, including its nonhuman members such as the land.

B. Empowerment is a concept that is merit-based and likely exclusive to the highest-profile members of the community.

C. The members of the community likely feel empowered by the small size of the community.

D. The members of the community are likely to see empowerment as a Western, neocolonial construct that has no place in the community.

ANS: A Rationale: For Indigenous peoples, empowerment is generally much more a collective phenomenon within which the individual is metaphysically indistinct from his or her extended family, ancestors, land, and historical tribal context.

Members of the community are unlikely to see empowerment as purely meritbased. A small community is not necessarily empowered.

PTS: 1 DIF: Easy REF: Page and Header: 87, Health and Empowerment OBJ: 2 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 6: Developing Individual Skills: Building Capacity for Individual, Collective, and Sociopolitical Empowerment KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand 13. A community health nurse has built a strong therapeutic relationship with an older adult client who is functionally illiterate. Illiteracy is associated with which health outcome(s) and determinants of health? Select all that apply.

A. Obesity B. Low income C. Substance abuse D. Low self-esteem E. Diabetes mellitus ANS: B, C, D Rationale: Low literacy has several indirect effects on health. Illiteracy may lead to difficulty obtaining and retaining employment, which in turn may result in low income, low self-esteem, social isolation, and the abuse of alcohol and tobacco. Although it is associated with poor management of chronic conditions, it is not identified as a direct contributor to diabetes or obesity.

PTS: REF: NAT: TOP:

1 DIF: Moderate Page and Header: 87, Literacy and Health for All OBJ: 3 Client Needs: Physiological Integrity: Reduction of Risk Potential Chapter 6: Developing Individual Skills: Building Capacity for Individual,

Collective, and Sociopolitical Empowerment KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Understand 14. The elders of an Indigenous community have initiated a health literacy campaign to promote health and empowerment among members of the community. This project is likely to be most effective if it: A. actively links health literacy to cultural continuity or connectedness.

B. focuses exclusively on reading and writing skills.

C. emphasizes the importance of possessing the skills to read at a 10th-grade level.

D. focuses on the ability to convey personal opinions and values in written form.

ANS: A Rationale: The mobilization of identities and cultural systems as capacities for individual and community empowerment within health-related initiatives is increasingly apparent within Canada and throughout the world. Approaches to health literacy with Indigenous peoples such as the rainbow approach emphasize multiple forms of literacy such as knowledge of mother tongue, knowledge of traditional ceremonies and spirituality, as well as the ability to read and write, promote cultural continuity, and therefore empowerment on people’s own terms.

PTS: 1 DIF: Difficult REF: Page and Header: 88, Literacy and Health for All OBJ: 2 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 6: Developing Individual Skills: Building Capacity for Individual, Collective, and Sociopolitical Empowerment KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Understand 15. Which event most clearly exemplifies the phenomenon of relative deprivation?

A. A man lacks the knowledge to effectively manage his kidney disease.

B. A woman experiences exclusion from society due to her low income.

C. A man feels patronized by the health professionals that he engages with.

D. A woman’s remote residence limits her access to health care facilities.

ANS: B Rationale: Relative deprivation, or relative access to environmental capacities, is significant with respect to both health and empowerment. Inequalities in incomes are important in that by having “less,” some sectors of the population are excluded socially and materially from the life of society. This phenomenon is not directly attributable to geography or knowledge.

PTS: REF: OBJ: TOP:

1 DIF: Difficult Page and Header: 89, Power-Culture, Empowerment, and Health 3 NAT: Client Needs: Health Promotion and Maintenance Chapter 6: Developing Individual Skills: Building Capacity for Individual,

Collective, and Sociopolitical Empowerment KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze 16. Groups that are culturally and economically marginalized have lower levels of access to environmental supports such as employment, adequate income and housing, and appropriate health care. This is primarily because of: A. personal bigotry toward them.

B. their own ignorance about mainstream culture.

C. structural and personal discrimination.

D. low literacy levels.

ANS: C Rationale: Lack of access to the environmental supports conducive to health is mainly related to the lack of alignment of a community’s realities and cultural values with the rules, norms, and conventions on which institutions and public policies are based. For example, state-owned housing or employment conditions may not be suitable for people with disabilities because they are based on mainstream ableist norms. Furthermore, the ability to produce and disseminate culture or societal norms on a large scale is closely tied to economic or material forms of power. Members of economically and culturally dominant groups (e.g., Caucasian, male, middle class) tend to control major sources of media and therefore hold the power to construct beliefs; often positioning cultural minority groups in negative ways which can lead to personal discrimination and therefore the denial of access or a lower quality of environmental supports for well-being (e.g., appropriate health care).

PTS: 1 DIF: Moderate REF: Page and Header: 90, Power-Culture, Empowerment, and Health OBJ: 3 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 6: Developing Individual Skills: Building Capacity for Individual, Collective, and Sociopolitical Empowerment KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand 17. Despite being a member of an at-risk minority group, a community member demonstrates strengths within the internal empowerment terrain. What aspects of this individual’s life would be considered to be a component of this terrain?

A. A unified and supportive family B. Sufficient income to access recreational facilities C. A strong self-identity D. Adequate housing ANS: C Rationale: The internal empowerment terrain refers to the more subjective or psychological elements of empowerment---consciousness, identity, and culture.

Consciousness includes knowledge, skills, ability to think critically, and intuition and identity includes one’s sense of self, belonging, and self-esteem.

PTS: 1 DIF: Difficult REF: Page and Header: 90, The Empowerment Terrain OBJ: 3 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 6: Developing Individual Skills: Building Capacity for Individual, Collective, and Sociopolitical Empowerment KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze 18. A same-sex--attracted high school student is recognized by peers and teachers as having strong and resilient self-esteem. This strength is a component of the youth’s: A. culture.

B. external empowerment terrain.

C. relative deprivation.

D. internal empowerment terrain.

ANS: D Rationale: The internal empowerment terrain refers to the more subjective or psychological elements of empowerment---consciousness, identity, and culture.

Consciousness includes knowledge, skills, ability to think critically, and intuition and identity includes one’s sense of self, belonging, and self-esteem.

PTS: 1 DIF: Easy REF: Page and Header: 90, The Empowerment Terrain OBJ: 3 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 6: Developing Individual Skills: Building Capacity for Individual, Collective, and Sociopolitical Empowerment KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand 19. A transgender person in the process of gender transition presents to a practice nurse with symptoms of work-related stress following a poor performance appraisal. From an empowerment perspective, the practice nurse should: A. respect the client’s privacy and adopt a strictly biomedical approach.

B. adopt a holistic approach which includes learning as much as possible about the person’s working conditions, contexts, collegial relationships, and reoccurring cultural-power dynamics that may have a bearing on work performance and experience of stress.

C. assume that being a transgender person is the primary cause of the person’s stress-related symptoms and immediately refer the person for further help in this area.

D. advise the client to improve work performance to make the stress go away.

ANS: B

Rationale: The nature and context of work, including the individual and collective power relations in employment contexts, can contribute to health inequalities. Using the power-culture lens would enable the nurse to consider how different forms of power (individual, group, and institutional) interacting with cultural systems operative in the workplace (in this case, perhaps, forms of hetero- or gender-normativity) might contribute to stress by limiting the person’s opportunities for success, well-being, and sense of empowerment.

PTS: 1 DIF: Difficult REF: Page and Header: 89, Power-Culture, Empowerment, and Health OBJ: 3 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 6: Developing Individual Skills: Building Capacity for Individual, Collective, and Sociopolitical Empowerment KEY: Integrated Process: Caring BLM: Cognitive Level: Apply

Chapter 7, Creating Supportive Environments for Health: Enabling Community Action 1. The Ottawa Charter of 1986 stated that the protection of the natural and built environments and the conservation of natural resources must be addressed in any health promotion strategy. The principle of reciprocal maintenance is linked to this assertion. What statement best describes the principle of reciprocal maintenance?

A. Caring for each other, our communities, and our natural environment B. Caring for our communities and the natural environment C. Embedding recycle, reduce, and reuse strategies in health promotion initiatives D. Embedding a caring approach in all that we do ANS: A Rationale: The Ottawa Charter specifically describes reciprocal maintenance as caring for each other, our communities, and our natural environment. By including caring for each other, explicit links are drawn between people and their environments. Recent efforts to promote environmental stewardship adopt the slogans of recycle, reduce, and reuse; however, these do not encompass the human and relational components of our global responsibilities. Similarly, while nursing practice emphasizes a general caring approach for the environment, more specific descriptors are required.

PTS: 1 DIF: Easy REF: Page and Header: 95, Introductory Quote from Ottawa Charter OBJ: 1 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 7: Creating Supportive Environments for Health: Enabling Community Action KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand 2. The 1986 Global Health Promotion Conference held in Ottawa was a landmark event in the history of population health and the relationship between health and environments. What plan for action emerged from the resolutions of this conference?

A. Increase immunization rates B. End prejudice and oppression C. Promote health autonomy D. Educate primary health providers ANS: B

Rationale: Five components for action were identified in Ottawa: ending prejudice and oppression; creating a new vision of environmental choice; fostering technology for assessing our environment; accommodating diversity through participation; and becoming world experts in intersectoral action in the design of healthy environments. Increasing immunization rates, promoting health autonomy, and educating primary health providers are important health promotion strategies, but were not included in the resolutions..

PTS: 1 DIF: Easy REF: Page and Header: 96, Introduction OBJ: 1 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 7: Creating Supportive Environments for Health: Enabling Community Action KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand 3. Which strategy for action has been identified as a means of realizing the goals of the 1986 Global Health Promotion Conference held in Ottawa?

A. Increase punitive measures for citizens who knowingly neglect their health.

B. Increase the role of private enterprise in the delivery of Canadian health care.

C. Educate the public about the role of the environment in health.

D. Delegate health education from nurses and physicians to citizen action committees.

ANS: C Rationale: Out of the Ottawa conference, four strategies for action arose from a commitment to make healthy environments available to all Canadians: political vision and leadership in all five identified action components; scientific and social research and industrial incentive to produce materials that are cleaner, less risky, and less damaging; public education about environmental effects on health; and legislative review and reexamination of policies to ensure that individuals control their environments.

PTS: 1 DIF: Moderate REF: Page and Header: 96, Introduction OBJ: 1 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 7: Creating Supportive Environments for Health: Enabling Community Action KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Understand 4. The Third International Conference on Health Promotion in Sundsvall, Sweden, issued a call to people in all parts of the world to actively engage in making environments more supportive to health. What dimensions of the concept of “environment” underpinned discussions at the Sundsvall conference?

A. Physical, economic, and political components B. Physical, economic, mental, and political components C. Physical, social, economic, and political components D. Physical, economic, social, mental, and political components ANS: C

Rationale: The concept of environment is broad, and is not limited to physical dimensions. It also includes political, economic, and social realities. Mental health promotion is an important area of focus but is not considered a dimension of the environment.

PTS: 1 DIF: Moderate REF: Page and Header: 96, Sundsvall Conference and Statement OBJ: 2 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 7: Creating Supportive Environments for Health: Enabling Community Action KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand 5. Participants in the Third International Conference on Health Promotion in Sundsvall, Sweden, noted several deficits in global environments and the role that these environments play in supporting health. These deficits included which phenomenon?

A. Health inequalities between rich nations and poor nations B. Increasing apathy about health among residents of developed countries C. Declines in the quantity and quality of health research D. Political interests that run contrary to the principles of population health ANS: A Rationale: Participants at Sundsvall noted the significant health inequalities as reflected in the widening gap in health status both within nations and between rich and poor countries; millions of people live in extreme poverty and deprivation in an increasingly degraded environment; an alarming number of people suffer from the tragic consequences of armed conflicts; and rapid population growth is a major threat to sustainable development forcing people to survive without clean water and adequate food, shelter, or sanitation.

PTS: 1 DIF: Easy REF: Page and Header: 97, Sundsvall Conference and Statement OBJ: 2 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 7: Creating Supportive Environments for Health: Enabling Community Action KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand 6. The Sundsvall Statement suggests that interventions to achieve health for all must reflect two basic principles: equity and public action. What action best demonstrates the principle of equity?

A. Investing health capital in a way that ensures a balance between short-term, medium-term, and long-term improvements in health outcomes B. Allocating resources in a way that acknowledges the fact that many groups are marginalized C. Soliciting and integrating input from citizens on the appropriate use of public funds for health D. Aiming to ensure an equal per capita level of health spending between individuals and across communities and populations ANS: B

Rationale: The concept of equity dictates that any action and resource allocation should be based on clear priorities and a commitment to those marginalized by poverty, gender, race, or disability. Equity is not synonymous with equality in spending and does not necessitate a balance between shortterm and longer-term outcomes.

PTS: 1 DIF: Difficult REF: Page and Header: 97, Sundsvall Conference and Statement OBJ: 1 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 7: Creating Supportive Environments for Health: Enabling Community Action KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze 7. Delegates at the International Conference on Health Promotion in Sundsvall, Sweden, specified four key action strategies to create supportive environments at the community level. What intervention best exemplifies one of these strategies?

A. Supporting and encouraging women's groups to advocate for health B. Increasing public spending on the treatment of chronic disease C. Regionalizing health care to ensure financial cost savings D. Prioritizing primary health prevention over secondary and tertiary prevention ANS: A Rationale: There were four key action strategies identified at Sundsvall to create supportive environments at the community level: strengthen advocacy through community action, particularly through groups organized by women; enable communities and individuals to take control over their health and environment through education and empowerment; build alliances for health and supportive environments in order to strengthen the cooperation between health and environmental campaigns and strategies; and mediate between conflicting interests in society in order to ensure equitable access to supportive environments and health.

PTS: 1 DIF: Difficult REF: Page and Header: 97, Sundsvall Conference and Statement OBJ: 1 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 7: Creating Supportive Environments for Health: Enabling Community Action KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze 8. The Rio+20 conference held in Rio de Janeiro in 1992 reinforced the commitments made at the original health promotion conference. In the summary report entitled The Future We Want, the overarching objectives and requirements for sustainable development were clearly articulated. Which best summarizes these objectives and requirements?

A. Poverty eradication; promoting sustainable patterns of consumption and production; protecting and managing the natural resource base of economic and social development

B. Poverty eradication; protecting and managing the natural resource base of economic and social development C. Poverty reduction; promoting sustainable patterns of consumption and production; managing natural resources D. Poverty eradication; changing unsustainable and promoting sustainable patters of consumption and production ANS: A Rationale: As articulated at the Rio+20 conference, there are three main objectives and requirements for sustainable development; they are poverty eradication, changing unsustainable and promoting sustainable patterns of consumption and production, and protecting and managing the natural resource base of economic and social development.

PTS: 1 DIF: Easy REF: Page and Header: 97, The Future We Want---Rio+20 OBJ: 2 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 7: Creating Supportive Environments for Health: Enabling Community Action KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand 9. As highlighted in the WHO Commission on Social Determinants of Health report that was released in 2008, the first of its overarching recommendations was “Improve Daily Living Conditions”. Inequities in daily living are usually seen in what domains?

A. Early childhood and schooling; employment and working conditions; the built environment B. Early childhood and schooling; employment and working conditions; the built environment; the quality of the natural environment C. Employment and working conditions; the built environment; the quality of the natural environment D. Early childhood and schooling; employment and working conditions; the quality of the natural environment ANS: B Rationale: There were four main conditions associated with the first recommendation to “Improve Daily Living Conditions.” These included the following: early childhood and schooling; employment and working conditions; the physical form of the built environment; the quality of the natural environment in which people reside.

PTS: 1 DIF: Easy REF: Page and Header: 98, Health Equity---World Health Organization OBJ: 2 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 7: Creating Supportive Environments for Health: Enabling Community Action KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand

10. The level of contaminants present in the bodies of Canadians differs markedly between and among groups. What group of Canadians is identified as being particularly susceptible to high contamination levels?

A. Women B. People who live near manufacturing and processing plants C. People who are engaged in physical labour D. Children younger than 6 ANS: B Rationale: In some parts of Canada, the results of environmental abuse have caused many Canadians, particularly those populations that live near manufacturing and processing plants, or in remote areas, to have detectable levels of contaminants in their blood, hair, and body tissues.

PTS: 1 DIF: Easy REF: Page and Header: 98, The Natural Environment OBJ: 2 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 7: Creating Supportive Environments for Health: Enabling Community Action KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Understand 11. Poor air quality can cause a variety of health effects. The level of contamination in outdoor air is primarily influenced by: A. degree of industrialization, local pollution emission standards, season, and daily weather conditions.

B. population density, local pollution emission standards, climate, and daily weather conditions.

C. population density, degree of industrialization, local pollution emission standards, season, climate, and daily weather conditions.

D. degree of industrialization, local pollution emission standards, and daily weather conditions.

ANS: C Rationale: Influences on outdoor air pollution are multiple and complex. They include the following six influences: population density, degree of industrialization, local pollution emission standards, season, climate, and daily weather conditions.

PTS: 1 DIF: Easy REF: Page and Header: 99, Air Quality OBJ: 2 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 7: Creating Supportive Environments for Health: Enabling Community Action KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand 12. A resident of a First Nations reserve that is located downstream from a large, industrial complex has presented for care to a health outpost with a number of health problems. Based on the client's geographic location, the nurse would be justified in assessing the client for what form of contamination?

A. Lead

B. Escherichia coli C. Listeria D. Ionizing radiation ANS: A Rationale: The presence of contaminants such as lead and mercury is closely associated with proximity to processing and manufacturing plants. The effects of bacteria and radiation are less likely to result from this proximity.

PTS: 1 DIF: Moderate REF: Page and Header: 98, The Natural Environment OBJ: 2 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 7: Creating Supportive Environments for Health: Enabling Community Action KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply 13. The results of a community analysis demonstrate a high incidence and prevalence of asthma in a community. The nurse understands that the course of this disease is highly influenced by: A. low atmospheric oxygen levels.

B. waterborne microorganisms.

C. industrial waste.

D. airborne contaminants.

ANS: D Rationale: Asthma is triggered by a variety of airborne contaminants. The incidence and manifestations of the disease are not commonly affected by industrial waste, microorganisms in water, or low atmospheric oxygen levels.

PTS: 1 DIF: Easy REF: Page and Header: 98, Air Quality OBJ: 2 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 7: Creating Supportive Environments for Health: Enabling Community Action KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand 14. Management of a provincial government office has noted a sharp increase in employees' sick time in the past several months and has now consulted community health nurses. What phenomenon has the greatest potential to affect these workers' rates of illness?

A. Indoor workers are vulnerable to the effects of water pollution in the pipes of high-rise buildings.

B. “White collar” workers often suffer the effects of low activity levels and a sedentary lifestyle.

C. Sudden increases in sick time usually result from a cultural normalization of absenteeism in a workplace.

D. The accumulation of indoor contaminants existing in “sick buildings.”

ANS: D

Rationale: Pollutants can also arise from poor building ventilation that allows contaminants from building materials, furnishings, heating, cooking, consumer products (e.g., tobacco, perfumes), and the soil to build up indoors. This often results in “sick buildings.” A sedentary lifestyle is associated with illness, but this is unlikely to result in a sudden or sharp increase in sick time. Water pollution is less common than air pollution in buildings.

PTS: 1 DIF: Easy REF: Page and Header: 99, Air Quality OBJ: 2 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 7: Creating Supportive Environments for Health: Enabling Community Action KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand 15. A nurse is participating in a health forum with a group of young adults at a university college. Which teaching point should the nurse provide to participants about the risks of skin cancer?

A. “All in all, it's best if you completely avoid going to tanning salons.”

B. “There are lifestyle factors involved in the development of skin cancer but genetics is a major factor as well.”

C. “As much as possible, it's best to avoid getting a job where you'd be required to be outside for long periods.”

D. “Apart from advocating for measures to preserve the ozone layer, there's little you can personally do to alter your risk of skin cancer.”

ANS: A Rationale: Tanning is a major preventable risk factor for skin cancer. It is unnecessary to avoid all outside exposure to the sun, since protective measures (sunscreen, clothing, hats) can be taken. Genetics is not identified as a major risk factor.

PTS: 1 DIF: Easy REF: Page and Header: 99, Air Quality OBJ: 2 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 7: Creating Supportive Environments for Health: Enabling Community Action KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply 16. Despite the fact that drinking water is a comparatively minor source of pollutants and contaminants in Canada, the nurse is aware that risks do still exist. What water source is associated with the majority of water-borne diseases in Canada?

A. Rain water B. Private wells C. Municipal tap water D. Imported bottled water ANS: B

Rationale: With a few exceptions, the most serious water contamination problems in Canada involve tap water from untreated sources, such as private wells.

PTS: 1 DIF: Easy REF: Page and Header: 99, Water Quality OBJ: 2 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 7: Creating Supportive Environments for Health: Enabling Community Action KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand 17. A community health nurse is conducting a well-baby visit to the home of a firsttime mother and her infant. The mother has expressed concern that the fluoride in tap water may pose a threat to her baby's health, and she has consequently been using bottled water to reconstitute commercial formula. How should the nurse best respond to this client?

A. “You're practicing due diligence, so keep up the good work!”

B. “You're right. Most people don't acknowledge the health risks of infant exposure to fluoride.”

C. “As long as you limit your baby's fluid intake to reasonable levels, this shouldn't be a problem.”

D. “There are many rumours about the health risks of fluoridated water, but research hasn't demonstrated any serious risks.”

ANS: D Rationale: Despite claims to the contrary, there is no evidence that fluoridated water causes heart disease, cancer, thyroid problems, birth defects, miscarriages, or hearing or vision problems. It would be inappropriate to suggest fluid restriction to the mother.

PTS: 1 DIF: Easy REF: Page and Header: 99, Water Quality OBJ: 2 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 7: Creating Supportive Environments for Health: Enabling Community Action KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply 18. A community health nurse recognizes that members of the public cannot take action to manage and minimize their health risks unless they are cognizant of these risks. Which is the clearest example of risk communication?

A. The ParticipACTION program B. Warning labels on cigarette packages C. Sun protection factor (SPF) ratings on sunscreen D. Immunization campaigns ANS: B

Rationale: Risk communication involves the exchange of information about the existence, nature, form, severity, or acceptability of health or environmental risks. SPF ratings do not directly inform citizens of the risks of sun exposure and health promotion campaigns do not necessarily teach about the risks of inactivity or foregoing immunizations.

PTS: 1 DIF: Easy REF: Page and Header: 96, Introduction OBJ: 1 NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential TOP: Chapter 7: Creating Supportive Environments for Health: Enabling Community Action KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Understand 19. A nurse is involved in the planning of a health promotion program that aims to create a supportive environment for the health of inner-city youth. According to the Action Process for Creating Supportive Environment for Health Action Plan (APCSEH), how should the nurse begin this process?

A. By publicizing the potential benefits of the program for youth and the other members of the community B. By enlisting a core group of youth to act as ambassadors for the program C. By securing funding from municipal, provincial or territorial, and federal sources D. By promoting partnerships and commitment among youth and other community members ANS: D Rationale: A planning approach called the Action Process for Creating Supportive Environment for Health Action Plan (APCSEH) suggests following concrete steps that begin with the preparatory stages of gaining commitment, forming partnerships, and creating the processes of working together; followed by assessment, analysis, public participation, and priority setting; and completed by the planning approval, launch, and evaluation stages.

PTS: 1 DIF: Easy REF: Page and Header: 100, Action Process for Creating Supportive Environments for Health OBJ: 4 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 7: Creating Supportive Environments for Health: Enabling Community Action KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply 20. In an effort to foster a supportive environment for health, a nurse is aware of the importance of settings. Which statement is true of a settings approach to environmental health?

A. The success or failure of strategies to create supportive environments depends largely on the characteristics of a unique context.

B. Human relationships are the sole determinant of the quality and character of environmental health initiatives.

C. A health promotion strategy that was effective in one setting is, by definition, inappropriate for any other setting.

D. A health care setting is beyond the influence of nurses and citizens alike.

ANS: A Rationale: The success of health strategies depends on their fit with the people who are involved, the health issue being addressed, and the environmental characteristics of the setting. This does not mean that a setting may never be influenced. People and relationships are central factors but not the only ones.

Strategies may be adopted between different settings.

PTS: 1 DIF: Easy REF: Page and Header: 103, Action Process for Creating Supportive Environments for Health OBJ: 3 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 7: Creating Supportive Environments for Health: Enabling Community Action KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand

Chapter 8, Reorienting Health Services: New Directions for Health Promotion 1. Which document first paved the way for recommendations on strengthening the primary health care (PHC) system in Canada?

A. Declaration of Alma-Ata B. Lalonde Report C. Ottawa Charter D. Millennium Development Goals ANS: B Rationale: Several foundational texts influence PHC in Canada, beginning with the Lalonde Report in 1974, followed by the International Conference on Primary Health Care that resulted in the Alma-Ata Declaration of 1978, which was followed by the Ottawa Charter in 1986, and Millennium Development Goals in 2000.

PTS: 1 DIF: Easy REF: Page and Header: 108, Primary Health Care OBJ: 1 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 8: Reorienting Health Services: New Directions for Health Promotion KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand 2. One of the stated goals of the Declaration of Alma-Ata was to achieve “Health for All.” What action best demonstrates one of the principles that formed the basis of Health for All? A. Teaching elementary students how to integrate physical activity into their daily routines B. Providing tax incentives for pharmaceutical research and development C. Building more community-based hospice care facilities for acute needs clients D. Providing outreach to encourage members of minority groups to secure positions in the health care professions ANS: A Rationale: One of the principles of Health for All was the reorientation of the health system for the promotion of health and prevention of disease and injury, a principle that is enacted by teaching people to adopt healthy lifestyles.

Minority participation in health care, encouraging research and development, and funding more hospital beds are all laudable actions, but they do not directly exemplify the principles of Health for All. PTS: 1 DIF: Difficult REF: Page and Header: 108, Primary Health Care

OBJ:

1

NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 8: Reorienting Health Services: New Directions for Health Promotion KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze 3. The most recent revisions to “Health for All” specify the need for universal access to health care and coverage on the basis of need. In the spirit of this revision, how should this principle be translated into policy and practice?

A. Those who require health care should receive the care that is necessary.

B. Health care spending per capita should be equal regardless of social status.

C. Governments should be the sole funders of a nation’s health care systems.

D. No individual should have access to unnecessary health care procedures.

ANS: A Rationale: This principle suggests that all residents of a community should be able to get the care that they need. It does not necessarily mean that governments should be the sole funders of health care or that spending should be identical per capita.

PTS: 1 DIF: Moderate REF: Page and Header: 108, Primary Health Care OBJ: 1 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 8: Reorienting Health Services: New Directions for Health Promotion KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply 4. The Declaration of Alma-Ata identifies eight essential services as components of primary health care. Among these is maternal and child health care, which was included as a means of: A. fostering reproductive rights and reducing infant mortality.

B. promoting breast-feeding and decreasing long maternal hospital stays.

C. controlling traditional birthing practices and improving access to medical care.

D. increasing access to quality technology and boosting economic stability.

ANS: A

Rationale: At a policy level, family planning and other maternal and child health care initiatives (e.g., immunization) are grounded in reducing infant mortality rates and increasing chances of children living to adulthood. While programs for breast-feeding and decreasing hospital stays may achieve this, these are specific initiatives that do not operate at a broad, international policy level, where local contexts (i.e., hunger, secure food supplies, traditional wellness infrastructure) may require adapted approaches. While PHC seeks to improve access to medical care, in principle it does not dismiss traditional health practices nor emphasize that access to quality technology will invariably improve well-being. Furthermore, the Declaration of Alma-Ata is articulated around a social justice and community participation vision of health, rather than justifying reoriented health services through the prospect of economic stability.

PTS: 1 DIF: Difficult REF: Page and Header: 109, Primary Health Care OBJ: 4 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 8: Reorienting Health Services: New Directions for Health Promotion KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand 5. Which factor has most influenced the current, predominant understanding of health in Canada?

A. Increases in the incidence and prevalence of chronic diseases B. The Western, biomedical model of health C. The eradication of many infectious diseases D. The community-oriented, collectivist orientation of Canadian cultures ANS: B Rationale: In countries such as Canada, one of the most salient influences on the character and organization of health care has been the Western, biomedical model of health and illness. There is an individualistic, not collectivist, character to Canadian culture. Although chronic diseases are becoming more common while infectious diseases become less common, this trend is less significant to shaping predominant understandings of health grounded in Western philosophical underpinnings.

PTS: 1 DIF: Easy REF: Page and Header: 111, Toward an Integrated Model of Health OBJ: 2 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 8: Reorienting Health Services: New Directions for Health Promotion KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand 6. Which of the following are standards for promoting healthy workplaces in hospitals? Select all that apply.

A. Management has written policy for health promotion.

B. In partnership, clients and professionals systematically assess health promotion needs.

C. Management establishes conditions for the development of a healthy workplace.

D. Organization has planned approach for collaboration with other health service levels/institutions/sectors.

E. Management defers to Board of Governors in questions of professional misconduct.

ANS: A, B, C, D Rationale: The WHO has established standards for assessing the quality of health promotions in hospitals, which address management policy, patient assessment, information and intervention, promoting a healthy workplace, and continuity and cooperation. These standards aim to assist hospitals in their role in health promotion by incorporating capacity building and organizational change to promote health. Issues of professional misconduct are not specified in the WHO’s list.

PTS: 1 DIF: Moderate REF: Page and Header: 112, Standards for Health Promotion in Hospitals (Table 8.1) OBJ: 3 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 8: Reorienting Health Services: New Directions for Health Promotion KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Remember 7. Full implementation of primary health care policy documents in Canada, such as the Lalonde Report and Ottawa Charter, would entail which action?

A. Community development initiatives would replace acute care and treatment services.

B. The role of physicians in the health care system would be phased out.

C. More money would be spent on health promotion and illness/injury prevention services.

D. Individuals would bear the direct costs of their health care in order to foster accountability.

ANS: C Rationale: Position statements such as the Lalonde Report do not advocate the abandonment of acute care or physicians’ services, but rather recommend a greater proportion of health care spending on health promotion and disease prevention. User-pay systems are not recommended.

PTS: 1 DIF: Moderate REF: Page and Header: 113, Healthy and Safe Communities OBJ: 2 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 8: Reorienting Health Services: New Directions for Health Promotion

KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply 8. In contrast to primary care, primary health care (PHC): A. emphasizes the role of family physicians in the delivery of care.

B. broadly mobilizes forces within the society toward a transformed health systems agenda.

C. implements treatment- and cure-based efforts to tackle preventable diseases.

D. is principally located in health-promoting hospitals.

ANS: B Rationale: PHC is not uniquely physician- or even health service provisionfocused, nor dedicated predominantly to disease treatment efforts. It is located broadly within society and not uniquely within hospitals, even if these are health promoting.

PTS: 1 DIF: Moderate REF: Page and Header: 108, Primary Health Care OBJ: 2 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 8: Reorienting Health Services: New Directions for Health Promotion KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand 9. School health promotion is expected to: A. hold teachers accountable for the well-being of children with whom they work.

B. reduce injury and psychosomatic symptoms of bullying.

C. enable routine drug testing among at-risk youth.

D. train children to have more confidence in the health care system.

ANS: B Rationale: Health promotion in schools is based on the idea that children and youth with safe, health-promoting school environments are more likely to view school as a positive experience and are less likely to engage in risk behaviours.

A health-promoting school provides education on media literacy, problemsolving, and communication skills, and provides support services to allow students to become healthy, productive members of society, thereby reducing injury and violence (e.g., bullying). Teachers alone are not accountable for the well-being of children; rather, administration, staff, faculty, and students all must act together to promote health. The focus of health promotion in schools is not to train children to have more confidence in the health care system, but rather to encourage students to become responsible for their own lifelong health practices. Routine drug testing is not expected in the course of school health promotion.

PTS: 1 DIF: Moderate REF: Page and Header: 113, The Health Promoting Schools Movement

OBJ: 3 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 8: Reorienting Health Services: New Directions for Health Promotion KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand 10. Which example shows the highest commitment to health-promoting principles related to a disaster response strategy?

A. A hospital develops strategic response to natural disaster impacting marginalized population through community partnerships.

B. A hospital purchases and distributes staff copies of health promotion manual from disciplinary bodies.

C. A hospital has diverse disaster response plans in distinct units of the institution.

D. A hospital budgets for infrastructure to support disaster response plans.

ANS: A Rationale: Health-promoting initiatives involve community partnerships and do not merely rely on staff to become more informed. They also involve intersectoral collaboration integrating multiple units and reach beyond infrastructure to the networks and people who carry out health promotion.

PTS: 1 DIF: Moderate REF: Page and Header: 115, Health Sector Reform OBJ: 5 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 8: Reorienting Health Services: New Directions for Health Promotion KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze 11. Client participation in service planning, delivery, and evaluation decisions within hospital contexts is an example emerging from which specific movement?

A. Primary care movement B. Health training movement C. Community involvement movement D. Health promoting hospitals movement ANS: D Rationale: Client participation in service planning in hospitals emerged through an international movement for health-promoting hospitals that was beyond a primary care or uniquely staff training focus. While inclusive of nonmedical people in health service planning, delivery, and evaluation, this movement began with a focus on clients and not the wider community in which a hospital is located.

PTS: REF: OBJ: TOP:

1 DIF: Easy Page and Header: 112, The Health Promoting Hospital Movement 3 NAT: Client Needs: Health Promotion and Maintenance Chapter 8: Reorienting Health Services: New Directions for Health

Promotion KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand 12. Which statement by a hospital administrator conveys an accurate understanding of the principles of the health-promoting hospitals (HPH) movement?

A. “We need to reframe our understanding of the hospital from something that exists for clients to something that exists for our workers.”

B. “We should be diverting some of our budget to efforts at building the community’s capacity for change.”

C. “We need to acknowledge that not everyone who uses our hospital lives near to it.”

D. “We should stop relying on tried-and-true methods of treatment and be more ready to embrace innovation.”

ANS: B Rationale: The HPH movement involves an acknowledgement that it is necessary to create capacity for healthful change. The movement does not imply that hospitals exist for their staff or that innovative treatments are imperative.

PTS: 1 DIF: Moderate REF: Page and Header: 112, The Health Promoting Hospital Movement OBJ: 3 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 8: Reorienting Health Services: New Directions for Health Promotion KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze 13. Which initiative best demonstrates the principles of the health-promoting hospitals (HPH) movement?

A. An international staff recruitment drive B. Establishment of an outpatient eye surgery clinic C. A staff diabetes screening and education program D. A technology-awareness campaign for staff ANS: C Rationale: Screening and prevention efforts are characteristic of the HPH movement. Establishment of outpatient clinics and technology programs are not incongruent with the HPH movement, but they are not direct examples of the HPH principles.

PTS: 1 DIF: Easy REF: Page and Header: 112, The Health Promoting Hospital Movement OBJ: 3 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 8: Reorienting Health Services: New Directions for Health Promotion KEY: Integrated Process: Nursing Process

BLM: Cognitive Level: Analyze 14. A community health nurse has been building partnerships with teachers and school administrators in the community. What is the rationale for the nurse’s actions?

A. Students normally have no contact with the health care system apart from school.

B. Health is necessary in order for a student to be able to learn effectively.

C. Students are among the least healthy group in Canadian society.

D. Traditional educational content conveys inaccurate messages about health and illness.

ANS: B Rationale: School health promotion is based on the premise that health is a prerequisite for learning. While health problems do indeed exist in school-aged children, they are not among the least healthy Canadians and school is among several likely points of contact between students and the health care system.

Health teaching in schools has not been identified as inaccurate.

PTS: 1 DIF: Easy REF: Page and Header: 113, The Health Promoting Schools Movement OBJ: 3 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 8: Reorienting Health Services: New Directions for Health Promotion KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand 15. Some members of the community have expressed confusion at the fact that the regional health authority has opposed a waste reduction plan that would involve trucking garbage to a rural landfill at great expense. Why is this aspect of community life relevant to the health care sector?

A. Efficient logistics are an indicator of healthy communities.

B. Factors that influence the health of communities and the environment have an effect on the health of residents.

C. The mandate of health care systems in the primary health promotion model is administrative.

D. Waste management most often falls within the legal jurisdiction of health care systems.

ANS: B Rationale: A reorientation of health services means embracing movements that are outside the traditional health purview, such as the programs that are developing to ensure the cities, towns, and neighbourhoods in which we live are safe and healthy. This does not mean that health services necessarily have the primary or sole responsibility for such issues, however. Health care systems do not normally have a broad administrative mandate.

PTS: 1 DIF: Moderate REF: Page and Header: 113, Healthy and Safe Communities

OBJ:

3| 4

NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 8: Reorienting Health Services: New Directions for Health Promotion KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand 16. A core principle or skill shared by practitioners committed to reorienting health services is: A. medical expertise.

B. fiscal prudence.

C. social justice D. operational authority.

ANS: C Rationale: Primary health care emphasizes equity and social determinants of health over other considerations such as medical expertise, fiscal management, and operational structure.

PTS: 1 DIF: Easy REF: Page and Header: 108, Primary Health Care OBJ: 1 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 8: Reorienting Health Services: New Directions for Health Promotion KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand 17. A team has acknowledged that the goal of building capacity in a community is dependent on a number of interpersonal and organizational variables. Which action is most likely to facilitate the team’s goal of building capacity?

A. Ensuring that sanctions exist for nonparticipation in the initiative B. Limiting input from health care workers and institutions that are rooted in a biomedical model of health C. Creating partnerships between acute care health workers, community health workers, and health administrators D. Ensuring that recognized experts are present and involved in all aspects of planning, implementation, and evaluation ANS: C Rationale: A critical component to capacity building is the development and enhancement of partnerships between different sectors in the health system.

Punitive measures do not promote capacity building, and professionals from a biomedical background or mindset should not be excluded. Expertise is needed, but experts need not be central in all aspects of such a program.

PTS: 1 DIF: Moderate REF: Page and Header: 115, Capacity Building and the Reorientation of Health Services OBJ: 4 NAT: Client Needs: Safe and Effective Care Environment: Management of Care

TOP: Chapter 8: Reorienting Health Services: New Directions for Health Promotion KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply 18. Which factor is known to best facilitate health promotion?

A. Healthy communities B. Individual autonomy C. Negative reinforcement D. Consumer choice ANS: A Rationale: The healthy community approach is known as a tangible expression of health promotion; if people are to have more control over their health, they must have more control over all the different factors in the community that affect their health. Negative reinforcement is an ineffective approach.

Consumer choice and autonomy are valid realities but neither is identified as a factor that encourages health promotion.

PTS: 1 DIF: Easy REF: Page and Header: 113, Healthy and Safe Communities OBJ: 3 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 8: Reorienting Health Services: New Directions for Health Promotion KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand 19. The Canadian health system is organized around which functions?

A. Acute care, rural and remote health care, disability care, recreation B. Health promotion, educational outreach, preventative medicine, community/public health care C. Urgent care, rehabilitation care, chronic disease care, educational outreach D. Acute care, rehabilitation and long-term care, mental health care, community/public health care ANS: D Rationale: The current health system in Canada is significantly organized around the presentation of and response to disease, rather than its prevention.

This means that community/public health care competes with acute care, longterm care, and mental health care for funding. While educational outreach and recreation form important components of community/public health, they do not function at a system level.

PTS: 1 DIF: Moderate REF: Page and Header: 111, Toward an Integrated Model of Health OBJ: 2 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 8: Reorienting Health Services: New Directions for Health Promotion

KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand 20. New realities around health unforeseen when the Ottawa Charter and earlier initiatives were drafted include: A. neglected tropical diseases.

B. climate change.

C. a global shift toward socialism.

D. unionization of health workforces.

ANS: B Rationale: Foundational documents to health promotion drafted between the 1970s and 1990s pose some blind spots for policy in a contemporary era, where the health of populations is increasingly shaped by the strengthened forces of global capitalism and rapid climate change associated with this, which have tended to erode health and social protections for society’s most vulnerable people.

PTS: 1 DIF: Easy REF: Page and Header: 110, Toward an Integrated Model of Health OBJ: 5 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 8: Reorienting Health Services: New Directions for Health Promotion KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand 21. Within the settings approach to health, which location(s) would be classified as a setting? Select all that apply.

A. The administrative office complex of a software firm B. A farm on which the owner employs three labourers C. The condominium recently purchased by a couple D. A community centre that houses a gym, library, and several meeting rooms E. A private high school that draws students from many neighbouring communities ANS: A, B, C, D, E Rationale: The settings approach to health acknowledges the importance of all the locations where members of a community work, live, and participate in daily activities.

PTS: 1 DIF: Easy REF: Page and Header: 111, The Settings Approach to Health OBJ: 3 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 8: Reorienting Health Services: New Directions for Health Promotion KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand

Chapter 9, Economic Thinking in Healthy Public Policy 1. A nurse is asked by the Manager of Health Promotion to create a healthy public policy on prenatal care for the poor that will guide public health nurses. Is the Manager using the term healthy public policy correctly in this context?

A. Yes, the health sector serves the public and promotes the welfare of the public.

B. Yes, healthy public policy requires collaboration and support from many levels.

C. No, only elected officials write public policy. The stated purpose is internal to the organization.

D. No, what is asked for is not policy but is terms of reference for public health nurses.

ANS: C Rationale: Public policy is defined as “the actions of government and the intentions that determine these actions.” It does not include the actions that result from public policy. The Manager, although being in the health sector, is not an elected official, and the intent of the policy is organizational, that is, employee roles. The product can be a policy at the organizational level and could be developed with a critique of existing public policies.

PTS: 1 DIF: Moderate REF: Page and Header: 119, Introduction OBJ: 1 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 9: Economic Thinking in Healthy Public Policy KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand 2. A new public policy has resulted in a reallocation of health care resources in a province. Who creates public policy?

A. Senior civil servants B. Politically active members of the public C. Elected officials D. Nursing leaders ANS: C Rationale: Public policy in a democracy is made by elected officials, but it does not occur in a vacuum in the offices of the government. In the policy cycle, many people may participate in advocating for certain wording, outcomes, principles, and so on, for a forthcoming policy. Research, or the authors of such research, may be consulted.

PTS: 1 Introduction OBJ: 3

DIF:

Easy

REF: Page and Header: 119,

NAT: TOP: KEY: BLM:

Client Needs: Safe and Effective Care Environment: Management of Care Chapter 9: Economic Thinking in Healthy Public Policy Integrated Process: Nursing Process Cognitive Level: Remember

3. Although the process is not linear, policy making is known to encompass a series of discrete phases. Which example is characteristic of the process of agenda setting?

A. The nurses’ union expresses support for a new, supervised drug injection site.

B. There is a public outcry against media reports of an elderly woman discharged from the hospital without a place to go.

C. A decision is made to allow nurses who were educated in an Eastern European country to practice in Canada.

D. A rural nursing outpost is established in a small community in the Northwest Territories.

ANS: B Rationale: Agenda setting is the process through which problems come to the attention of elected officials or policy makers. This is the problem recognition stage and may result from the publicity of an exemplar case. Expressing support for initiatives and establishing new initiatives are normally after agenda setting.

PTS: 1 DIF: Moderate REF: Page and Header: 120, Agenda Setting OBJ: 1 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 9: Economic Thinking in Healthy Public Policy KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze 4. After holding meetings with survivors of residential schools across the country, The Truth and Reconciliation Commission of Canada produced a report called Calls to Action with several recommendations. This is an example of which aspect of the policy-making process?

A. Policy evaluation B. Policy formulation C. Decision making D. Agenda setting ANS: D Rationale: In the agenda setting process, decision makers receive feedback from both external and internal sources. This type of commission attempts to get recommendations on the agendas of relevant governments. The TRC had no direct link to writing policy but it called for many changes in public policy.

PTS: 1 Setting

DIF:

Moderate

REF: Page and Header: 120, Agenda

OBJ: NAT: TOP: KEY: BLM:

1 Client Needs: Safe and Effective Care Environment: Management of Care Chapter 9: Economic Thinking in Healthy Public Policy Integrated Process: Nursing Process Cognitive Level: Analyze

5. Howlett and Ramesh (2009) point out that the formulation of public policy requires the opening of a policy window. What circumstances must exist for a policy window to open?

A. Solutions to problems must align with a favourable political stream.

B. Evidence must be disseminated that validates a particular solution.

C. Expertise, political will, and public opinion must be in conflict.

D. Health professionals and members of the public must share a common understanding of a problem.

ANS: A Rationale: When solutions become joined to problems, and a favourable political stream exists, a policy window opens. This does not necessarily require evidence or a common understanding between health professionals and the public.

PTS: REF: NAT: TOP: KEY: BLM:

1 DIF: Easy Page and Header: 120, Policy Formulation OBJ: 1 Client Needs: Safe and Effective Care Environment: Management of Care Chapter 9: Economic Thinking in Healthy Public Policy Integrated Process: Nursing Process Cognitive Level: Understand

6. Advocacy groups and politicians are aligned in their desire to create new health policy for Northern First Nations communities. Which event will occur during the decision-making stage of the policy development process?

A. Champions and experts will be chosen to lead the policy implementation.

B. The problem underlying the policy development effort will be explored and refined.

C. The desired outcomes for the new policy will be identified and publicized.

D. One or more options developed during the policy formulation stage will be chosen.

ANS: D Rationale: In the decision-making stage, policy makers select from among policy options developed in the formulation stage. This normally follows agenda setting and precedes implementation.

PTS: 1 DIF: Moderate REF: Page and Header: 126, Decision Making OBJ: 1 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 9: Economic Thinking in Healthy Public Policy KEY: Integrated Process: Nursing Process

BLM: Cognitive Level: Understand 7. A subcommittee has submitted a cost--benefit analysis of a proposed new community-based immunization campaign. Economic analysis typically accompanies the process of: A. agenda setting.

B. policy formulation.

C. decision making.

D. policy implementation.

ANS: C Rationale: Economic analysis can be useful in choosing a public policy alternative; this typically occurs during the decision-making process.

PTS: 1 DIF: Moderate REF: Page and Header: 126, Decision Making OBJ: 4 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 9: Economic Thinking in Healthy Public Policy KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand 8. A province’s anti-smoking policy has prompted the creation of a number of new laws aimed at curbing the sale and consumption of tobacco. A group of professionals is now participating in an effort to determine whether these policies and laws had the desired effect. This activity is characteristic of which aspect of the policy development process?

A. Decision making B. Policy formulation C. Policy evaluation D. Agenda setting ANS: C Rationale: Policy evaluation includes processes by which results of policies are monitored. Evaluations can help to assess whether social change has occurred and how it occurred. Even though the policy development process is iterative, the actions of agenda setting, decision making, and policy formulation usually precede the evaluative stage.

PTS: REF: OBJ: NAT: TOP: KEY: BLM:

1 DIF: Easy Page and Header: 126, Policy Implementation and Evaluation 1 Client Needs: Safe and Effective Care Environment: Management of Care Chapter 9: Economic Thinking in Healthy Public Policy Integrated Process: Nursing Process Cognitive Level: Analyze

9. Howlett and Ramesh (2009) identify the importance of policy communities in the various stages of the policy development process. What is a policy community?

A. All the people who are concerned about a particular policy issue B. All the residents of a community who are affected by a policy C. Unpaid members of the public who influence policy makers D. Impartial observers who have the political power to influence policy ANS: A Rationale: People who are concerned about a particular policy issue and express their concern to others are considered by Howlett and Ramesh (2009) to form a policy community. Membership is not limited to politicians or unpaid members of the public, but it is not so broad as to include every person who may be influenced by a policy.

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1 DIF: Moderate Page and Header: 127, Policy Communities, Networks, and Coalitions 2 Client Needs: Safe and Effective Care Environment: Management of Care Chapter 9: Economic Thinking in Healthy Public Policy Integrated Process: Nursing Process Cognitive Level: Understand

10. Community advocates have identified the need for a broad representation in a policy development network. Ensuring that there are individuals from a range of backgrounds and allegiances will have what effect on the policy development process?

A. A policy consensus will be difficult to achieve and existing policies may persist.

B. The likelihood of social control and the reinforcement of social elites will be decreased.

C. Economic interests of individuals and corporations will trump the interests of the community at large.

D. Media reports and popular opinion will supersede the evidence base for a particular policy.

ANS: B Rationale: One of the unintended consequences of ignoring power and equity in policy development is that participation of social elites can be strengthened at the expense of redistribution of power. Broad participation can help mitigate the interests of large corporations. This does not mean that the evidence base or the possibility of reaching a consensus will necessarily suffer.

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1 DIF: Moderate Page and Header: 128, Policy Communities, Networks, and Coalitions 3 Client Needs: Safe and Effective Care Environment: Management of Care Chapter 9: Economic Thinking in Healthy Public Policy Integrated Process: Nursing Process

BLM: Cognitive Level: Apply 11. Which phenomenon has been identified as a contributor to healthy public policy?

A. Cooperation between the different sectors that are involved with health B. Removal of elected officials from the policy development process C. Leadership of the policy development process by impartial experts D. Involvement of international corporations in policy development ANS: A Rationale: In Canada, emphasis has been placed on the need for intersectoral action to effectively address the broad determinants of health and develop healthy public policy.

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1 DIF: Easy Page and Header: 128, Policy Communities, Networks, and Coalitions 3 Client Needs: Safe and Effective Care Environment: Management of Care Chapter 9: Economic Thinking in Healthy Public Policy Integrated Process: Nursing Process Cognitive Level: Understand

12. A community health nurse is aware of the realities of economics in the policy development process. Central to the study of economics is the concept of: A. authority.

B. utility.

C. autonomy.

D. scarcity.

ANS: D Rationale: The central concern of economics as a discipline is the study of the allocation of scarce resources, with the objective being the identification of policies and institutions that improve the standard of living for a population.

Scarcity as a concept reflects that individuals have unlimited wants in the face of limited resources.

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1 DIF: Easy Page and Header: 121, Efficacy, Effectiveness, and Safety Considerations 2 Client Needs: Safe and Effective Care Environment: Management of Care Chapter 9: Economic Thinking in Healthy Public Policy Integrated Process: Nursing Process Cognitive Level: Remember

13. A community health nurse is aware of the realities of economics in the policy development process. Which question lies outside the domain of economics?

A. Will this program have unintended negative outcomes?

B. What value do individuals assign to this program?

C. Do individuals desire to participate in such a program?

D. What are the costs associated with this program?

ANS: A Rationale: Questions of demand, cost, and value are central to economics.

Questions of program efficacy and unintended consequences, however, are beyond the scope of the discipline.

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1 DIF: Moderate Page and Header: 121, Efficacy, Effectiveness, and Safety Considerations 2 Client Needs: Safe and Effective Care Environment: Management of Care Chapter 9: Economic Thinking in Healthy Public Policy Integrated Process: Nursing Process Cognitive Level: Analyze

14. When comparing several proposed actions, the term “cost” can be used liberally by advocates for a specific action. Which is an example of a sunk cost?

A. The staffing budget for a health promotion campaign that proved ineffective B. The construction costs of building a proposed hospital addition C. The funding required for increasing the number of seats in a university’s nursing program D. The prices of the drugs commonly stocked in a hospital unit ANS: A Rationale: A sunk cost is something that cannot be recovered no matter what happens, and, as such, should not bear on the decision-making process once it has been spent. An example would be wages that have been paid out. Proposed spending or recurring costs are not normally sunk costs.

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1 DIF: Moderate Page and Header: 122, Sunk and Fixed Costs OBJ: 4 Client Needs: Safe and Effective Care Environment: Management of Care Chapter 9: Economic Thinking in Healthy Public Policy Integrated Process: Nursing Process Cognitive Level: Analyze

15. The board of a health region is faced with the need to update information technology (IT) systems, but it cannot afford to do so if it is to respond to public pressure to increase the budget for community health promotion. The board is faced with a: A. win--win situation.

B. trade-off.

C. cost--benefit analysis.

D. fixed cost.

ANS: B

Rationale: In administration, choosing between two courses of action means that one may be ignored in favour of another, or the response to both lower than that is needed to do the work effectively. This situation is known as a trade-off.

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1 DIF: Moderate Page and Header: 122, Trade-Offs and Opportunity Costs 4 Client Needs: Safe and Effective Care Environment: Management of Care Chapter 9: Economic Thinking in Healthy Public Policy Integrated Process: Nursing Process Cognitive Level: Understand

16. A provincial government has decided to direct newly available funds toward hiring doctors and nurses in rural areas. The province can hire either two doctors or ten nurses. In the end, the province decides to hire ten nurses. What is the opportunity cost of this decision?

A. The wages and benefits of the ten nurses hired B. Two doctors C. Additional health care workers in urban areas D. The public’s preference for doctors over nurses ANS: B Rationale: The opportunity cost of any choice or decision is what is given up to hire the nurses, in this case, that would be the two doctors. Since the money is for nurses in rural areas, urban areas are not part of the decision-making process. There was no opportunity in this particular choice to change public preference.

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1 DIF: Moderate Page and Header: 122, Trade-Offs and Opportunity Costs 4 Client Needs: Safe and Effective Care Environment: Management of Care Chapter 9: Economic Thinking in Healthy Public Policy Integrated Process: Nursing Process Cognitive Level: Apply

17. One of the cornerstones of economic theory is that people respond to incentives by changing their behaviour. Which smoking-based health intervention targets smoker’s incentives?

A. A tax on cigarettes B. A ban on cigarette company advertising C. Labeling cigarette cartons with graphic images of smoking’s health effects D. Keeping cigarettes out of view in stores ANS: A

Rationale: A tax increases the cost of cigarettes and directly targets the incentives around smoking. Education campaigns are not targeting incentives unless we assume smokers are unaware smoking is unhealthy, which is rarely the case in Canada.

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1 DIF: Moderate Page and Header: 124, Incentives and Trade Client Needs: Health Promotion and Maintenance Chapter 9: Economic Thinking in Healthy Public Policy Integrated Process: Nursing Process Cognitive Level: Analyze

OBJ:

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18. Rare conditions are often untreated because there are no research and development efforts going toward their cure. This is because companies do not have an incentive to invest in treating conditions that only affect a few people.

Which market failure is evident?

A. Externalities B. Information asymmetry C. An absence of competition D. A missing market ANS: D Rationale: Individuals with this condition would pay for treatment if they could but cannot since the market for treatment does not exist. Governments can correct this by subsidizing research or creating incentives for producers.

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1 DIF: Moderate Page and Header: 125, Market Forces and Failures OBJ: 2 Client Needs: Safe and Effective Care Environment: Management of Care Chapter 9: Economic Thinking in Healthy Public Policy Integrated Process: Nursing Process Cognitive Level: Understand

19. Market efficiency means that no adjustment of the allocation of goods is possible without making at least one person worse off. Which statement indicates an inefficient market?

A. Doctors’ salaries are high compared to the average Canadian.

B. Some employer insurance plans only reimburse 70% of drug costs.

C. Waitlists for some procedures are so long that the individuals waiting suffer poor health outcomes.

D. New health care technology can be more expensive than a province is willing to pay.

ANS: C Rationale: A waitlist would be corrected if prices were allowed to fluctuate for medical procedures. Inefficiency here is the lack of price information; that is, the price is kept at zero so the market cannot operate as it would with excess demand.

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1 DIF: Difficult Page and Header: 125, Market Forces and Failures OBJ: 4 Client Needs: Safe and Effective Care Environment: Management of Care Chapter 9: Economic Thinking in Healthy Public Policy Integrated Process: Nursing Process Cognitive Level: Analyze

Chapter 10, Social Justice and Equity for Health Promotion 1. A community health program has been established that has the goal of increasing equity among residents. This goal implies that: A. goods and services will be distributed equally to residents.

B. residents will be responsible for leading the program.

C. residents will all be able to access the program.

D. every resident will benefit from the program in the same way.

ANS: C Rationale: Equity means equitable access, not equal access to resources.

Achieving equitable access requires recognizing that some people have a greater need than others, so they require more resources than others would to achieve equal opportunities for health.. Equity does not necessarily mean that residents will lead the program.

PTS: 1 DIF: Easy REF: Page and Header: 131, Definitions and History of Social Justice and Equity OBJ: 1 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 10: Social Justice and Equity for Health Promotion KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand 2. A community health worker who promotes social justice through practice is most likely involved in which initiative?

A. Teaching the public about nutrition B. Helping a community develop strategies to lobby city council to achieve their vision of lower-cost transportation for families experiencing poverty C. Seeing families at the local community health centre to address their health issues D. Directing a community on the correct course of action to address a public health concern ANS: B Rationale: Seeking social justice often involves partnering with a community to seek solutions by using the community development process and employing relationship-building skills. In this approach, community members cocreate solutions to their problems. In all the other answers, the worker is using an expert or service-driven model that does not promote social justice.

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1 DIF: Moderate Page and Header: 138, Practice Implications OBJ: 3 Client Needs: Safe and Effective Care Environment: Management of Care Chapter 10: Social Justice and Equity for Health Promotion

KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply 3. Which are key components of a practice that includes efforts to promote equity and social justice? Select all that apply.

A. Promoting the urgency of addressing the social determinants of health B. Taking action at multiple levels of the Population Health Promotion Model C. Maximizing opportunities to exert influence in policy development D. The interests of minority groups are prioritized over majority groups E. Individual interests will supersede collective interests ANS: A, B, C Rationale: Practice that promotes equity and social justice addresses the social determinants of health, uses the Population Health Promotion Model and maximizes opportunity to influence policy. Minority groups are thoughtfully integrated into practice, but that does not mean that their interests always override those of the majority. Similarly, individual interests do not typically override collective interests.

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1 DIF: Easy Page and Header: 139, Steps Toward Creating a Socially Just World 3 NAT: Client Needs: Health Promotion and Maintenance Chapter 10: Social Justice and Equity for Health Promotion Integrated Process: Nursing Process Cognitive Level: Understand

4. Social justice and equity are concepts that were identified as prerequisites for health in which document?

A. The Kalahachi Charter B. The Lalonde Report C. The Ottawa Charter D. The Epper Report ANS: C Rationale: The Ottawa Charter is the seminal document that discussed social justice and equity as prerequisites for health. The Lalonde Report predated this document, and the Kalahachi Charter and the Epper Report do not exist (they are pretend documents).

PTS: 1 DIF: Easy REF: Page and Header: 130, Introduction OBJ: 2 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 10: Social Justice and Equity for Health Promotion KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Remember 5. Social justice is considered a human rights issue for which reason?

A. It addresses the stigmatization and marginalization of particular populations.

B. It focuses on ensuring everyone has equal access to resources.

C. The Canadian government determined this should occur.

D. The World Health Organization declared oppression has ended.

ANS: A Rationale: A growing body of literature shows a clear relationship between the root causes of health problems/concerns in communities or populations and issues of social justice and equity. Populations that are marginalized or stigmatized are overrepresented in this literature.

PTS: 1 DIF: Moderate REF: Page and Header: 130, Introduction OBJ: 1 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 10: Social Justice and Equity for Health Promotion KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand 6. What best describes discrimination in health care settings?

A. Largely inevitable B. Unacceptable C. Widespread D. A barrier to receiving health care services E. Conveyed through opinions, attitudes, and behaviours of staff ANS: B, C, D, E Rationale: Discrimination is widespread, may be explicit or implicit in service delivery, and is often portrayed by the actions of staff. Discrimination is unacceptable and becomes a barrier to receiving health care services because recipients may be driven away by judgmental or disrespectful attitudes or treatment by staff. However, it should not be accepted as inevitable.

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1 DIF: Moderate Page and Header: 133, Oppression and Discrimination OBJ: Client Needs: Psychosocial Integrity Chapter 10: Social Justice and Equity for Health Promotion Integrated Process: Nursing Process Cognitive Level: Understand

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7. The language professionals use to describe populations can inadvertently cause harm. Which statement about a community uses the least stigmatizing or marginalizing language?

A. The community is a low-income, high-needs district.

B. Because of potential language barriers, many immigrant women living in the community are vulnerable to social isolation.

C. Children of immigrant families in the community are at risk of not completing high school.

D. The community is capable of defining ways to improve the educational outcomes for their children.

ANS: D Rationale: Language that is not stigmatizing or marginalizing does not focus on the deficits of the community, and uses a strength-building, nondiscriminatory approach to problem solving in partnership with the community.

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1 DIF: Moderate Page and Header: 137, Practice implications OBJ: Client Needs: Psychosocial Integrity Chapter 10: Social Justice and Equity for Health Promotion Integrated Process: Communication and Documentation Cognitive Level: Analyze

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8. What is the strongest rationale for including the concepts of social justice and equity in health professionals’ education?

A. Advocating for social justice may be required by the code of ethics for some health professions.

B. Classroom education provides a safe learning environment for most learners.

C. Social justice issues affect the health of all Canadians.

D. Students’ practicum placements may include vulnerable populations.

ANS: C Rationale: The fact that social justice issues affect the health of all Canadians is the strongest argument presented, as it emphasizes the great impact and importance of social justice and equity issues. Although the other options are accurate statements, they refer to smaller-scale implications and are therefore not the most compelling reason for health professionals to learn about the concepts of social justice and equity.

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1 DIF: Moderate Page and Header: 139, Steps Toward Creating a Socially Just World 2 Client Needs: Safe and Effective Care Environment: Management of Care Chapter 10: Social Justice and Equity for Health Promotion Integrated Process: Teaching/Learning Cognitive Level: Understand

9. Which action is required for health impact assessments (HIA) to become effective instruments for influencing public health policies?

A. Media pressure B. Cross-government high-level mandates and support C. Grassroots support and action D. Organizational high-level mandates and support ANS: B

Rationale: HIA highlights the potential effects of a program or policy on vulnerable groups and thereby helps reduce health inequities by informing policy makers of probable negative or positive effects that must be considered.

HIA can be effective as a health equity policy formulation instrument within a policy cycle; however, successful implementation of HIA requires a crossgovernment high-level mandate and support.

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1 DIF: Moderate Page and Header: 137, Policy: From Evidence to Action OBJ: 3 Client Needs: Safe and Effective Care Environment: Management of Care Chapter 10: Social Justice and Equity for Health Promotion Integrated Process: Nursing Process Cognitive Level: Remember

10. A community health nurse wishes to be a strong advocate for social justice.

Which barrier to using a social justice approach is the nurse least likely to encounter?

A. The current illness care system B. Colleagues’ lack of understanding of the community development process C. A health-in-all-policies approach to governments’ cross-sector policy development D. A focus on individual change in health promotion strategies ANS: C Rationale: A health-in-all-policies approach to policy development is a facilitator to using a social justice approach in practice. The other answers all exemplify barriers to using a social justice approach in practice as outlined throughout the chapter.

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1 DIF: Moderate Page and Header: 136, The Ottawa Charter Revisited OBJ: 3 Client Needs: Safe and Effective Care Environment: Management of Care Chapter 10: Social Justice and Equity for Health Promotion Integrated Process: Nursing Process Cognitive Level: Understand

11. A public health program is being evaluated in light of the Canadian Nurses Association’s definition of social justice. What program outcomes exemplify the defining attributes of social justice? Select all that apply.

A. The program adhered to the principles of evidence-informed practice.

B. Community members acknowledge that the program built capacity in the community.

C. A reduction in local poverty rates has been attributed to the program.

D. The program made effective use of partnerships between school-, church-, and neighbourhood-based groups.

E. The results of the program were published in a peer-reviewed journal.

ANS: B, C, D

Rationale: Capacity building, poverty reduction, and the effective use of partnerships are components of social justice. Evidence-informed practice and dissemination of results are valid and beneficial aspects of a program, but are not specific attributes of social justice.

PTS: 1 DIF: Moderate REF: Page and Header: 131, Definitions and History of Social Justice and Equity OBJ: 1| 3 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 10: Social Justice and Equity for Health Promotion KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze 12. Legislation has been introduced with the expressed goal of advancing equity in health in a province. In order to determine whether health equity is being achieved, nurses in the province should identify what goal?

A. All community residents experience the same, or very similar, health outcomes.

B. Each member of the community utilizes the same quantity and type of health services.

C. All members of the community have similar opportunities to advance and protect their health.

D. No members of the community use more health services than other members.

ANS: C Rationale: Equity is not synonymous with equality; it is unrealistic to expect that all members of a community should use the same amount of services or experience identical health outcomes. Instead, equity exists when individuals have equal opportunities for health.

PTS: 1 DIF: Moderate REF: Page and Header: 131, Definitions and History of Social Justice and Equity OBJ: 1| 2 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 10: Social Justice and Equity for Health Promotion KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply 13. A nurse’s interactions with a client suggest that the client has a history of oppression. What is the most likely cause of this circumstance?

A. The client has experienced a series of injustice over time, in varied settings.

B. The client has a chronic illness or has had otherwise required many health care services.

C. The client has unrealistic expectations of his own health and the performance of the health care system.

D. The client lacks social support.

ANS: A Rationale: Oppression is a complex phenomenon, but it is often attributable to repeated, systemic injustice over a prolonged period of time. Oppression is not caused by an individual’s frequent use of health services. Lack of social support has many negative effects, but does not directly result in oppression.

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1 DIF: Easy Page and Header: 132, Oppression and Discrimination OBJ: Client Needs: Psychosocial Integrity Chapter 10: Social Justice and Equity for Health Promotion Integrated Process: Nursing Process Cognitive Level: Understand

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14. A program has been proposed that aims to address many of the health disparities that exist among Indigenous Canadians. When planning and implementing this program, policy makers and health care providers must: A. ensure that equality in health care exists among Indigenous Canadians.

B. ensure that the language used does not contribute to marginalization.

C. educate Indigenous Canadians about how to make better lifestyle choices.

D. arrange for equal representation from Indigenous and non-Indigenous Canadians.

ANS: B Rationale: It is important to examine language closely to ensure that it does not further contribute to marginalization or discrimination. A focus on “lifestyle choices” demonstrates a misunderstanding of the complexities of health and the role of the determinants of health. Equality and equity are not the same; equality connotes sameness, while equity is linked to justice.

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1 DIF: Moderate Page and Header: 137, Practice Implications OBJ: Client Needs: Psychosocial Integrity Chapter 10: Social Justice and Equity for Health Promotion Integrated Process: Communication and Documentation Cognitive Level: Apply

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15. A community health nurse works with a diverse clientele. Which client is most likely to have experienced social injustice?

A. A 77-year-old female client who resides in an assisted living facility B. A 33-year-old male client who is claiming refugee status C. A middle-aged male client who has been unemployed for 2 years D. A 19-year-old female client who identifies herself as a lesbian ANS: D Rationale: LGBTIQ youth are known to experience disproportionately high levels of human rights violations and social injustice.

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DIF:

Easy

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Page and Header: 134, Social Justice and Human Rights OBJ: Client Needs: Psychosocial Integrity Chapter 10: Social Justice and Equity for Health Promotion Integrated Process: Nursing Process Cognitive Level: Analyze

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16. A nurse has joined an advocacy group that is committed to increasing health equity. Which strategy is most likely to meet the group’s goal?

A. Collaborating closely with members of other health disciplines B. Lobbying for increased funding for provincial and territorial health care systems C. Educating Canadians about the need to adopt healthy lifestyle practices D. Advocating for a shift in emphasis from illness care to health promotion ANS: D Rationale: One of the significant barriers to a focus on the determinants of health and health equity is the current illness care system. Until the focus shifts from illness care to an upstream focus on prevention and health promotion, little change is likely to occur. Health equity will not necessarily be achieved solely through an increase in funds for health care systems. Similarly, collaboration is important but does not necessarily lead to health equity. A focus on “lifestyle” does not accurately reflect the realities of the determinants of health.

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1 DIF: Moderate Page and Header: 135, The Ottawa Charter Revisited OBJ: 3 Client Needs: Safe and Effective Care Environment: Management of Care Chapter 10: Social Justice and Equity for Health Promotion Integrated Process: Nursing Process Cognitive Level: Apply

17. Which is an example of a health-in-all-policies (HIAP) approach?

A. Employment insurance premiums are reduced for lower income brackets.

B. An immunization campaign is launched on a university campus.

C. A school of nursing receives funding to increase the number of admissions.

D. A new housing development is mandated to include pedestrian and cycling paths.

ANS: D Rationale: Requiring a developer to accommodate pedestrians and cyclists is outside the health care sector, but is a policy that has a direct impact on public health. In this way, it exemplifies the HIAP approach. Immunization and nursing education are beneficial, but are within the broad scope of health care systems.

Changes to employment insurance may or may not have a direct benefit on health.

PTS: 1 DIF: Moderate REF: Page and Header: 136, The Ottawa Charter Revisited NAT: Client Needs: Health Promotion and Maintenance

OBJ:

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TOP: Chapter 10: Social Justice and Equity for Health Promotion KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze 18. Changes have been proposed to a city’s public transportation system and a health impact assessment (HIA) has been ordered. The results of this assessment will allow policy makers to: A. identify other options that will have a more beneficial effect on residents’ health.

B. identify the possible effect on health care workers and the health care sector.

C. identify the policy’s likely effects on the health and well-being of residents.

D. elicit input from members of health disciplines.

ANS: C Rationale: HIA highlights the potential effects of a program or policy on vulnerable groups and thereby helps reduce health inequities by informing policy makers of probable negative or positive effects that must be considered.

An HIA does not focus on promoting alternative policies and the focus is on the interests of community members, not the health care system or health care providers.

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1 DIF: Easy Page and Header: 137, Policy: From Evidence to Action OBJ: 3 Client Needs: Safe and Effective Care Environment: Management of Care Chapter 10: Social Justice and Equity for Health Promotion Integrated Process: Nursing Process Cognitive Level: Understand

19. A public health campaign has been launched that challenges community residents to “make a change” and “adopt a healthy lifestyle.” A nurse should recognize that this directive: A. is not applicable to members of many cultures.

B. is not achievable for a majority of residents.

C. inadvertently blames people for their lack of health.

D. accurately reflects the determinants of health.

ANS: C Rationale: A single-focused lifestyle approach to health holds a danger of potentially blaming people for their poor health status and limiting not only the resources and efforts of health workers, but also the possibilities for partnering with individuals and communities in health-promoting action for change that would enhance social justice and equity.

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1 DIF: Easy Page and Header: 137, Practice Implications OBJ: Client Needs: Health Promotion and Maintenance Chapter 10: Social Justice and Equity for Health Promotion Integrated Process: Nursing Process

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BLM: Cognitive Level: Understand 20. A group of nurse have resolved to take action to promote social justice. In order to do so, the nurses should: A. focus their efforts exclusively on individuals who have low incomes.

B. collaborate with members of other health disciplines to advocate for change.

C. encourage all individuals to make healthy choices.

D. lobby for increased funding for health.

ANS: B Rationale: Achieving social justice requires interdisciplinary collaboration.

Individuals with lower incomes have worse health outcomes, but it would be inappropriate to limit efforts solely to this population. A focus on “healthy choices” reinforces the focus on individuals instead of communities. Increased funding for health does not necessarily result in social justice.

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1 DIF: Moderate Page and Header: 139, Steps Toward Creating a Socially Just World 3 Client Needs: Safe and Effective Care Environment: Management of Care Chapter 10: Social Justice and Equity for Health Promotion Integrated Process: Nursing Process Cognitive Level: Apply

Chapter 11, Negotiating the Cultural Context of Community Care 1. A community health nurse has encountered ethnocentric views in a care setting.

What are ethnocentric views?

A. Dual patterns of identification of two cultures, lifestyles, and sets of values B. A tendency to see reality through one’s own cultural perspective C. Belonging to a specific group of individuals who share a common social and cultural heritage D. A research framework that is used to provide the ability to focus on the culture of the community where the nurse is practicing ANS: B Rationale: Ethnocentrism is a tendency to see reality through one’s own cultural perspective---a culture that is deemed necessary, normal, and desirable. With this preferred cultural lens comes a faith in the superiority of one’s ethnic or cultural group and a privileging of its values and views, beliefs, and behaviours.

Ethnography is research that provides a framework to focus on the culture of a group of individuals.

PTS: 1 DIF: Easy REF: Page and Header: 150, Ethnocentrism OBJ: 5 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 11: Negotiating the Cultural Context of Community Care KEY: Integrated Process: Caring BLM: Cognitive Level: Understand 2. Ethnicity should be understood as a social differentiation that engenders a sense of self-awareness and exclusivity as well a sense of belonging. An ethnic group consists of: A. minority or majority populations who share the same cultural background.

B. minority populations that do not share the traditions of their social heritage.

C. individuals who share a unique physical and cultural heritage that is passed from one generation to the next.

D. individuals that have distinct identity who relate well within the community at large.

ANS: C Rationale: Whether ethnicity is associated with minority or majority populations, ethnic groups are composed of people who share a unique cultural background and social heritage that is passed from one generation to another. Ethnicity is not synonymous with culture.

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1 DIF: Moderate Page and Header: 148, Key Concepts Related to Cultural Diversity 2 NAT: Client Needs: Psychosocial Integrity Chapter 11: Negotiating the Cultural Context of Community Care

KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand 3. A community nurse is aware of the varied nature of the determinants of health and their influence on the health of individuals and communities. Which of the following is among the 12 determinants of health identified by Health Canada?

A. Skin colour B. Culture C. Ethnicity D. Race ANS: B Rationale: Culture is a recognized determinant of health identified by Health Canada. Skin colour, ethnicity, and race are not among the list of 12 determinants.

PTS: 1 DIF: Easy REF: Page and Header: 143, Introduction OBJ: 1 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 11: Negotiating the Cultural Context of Community Care KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Remember 4. Organizers of a national health promotion initiative recognize the need to consider culture in all phases of the project’s planning and implementation. These organizers should recognize that Indigenous people make up the highest percentage of the population in which Canadian region?

A. The North B. British Columbia C. The Prairie provinces D. Atlantic Canada ANS: A Rationale: Over 85% of the population of Nunavut, 50% of the Northwest Territories, and 23% of the Yukon Territory is composed of Indigenous people.

These three territories comprise Northern Canada, and have the highest percentages of Indigenous people out of any other region.

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1 DIF: Easy Page and Header: 144, Indigenous Peoples (Table 11.1) OBJ: 1 Client Needs: Health Promotion and Maintenance Chapter 11: Negotiating the Cultural Context of Community Care Integrated Process: Nursing Process Cognitive Level: Remember

5. In the most recent census, 19.1% of Canadians identified themselves as members of a visible minority. Visible minorities in Canada are defined as: A. persons who are within one generation of immigration to Canada.

B. persons who have skin that is darker than the Caucasian norm.

C. persons who are non-Caucasian and non-Indigenous.

D. persons who have ethnic origins outside of Europe.

ANS: C Rationale: In Canada, the official definition of visible minority population is derived from the Employment Equity Act. Members of visible minorities are persons, other than Indigenous persons, who are not Caucasian.

PTS: REF: NAT: TOP: KEY: BLM:

1 DIF: Easy Page and Header: 146, Visible Minorities OBJ: 2 Client Needs: Health Promotion and Maintenance Chapter 11: Negotiating the Cultural Context of Community Care Integrated Process: Nursing Process Cognitive Level: Understand

6. An understanding of cultural, organizational, and ideational values, attitudes, and behaviours is imperative to provide safe care for clients, both individually and collectively. This understanding is referred to as what?

A. Culture B. Ethnicity C. Prejudice D. Racism ANS: B Rationale: Ethnicity refers to cultural, organizational, and ideational values, attitudes, and behaviours. In its broadest sense, ethnicity refers to groups whose members share a common social and cultural heritage passed on to successive generations.

PTS: REF: OBJ: TOP: KEY: BLM:

1 DIF: Easy Page and Header: 148, Key Concepts Related to Cultural Diversity 2 NAT: Client Needs: Health Promotion and Maintenance Chapter 11: Negotiating the Cultural Context of Community Care Integrated Process: Nursing Process Cognitive Level: Understand

7. A community health worker has identified the need to apply the principles of cultural relativism to a health promotion program. What statement best describes cultural relativism?

A. Beliefs are influenced by and best understood within the context of culture.

B. One’s own culture should be recognized as a benchmark and point of comparison.

C. Cultural relativism refers to groups whose members share a common social and cultural heritage passed on to successive generations.

D. Cultures can be placed on a continuum in terms of their relative merits.

ANS: A

Rationale: Cultural relativism is the view that beliefs are influenced by and best understood within the context of culture. This theory developed by anthropologists is used to prevent the natural tendency to judge other cultures in comparison with one’s own and to promote the collection and analysis of information about other cultures without this bias. Cultural relativism prevents the appointment of one’s own culture as a benchmark, and ethnicity refers to groups whose members share a common social and cultural heritage passed on to successive generations.

PTS: REF: OBJ: TOP: KEY: BLM:

1 DIF: Moderate Page and Header: 148, Key Concepts Related to Cultural Diversity 2 NAT: Client Needs: Health Promotion and Maintenance Chapter 11: Negotiating the Cultural Context of Community Care Integrated Process: Nursing Process Cognitive Level: Understand

8. Canada’s multicultural policy of 1971 was foundational to the current understanding of culture in Canada. Which of the following is a component of this policy?

A. Every language in Canada is afforded the same recognition as French and English.

B. Members of visible minority groups are encouraged to strengthen their identities at the same time as assimilating into Canadian society.

C. Ethnic groups are encouraged to strengthen their identities by concentrating their membership in defined geographic areas.

D. Ethnic groups are encouraged to maintain and develop themselves as distinctive groups within Canadian society.

ANS: D Rationale: Multiculturalism seeks to avoid assimilation by encouraging ethnic groups to maintain and develop themselves as distinctive groups within Canadian society. French and English are defined as the official languages, and geographic concentration is not promoted.

PTS: REF: NAT: TOP: KEY: BLM:

1 DIF: Moderate Page and Header: 148, Multiculturalism in Canada OBJ: 3 Client Needs: Health Promotion and Maintenance Chapter 11: Negotiating the Cultural Context of Community Care Integrated Process: Nursing Process Cognitive Level: Understand

9. The Canadian Charter of Rights and Freedoms of 1982 complemented the framework that was created by the policy of multiculturalism in 1971. The Charter primarily impacts Canadian society in what domain?

A. International B. Familial C. Legal D. Religious ANS: C

Rationale: The Canadian Charter of Rights and Freedoms located multiculturalism within the wider framework of Canadian society and empowered the courts accordingly. Because the Charter was a constitutional amendment, it exists primarily within the legal domain.

PTS: REF: OBJ: TOP: KEY: BLM:

1 DIF: Moderate Page and Header: 149, Canadian Charter of Rights and Freedoms 3 NAT: Client Needs: Health Promotion and Maintenance Chapter 11: Negotiating the Cultural Context of Community Care Integrated Process: Nursing Process Cognitive Level: Understand

10. Canada’s policy of multiculturalism has been shown to be of benefit to Canadian society in a number of domains. How does multiculturalism foster health?

A. Diverse complementary and traditional (CAT) medical treatments are formally supported.

B. Racial and ethnic heterogeneity in the population has been linked with improved health outcomes.

C. Possession of a strong sense of belonging can be seen as a primary prevention strategy.

D. The legal framework for the Canadian health care system is enacted in the Canadian Multiculturalism Act. ANS: C Rationale: Multiculturalism is a primary prevention program with the intention of giving every individual and ethnocultural group a place and a sense of belonging in Canadian society. Multiculturalism does not provide a formal basis for CAT medicine and the Canadian health care system is not rooted in the Canadian Multiculturalism Act. Objective health benefits of racial and ethnic heterogeneity have not been proven.

PTS: REF: NAT: TOP: KEY: BLM:

1 DIF: Moderate Page and Header: 150, Benefits of Multiculturalism OBJ: 3 Client Needs: Health Promotion and Maintenance Chapter 11: Negotiating the Cultural Context of Community Care Integrated Process: Nursing Process Cognitive Level: Understand

11. When individuals or groups are denied equality of treatment, it is referred to as discrimination. A popular equation to summarize the components of racism is: racism = prejudice ´ discrimination ´ ______________.

A. Power B. Ethnocentrism C. Stereotyping D. Culture ANS: A

Rationale: Discrimination occurs when individuals or groups of people are denied equality of treatment because of race, ethnicity, gender, or disability. Fleras (2014) uses a popular equation to summarize the components of racism: racism = prejudice ´ discrimination ´ power.

PTS: 1 DIF: Easy REF: Page and Header: 151, Discrimination OBJ: 2 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 11: Negotiating the Cultural Context of Community Care KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand 12. Canada’s diversity has benefited from attracting immigrants from around the world. Which was the largest source country from which immigrants came to Canada in 2013?

A. The Philippines B. China C. India D. United States of America ANS: B Rationale: In 2013, over 258,000 people immigrated to Canada according to Citizenship and Immigration Canada. In 2013, the majority of immigrants came from the People’s Republic of China, which surpassed the Philippines for the first time.

PTS: OBJ: TOP: KEY: BLM:

1 DIF: Easy REF: Page and Header: 145, Immigrants 1 NAT: Client Needs: Health Promotion and Maintenance Chapter 11: Negotiating the Cultural Context of Community Care Integrated Process: Nursing Process Cognitive Level: Remember

13. A community health nurse is struggling to address the ethnocentric attitudes that have been demonstrated by some members of the community. The nurse recognizes that ethnocentrism is characterized by: A. a tendency to compare all other cultures to the norms and values of one’s own culture.

B. a deep mistrust and hatred for the members of other cultures.

C. a lack of understanding of how members of other cultures structure their lives.

D. a tendency to confuse the beliefs and traits of other cultures that are in fact dissimilar.

ANS: A Rationale: Ethnocentrism is a tendency to see reality through one’s own cultural perspective---a culture that is deemed necessary, normal, and desirable.

PTS: 1 Ethnocentrism OBJ: 4

DIF:

Moderate

REF: Page and Header: 150,

NAT: Client Needs: Psychosocial Integrity

TOP: Chapter 11: Negotiating the Cultural Context of Community Care KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand 14. A community health nurse is providing direction to a new orientee who has admitted how difficult it can be to avoid stereotyping members of other cultures.

Which teaching point should the nurse provide to the orientee?

A. “It is inherently racist to categorize people and it’s important to consciously avoid looking for similarities.”

B. “Remember that any differences between people and groups are actually superficial and ultimately insignificant.”

C. “Try to focus on information from the current situation instead of generalizations when you interact with members of other cultures.”

D. “As long as your stereotypes are accurate and thoughtful, you can use them to streamline many of your interactions with clients.”

ANS: C Rationale: Stereotyping involves the rejection of individual differences in favour of simplistic explanations. A solution to this involves focusing on the specifics of the situation or interaction at hand. Categorizations of all types are not necessarily racist. Genuine and significant differences exist between and among cultural groups.

PTS: 1 DIF: Difficult REF: Page and Header: 150, Stereotyping OBJ: 5 NAT: Client Needs: Psychosocial Integrity TOP: Chapter 11: Negotiating the Cultural Context of Community Care KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply 15. Health professionals have a responsibility to encourage and actively support integration and multiculturalism in communities and organizations. What is a health professional’s most appropriate response to a client who alludes to a historical injustice that was experienced by members of his or her ethnic group?

A. Explore with the client the differences between past and present social norms B. Acknowledge the pain and damage that resulted from the injustice C. Encourage the client to debrief with a member of his or her ethnic group D. Ask the client how the event may have affected his or her health ANS: B Rationale: It is important to acknowledge the pain of oppression, even if the event in question occurred in the distant past. It would be inappropriate to defer to a member of the client’s own ethnic group or to redirect the discussion matters of health.

PTS: REF: NAT: TOP:

1 DIF: Difficult Page and Header: 155, Cultural Attunement OBJ: 5 Client Needs: Psychosocial Integrity Chapter 11: Negotiating the Cultural Context of Community Care

KEY: Integrated Process: Caring

BLM: Cognitive Level: Apply

16. A community health nurse strives to develop and exhibit cultural attunement when providing care. The nurse should consequently adopt an attitude of: A. self-deprecation.

B. authority.

C. dependence.

D. humility.

ANS: D Rationale: Humility is an act of control, restraint, temperance, and modesty that fosters cultural attunement. Practitioners strive to resist the inclination to privilege their own cultures and their own perspectives in their work.

PTS: REF: NAT: TOP: KEY:

1 DIF: Moderate Page and Header: 155, Engaging in Acts of Humility OBJ: 5 Client Needs: Psychosocial Integrity Chapter 11: Negotiating the Cultural Context of Community Care Integrated Process: Caring BLM: Cognitive Level: Apply

17. A nurse who is a member of the dominant culture is providing care for a member of a marginalized group. In doing so, the nurse is being deliberate in an attempt to revere the client as an individual and as a member of another culture. What expectation should the nurse bring to this interaction?

A. The client will be profoundly grateful for the nurse’s gesture of respect.

B. The client may not necessarily reciprocate.

C. The nurse’s actions are unlikely to affect the interaction significantly.

D. The nurse may exacerbate any interpersonal distance.

ANS: B Rationale: Efforts made at vulnerability may not be well received by those who have been marginalized by the dominant culture. This does not mean, however, that such actions are inconsequential or counterproductive.

PTS: REF: NAT: TOP: KEY: BLM:

1 DIF: Moderate Page and Header: 155, Engaging in Acts of Humility OBJ: 5 Client Needs: Psychosocial Integrity Chapter 11: Negotiating the Cultural Context of Community Care Integrated Process: Nursing Process Cognitive Level: Apply

18. A community health professional who works in a large, urban centre has resolved to prioritize cultural attunement in the provision of care. Cultural attunement is best understood as: A. an advanced practice skill set.

B. a complex interpersonal task.

C. a way of being.

D. a personality trait.

ANS: C Rationale: Cultural attunement encompasses a “way of being” situated within the ethics of a caring community practice. It is more holistic than a task or a skill set and is not an innate characteristic.

PTS: REF: OBJ: TOP: KEY:

1 DIF: Moderate Page and Header: 156, Maintaining a Position of “Not Knowing” 5 NAT: Client Needs: Psychosocial Integrity Chapter 11: Negotiating the Cultural Context of Community Care Integrated Process: Caring BLM: Cognitive Level: Understand

19. A community health nurse understands that there is a consensus in Canadian society that creating a multicultural “mosaic” is beneficial to the nation. This “mosaic” has the potential to prevent which of the following phenomena?

A. Discrimination B. Immigration C. Cultural attunement D. Mobility ANS: A Rationale: Canada aims to promote diversity through the concept of multiculturalism. Multiculturalism offers a theoretical, ethical, and practical framework for community practice and working toward the improvement of human rights and social conditions in Canadian communities. John Berry (1991) identified the social benefits of multiculturalism: the support and encouragement of groups and individuals to adopt an integration strategy, following a midcourse between the alternatives of assimilation and separation, and moving away from the social and psychological pathologies associated with marginalization.

PTS: REF: NAT: TOP: KEY: BLM:

1 DIF: Moderate Page and Header: 149, Benefits of Multiculturalism OBJ: 4 Client Needs: Health Promotion and Maintenance Chapter 11: Negotiating the Cultural Context of Community Care Integrated Process: Nursing Process Cognitive Level: Understand

Chapter 12, Population Health Action: Prevention and Harm Reduction 1. Which of the following levels of prevention represents the most upstream work health practitioners can undertake?

A. Prima facie prevention B. Primary prevention C. Primordial prevention D. Secondary prevention ANS: C Rationale: Primordial prevention is the attempt to prevent risk factors from existing, which is a far upstream preventive approach. If risk factors are established, then primary prevention can serve to prevent them from becoming disease, while secondary prevention exists to detect and treat early disease. The term prima facie (“at first appearance”) is not a medical term and does not refer to levels of prevention.

PTS: REF: NAT: TOP: KEY: BLM:

1 DIF: Easy Page and Header: 161, Prevention and Care OBJ: 2 Client Needs: Health Promotion and Maintenance Chapter 12: Population Health Action: Prevention and Harm Reduction Integrated Process: Nursing Process Cognitive Level: Understand

2. The term “levels of care” is different from “levels of prevention” and refers to which of the following?

A. The mix of prevention activities and human resources in a care setting B. The number of health professionals within a given care setting C. The size of a care facility D. The location of a care facility ANS: A Rationale: Levels of care include primary care and primary health care systems, which often focus on primary and secondary prevention activities, secondary care systems often focus on secondary prevention activities, but may also focus on primary prevention activities, and tertiary care systems refer to highly specialized centres and systems for the management of advanced disease and injury. The precise number and composition of any of these teams may vary depending on the setting and centre, and does not strictly define the level of care. The size and location of the facility also do not strictly define the level of care.

PTS: REF: NAT: TOP:

1 DIF: Easy Page and Header: 162, Levels of Care (Table 12.2) OBJ: 1 Client Needs: Health Promotion and Maintenance Chapter 12: Population Health Action: Prevention and Harm Reduction

KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand 3. The social determinants of health are defined as the impact of: A. socioeconomic status on health of populations.

B. social systems on the health of populations.

C. populations on hospitals.

D. hospitals on society.

ANS: B Rationale: The social systems that influence or “determine” health are many.

They include systems of economics, education, and employment. These systems contribute to an individual’s socioeconomic status, but this status is not on its own a determinant of health. Others include gender, ethnicity, early childhood development, and many more. The impacts of populations on hospitals and of hospitals on society are not considered to be determinants of health.

PTS: 1 DIF: Moderate REF: Page and Header: 163, Determinants of Health and Disease and Injury Prevention OBJ: 3 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 12: Population Health Action: Prevention and Harm Reduction KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand 4. A community health nurse is approached by a local coalition to improve the intake of fruits and vegetables in a neighborhood. What action by the nurse would be considered primary prevention?

A. Participation in local committees on establishment of green grocers in the community B. Participation in screening for diabetes C. Treatment of clients with malnutrition D. Participation in a multidisciplinary clinic to counsel clients on appropriate healthy food choices ANS: D Rationale: The counseling of clients on healthy food choices presumes that they are at some risk from eating unhealthy foods already (either because they already eat them sometimes or they may eat them in future). Primary prevention includes preventing risk factors for becoming disease, and so counseling about said risks would be an appropriate primary preventive measure. Preventing the risk of exposure to unhealthy food from existing by placing healthy vendors in a community would be a primordial preventive measure. Screening for disease, even early disease, is secondary prevention. Treatment of existing health problems is tertiary prevention.

PTS: 1 DIF: Moderate REF: Page and Header: 161, Prevention and Care NAT: Client Needs: Health Promotion and Maintenance

OBJ:

1

TOP: Chapter 12: Population Health Action: Prevention and Harm Reduction KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze 5. What are the three components of the triad which explain injury, according to the theory of injury prevention?

A. Environment B. Host C. Process D. Vector E. Agent F. Outcome ANS: A, B, E Rationale: John E. Gordon applied the epidemiologic triad to injury, modeling it after infectious disease.

PTS: REF: NAT: TOP: KEY: BLM:

1 DIF: Moderate Page and Header: 166, Injury Prevention Theory OBJ: 4 Client Needs: Physiological Integrity: Physiological Adaptation Chapter 12: Population Health Action: Prevention and Harm Reduction Integrated Process: Nursing Process Cognitive Level: Remember

6. Which of these are the four E’s of injury prevention? Select all that apply.

A. Engagement B. Enactment C. Engineering D. Enforcement E. Enablement F. Education ANS: C, D, F Rationale: Traditionally, the E’s are education, engineering, and enforcement.

This approach was developed to encompass Haddon’s 10 countermeasures.

PTS: REF: NAT: TOP: KEY: BLM:

1 DIF: Moderate Page and Header: 168, The Haddon Matrix OBJ: 4 Client Needs: Health Promotion and Maintenance Chapter 12: Population Health Action: Prevention and Harm Reduction Integrated Process: Nursing Process Cognitive Level: Remember

7. Which of the following safety interventions are mostly passive? Select all that apply.

A. Speed bumps B. Airbags in automobiles C. “Crumple zones” in automobiles D. Bicycle helmets

E. Looking both ways before crossing the street F. Speed limit sign posting ANS: B, C Rationale: Air bags and crumple zones work regardless of the actions of an individual, therefore they are passive in nature. The other interventions all require some action on behalf of an individual to be effective.

PTS: 1 DIF: Moderate REF: Page and Header: 169, The Haddon Matrix OBJ: 4 NAT: Client Needs: Safe and Effective Care Environment: Safety and Infection Control TOP: Chapter 12: Population Health Action: Prevention and Harm Reduction KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand 8. What is the primary intent of a harm reduction approach to disease and injury prevention?

A. Complement abstinence-based messages or health promotion programming B. Build interpersonal skill set of health care providers C. Reduce or minimize the harm associated with higher-risk activities D. Screen high-risk populations for communicable diseases ANS: C Rationale: While a harm reduction approach to disease and injury prevention may complement abstinence-based messages and health promotion programming, and assist health care providers develop interpersonal communication skills, the primary intent is to reduce or minimize harm associated with higher-risk activities. The intent of a harm reduction approach is not to screen for communicable diseases.

PTS: 1 DIF: Moderate REF: Page and Header: 169, Harm Reduction OBJ: 5 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 12: Population Health Action: Prevention and Harm Reduction KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Remember 9. Harm reduction is founded on several key principles. The understanding that risk-taking is a natural part of the human experience is related to which principle?

A. Pragmatism B. Human rights/autonomy C. Focus on harms D. Priority of immediate goals ANS: A

Rationale: The principle of pragmatism supports the need for harm reduction initiatives because it is based on the acknowledgement that there will always be individuals engaged in higher-risk activities. The principle of human rights/autonomy is based on the notion of respect and dignity for all people, thereby contesting the moral condemnation often associated with higher-risk activities. A focus on harms addresses the negative health impact of higher-risk behaviours rather than the behaviour itself, and the priority of immediate goals addresses the context in which people live and are largely influenced by the social determinants of health.

PTS: OBJ: TOP: KEY: BLM:

1 DIF: Moderate REF: Page and Header: 171, Pragmatism 5 NAT: Client Needs: Health Promotion and Maintenance Chapter 12: Population Health Action: Prevention and Harm Reduction Integrated Process: Nursing Process Cognitive Level: Understand

10. Many harm reduction initiatives in community health practice are supported by federal and/or provincial legislation. An example of a legislated harm reduction initiative is: A. needle exchanges.

B. sexual health clinics.

C. access to nicotine patches.

D. bicycle helmet use.

ANS: D Rationale: Needle exchanges, sexual health clinics, and access to nicotine replacement therapies including nicotine patches are all examples of harm reduction initiatives, however, these are not legislated programs. Only bicycle helmet use is a legislated harm reduction initiative.

PTS: 1 DIF: Difficult REF: Page and Header: 170, Harm Reduction OBJ: 5 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 12: Population Health Action: Prevention and Harm Reduction KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply 11. A community health nurse is part of an interdisciplinary team that will address chronic disease in the community. The team should address what major risk factors for chronic disease? Select all that apply.

A. The use of cigarettes B. Antibiotic resistance C. The spread of infectious disease D. Inadequate nutrition and unhealthy eating E. Lack of exercise F. Environmental pollution ANS: A, D, E

Rationale: The leading causes of death and disability in Canada are chronic diseases. Four main risk factors contribute to chronic disease---unhealthy diets, lack of physical activity, tobacco, and alcohol use. Antibiotic resistance, infections and pollution have significant effects on health, but they are not among the main risk factors for chronic disease.

PTS: 1 DIF: Moderate REF: Page and Header: 160, Introduction OBJ: 1 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 12: Population Health Action: Prevention and Harm Reduction KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply 12. A group of nursing students are participating in a health fair in which they will screen attendees for hypertension and measure their capillary blood glucose level. These students are performing health prevention at what level?

A. Primordial B. Primary C. Secondary D. Tertiary ANS: C Rationale: Screening for early detection is an example of secondary prevention.

Primordial prevention focuses on proactively eliminating (not identifying) risk factors. Primary prevention addresses existing risk factors and tertiary prevention involves treatment and rehabilitation from disease.

PTS: REF: NAT: TOP: KEY: BLM:

1 DIF: Moderate Page and Header: 161, Levels of Prevention (Table 12.1) OBJ: 1 Client Needs: Health Promotion and Maintenance Chapter 12: Population Health Action: Prevention and Harm Reduction Integrated Process: Nursing Process Cognitive Level: Understand

13. The nurses at a public health unit have chosen to focus on primordial prevention.

What activity will best meet this goal?

A. Conducting a review of the health unit’s health promotion activities over the past year B. Collaborating with physicians to address misconceptions about the safety of vaccines C. Forming partnerships with women’s groups to increase participation in mammogram programs D. Lobbying against the granting of more liquor licenses in a neighbourhood ANS: D

Rationale: Primordial prevention consists of preventing risk factors for disease from existing. Actions that could cap or reduce access to alcohol could be considered primordial prevention. Reviews and quality assurance characterize quaternary prevention. Immunizations are an example of primary prevention and screening mammography is secondary prevention.

PTS: REF: NAT: TOP: KEY: BLM:

1 DIF: Moderate Page and Header: 161, Levels of Prevention (Table 12.1) OBJ: 1| 2 Client Needs: Health Promotion and Maintenance Chapter 12: Population Health Action: Prevention and Harm Reduction Integrated Process: Nursing Process Cognitive Level: Analyze

14. Staff members of a local hospital have petitioned their member of the legislative assembly to support increased tobacco taxes and an increase in the age of tobacco purchases from 18 to 19. How should a community health nurse best interpret these efforts?

A. The staff members’ support is an example of quaternary illness prevention.

B. The staff members’ are engaging in primordial prevention.

C. The staff members’ political action is unrelated to health.

D. The staff members’ actions are an example of harm reduction.

ANS: B Rationale: Policy and legislative changes that prevent risk factors from developing (by limiting tobacco access, for example) exemplify primordial prevention.

Quaternary prevention involves quality assurance. Harm reduction focuses on the harms associated with high-risk behaviour.

PTS: 1 DIF: Moderate REF: Page and Header: 163, Determinants of Health and Disease and Injury Prevention OBJ: 2 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 12: Population Health Action: Prevention and Harm Reduction KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze 15. Community health nurses begin discussions about their activities for the upcoming year and the need to focus on primordial and primary prevention. What action should the nurses include in their planning?

A. Prioritize the need to encourage residents to make health lifestyle choices B. Prioritize the epidemiology of disease transmission in the community C. Identify the role of the social determinants of health in the community D. Consider harm reduction as the framework for quaternary prevention ANS: C

Rationale: The importance of social determinants of health cannot be overstated.

Harm reduction is a proven strategy in the context of high-risk activities, but it is not a framework for quaternary prevention. A focus on “healthy lifestyle choices” overlooks the reality of the determinants of health. Epidemiology and disease transmission are valid concerns but do not always have the ability to affect overall community health.

PTS: REF: NAT: TOP: KEY: BLM:

1 DIF: Moderate Page and Header: 164, Public Policy and Prevention OBJ: 3 Client Needs: Health Promotion and Maintenance Chapter 12: Population Health Action: Prevention and Harm Reduction Integrated Process: Nursing Process Cognitive Level: Apply

16. A nurse is leading a community-based injury-prevention program. The planning and implementation of this program should be based on what fact?

A. A majority of injuries can be predicted and can therefore be prevented.

B. Injury prevention is a key component of a harm reduction campaign.

C. A majority of injuries are intentional attempts at self-harm or suicide.

D. Injury rates in Canada have been steadily increasing for almost three decades.

ANS: A Rationale: Injuries are not accidents; 90% of the time injuries can be predicted and, therefore, prevented. Most injuries are not related to intentional self-harm.

Rates have decreased in recent years. Injury prevention is not a subcomponent of harm reduction.

PTS: REF: NAT: TOP: KEY: BLM:

1 DIF: Moderate Page and Header: 165, Injury Prevention in Canada OBJ: 4 Client Needs: Health Promotion and Maintenance Chapter 12: Population Health Action: Prevention and Harm Reduction Integrated Process: Nursing Process Cognitive Level: Apply

17. A nurse is providing care for a young adult client who suffered a traumatic brain injury after a fall while rock climbing. According to Gordon’s theory of injury prevention, what is the agent?

A. The difficulty of the climb the client was attempting B. The rocks that the client’s head hit C. The client’s level of skill at rock climbing D. Inadequacies in the client’s climbing equipment ANS: D Rationale: According to Gordon, the host is the person or people to whom an injury happens; the agent is the object that transfers energy and causes the injury; and the environment includes all the physical, social, and economic factors that surround the injury event.

PTS: 1

DIF:

Moderate

REF: NAT: TOP: KEY: BLM:

Page and Header: 166, Injury Prevention Theory OBJ: 4 Client Needs: Health Promotion and Maintenance Chapter 12: Population Health Action: Prevention and Harm Reduction Integrated Process: Nursing Process Cognitive Level: Understand

18. A nurse is conducting health promotion education that includes bicycle safety.

What component of injury prevention best addresses enforcement?

A. Teaching children to wear a helmet every time they cycle B. Ensuring that cyclists choose a helmet that fits them correctly C. Teaching cyclists to buy a new helmet every 3 years D. Fines that exist for people not wearing a helmet when they cycle ANS: D Rationale: Enforcement denotes the legal penalties for noncompliance. The other listed actions promote safety, but does not directly address enforcement.

PTS: REF: NAT: TOP: KEY: BLM:

1 DIF: Easy Page and Header: 168, The Haddon Matrix OBJ: 4 Client Needs: Health Promotion and Maintenance Chapter 12: Population Health Action: Prevention and Harm Reduction Integrated Process: Nursing Process Cognitive Level: Analyze

19. A harm reduction approach is being taken to address the issue of heavy alcohol use among high school students. This program should be premised on the fact that: A. the legal implications of underage drinking are the highest priority.

B. long-term goals are a priority over short-term goals.

C. human beings have the right to behave how they wish, regardless of the effect on others or themselves.

D. reducing the consequences of drinking will be prioritized over stopping students from drinking.

ANS: D Rationale: Harm reduction focuses on the consequences of a behaviour rather than the behaviour itself. Immediate goals are often prioritized over long-term behaviour. Autonomy is a human right, but it does not confer the right to behave in any way, regardless of the effect on others. The dictates of the law do not form the framework for harm reduction.

PTS: 1 DIF: Moderate REF: Page and Header: 171, Focus on Harms OBJ: 5 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 12: Population Health Action: Prevention and Harm Reduction KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply

20. A nurse is participating in a needle exchange program for users of intravenous drugs. How can the nurse best demonstrate the harm reduction principle of client involvement?

A. Publishing the results of the program in peer-reviewed journals B. Lobbying for increased funding for the program C. Eliciting suggestions for improvement from users of the program D. Encouraging program users to participate in community events ANS: C Rationale: Active participation of individuals involved in high-risk behaviour is integral to harm reduction. Individuals who are most impacted by risk reduction strategies have valuable insight from their personal experiences and are well positioned to help design effective interventions. Lobbying, publishing, and encouraging community involvement are beneficial but do not directly demonstrate client involvement.

PTS: REF: NAT: TOP: KEY: BLM:

1 DIF: Moderate Page and Header: 171, Client Involvement OBJ: 5 Client Needs: Health Promotion and Maintenance Chapter 12: Population Health Action: Prevention and Harm Reduction Integrated Process: Nursing Process Cognitive Level: Apply

Chapter 13, Community Mental Health Promotion 1. A community health nurse has been asked to be a consultant to the Mental Health Commission of Canada (MHCC). In this role, the nurse will participate in: A. investigating innovative, evidence-based treatments for mental illness in Canada.

B. promoting changes in the way that mental health is addressed in Canada.

C. increasing the amount of material on mental health in Canadian nursing curricula.

D. replacing provincial mental health systems with one federal mental health system.

ANS: B Rationale: MHCC was established in 2007 with a 10-year mandate to serve as a catalyst for change. The Commission used extensive consultation processes to develop the first mental health strategy for Canada, and to tackle a number of priority topics. The Commission does not independently research treatments or dictate changes in curricula. There is no effort toward dismantling provincial health systems.

PTS: 1 DIF: Easy REF: Page and Header: 177, Evolution and Current Status of Mental Health Promotion in Canada OBJ: 1| 3 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 13: Community Mental Health Promotion KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply 2. A group of community health nurses have referenced Changing directions, changing lives: The mental health strategy for Canada when planning their upcoming activities. What action should the nurses take in order to best address the first strategic direction of this strategy?

A. Plan activities that promote mental health in Canadians of all ages B. Address the stigma that is faced by Canadians who have mental health disorders C. Lobby for increased funding for the treatment of mental illness D. Increase collaboration between registered nurses and registered psychiatric nurses ANS: A Rationale: Changing directions, changing lives: The mental health strategy for Canada identifies six strategic directions for improving mental health in Canada.

The first strategic direction is to promote mental health across the lifespan in homes, schools, and workplaces, and prevent mental illness and suicide wherever possible.

PTS: 1 DIF: Moderate REF: Page and Header: 177, Evolution and Current Status of Mental Health Promotion in Canada OBJ: 3 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 13: Community Mental Health Promotion KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply 3. What statement by a client who is being treated for mental illness most clearly suggests that he is experiencing stigma?

A. “My meds used to be paid for, but now I’m having to pay out-of-pocket for a lot of them.”

B. “My family doctor doesn’t seem to know a lot about different mental health problems.”

C. “I thought I might be ready to return to work, but it doesn’t seem like that will happen any time soon.”

D. “My landlord doesn’t want much to do with me now that he knows I see a psychiatrist.”

ANS: D Rationale: Stigma is social exclusion that is often experienced by persons with mental illness. The client’s statements about medication, work, and the family doctor’s lack of knowledge do not indicate stigma.

PTS: REF: NAT: TOP: KEY: BLM:

1 DIF: Moderate Page and Header: 177, Stigma and Social Exclusion Client Needs: Psychosocial Integrity Chapter 13: Community Mental Health Promotion Integrated Process: Nursing Process Cognitive Level: Analyze

OBJ:

2

4. A client who has schizophrenia has told the nurse about an interaction she had which clearly demonstrated stigma. The nurse should recognize that stigma: A. is now illegal in every province and territory.

B. exacerbates the challenges faced by individuals with mental illness.

C. is experienced by all clients who have physical or mental illnesses.

D. can be eliminated and overcome by providing quality health care.

ANS: B Rationale: Stigma leads to, or worsens, many of the challenges faced by people who have mental illness. Most forms of stigma are subtle, and not necessarily illegal. Stigma is faced disproportionately by people who have mental illness. It can (and should) be challenged by health care providers, but improvements to health care will not necessarily eliminate stigma.

PTS: REF: NAT: TOP:

1 DIF: Moderate Page and Header: 177, Stigma and Social Exclusion Client Needs: Psychosocial Integrity Chapter 13: Community Mental Health Promotion

OBJ:

2

KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand 5. A client with a history of mental illness has experienced a steady decline in quality of life and health outcomes in recent years. The nurse should identify what client characteristics as potential causes? Select all that apply.

A. The client has been charged with four separate crimes in the past 2 years.

B. The client has experienced stigma because he is an Indigenous person.

C. The client comes from a family where violence was common.

D. The client has been forced to move several times due to the high cost of rent.

E. The client takes three different prescription medications.

ANS: A, B, C, D Rationale: Criminal justice issues, violence, unstable housing, and stigma faced

by Indigenous Canadians all contribute to mental health challenges. The use of prescription medications, however, is not a noted factor.

PTS: REF: NAT: TOP: KEY: BLM:

1 DIF: Moderate Page and Header: 177, Mental Health Challenges OBJ: 2 Client Needs: Physiological Integrity: Reduction of Risk Potential Chapter 13: Community Mental Health Promotion Integrated Process: Nursing Process Cognitive Level: Analyze

6. A community health nurse is interviewing a client who has a longstanding history of mental illness. The nurse learns that the client’s symptoms have been particularly challenging in recent months but she describes her quality of life as “really good, actually.” What is the nurse’s best interpretation of this data?

A. The client is well, rather than ill.

B. The client’s mental illness is in remission.

C. The client’s symptoms are less severe than she believes them to be.

D. The client is flourishing despite the presence of mental illness.

ANS: D Rationale: Mental health and mental illness are often viewed as part of a single continuum, but evidence supports a two-continuum model (Keyes, 2007) with one continuum being presence or absence of mental illness, and the second continuum anchored by flourishing and languishing. According to this model, flourishing and illness can coexist. This does not mean the client’s illness is in remission or that she is overestimating her symptoms.

PTS: REF: NAT: TOP: KEY: BLM:

1 DIF: Moderate Page and Header: 180, Promoting Mental Health OBJ: 2 Client Needs: Psychosocial Integrity Chapter 13: Community Mental Health Promotion Integrated Process: Nursing Process Cognitive Level: Analyze

7. The nurse’s assessment of a client with mental illness strongly suggests that the client is languishing. Based on this information, the nurse can conclude that: A. the client’s perception of his well-being is low.

B. the client is not adhering to prescribed treatment.

C. the client’s mental illness is likely depression.

D. the client would benefit from inpatient treatment.

ANS: A Rationale: Mental health and mental illness are often viewed as part of a single continuum, but evidence supports a two-continuum model (Keyes, 2007) with one continuum being presence or absence of mental illness, and the second continuum anchored by flourishing and languishing. Flourishing is associated with well-being, while languishing is characterized by its absence. This does not mean, however, that the client is not adhering to treatment or that he is necessarily depressed. Similarly, a client who is languishing does not necessarily need inpatient treatment.

PTS: REF: NAT: TOP: KEY: BLM:

1 DIF: Easy Page and Header: 180, Promoting Mental Health OBJ: 2 Client Needs: Psychosocial Integrity Chapter 13: Community Mental Health Promotion Integrated Process: Nursing Process Cognitive Level: Analyze

8. A nurse should identify what factor as contributing to the poor health outcomes of Canadians with mental health issues?

A. Increased incidence and prevalence of depression B. Inadequate funding for mental health initiatives C. Increased rates of suicide among adolescents and young adults D. Lack of research on which to base evidence-informed practice ANS: B Rationale: Inadequate funding has long been a reality surrounding mental health care in Canada. This is unrelated to epidemiologic trends or a lack of research on which to base practice.

PTS: 1 DIF: Moderate REF: Page and Header: 180, Limitations of Existing Health and Mental Health Services OBJ: 2| 3 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 13: Community Mental Health Promotion KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand 9. Community health nurses are planning a health promotion and illness prevention campaign that will focus on mental illness. The nurse should focus on what population?

A. Children between 3 and 8 B. Youth and young adults

C. Clients between their 30s and 50s D. Older adults ANS: B Rationale: Preventing mental health issues involves both population-level and targeted interventions. The window of opportunity for prevention occurs early in life. About half of all mental illnesses emerge by the age of 14, and 75% are present by the age of 24. Many mental illnesses are not diagnosable in young children.

PTS: REF: NAT: TOP: KEY: BLM:

1 DIF: Easy Page and Header: 180, Preventing Mental Health Issues OBJ: Client Needs: Health Promotion and Maintenance Chapter 13: Community Mental Health Promotion Integrated Process: Nursing Process Cognitive Level: Apply

3

10. Leaders in a community’s health care system have identified a series of broad goals for the future. Which goal has the greatest potential to prevent mental illness in the community?

A. “We will conduct health education in locations convenient for residents.”

B. “Education and interventions will focus on strengthening families.”

C. “Education will prioritize the needs of recent immigrants to Canada.”

D. “Members of all health disciplines will collaborate closely.”

ANS: B Rationale: Strengthening families is known to prevent mental illness. All the other listed goals support health, but none is specifically relevant to the prevention of mental illness.

PTS: REF: NAT: TOP: KEY: BLM:

1 DIF: Moderate Page and Header: 180, Preventing Mental Health Issues OBJ: Client Needs: Health Promotion and Maintenance Chapter 13: Community Mental Health Promotion Integrated Process: Nursing Process Cognitive Level: Apply

3

11. A community health nurse is training a group of adults in Mental Health First Aid (MHFA). Using the skills of MHFA, participants will be able to: A. help individuals with mental illness to receive the care they need without requiring inpatient treatment.

B. provide short-term support for individuals in mental distress until specialized services can be accessed.

C. apply the material in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition during emergencies.

D. recognize and diagnose mental disorders among people who have not yet been referred for psychiatric care.

ANS: B

Rationale: Like other forms of first aid, MHFA is provided to a person who is experiencing difficulty until more specialized services can be engaged. Users do not make diagnoses and it is not a replacement for inpatient care when it is necessary.

PTS: REF: NAT: TOP: KEY: BLM:

1 DIF: Moderate Page and Header: 181, Providing Early Intervention OBJ: Client Needs: Physiological Integrity: Basic Care and Comfort Chapter 13: Community Mental Health Promotion Integrated Process: Nursing Process Cognitive Level: Apply

3

12. A nurse is providing care for a client with a longstanding diagnosis of schizophrenia who is currently in recovery. The fact that the client is in recovery suggests that the client is: A. making improvement following a serious exacerbation of symptoms.

B. receiving adequate inpatient care.

C. cured of schizophrenia, or very close to being cured.

D. living well despite the presence of schizophrenia.

ANS: D Rationale: In the mental health context, recovery does not mean cure. Recovery means living well in the presence or absence of illness. It is not limited to inpatient treatment. The client has not necessarily had a serious exacerbation recently.

PTS: REF: NAT: TOP: KEY: BLM:

1 DIF: Moderate Page and Header: 182, Recovery-Oriented Services Client Needs: Health Promotion and Maintenance Chapter 13: Community Mental Health Promotion Integrated Process: Nursing Process Cognitive Level: Understand

OBJ:

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13. A nurse is assessing a client who has a history of mental illness. When applying the principles of recovery, the nurse should ask what assessment question?

A. “Do you believe that you have a chance of being cured?”

B. “Have you been adhering closely to your prescribed treatment?”

C. “What have you been up to since we last met?”

D. “What would you say are your greatest strengths?”

ANS: D Rationale: A focus on strengths is integral to the concept of recovery. It is not centred around adherence, though it improves the chances of recovery. Recovery is not synonymous with cure and the client’s recent activities are not of major importance.

PTS: 1 DIF: Moderate REF: Page and Header: 182, Recovery-Oriented Services NAT: Client Needs: Health Promotion and Maintenance

OBJ:

3

TOP: Chapter 13: Community Mental Health Promotion KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply 14. A nurse is applying the concept of recovery to the care of a client with mental illness. The nurse can best apply this concept by: A. ensuring that care is evidence-informed.

B. avoiding any mention of the client’s mental illness.

C. forming a strong therapeutic partnership with the client.

D. helping the client understand the motivation behind his behaviours.

ANS: C Rationale: An orientation toward recovery means shifting from largely provider-centred and medically oriented services toward partnerships with patients. There is no need to avoid mentioning the client’s illness.

Evidence-informed care and helping clients understand their motivations are beneficial, but do not directly demonstrate a focus on recovery.

PTS: REF: NAT: TOP: KEY:

1 DIF: Moderate Page and Header: 182, Recovery-Oriented Services OBJ: Client Needs: Health Promotion and Maintenance Chapter 13: Community Mental Health Promotion Integrated Process: Caring BLM: Cognitive Level: Apply

3| 4

15. A health region is doing strategic planning around the provision of mental health services. What goal should be prioritized during this process?

A. Educating residents about the incidence and prevalence of mental illness B. Consulting with local stakeholders C. Increasing the number of hospital beds designated for psychiatric care D. Creating conditions where clients can experience recovery ANS: D Rationale: In essence, the goal of mental health services is to create environments in which recovery can take place. This goal is the ultimate purpose of any educational efforts or assignment of resources. Consulting with stakeholders is one of the means of achieving this end.

PTS: REF: NAT: TOP: KEY: BLM:

1 DIF: Moderate Page and Header: 182, Recovery-Oriented Services Client Needs: Health Promotion and Maintenance Chapter 13: Community Mental Health Promotion Integrated Process: Nursing Process Cognitive Level: Apply

OBJ:

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16. A province is attempting to integrate mental health more closely into the public health care system. What action should health care leaders prioritize to achieve this goal?

A. Reducing inpatient treatment for mental illness B. Increasing education about mental health for health care providers

C. Teaching clients with mental illness to better advocate for their needs D. Educating police officers about mental health and mental illness ANS: B Rationale: Education of health professionals is a key strategy for the integration of mental health into public health practice. Educating police officers helps them meet the acute needs of persons with mental illness, but does not integrate mental health into the larger system. A reduction in inpatient treatment does not help achieve this goal. Teaching persons with mental illness to advocate for their individual needs is unlikely to lead to a system-wide change.

PTS: REF: OBJ: NAT: TOP: KEY: BLM:

1 DIF: Difficult Page and Header: 186, Integration into Public Health Practice 4 Client Needs: Safe and Effective Care Environment: Management of Care Chapter 13: Community Mental Health Promotion Integrated Process: Nursing Process Cognitive Level: Apply

17. Efforts are being made to better meet the needs of individuals in the community who experience acute psychosis. Education about meeting these needs should be offered to what group?

A. Emergency department physicians and nurses B. Social workers C. Police officers D. Transit operators and taxi drivers ANS: C Rationale: Police training is another example of developing skills to improve system response. Police have very little information in their training on how to respond to people who are experiencing mental health issues. Emergency physicians and nurses have more education on this subject.

PTS: REF: NAT: TOP: KEY: BLM:

1 DIF: Moderate Page and Header: 184, Building Personal Skills OBJ: 4| 5 Client Needs: Health Promotion and Maintenance Chapter 13: Community Mental Health Promotion Integrated Process: Teaching/Learning Cognitive Level: Apply

18. A public health nurse has made a commitment to prioritize mental health when providing care for clients with all backgrounds and diagnoses. The nurse should work toward achieving this by: A. integrating the concept of recovery into care.

B. prioritizing psychological needs over physiologic needs.

C. assessing every client’s mental status, coping skills, and thought patterns.

D. collaborating with a psychiatric nurse whenever possible.

ANS: A

Rationale: Embedding mental health into practice requires the use of a recovery-oriented framework for practice. It is not always possible or necessary for a nurse to collaborate with a psychiatric nurse. Physiologic needs often supersede psychological needs, at least in the short term. Different clients require different assessments; it is not always necessary to assess every client’s mental status, coping skills, and thought patterns.

PTS: REF: NAT: TOP: KEY: BLM:

1 DIF: Moderate Page and Header: 187, Integration into Personal Practice OBJ: Client Needs: Health Promotion and Maintenance Chapter 13: Community Mental Health Promotion Integrated Process: Nursing Process Cognitive Level: Apply

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19. A nurse is on a team that is trying to promote environments that foster mental health. What domains should the team address? Select all that apply.

A. Workplaces B. Schools C. Housing D. Recreational facilities E. Colleges and universities ANS: A, B, C, D, E Rationale: Healthy environments encompass all of the place where people are: their homes, workplaces, recreation sites, and schools.

PTS: REF: OBJ: TOP: KEY: BLM:

1 DIF: Easy Page and Header: 183, Creating Supportive Environments 3| 4 NAT: Client Needs: Health Promotion and Maintenance Chapter 13: Community Mental Health Promotion Integrated Process: Nursing Process Cognitive Level: Apply

20. A public health nurse is working toward enhancing the housing conditions in a community so that mental health is better supported. The nurse should: A. support the establishment of numerous mental health wellness centres.

B. oppose the construction of large, luxury homes.

C. advocate to increase the amount of parkland that the city sets aside.

D. ensure landlords do not discriminate against applicants with mental illness.

ANS: D Rationale: Ending stigma in discrimination in housing is integral to creating a supportive environment. The presence of a series of wellness centres does not necessarily enhance housing conditions. In the same way, increasing the number of parks does not enhance housing. It is likely unnecessary for the nurse to oppose construction of large homes.

PTS: 1

DIF:

Moderate

REF: OBJ: TOP: KEY: BLM:

Page and Header: 183, Creating Supportive Environments 4 NAT: Client Needs: Health Promotion and Maintenance Chapter 13: Community Mental Health Promotion Integrated Process: Nursing Process Cognitive Level: Apply

Chapter 14, Social Media and Health Promotion 1. Which of the following options best reflects what is defined as social media?

A. A web page that allows users to comment and share ideas with others B. Any networked information and communication technology (ICT) that derives its principal value from user engagement, permits distribution, editing, usability, and interoperability C. The Facebook, Twitter, Instagram, Snapchat, and YouTube social network platforms D. Any information and communication technology (ICT) that allows users to engage content, share ideas, and learn from wherever a person is located ANS: B Rationale: Social media is more than specific technologies and mobility, but something that transcends these specific qualities to be interoperable and networked in whatever ICT form.

PTS: 1 DIF: Easy REF: Page and Header: 190, Introduction OBJ: 2 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 14: Social Media and Health Promotion KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Remember 2. Standage (2013) has argued that social media is actually an old concept, with modern social network platforms serving as an updated version of what was done with other media throughout history. What qualities best reflect the modern incarnation of social media that distinguish it from what has come before?

A. Ability to share and remix content B. Mobility of messaging C. Increased speed of delivery D. Scale of interaction between one-to-one, one-to-many, and many-to-many ANS: D Rationale: People have always adapted and remixed content, passed it around, and have managed to do so quickly; however, all of those interactions are largely predicated on a one-to-one engagement from individual to individual, whereas the modern version powered by ICT allows for a rapid scaling of communication in multiple directions instantaneously, which is distinctive from anything that has come before it.

PTS: REF: OBJ: TOP: KEY:

1 DIF: Moderate Page and Header: 192, Social Media: Past, Present, and Future 2 NAT: Client Needs: Health Promotion and Maintenance Chapter 14: Social Media and Health Promotion Integrated Process: Communication and Documentation

BLM: Cognitive Level: Understand 3. What language best characterizes the principal shifts in knowledge-to-action activities that encompass social media and the system’s thinking approach that it relies on?

A. Knowledge dissemination and diffusion B. Knowledge integration C. Knowledge translation D. Knowledge exchange ANS: B Rationale: Social media is part of a system’s approach to communication that seeks to support the integration of knowledge into practice and embed communications within the fabric of an organization and regular activities.

Knowledge integration includes components of past generations of knowledge-to-action theories and models, but extends beyond them to promote a systems-oriented approach to communication where knowledge is gained from all facets of the organization, beyond exchange, dissemination, and translation.

PTS: 1 DIF: Difficult REF: Page and Header: 193, Health Promotion 2.0: New Thinking about Creating Conversations about Health Online OBJ: 1 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 14: Social Media and Health Promotion KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply 4. eHealth literacy is a meta-literacy skill that is defined as “the ability to seek, find, understand, and appraise health information from electronic sources and apply the knowledge gained to solving a health problem” (Norman & Skinner, 2006) and underpins the public’s use of social media for health promotion. Which of the following are literacies related to eHealth literacy? Select all that apply.

A. Information literacy B. Health literacy C. Nursing literacy D. Media literacy E. Emotional literacy ANS: A, B, D Rationale: eHealth literacy brings together elements of information, media, health, science, computer, and basic prose literacy (and numeracy) together to place health information in an electronic context with the skills associated for how to navigate, understand and apply lessons learned, and engage others through social media. It is a skill that transcends any particular health discipline.

PTS: 1 DIF: Moderate REF: Page and Header: 194, eHealth Literacy OBJ: 3 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 14: Social Media and Health Promotion

KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Understand 5. Social marketing research informs the way social media can be used to influence health behaviour. According to Lefebrve et al. (2013), which of the following are lessons for organizations seeking to use social media? Select all that apply A. “Likes” and “Followers” are the principal indicators of social media reach and impact.

B. Relationships and knowledge are better social currency than money.

C. Good strategy results in messages going viral, but viral is not a strategy in itself.

D. Social media is less about command and control, and more about engagement with audiences.

E. Social aspects of social media are both the medium of communication and the message.

ANS: B, C, D, E Rationale: Social media engagement with audiences place emphasis on relationships resulting in a nonlinear process of cultivating trust that can potentially lead to messages being shared and exchanged based on this trust.

Likes and Followers are only one metric associated with social media and may not reflect the quality of engagement with an audience. The social aspect of social media is both the content and the vehicle for sharing it.

PTS: REF: OBJ: TOP: KEY: BLM:

1 DIF: Moderate Page and Header: 195, Public and Professional Engagement 2 NAT: Client Needs: Health Promotion and Maintenance Chapter 14: Social Media and Health Promotion Integrated Process: Communication and Documentation Cognitive Level: Understand

6. Social media can play an important part of a health promotion campaign at different levels or orders in an intervention. What is the correct representation of the three orders of social media intervention?

A. Stand-alone, Adjunct, Integrated B. Stand-alone, Adjunct, Interconnected C. Independent, Connected, Interconnected D. Independent, Adjacent, Integrated ANS: A Rationale: The first order is Stand-alone, reflecting the independence of the intervention from other campaigns that may be underway. The second order is Adjunct in that it is a complement to another intervention, providing additional information or opportunities that are not present in the other program or intervention. The third order is Integrated as social media is not just connected to other aspects of interventions using different media, but is an integral part of the success of that intervention and not an optional adjunct.

PTS: 1

DIF:

Moderate

REF: OBJ: TOP: KEY: BLM:

Page and Header: 196, Public and Professional Engagement 1 NAT: Client Needs: Health Promotion and Maintenance Chapter 14: Social Media and Health Promotion Integrated Process: Communication and Documentation Cognitive Level: Understand

7. Which of the following best illustrates risks and opportunities associated with engaging the public in discussion of controversial public health issues through social media?

A. An organization may lose followers because of the controversy, while attracting new ones who can rally around a cause.

B. Being critical of misinformation online ensures that those spreading incorrect or potentially harmful information are identified as spreading harmful messages so that their followers can stop engaging with them and start following evidence-informed sources.

C. The risk is that the public may be exposed to harmful information, however, the opportunity is that the organization can assert its authority as a trusted source for health knowledge.

D. An organization may highlight some of the flaws in a particular argument or provide a contrary position, but it may also draw attention to those promoting harmful or unhealthy positions in the process of doing so.

ANS: D Rationale: Social media users follow people for a variety of reasons and often not just because of the quality of information. Health promoters must proceed with caution and not risk disengaging individuals by preaching to them, denigrating their choices of who to follow, while also balancing a desire to correct misperceptions, incomplete information, incorrect or poor-quality data, or deliberately false claims. Social media can amplify particular positions and individuals unintentionally if not approached carefully.

PTS: REF: OBJ: TOP: KEY: BLM:

1 DIF: Difficult Page and Header: 197, Case Study: Anti-vaccination messages 2 NAT: Client Needs: Health Promotion and Maintenance Chapter 14: Social Media and Health Promotion Integrated Process: Communication and Documentation Cognitive Level: Analyze

8. One of the central features of social media is its reliance on networks of interaction. Which of the following are recognized concepts in social network research related to social media? Select all that apply.

A. Cliques B. Network strength C. Median connection D. Symmetry E. Frequency ANS: A, B, D, E

Rationale: Cliques are clustered individuals, while network strength describes the amount of energy used to maintain connections between individuals and sustain them. Symmetry reflects the potential for mutually reinforcing connections, however, there are few “typical” or common connections that would require attention to what a “median” connection might be. Frequency denotes the number of transactions that take place, and the frequency of interactions is an indicator of overall engagement on a social network.

PTS: OBJ: TOP: KEY: BLM:

1 DIF: Moderate REF: Page and Header: 199, Networks 2 NAT: Client Needs: Health Promotion and Maintenance Chapter 14: Social Media and Health Promotion Integrated Process: Communication and Documentation Cognitive Level: Understand

9. Social media provides unique opportunities to engage the public and health professionals on issues pertaining to the social determinants of health. Which of the following are key recommendations provided by the National Collaborating Centres on the Social Determinants of Health (Norman & Muzumdar, 2013) for health promoters looking to use social media for work on the social determinants of health? Select all that apply.

A. Have a distinct, clear message; be authentic; and share what you know B. Leverage the opportunities provided by social media to get your perspective across to different audiences by broadcasting messages widely across different platforms C. Sensitize yourself to the needs of both health promotion organizations and audiences D. Create space for conversation, not just one-sided, unidirectional messages E. Make connections between people, concepts, and content whenever possible ANS: A, C, D, E Rationale: Norman and Muzumdar (2013) provide four key recommendations for health promoters who are seeking to engage audiences through social media, particularly on issues of social determinants of health: (1) Have a distinct, clear message; be authentic; and share what you know; (2) Create space for conversation, not just one-sided, unidirectional messages; (3) Whenever possible, make connections between people, concepts, and content: hyperlink, mention, and tag; and (4) Sensitize yourself to the needs of both health promotion organizations and audiences. It is important to have a perspective and to communicate that to others, but also use social media as a vehicle for listening and learning. Self-promotion and broadcasting represents a narrow use of social media and can discourage engagement among populations who may not feel they are being properly heard or respected.

PTS: REF: NAT: TOP: KEY: BLM:

1 DIF: Difficult Page and Header: 200, Media and Messaging OBJ: 3 Client Needs: Health Promotion and Maintenance Chapter 14: Social Media and Health Promotion Integrated Process: Communication and Documentation Cognitive Level: Understand

10. Which of the following are anticipated trends to watch for with social media and health promotion as they evolve together in the coming years? Select all that apply.

A. An increasing blend of local and global perspectives will be shared across social media platforms as more of the world’s population connects online.

B. Technology and social changes will continue to outpace traditional models of academic research, peer review, funding, and publication unless the system changes.

C. Privacy and security will continue to be a significant issue as new tools and technologies provide social media connections between the public and public health.

D. The use of technology will be concentrated in an increasingly narrow portion of the population.

E. There will a resurgence of older technologies fueled by a backlash against the cost of newer technologies.

ANS: A, B, C Rationale: As more of the world’s population uses social media and engages with each other, ideas will continue to evolve and the demand for social connectivity is likely to rise, creating more challenges for privacy and for researchers seeking to understand how social media influences the world. There is neither a decrease of the use of technology nor a resurgence of old technology expected in the coming years.

PTS: REF: NAT: TOP: KEY: BLM:

1 DIF: Moderate Page and Header: 201, Social Media Futures OBJ: 2 Client Needs: Health Promotion and Maintenance Chapter 14: Social Media and Health Promotion Integrated Process: Communication and Documentation Cognitive Level: Understand

11. A nurse is helping to plan a health promotion campaign that will have a large social media component. When addressing colleagues who are skeptical of social media, the nurse should cite what known benefit?

A. Engaging with individuals and populations that have previously been difficult to access B. Increasing the quality of information that is disseminated to the public C. Accessing government grants that were previously unavailable before the advent of social media D. Increasing health care providers’ accountability to members of the public and health care consumers ANS: A Rationale: With social media, there is an opportunity to engage with groups that have remained elusive. Increased grant funding, increased accountability, and enhanced quality of information are not among the noted benefits of social media.

PTS: 1 DIF: Moderate REF: Page and Header: 192, From Tools to Platforms

OBJ: 2

NAT: TOP: KEY: BLM:

Client Needs: Health Promotion and Maintenance Chapter 14: Social Media and Health Promotion Integrated Process: Communication and Documentation Cognitive Level: Apply

12. A community health nurse is summarizing some of the shifts in health communication that social media has caused. The nurse should describe what phenomenon?

A. Statements made by health professionals are more highly esteemed than in the past.

B. Information is now concentrated more highly in urban, densely populated regions.

C. There are fewer dissenting views available to consumers about controversial issues.

D. Information no longer flows in one direction from professionals to the public.

ANS: D Rationale: Traditional health communication emphasizes planned, structured messaging that is largely unidirectional from health professionals to the public; this is no longer the case. There is a notable democratization of ideas and there is believed to be less regard for professional views. Multiple dissenting views are present and information is not geographically limited.

PTS: 1 DIF: Easy REF: Page and Header: 193, Health Promotion 2.0: New Thinking about Creating Conversations about Health Online OBJ: 2 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 14: Social Media and Health Promotion KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Understand 13. A group of community nurses are applying their knowledge of systems thinking when planning a health promotion campaign. How can the nurses most directly apply the concept of system dynamics in this campaign?

A. Including members of the public in the planning process rather than just health care professionals B. Launching the campaign from a single urban centre even though it is intended to influence multiple rural, northern communities C. Focusing exclusively on the health behaviours of Canadians who are between 12 and 20 years of age D. Prioritizing the health behaviours of people who have some level of postsecondary education ANS: B

Rationale: System dynamics produce an environment where the impact of a social media action may be felt far from the source within the system; that is, actions from a city centre can immediately influence multiple, distant recipients. System dynamics does not involve focusing solely on younger or more educated people. It is important to include the public in the planning process, but it is not an aspect of system dynamics.

PTS: REF: NAT: TOP: KEY: BLM:

1 DIF: Difficult Page and Header: 194, Systems Thinking OBJ: Client Needs: Health Promotion and Maintenance Chapter 14: Social Media and Health Promotion Integrated Process: Communication and Documentation Cognitive Level: Apply

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14. When describing the potential application of systems thinking to a health promotion campaign, the nurse should explain what benefit?

A. “We could be able to create a campaign that costs a fraction of what health promotion campaigns used to cost.”

B. “This gives us an opportunity to have many more health professionals contribute to our campaign.”

C. “We can purchase a pre-existing health promotion program that can save us a lot of time and energy.”

D. “If we do this right, we can create a new and unprecedented network of influence.”

ANS: D Rationale: The systems concept of networks involves the ability to connect people together and form, extend, or transform networks of influence through those connections. Social media is not necessarily cheap or easy and it may or may not include a larger number of health professionals.

PTS: REF: NAT: TOP: KEY: BLM:

1 DIF: Moderate Page and Header: 194, Systems Thinking OBJ: Client Needs: Health Promotion and Maintenance Chapter 14: Social Media and Health Promotion Integrated Process: Communication and Documentation Cognitive Level: Understand

2

15. A client has brought numerous articles about the danger of vaccines to an appointment with a health provider. The provider observes that the articles are exclusively from websites that contain “quack” science. What is the best interpretation of this client’s actions?

A. The client should be cautioned against consulting the Internet.

B. The client’s skills at using social media are deficient.

C. The client has a lack of knowledge.

D. The client lacks eHealth literacy skills ANS: D

Rationale: The client’s lack of discernment suggests a lack of eHealth literacy skills. It is important for consumers to use the Internet in an informed manner, not to avoid it completely. This is not related to a lack of knowledge or an inability to use social media.

PTS: 1 DIF: Easy REF: Page and Header: 194, eHealth Literacy OBJ: 3 NAT: Client Needs: Health Promotion and Maintenance TOP: Chapter 14: Social Media and Health Promotion KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Analyze 16. A social media campaign is being planned to address obesity in a health region. A nurse participating in the campaign should recognize what attribute as the best form of social currency?

A. Expertise B. Relationships C. Credibility D. Education ANS: B Rationale: Successful use of social media is premised on the fact that relationships and knowledge are the best social currency, not money.

PTS: REF: OBJ: TOP: KEY: BLM:

1 DIF: Easy Page and Header: 195, Public and Professional Engagement 3 NAT: Client Needs: Health Promotion and Maintenance Chapter 14: Social Media and Health Promotion Integrated Process: Communication and Documentation Cognitive Level: Understand

17. What health promotion campaign should the nurse recognize as one where social media plays as adjunct role?

A. An antismoking campaign that exists solely on Twitter and YouTube B. A campaign against sexually transmitted infections that includes pamphlets and television advertising C. A multifaceted crisis intervention campaign that has numerous aspects, including a Facebook page D. A suicide hotline that involves Twitter, Facebook, and radio advertising ANS: D

Rationale: The suicide hotline promoted via Twitter, Facebook, and radio advertising is an example of an adjunct intervention. An adjunct (second-order) campaign is one in which social media is designed to be used along with another type of resource. A stand-alone tool includes only one resource used independently of any other resources, such as a social media-only anti-smoking campaign. A third-order intervention, like the multifaceted crisis intervention campaign in this scenario, is part of an integrated program of delivery where the ICT is but one component. Unlike second-order interventions, a third-order intervention is embedded within a larger program, and the resource is not viewed as integral to the larger initiative or apart from it. The pamphlet/television advertising campaign does not include social media as a resource at all.

PTS: REF: OBJ: TOP: KEY: BLM:

1 DIF: Moderate Page and Header: 196, Public and Professional Engagement 3 NAT: Client Needs: Health Promotion and Maintenance Chapter 14: Social Media and Health Promotion Integrated Process: Communication and Documentation Cognitive Level: Analyze

18. A nurse is attempting to address the digital divide when planning the social media components of a health promotion initiative. It is important for the nurse to recognize and address the digital divide because: A. traditional forms of media still predominate in many communities.

B. the information on social media is often deceptive and inaccurate.

C. many Canadians cannot discern between reliable and unreliable sources of digital information.

D. many Canadians lack sufficient and high-quality access to technology.

ANS: D Rationale: The “digital divide” exists because there is no state of equity in Canadians’ access to technology. This is not necessarily a result of the presence of traditional media or inaccuracies in electronic information. Discerning reliable sources is more related to eHealth literacy, not the digital divide.

PTS: REF: NAT: TOP: KEY: BLM:

1 DIF: Moderate Page and Header: 196, Equity and Access OBJ: Client Needs: Health Promotion and Maintenance Chapter 14: Social Media and Health Promotion Integrated Process: Communication and Documentation Cognitive Level: Understand

2| 3

19. Community health nurses are planning to engage youth and young adults in a social media campaign. According to Norman and Muzumdar (2013), the nurses should: A. maximize the use of humor in the campaign to increase engagement.

B. present a clear, simple message in an authentic way.

C. prioritize the World Wide Web over other social media platforms.

D. limit the campaign to no more than 4 to 6 months.

ANS: B

Rationale: Norman and Muzumdar (2013) recommend a distinct, clear message; authenticity; and sharing what you know. There is no absolute need to limit a campaign to a few months and there are numerous alternatives to the World Wide Web. Humor must be used judiciously.

PTS: REF: NAT: TOP: KEY: BLM:

1 DIF: Moderate Page and Header: 200, Media and Messaging OBJ: 3 Client Needs: Health Promotion and Maintenance Chapter 14: Social Media and Health Promotion Integrated Process: Communication and Documentation Cognitive Level: Apply

20. A social media campaign has been designed so that members of the community can readily ask questions, seek clarification, give feedback, and otherwise engage with the health professionals leading the campaign. This campaign demonstrates what characteristic of social networking?

A. Cliques B. Network strength C. Symmetry D. Role ANS: C Rationale: Symmetrical relations in social networks are assessed through bidirectional ties, whereby interactions are mutually beneficial. Cliques are measured through shared network connections and clustering of links. Network strength is assessed by the emotional or intellectual intensity, intimacy, or reciprocity or amount of time invested in interactions. Users play many roles in social networking, but “Role” itself is not a characteristic of this campaign.

PTS: OBJ: TOP: KEY: BLM:

1 DIF: Moderate REF: Page and Header: 199, Networks 2 NAT: Client Needs: Health Promotion and Maintenance Chapter 14: Social Media and Health Promotion Integrated Process: Communication and Documentation Cognitive Level: Analyze

Chapter 15, A Model to Guide Practice 1. A community health worker is using the Canadian Community as Partner (CCAP) model to complete a community health assessment. What type of model does this represent?

A. Disease oriented B. Medical C. Organ focused D. Systems ANS: D Rationale: CCAP is built on Anderson and McFarlane’s community-as-partner model that was created with Neuman’s Systems Model in mind. Neuman’s total-person approach and, subsequently, the Community as Partner model are considered systems models.

PTS: REF: OBJ: NAT: TOP: KEY: BLM:

1 DIF: Easy Page and Header: 211, Canadian Community as Partner Model 3 Client Needs: Safe and Effective Care Environment: Management of Care Chapter 15: A Model to Guide Practice Integrated Process: Nursing Process Cognitive Level: Understand

2. There are four concepts that are central to nursing (person, environment, health, and nursing). What is the definition for the person in the Canadian Community as Partner (CCAP) model?

A. A population or an aggregate B. A network of people and their surroundings C. A resource for everyday life, not the objective of living D. Based on definitions of the other three concepts, it is prevention ANS: A Rationale: There are three concepts of the CCAP model that help define nursing.

These concepts are person, environment, and health. Within the CCAP model, the person is a population or an aggregate. Environment is a network of people and their surroundings. Health is a resource for everyday life, not the objective of living. Nursing is based on definitions of the other three concepts; it is prevention.

PTS: REF: OBJ: NAT: TOP: KEY: BLM:

1 DIF: Easy Page and Header: 211, Canadian Community as Partner Model 3 Client Needs: Safe and Effective Care Environment: Management of Care Chapter 15: A Model to Guide Practice Integrated Process: Nursing Process Cognitive Level: Understand

3. A community health worker is using the Canadian Community as Partner (CCAP) model to complete a community health assessment. The community health worker is reviewing the flexible line of defence, depicted as a broken line around the community and its normal line of defence (Comm-NLD). What does the flexible line of defence represent?

A. The level of health the community has reached over time B. The internal mechanisms that act to defend against stressors C. A buffer zone that represents the result of a temporary response to a stressor D. Tension-producing stimuli that have the potential of causing disequilibrium in the system ANS: C Rationale: The flexible line of defence is the buffer zone representing a dynamic level of health resulting from a temporary response to stress. Normal line of defence is the level of health the community has reached over time. Lines of resistance are internal mechanisms that act to defend against stressors.

Stressors are tension-producing stimuli that have the potential of causing disequilibrium in the system.

PTS: REF: NAT: TOP: KEY: BLM:

1 DIF: Easy Page and Header: 216, Lines of Resistance OBJ: 3 Client Needs: Safe and Effective Care Environment: Management of Care Chapter 15: A Model to Guide Practice Integrated Process: Nursing Process Cognitive Level: Understand

4. A community health worker is using the Community as Partner model to complete a community health assessment. What do mortality and morbidity rates represent in this model?

A. The degree of reaction to a stressor B. The people who make up the community core C. The community’s flexible line of defence D. The population’s normal line of defence ANS: B Rationale: The core of the assessment wheel represents the people who make up the community and population’s health status (Pop-NLD) as represented by health statistics such as mortality and morbidity. The degree of reaction is the amount of disequilibrium or disruption that results from stressors impinging on the community’s lines of defence. Flexible line of defence is the buffer zone representing a dynamic level of health resulting from a temporary response to stress. Normal line of defence (Comm-NLD) is the level of health the community has reached over time.

PTS: REF: OBJ: NAT:

1 DIF: Moderate Page and Header: 212, The Community Assessment Wheel 3 Client Needs: Safe and Effective Care Environment: Management of Care

TOP: Chapter 15: A Model to Guide Practice KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand 5. A community health worker is using the Canadian Community as Partner model to complete a community health assessment. What does a high rate of immunity represent in this model?

A. Population’s normal line of defence B. Flexible line of defence C. Lines of resistance D. Degree of reaction ANS: A Rationale: Population’s normal line of defence (Pop-NLD) is the level of health of the population. Flexible line of defence is the buffer zone representing a dynamic level of health resulting from a temporary response to stress. Lines of resistance are internal mechanisms that act to defend against stressors. The degree of reaction is the amount of disequilibrium or disruption that results from stressors impinging on the community’s lines of defence.

PTS: REF: OBJ: NAT: TOP: KEY: BLM:

1 DIF: Easy Page and Header: 215, The Community Assessment Wheel 3 Client Needs: Safe and Effective Care Environment: Management of Care Chapter 15: A Model to Guide Practice Integrated Process: Nursing Process Cognitive Level: Understand

6. A community health worker is using the Canadian Community as Partner model to complete a community health assessment. What do the demographics of the population represent in this model?

A. Degree of reaction B. The community core C. Flexible line of defence D. Normal line of defence ANS: B Rationale: The core of the assessment wheel represents the people who make up the community. The degree of reaction is the amount of disequilibrium or disruption that results from stressors impinging on the community’s lines of defence. Flexible line of defence is the buffer zone representing a dynamic level of health resulting from a temporary response to stress. Normal line of defence is the level of health the community has reached over time.

PTS: REF: OBJ: NAT: TOP:

1 DIF: Easy Page and Header: 212, The Community Assessment Wheel 3 Client Needs: Safe and Effective Care Environment: Management of Care Chapter 15: A Model to Guide Practice

KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand 7. A nurse is using the Community as Partner model to complete a community health assessment. What are the stressors in this model?

A. Level of health the community has reached over time B. Internal mechanisms that act to defend against stressors C. Buffer zone representing a dynamic level of health resulting from a temporary response to stress D. Tension-producing stimuli that have the potential of causing disequilibrium in the system ANS: D Rationale: Stressors are tension-producing stimuli that have the potential of causing disequilibrium in the system. Flexible line of defence is the buffer zone representing a dynamic level of health resulting from a temporary response to stress. Normal line of defence is the level of health the community has reached over time. Lines of resistance are internal mechanisms that act to defend against stressors.

PTS: OBJ: NAT: TOP: KEY: BLM:

1 DIF: Easy REF: Page and Header: 216, Stressors 3 Client Needs: Safe and Effective Care Environment: Management of Care Chapter 15: A Model to Guide Practice Integrated Process: Nursing Process Cognitive Level: Understand

8. A community health worker is using the Canadian Community as Partner model to complete a community health assessment. What assessment should the nurse complete first?

A. Community core B. Community subsystems C. Perceptions about community D. Degree of reaction ANS: A Rationale: The core of a community is its people---their history, characteristics, values, and beliefs. The first stage of assessing a community, then, is to learn about its people.

PTS: OBJ: NAT: TOP: KEY: BLM:

1 DIF: Easy REF: Page and Header: 217, Assessment 5 Client Needs: Safe and Effective Care Environment: Management of Care Chapter 15: A Model to Guide Practice Integrated Process: Nursing Process Cognitive Level: Apply

9. When completing a community assessment, the community health worker has to take several aspects of the community into account. What is the first stage of this assessment?

A. Learn about the people that comprise the community B. Understand the major illnesses affecting people C. Identify the boundaries of the community D. Identify resources available in the community ANS: A Rationale: The first stage of assessing a community is to learn about its people.

Once statistics have been compiled about the people, then individual components of the community can be assessed, such as illness, boundaries of the community, and resources in the community.

PTS: OBJ: NAT: TOP: KEY: BLM:

1 DIF: Moderate REF: Page and Header: 217, Assessment 5 Client Needs: Safe and Effective Care Environment: Management of Care Chapter 15: A Model to Guide Practice Integrated Process: Nursing Process Cognitive Level: Understand

10. A nurse has utilized a nursing model to aid in the assessment, planning, and implementation of a community-based intervention. In nursing practice, a model is best defined as: A. a prescriptive representation of best actions.

B. a frame of reference that represents practice.

C. a way of describing people and their environments.

D. a linear process of performing nursing interventions.

ANS: B Rationale: A model provides a frame of reference, and is a representation of practice, not a reality. It is not necessarily linear, descriptive, or prescriptive.

PTS: OBJ: NAT: TOP: KEY: BLM:

1 DIF: Moderate REF: Page and Header: 208, Models 1 Client Needs: Safe and Effective Care Environment: Management of Care Chapter 15: A Model to Guide Practice Integrated Process: Nursing Process Cognitive Level: Remember

11. Among the numerous models that are applicable to health care, the medical model is one of the most prevalent and widely implemented. The medical model has proven especially valuable in which of the following aspects of health?

A. Preventing communicable diseases B. Empowering communities C. Building community capacity D. Addressing determinants of health ANS: A

Rationale: The medical model has been valuable in efforts to eliminate childhood communicable diseases and common preventable illness. However, reliance on the medical model that focuses on individuals excludes health promotion and the holistic focus that is central to population/public health and community well-being.

PTS: OBJ: NAT: TOP: KEY: BLM:

1 DIF: Moderate REF: Page and Header: 208, Models 3 Client Needs: Safe and Effective Care Environment: Management of Care Chapter 15: A Model to Guide Practice Integrated Process: Nursing Process Cognitive Level: Understand

12. Despite the wide variety of models available to guide health care practice, general agreement exists that certain concepts are central to health disciplines. These concepts include: A. stressors, resilience, and social support.

B. illness, injury, and disability.

C. person, environment, and health.

D. vulnerability, capacity, and belonging.

ANS: C Rationale: The four concepts that are central to health disciplines are person, environment, health, and the defining characteristics of the specific health discipline (e.g., nursing, social work, medicine, nutrition).

PTS: OBJ: NAT: TOP: KEY: BLM:

1 DIF: Moderate REF: Page and Header: 208, Models 3 Client Needs: Safe and Effective Care Environment: Management of Care Chapter 15: A Model to Guide Practice Integrated Process: Nursing Process Cognitive Level: Understand

13. The concept of health has been defined traditionally as the absence of disease, a definition that has proven insufficient in the quest to promote the well-being of communities and populations. Hancock and Perkins (1985) proposed a model of health that has what attributes?

A. There is a dichotomy between health and illness.

B. Health and illness exist on a linear continuum.

C. Health is understood in a holistic sense.

D. Health is synonymous with interpersonal harmony.

ANS: C Rationale: Health is understood in a holistic sense, so the health of the population is seen as having body, mind, and spiritual dimensions.

PTS: 1 DIF: Easy REF: Page and Header: 208, Mandala of Health Model

OBJ: 3

NAT: TOP: KEY: BLM:

Client Needs: Safe and Effective Care Environment: Management of Care Chapter 15: A Model to Guide Practice Integrated Process: Nursing Process Cognitive Level: Understand

14. In recognition of the fact that people live in a complex environment that influences experiences and perceptions, Hancock and Perkins have created a model that conceptualizes health in a holistic way. Their Mandala of Health characterizes the health of populations as encompassing: A. person, place, and time.

B. body, mind, and spirit.

C. autonomy, capacity, and resilience.

D. client, family, and community.

ANS: B Rationale: In the Mandala of Health, health is understood in a holistic sense, so the health of the population is seen as having body, mind, and spiritual dimensions.

PTS: REF: NAT: TOP: KEY: BLM:

1 DIF: Easy Page and Header: 208, Mandala of Health Model OBJ: 3 Client Needs: Safe and Effective Care Environment: Management of Care Chapter 15: A Model to Guide Practice Integrated Process: Nursing Process Cognitive Level: Understand

15. The Rural Development Institute (RDI) has created a model that includes an action component that has the potential to inform and guide population health practice. An initiative that is based on this model would have what goal of action?

A. To improve the health of individuals B. To foster community members’ autonomy C. To increase compliance with healthy lifestyles D. To improve the community’s health ANS: D Rationale: Within the RDI’s model, the goal of action is to improve community health. Compliance, autonomy, and individual health are not central components of this community-focused model.

PTS: REF: OBJ: TOP: KEY: BLM:

1 DIF: Moderate Page and Header: 210, RDI Model: Being, Belonging, Becoming 3 NAT: Client Needs: Health Promotion and Maintenance Chapter 15: A Model to Guide Practice Integrated Process: Nursing Process Cognitive Level: Apply

16. A community health worker recognizes that there are numerous models that have differing understandings of health and health care. Which of the following models has historically downplayed the public participation component of health?

A. The medical model B. The Mandala of health C. The Rural Development Institute’s model D. The Canadian Community as Partner model ANS: A Rationale: The medical model’s conflation of health with the absence of disease has tended to minimize the importance of public participation in health, a fact that is acknowledged in different ways among more contemporary models.

PTS: OBJ: NAT: TOP: KEY: BLM:

1 DIF: Easy REF: Page and Header: 208, Models 3 Client Needs: Safe and Effective Care Environment: Management of Care Chapter 15: A Model to Guide Practice Integrated Process: Nursing Process Cognitive Level: Understand

17. The Canadian Community as Partner (CCAP) model has guided the understanding and practice of community health nursing. Within the CCAP model, what are the two central concepts of interest?

A. Lifestyle and initiative B. Systems and environments C. Diseases and stressors D. Community capacity and illness ANS: B Rationale: The CCAP model is based on a social--ecologic foundation with community systems and related environments being central concepts.

PTS: REF: OBJ: NAT: TOP: KEY: BLM:

1 DIF: Easy Page and Header: 211, Canadian Community as Partner Model 3 Client Needs: Safe and Effective Care Environment: Management of Care Chapter 15: A Model to Guide Practice Integrated Process: Nursing Process Cognitive Level: Remember

18. A group of community health workers is currently conceptualizing a new health promotion initiative. Which statement most clearly demonstrates adherence to the Community as Partner model?

A. “Let’s try to build the capacity of the members of the community.”

B. “We need to show community members the real benefits of a healthy lifestyle.”

C. “What we need to do is to teach residents how to take better care of themselves.”

D. “Let’s try to build an awareness of what health care services are available in the community.”

ANS: A

Rationale: A central component of the Community as Partner model is capacity building. This supersedes microlevel goals or interventions involving lifestyle, self-care, and awareness.

PTS: REF: OBJ: NAT: TOP: KEY: BLM:

1 DIF: Moderate Page and Header: 211, Canadian Community as Partner Model 5 Client Needs: Safe and Effective Care Environment: Management of Care Chapter 15: A Model to Guide Practice Integrated Process: Nursing Process Cognitive Level: Analyze

19. Central to the Canadian Community as Partner model is a clear understanding of the concept of community. A community consists of: A. people who share a geographic connection.

B. people with demographic similarities.

C. people who share a common bond.

D. a populated place with a common government.

ANS: C Rationale: In the Community as Partner model, the term community places a boundary (real or symbolic) around a group of people that demarcates who is in and who is out of that group. It refers to people who have a common bond that identifies participants and their degree of adhesion to the group.

PTS: REF: NAT: TOP: KEY: BLM:

1 DIF: Easy Page and Header: 211, What is Community?

OBJ: 4 Client Needs: Safe and Effective Care Environment: Management of Care Chapter 15: A Model to Guide Practice Integrated Process: Nursing Process Cognitive Level: Understand

20. A team is applying the Canadian Community as Partner (CCAP) model to a new health promotion initiative that is aimed at new mothers in the community and their partners. Within this model, the subsystems of the community closely parallel the: A. determinants of health.

B. individuals who make up the community.

C. lines of defence and lines of resistance.

D. various health care workers in the community.

ANS: A Rationale: In the CCAP model, the eight subsystems of the community are consistent with the broad determinants of health; they are physical environment, education, safety and transportation, politics and government, health and social services, communication, economics, and recreation.

PTS: 1

DIF:

Moderate

REF: OBJ: NAT: TOP: KEY: BLM:

Page and Header: 213, The Community Assessment Wheel 3 Client Needs: Safe and Effective Care Environment: Management of Care Chapter 15: A Model to Guide Practice Integrated Process: Nursing Process Cognitive Level: Understand

Chapter 16, Community Assessment 1. A community health worker is using the Canadian Community as Partner model to complete a community health assessment. Which assessment should the nurse complete first?

A. Community core B. Community subsystems C. Perceptions about community D. Degree of reaction ANS: A Rationale: The core of a community is its people---their history, characteristics, values, and beliefs. The first stage of assessing a community, then, is to learn about its people.

PTS: Core OBJ: NAT: TOP: KEY: BLM:

1

DIF:

Easy

REF: Page and Header: 239, Community

1 Client Needs: Safe and Effective Care Environment: Management of Care Chapter 16: Community Assessment Integrated Process: Nursing Process Cognitive Level: Apply

2. A community worker is using the Canadian Community as Partner model to complete a community health assessment. The nurse gathers information about births and deaths in the community. What does this represent in the community core?

A. History of the community B. Demographics and ethnicity C. Vital statistics D. Values, beliefs, and religion ANS: C Rationale: Vital statistics include birth and death statistics. Demographics and ethnicity include age, sex, race, and ethnicity data. All ethnic and racial groups have values and beliefs that interact with each community system to influence the people’s health.

PTS: REF: NAT: TOP: KEY: BLM:

1 DIF: Easy Page and Header: 230, Planning the Data Collection OBJ: 1 Client Needs: Safe and Effective Care Environment: Management of Care Chapter 16: Community Assessment Integrated Process: Nursing Process Cognitive Level: Understand

3. When completing a community assessment, the community health worker has to take several aspects of the community into account. Which stage of this assessment should the nurse perform first?

A. Learn about the people in the community B. Understand the major illnesses affecting the population C. Identify the boundaries of the community D. Identify resources available in the community ANS: A Rationale: The first stage of assessing a community is to learn about its people.

Once statistics have been compiled about the people, then individual components of the community can be assessed, such as illness, boundaries of the community, and resources in the community.

PTS: Core OBJ: NAT: TOP: KEY: BLM:

1

DIF:

Easy

REF: Page and Header: 239, Community

1 Client Needs: Safe and Effective Care Environment: Management of Care Chapter 16: Community Assessment Integrated Process: Nursing Process Cognitive Level: Apply

4. A community health worker is trying to locate information about median household income, specifically the percentage of households below the poverty level in the community. Which is the best source for these data?

A. Census records B. Chamber of Commerce C. Health Canada D. Local union offices ANS: A Rationale: Census records are the best source of information about financial characteristics, including the percentage of households below the poverty level in the community. The Chamber of Commerce, Health Canada, and union offices do not provide information about income characteristics.

PTS: 1 DIF: Moderate REF: Page and Header: 246, Indicators and Sources of Information for Business and Economics Subsystems (Table 16.8) OBJ: 5 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 16: Community Assessment KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply 5. A community health worker needs to disseminate a formal announcement about an upcoming health promotion program. What is the best example of a formal communication method that can be used in the community?

A. Word of mouth B. Posters

C. Hand-delivered flyers D. Newspaper ANS: D Rationale: Newspaper is a formal method of communication. Word of mouth, posters, and hand-delivered flyers are informal forms of communication.

PTS: 1 DIF: Easy REF: Page and Header: 244, Communication OBJ: 1 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 16: Community Assessment KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply 6. What information is obtained when a community’s subsystems are reviewed?

A. Insights about programs, policies, and services that affect people’s health B. Information on climate, terrain, natural boundaries, and resources C. Information on community sounds and residents’ health status D. Information on community capacity and empowerment ANS: A Rationale: A review of a community’s subsystems tell us about the context in which people live, work, play, pray, and go to school. It provides insights into factors that influence how people live, what choices they make, and why.

PTS: OBJ: NAT: TOP: KEY: BLM:

1 DIF: Moderate REF: Page and Header: 241, Subsystems 1 Client Needs: Safe and Effective Care Environment: Management of Care Chapter 16: Community Assessment Integrated Process: Nursing Process Cognitive Level: Understand

7. The Canadian Community as Partner model is being applied to a health promotion initiative in a small Canadian town. How should the organizers of the initiative best integrate members of the community into the process?

A. Have members of the community provide input and advice into the formation of the interdisciplinary professional team that will plan and implement the initiative B. Limit the involvement of community members to the implementation stage of the process C. Identify suitable candidates from the community during the assessment stage and then involve them in the implementation and evaluation stages of the process D. Enlist members of the community to participate in all aspects of the process, beginning with assessment ANS: D

Rationale: Within the Community as Partner model, it is imperative to involve members of the community in all aspects of the process. A team should not be limited to health professionals.

PTS: REF: OBJ: NAT: TOP: KEY: BLM:

1 DIF: Moderate Page and Header: 223, The Community Assessment Team 1 Client Needs: Safe and Effective Care Environment: Management of Care Chapter 16: Community Assessment Integrated Process: Nursing Process Cognitive Level: Apply

8. After receiving a mandate from the provincial Ministry of Health, a group of community health workers has set a date to begin a community assessment.

What goal should the team prioritize for the community assessment?

A. Accurately profile the community’s residents, strengths, subsystems, and risks B. Identify the factors that inhibit the health of the members of the community C. Determine the incidence, prevalence, mortality, and morbidity associated with common health problems D. Enlist the support and assistance of members of the community in an effort to generate rapport and “buy-in” ANS: A Rationale: The outcome of a community assessment is a realistic profile of the community, its people, and its subsystems that allows a meaningful determination of strengths and capacities as well as an identification of risks to population aggregates and the environment. The development of partnership, gathering epidemiologic data, and identifying threats to health are all methods for achieving this goal, not the goal itself..

PTS: REF: OBJ: NAT: TOP: KEY: BLM:

1 DIF: Difficult Page and Header: 225, The Community Assessment Team 1 Client Needs: Safe and Effective Care Environment: Management of Care Chapter 16: Community Assessment Integrated Process: Nursing Process Cognitive Level: Apply

9. A team of community health workers has been surprised at the active and passive resistance they have met when beginning a community assessment. What action should the team take in order to facilitate the assessment process?

A. Obtain written documentation that specifies the team’s mandate and credentials B. Take a more “hands-off” approach and allow the community to perform the assessment independently C. Cultivate trusting relationships with numerous members of the community D. Proceed to the planning and implementation stages of the process based on the data available to this point

ANS: C Rationale: The team may encounter barriers during the entry phase. It is important to cultivate relationships among key community stakeholders, gatekeepers, and champions to ensure a smooth process. Displaying authority, skipping ahead in the process to implementation, and disengaging from the assessment process are all inappropriate strategies.

PTS: REF: NAT: TOP: KEY: BLM:

1 DIF: Moderate Page and Header: 228, Getting to Know the Community OBJ: 3 Client Needs: Safe and Effective Care Environment: Management of Care Chapter 16: Community Assessment Integrated Process: Nursing Process Cognitive Level: Apply

10. A health promotion team has been diligent in its efforts to collect community data that are as accurate and current as possible. What would the team recognize as primary data?

A. The results of interviews that team members conducted with community champions B. Demographic data from Statistics Canada reports C. Crime statistics provided by the Royal Canadian Mounted Police (RCMP) D. The results of a review of historical documents in the community archives ANS: A Rationale: Primary data are composed of information from direct sources specifically for the project---key informant interview data, specific health utilization data, local survey data, and the like. Secondary data, on the other hand, are data from sources that collect, store, and report certain information on a routine basis––census, vital statistics, notifiable disease reports, social services reports, crime statistics, education system reports, regional social surveys, local research reports, and historical documents.

PTS: REF: NAT: TOP: KEY: BLM:

1 DIF: Moderate Page and Header: 229, Planning the Data Collection OBJ: 4 Client Needs: Safe and Effective Care Environment: Management of Care Chapter 16: Community Assessment Integrated Process: Nursing Process Cognitive Level: Analyze

11. A diverse assessment team has been assembled early in the process of creating a population health initiative. Because of this diversity, members of the team will have few opportunities for face-to-face contact during the assessment process.

How should the team best ensure an accurate and efficient community assessment?

A. Limiting the assessment to electronic methods that are readily accessible to community members B. Establishing and disseminating a detailed work plan early in the assessment process

C. Establishing punitive measures that can be applied to motivate team members to accomplish their designated tasks D. Encouraging each member of the team to move on to planning and implementation once the person is satisfied with his or her part of the assessment ANS: B Rationale: A work plan that sets the time lines, delineates responsibilities, and estimates resources required for each activity will guide the assessment team and keep it on track. It would be inappropriate to rely solely on electronic data gathering or to rely on punitive measures. It would also be wrong to have members of the assessment team independently moving through the Community as Partner process.

PTS: 1 DIF: Moderate REF: Page and Header: 226, Beginning to Work as a Community Assessment Team OBJ: 3 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 16: Community Assessment KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply 12. A community health team is gathering data about the community using a variety of sources and methods. One of the guidelines that the group has established is that data should be triangulated whenever possible. How can this best be accomplished?

A. Data gathering should be performed by groups of three team members who are from different backgrounds or professions.

B. Data gathered using one method should ideally be corroborated by data gathered using another method.

C. Data that are gathered using electronic methods should also be available in a “pen and paper” format for those who prefer it.

D. Data should be analyzed for macrolevel themes, mesolevel themes, and microlevel themes.

ANS: B Rationale: No one data-collection method will give complete information; therefore, multiple methods are recommended, and triangulation of information from one source to another, one type of data to another, and from different methods is needed to ensure the veracity of any inferences or conclusions drawn.

PTS: REF: OBJ: NAT: TOP: KEY: BLM:

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13. A community health worker is preparing to embark on a walking survey of a neighbourhood that will soon be the site of a community health program. A walking survey will best assist the worker to determine: A. the most active and highest profile members of the community.

B. the community’s normal and flexible lines of defence.

C. the general essence or tone of the community.

D. health promotion strategies that have met with success in the past.

ANS: C Rationale: Windshield or walking surveys are other observational techniques.

Using this type of observation, team members make use of a variety of physical senses to capture the essence of a community, determine areas for further investigation, and sense the tone of the community. This less focused type of data collection will not identify community leaders, specific strategies, or normal and flexible lines of defence.

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14. A community health worker is gathering community assessment data from a wide variety of sources using a number of different methods. Which individual is the most likely candidate for a key informant interview?

A. A teenager who was treated for leukemia at the local hospital B. A health professional who recently relocated to the community C. The principal of the community’s largest high school D. The office administrator of a local long-term care facility ANS: C Rationale: While community data should always be sought from a large number of individuals from varied backgrounds, key informant interviews normally focus on people who are in leadership positions or who serve the community in a particular way. The principal of a school is likely to be a useful source of community information by virtue of his or her involvement with numerous families in the community.

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1 DIF: Moderate Page and Header: 233, Key Informant Interview OBJ: 4 Client Needs: Safe and Effective Care Environment: Management of Care Chapter 16: Community Assessment Integrated Process: Nursing Process Cognitive Level: Apply

15. As part of a community assessment, a community health worker has organized an interview with the head of the local Ministry of Children and Families office. What explanation should the nurse provide to this individual prior to the interview?

A. “Please know that anything you tell me may be quoted along with your name in reports that our assessment team produce.”

B. “If it’s okay with you, I’d like to record our conversation and takes some notes while we talk.”

C. “I greatly appreciate what you’ll tell me, but I’m obliged to corroborate anything you say with a third party.”

D. “What I’m primarily interested in are what you see as the greatest threats, risks, and weaknesses in the community.”

ANS: B Rationale: It is appropriate to record interviews, provided appropriate ethical principles are adhered to. Individuals may speak “off the record,” and it is unnecessary to seek independent verification of data. Interviews (like all assessments) should not focus solely on problems, threats, and other negative aspects of the community.

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1 DIF: Moderate Page and Header: 234, Key Informant Interview OBJ: 4 Client Needs: Safe and Effective Care Environment: Management of Care Chapter 16: Community Assessment Integrated Process: Communication and Documentation Cognitive Level: Apply

16. A community health worker has been chosen to organize a focus group during the larger community assessment. What guideline should the worker follow when planning the focus group?

A. The demographics of the focus group should be representative of the community as a whole.

B. The size of the focus group should not exceed five to six people.

C. The focus group should be made up of a mix of community leaders and “average” residents.

D. The focus group interviews should address themes that have emerged from other data gathering methods.

ANS: D Rationale: Focus groups are not intended to be group interviews in which new data are collected. Instead, they are best used when data themes have emerged from other sources and the team wants to add to the understanding of each theme and determine if they include a complete and accurate picture of community perspectives. Hence, focus group participants are limited to 8 to 12 people who share common characteristics.

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1 DIF: Difficult Page and Header: 235, Focus Group Interviews OBJ: 4 Client Needs: Safe and Effective Care Environment: Management of Care Chapter 16: Community Assessment Integrated Process: Nursing Process Cognitive Level: Apply

17. At a recent team meeting, it was decided that the community assessment process would benefit from the administration of a survey in the community. What should the team consider when choosing the specific survey to distribute?

A. The reliability and validity of the chosen instrument.

B. That the survey is rooted in the cultural context of the most prevalent ethnic group in the community.

C. That a selection of three to five alternative surveys is available to community members.

D. That the instrument is specific to the particular community and not from an outside source.

ANS: A Rationale: When choosing a survey instrument, it is vital that the instrument be reliable and valid. It is inappropriate to offer a number of different surveys. It is common and acceptable to utilize an existing instrument rather than creating one that is unique to the specific program and community. As much as possible, a survey that is accessible to a variety of ethnic groups is preferred.

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1 DIF: Moderate Page and Header: 236, Surveys and Questionnaires OBJ: 4 Client Needs: Safe and Effective Care Environment: Management of Care Chapter 16: Community Assessment Integrated Process: Nursing Process Cognitive Level: Apply

18. As part of an initiative that is utilizing the Canadian Community as Partner model, a team of community health workers is assessing the community’s subsystems.

In doing so, the team will assess what dimensions?

A. Coping skills B. Stressors and responses C. Genetic risk factors D. Demographics ANS: B Rationale: Subsystems are assessed to find if there are any stressors acting on the population and what flexible lines of defence (temporary responses) and lines of resistance (strengths) are in place to protect the core. Coping skills and genetic risk factors are not subsystems, though they are relevant to the community core.

Demographic characteristics are associated with the community core (people).

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1 DIF: Easy REF: Page and Header: 242, Subsystems 1 Client Needs: Safe and Effective Care Environment: Management of Care Chapter 16: Community Assessment Integrated Process: Nursing Process Cognitive Level: Understand

19. Organizers of a health promotion campaign in a suburban setting have identified that many community residents go to a large, tertiary care hospital in the adjacent urban centre for many of their health needs. How would this hospital be categorized during the community assessment and analysis?

A. An extracommunity facility B. An extraneous health setting C. An infrastructure asset D. An intracommunity facility ANS: A Rationale: One method of classifying health and social services is to differentiate between facilities located outside the community (extracommunity) versus those within the community (intracommunity).

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1 DIF: Easy Page and Header: 244, Health and Social Services OBJ: 5 Client Needs: Safe and Effective Care Environment: Management of Care Chapter 16: Community Assessment Integrated Process: Nursing Process Cognitive Level: Understand

20. A community health team has recently concluded data gathering and is currently organizing and analyzing the data. According to the Canadian Community as Partner model, age, sex, and marital data about a community are classified within which category?

A. Health and social services category B. Flexible line of defence C. Community core D. Subsystems ANS: C Rationale: The community core is the people of the community and their attributes such as age, sex, and marital status.

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5 Client Needs: Safe and Effective Care Environment: Management of Care Chapter 16: Community Assessment Integrated Process: Nursing Process Cognitive Level: Apply

Chapter 17, Community Analysis and Diagnosis 1. During analysis, what is the name for any need for further data collection in the community assessment data?

A. End point B. Gaps C. Qualitative D. Quantitative ANS: B Rationale: During analysis, any need for further data collection is revealed as gaps and incongruities in the community assessment data. The end point of analysis is the community nursing diagnosis. Analysis is the study and examination of data. These data may be quantitative (numerical) as well as qualitative.

PTS: 1 DIF: Easy REF: Page and Header: 249, Introduction OBJ: 3 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 17: Community Analysis and Diagnosis KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand 2. Analysis is the study and examination of data. What is the end point of analysis?

A. Community health needs B. Community health diagnosis C. Patterns of health responses D. Trends in health care use ANS: B Rationale: The end point of analysis is the community health diagnosis. Analysis is necessary to determine community health needs and community strengths, as well as to identify patterns of health responses and trends in health care use.

PTS: 1 DIF: Easy REF: Page and Header: 249, Introduction OBJ: 2 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 17: Community Analysis and Diagnosis KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand 3. Analysis, like many aspects of community practice, may be viewed as a process with multiple steps. What is the first phase of a community analysis that a community health nurse should perform?

A. Classification B. Interpretation C. Validation D. Summarization ANS: A Rationale: The phases in order that are used to help in the analysis are classification, summarization, interpretation, and validation.

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1 DIF: Moderate Page and Header: 249, Community Analysis OBJ: 2 Client Needs: Safe and Effective Care Environment: Management of Care Chapter 17: Community Analysis and Diagnosis Integrated Process: Nursing Process Cognitive Level: Apply

4. Community analysis is a process with multiple steps. What is the last phase of a community analysis that should be completed by the community health nurse?

A. Classification B. Interpretation C. Validation D. Summarization ANS: C Rationale: The phases in order that are used to help in the analysis are classification, summarization, interpretation, and validation.

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1 DIF: Moderate Page and Header: 249, Community Analysis OBJ: 2 Client Needs: Safe and Effective Care Environment: Management of Care Chapter 17: Community Analysis and Diagnosis Integrated Process: Nursing Process Cognitive Level: Apply

5. To analyze community assessment data, data can be categorized in a variety of ways. What is an example of socioeconomic characteristics?

A. Area boundaries B. Educational attainment C. Public spaces D. Ethnic and racial groupings ANS: B Rationale: Socioeconomic characteristics include occupation and income categories, educational attainment, and rental or home ownership patterns.

Demographic characteristics include family size, age, sex, and ethnic and racial groupings. Geographic characteristics include area boundaries and number and size of neighbourhoods, public spaces, and roads.

PTS: 1 DIF: Easy REF: Page and Header: 249, Classification OBJ: 2 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 17: Community Analysis and Diagnosis KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze 6. A community health worker has to analyze community assessment data. What is an example of demographic characteristics?

A. Number and size of neighbourhoods B. Occupation and income categories C. Rental or home ownership patterns D. Sex and family size ANS: D Rationale: Demographic characteristics include family size, age, sex, and ethnic and racial groupings. Geographic characteristics include area boundaries and number and size of neighbourhoods, public spaces, and roads. Socioeconomic characteristics include occupation and income categories, educational attainment, and rental or home ownership patterns.

PTS: 1 DIF: Easy REF: Page and Header: 249, Classification OBJ: 2 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 17: Community Analysis and Diagnosis KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze 7. Models are used by community health workers for analysis of community health data. What is the core in the community assessment wheel model?

A. Lines of resistance B. Major focus for analysis C. Strengths of the population D. Stressors in the subsystems ANS: B Rationale: The core is the major focus for analysis, with the subsystems representing the context. Stressors and strengths (lines of resistance) may be contributed by the core, the subsystems, or both.

PTS: 1 DIF: Easy REF: Page and Header: 249, Classification OBJ: 2 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 17: Community Analysis and Diagnosis KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand

8. Data gaps are inevitable, as are mistakes in recording data; the important task is to analyze data critically and be aware of the potential for gaps and omissions. In what phase of a community analysis should the nurse examine data gaps?

A. Classification B. Interpretation C. Validation D. Summarization ANS: B Rationale: Outcomes of data analysis during the interpretation phase include the identification of data gaps, inconsistencies, or omissions and the generation of inferences or hypotheses about the findings.

PTS: 1 DIF: Moderate REF: Page and Header: 251, Interpretation OBJ: 3 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 17: Community Analysis and Diagnosis KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply 9. A community health worker is checking with community members to ensure the accuracy and applicability of the information that was collected and synthesized.

In what stage of the community analysis should the nurse perform this process?

A. Classification B. Interpretation C. Validation D. Summarization ANS: C Rationale: Having classified, summarized, and interpreted the data the nurse has collected, the next phase is to validate with members of the community before making a community health diagnosis.

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1 DIF: Moderate REF: Page and Header: 251, Validation 6 Client Needs: Safe and Effective Care Environment: Management of Care Chapter 17: Community Analysis and Diagnosis Integrated Process: Nursing Process Cognitive Level: Apply

10. A community health worker is preparing to validate the results of a community analysis. How should the worker perform this step in the community analysis process?

A. By liaising with nurses who reside in the community B. By holding a public meeting or distributing a survey C. By contrasting the findings with the nursing literature D. By consulting the Statistics Canada website

ANS: B Rationale: Validation can be carried out by town hall or focus group meetings, purposive surveys, or interviews.

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1 DIF: Moderate REF: Page and Header: 251, Validation 6 Client Needs: Safe and Effective Care Environment: Management of Care Chapter 17: Community Analysis and Diagnosis Integrated Process: Nursing Process Cognitive Level: Apply

11. What is a nursing diagnosis?

A. A statement that synthesizes assessment data B. A statement that describes a situation and implies an etiology C. A statement that represents human responses to actual or potential health problems that nurses are licensed to address D. Diagnosis of the community group, population, or cluster of people with at least one common characteristic ANS: C Rationale: A nursing diagnosis limits the diagnostic process to those diagnoses that represent human responses to actual or potential health problems that nurses are licensed to treat. The other options are characteristic of community health diagnoses, which differ from nursing diagnoses in that they are focused on the health of a group (like a population or community), rather than an individual.

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1 DIF: Easy Page and Header: 260, Community Health Diagnosis OBJ: 5 Client Needs: Safe and Effective Care Environment: Management of Care Chapter 17: Community Analysis and Diagnosis Integrated Process: Nursing Process Cognitive Level: Remember

12. The process of deriving community health diagnoses follows a pattern that is applicable to numerous settings and situations. What step in the process should the nurse perform first?

A. Associated inferences are identified that explain the derivation of continuation of the problem.

B. Assessment data are classified and studied for inferences that are descriptive of potential or actual health problems amenable to nursing interventions.

C. Community health diagnoses are documented using a four-part statement of the problem, population, etiology, and signs and symptoms.

D. Interventions are planned based on identification of only community goals and resources as well as the community priorities.

ANS: B

Rationale: The phases in the process that results in nursing diagnoses are classification, summarization, interpretation, and validation.

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1 DIF: Moderate Page and Header: 260, Community Health Diagnosis OBJ: 2 Client Needs: Safe and Effective Care Environment: Management of Care Chapter 17: Community Analysis and Diagnosis Integrated Process: Nursing Process Cognitive Level: Apply

13. The completeness and validity of community health diagnoses are tested during what process?

A. Community assessment B. Program planning C. Data collection D. Data analysis ANS: B Rationale: Completeness and validity are tested during the program planning stage of the nursing process. Community assessment, data collection, and data analysis are all steps in the process of deriving a community health diagnosis, and therefore must be completed before any validity can be tested.

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1 DIF: Easy Page and Header: 262, Community Health Diagnosis OBJ: 2 Client Needs: Safe and Effective Care Environment: Management of Care Chapter 17: Community Analysis and Diagnosis Integrated Process: Nursing Process Cognitive Level: Understand

14. What is missing from the following community health diagnosis: “Stress overload of being criminally victimized as manifested by police crime statistics of the past year and personal testimony of residents, especially gay men and the elderly”?

A. A description of the problem, response, or state B. Identification of factors etiologically related to the problem C. Signs and symptoms that are characteristic of the problem D. Nothing is missing; it is a complete community health diagnosis ANS: D Rationale: Most community diagnoses have four parts: a description of the issue, problem, response, or state; a statement indicating the aggregate, population, or community of focus; identification of factors related to the issue, problem, response, or state; and signs and symptoms (manifestations) that are characteristic of the issue, problem, response, or state.

“Stress overload (issue) of being criminally victimized (etiology) as manifested by police crime statistics of the past year and personal testimony of residents (data), especially gay men and the elderly (focus).”

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Page and Header: 260, Community Health Diagnosis OBJ: 5 Client Needs: Safe and Effective Care Environment: Management of Care Chapter 17: Community Analysis and Diagnosis Integrated Process: Nursing Process Cognitive Level: Analyze

15. What is missing from the following community health diagnosis: “Risk for suffocation related to discarding of refrigerators with doors as manifested by reported safety concerns of parents with young children”?

A. A statement indicating the aggregate, population, or community of focus B. Identification of factors etiologically related to the problem C. Signs and symptoms that are characteristic of the problem D. Nothing is missing; it is a complete community nursing diagnosis ANS: A Rationale: Who (aggregate, population, or community) is at risk of suffocation is not identified. Most community diagnoses have four parts: a description of the issue, problem, response, or state; a statement indicating the aggregate, population, or community of focus; identification of factors related to the issue, problem, response, or state; and signs and symptoms (manifestations) that are characteristic of the issue, problem, response, or state.

“Risk for suffocation (issue) related to discarding of refrigerators with doors (etiology) as manifested by reported safety concerns of parents with young children (data).”

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1 DIF: Difficult Page and Header: 260, Community Health Diagnosis OBJ: 5 Client Needs: Safe and Effective Care Environment: Management of Care Chapter 17: Community Analysis and Diagnosis Integrated Process: Nursing Process Cognitive Level: Analyze

16. What is missing from the following community health diagnosis: “Air pollution as manifested by increased incidence of chronic obstructive pulmonary disease among older adults”?

A. A description of the problem, response, or state B. Identification of factors etiologically related to the problem C. Signs and symptoms that are characteristic of the problem D. A statement indicating the aggregate, population, or community of focus ANS: B Rationale: “Air pollution (issue) as manifested by increased incidence of chronic obstructive pulmonary disease (unrelated etiology) among older adults (focus).”

Most community diagnoses have four parts: a description of the issue, problem, response, or state; a statement indicating the aggregate, population, or community of focus; identification of factors related to the issue, problem, response, or state; and signs and symptoms (manifestations) that are characteristic of the issue, problem, response, or state.

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1 DIF: Difficult Page and Header: 260, Community Health Diagnosis OBJ: 5 Client Needs: Safe and Effective Care Environment: Management of Care Chapter 17: Community Analysis and Diagnosis Integrated Process: Nursing Process Cognitive Level: Analyze

17. What is missing from the following community health diagnosis: “Lack of support groups and programs for single parents, the elderly, and persons with STIs as manifested by high incidence and prevalence of sexually transmitted infections”?

A. A description of the problem, response, or state B. Identification of factors etiologically related to the problem C. Signs and symptoms that are characteristic of the problem D. A statement indicating the aggregate, population, or community of focus ANS: A Rationale: “Lack of support groups and programs for single parents (etiology), the elderly, and persons with STIs (focus) as manifested by high incidence and prevalence of sexually transmitted diseases (data).” Most community diagnoses have four parts: a description of the issue, problem, response, or state; a statement indicating the aggregate, population, or community of focus; identification of factors related to the issue, problem, response, or state; and signs and symptoms (manifestations) that are characteristic of the issue, problem, response, or state.

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1 DIF: Moderate Page and Header: 260, Community Health Diagnosis OBJ: 5 Client Needs: Safe and Effective Care Environment: Management of Care Chapter 17: Community Analysis and Diagnosis Integrated Process: Nursing Process Cognitive Level: Analyze

18. What is missing from the following community health diagnosis: “Ineffective community coping related to deficits in community social support services”?

A. A description of the problem, response, or state B. Identification of factors etiologically related to the problem C. Signs and symptoms that are characteristic of the problem D. A statement indicating the aggregate, population, or community of focus ANS: C Rationale: “Ineffective community (focus) coping (issue) related to deficits in community social support services (etiology).” Most community diagnoses have four parts: a description of the issue, problem, response, or state; a statement indicating the aggregate, population, or community of focus; identification of factors related to the issue, problem, response, or state; and signs and symptoms (manifestations) that are characteristic of the issue, problem, response, or state.

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Client Needs: Safe and Effective Care Environment: Management of Care Chapter 17: Community Analysis and Diagnosis Integrated Process: Nursing Process Cognitive Level: Analyze

19. What is missing from the following community health diagnosis: “Readiness for enhanced community coping related to community sense of power to manage stressors as manifested by monthly community meetings to identify and talk about stress concerns”?

A. A description of the problem, response, or state B. Identification of factors etiologically related to the problem C. Signs and symptoms that are characteristic of the problem D. A statement indicating the aggregate, population, or community of focus ANS: D Rationale: “Readiness for enhanced community coping (issue) related to community sense of power to manage stressors (etiology) as manifested by monthly community meetings to identify and talk about stress concerns (data).”

Most community diagnoses have four parts: a description of the issue, problem, response, or state; a statement indicating the aggregate, population, or community of focus; identification of factors related to the issue, problem, response, or state; and signs and symptoms (manifestations) that are characteristic of the issue, problem, response, or state.

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1 DIF: Moderate Page and Header: 260, Community Health Diagnosis OBJ: 5 Client Needs: Safe and Effective Care Environment: Management of Care Chapter 17: Community Analysis and Diagnosis Integrated Process: Nursing Process Cognitive Level: Analyze

20. What is missing from the following community health diagnosis: “Ineffective therapeutic regimen management related to participation rate of less than 20% in preventive health services as manifested by an above average infant mortality rate”?

A. A description of the problem, response, or state B. Identification of factors etiologically related to the problem C. Signs and symptoms that are characteristic of the problem D. A statement indicating the aggregate, population, or community of focus ANS: D Rationale: “Ineffective therapeutic regimen management (issue) related to participation rate of less than 20% in preventive health services (etiology) as manifested by an above average infant mortality rate (data).” Most community diagnoses have four parts: a description of the issue, problem, response, or state; a statement indicating the aggregate, population, or community of focus; identification of factors related to the issue, problem, response, or state; and signs and symptoms (manifestations) that are characteristic of the issue, problem, response, or state.

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1 DIF: Difficult Page and Header: 260, Community Health Diagnosis OBJ: 5 Client Needs: Safe and Effective Care Environment: Management of Care Chapter 17: Community Analysis and Diagnosis Integrated Process: Nursing Process Cognitive Level: Analyze

Chapter 18, Planning a Community Health Program 1. A community health worker has assessed the community’s health, analyzed the data, and derived community health diagnoses. What step should the nurse perform next?

A. Population health analysis B. Formulate a community-based plan C. Implement a community health program D. Evaluate a community health program ANS: B Rationale: Once a community’s health has been assessed, the data have been analyzed, and community nursing diagnoses have been derived, it is time to consider nursing interventions that will promote the community’s health by formulating a community-based plan.

PTS: 1 DIF: Easy REF: Page and Header: 264, Introduction OBJ: 2 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 18: Planning a Community Health Program KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply 2. Validating community nursing diagnoses with community residents is an important step for establishing and maintaining a partnership. Which is a key principle that the community health worker needs to keep in mind about this partnership?

A. Community leaders cannot have access to confidential privileged information.

B. Community organizations have the right to choose not to participate in health planning.

C. Community residents have the right not to identify their own health needs.

D. Community leaders and organizations are not involved in negotiation of specific programs.

ANS: B Rationale: Validating community nursing diagnoses with the community residents is an important step for establishing and maintaining the partnership. Equally important are the right of community leaders, organizations, and residents to confidentiality of privileged information and the right to choose not to participate in health planning. Communities have the right to identify their own health needs and negotiate with the community health nurse with regard to interventions and specific programs.

PTS: 1 DIF: Moderate REF: Page and Header: 266, Planning in Partnership With the Community

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2 Client Needs: Safe and Effective Care Environment: Management of Care Chapter 18: Planning a Community Health Program Integrated Process: Nursing Process Cognitive Level: Apply

3. A community health worker is using principles of change theory to direct the planning process. What occurs during the moving stage?

A. Client system becomes aware of a problem and the need for change.

B. Problem is diagnosed, and solutions to the problem are identified.

C. From alternative solutions, one is chosen that is most appropriate for the situation.

D. The program for solving the problem is planned in detail and begun.

ANS: D Rationale: During the unfreezing stage, the client system becomes aware of a problem and the need for change. Then the problem is diagnosed, and solutions to the problem are identified. From these alternative solutions, one is chosen that seems most appropriate for the situation. In the moving stage, the change actually occurs. The problem is clarified, and the program for solving the problem is planned in detail and begun.

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1 DIF: Moderate Page and Header: 270, Applying Change Theory to Community Planning 1 Client Needs: Safe and Effective Care Environment: Management of Care Chapter 18: Planning a Community Health Program Integrated Process: Nursing Process Cognitive Level: Understand

4. A community health worker is using principles of change theory to direct the planning process. During what stage do the accomplished changes become integrated into the values of the client system?

A. Intervention B. Moving C. Refreezing D. Unfreezing ANS: C Rationale: During the unfreezing stage, the client system becomes aware of a problem and the need for change. Then the problem is diagnosed, and solutions to the problem are identified. From these alternative solutions, one is chosen that seems most appropriate for the situation. In the moving stage, the change actually occurs. The problem is clarified, and the program for solving the problem is planned in detail and begun. The refreezing stage consists of the accomplished changes becoming integrated into the values of the client system. In this stage, the idea is established and continues to be influential.

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Page and Header: 270, Applying Change Theory to Community Planning 1 Client Needs: Safe and Effective Care Environment: Management of Care Chapter 18: Planning a Community Health Program Integrated Process: Nursing Process Cognitive Level: Understand

5. A community health nurse is using principles of change theory to direct the planning process. What occurs during the unfreezing stage?

A. Identification of a need for change B. Identification of problems C. Consideration of alternatives D. Adaption of plan to circumstances ANS: A Rationale: During the unfreezing stage, the client system becomes aware of a problem and the need for change. Then the problem is diagnosed, and solutions to the problem are identified. From these alternative solutions, one is chosen that seems most appropriate for the situation. In the moving stage, the change actually occurs. The problem is clarified, and the program for solving the problem is planned in detail and begun.

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1 DIF: Easy Page and Header: 270, Applying Change Theory to Community Planning 1 Client Needs: Safe and Effective Care Environment: Management of Care Chapter 18: Planning a Community Health Program Integrated Process: Nursing Process Cognitive Level: Understand

6. Planned change is a well-thought-out effort designed to make something happen; all efforts are directed and targeted to produce change. According to Reinkemeyer’s stages of planned change, when does planning a community health program occur?

A. Stage 1: Identification and development of a felt need and desire for the change B. Stage 2: Development of a change relationship between the community health nurse and the community C. Stage 3: Clarification or diagnosis of the community’s problem, need, or objective D. Stage 4: Examination of alternative routes and tentative goals and intention of actions ANS: D Rationale: Both stages 1 and 2 are completed during assessment presentations.

The third stage is to validate the community nursing diagnoses. Stage 4 is where planning occurs.

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REF: Page and Header: 269, Reinkemeyer’s Stages of Planned Change (Box 18.1) OBJ: 1 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 18: Planning a Community Health Program KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand 7. Planned change is a well-thought-out effort designed to make something happen; all efforts are directed and targeted to produce change. According to Reinkemeyer’s stages of planned change, when should the nurse validate community nursing diagnoses?

A. Stage 1: Identification and development of a felt need and desire for the change B. Stage 2: Development of a change relationship between the community health nurse and the community C. Stage 3: Clarification or diagnosis of the community’s problem, need, or objective D. Stage 4: Examination of alternative routes and tentative goals and intention of actions ANS: C Rationale: Both stages 1 and 2 are completed during assessment presentations.

The third stage is to validate the community health diagnoses. Stage 4 is where planning occurs.

PTS: 1 DIF: Easy REF: Page and Header: 269, Reinkemeyer’s Stages of Planned Change (Box 18.1) OBJ: 1 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 18: Planning a Community Health Program KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand 8. Planned change is a well-thought-out effort designed to make something happen; all efforts are directed and targeted to produce change. According to Reinkemeyer’s stages of planned change, when does implementation of a community health program occur?

A. Stage 3: Clarification or diagnosis of the community’s problem, need, or objective B. Stage 4: Examination of alternative routes and tentative goals and intention of actions C. Stage 5: Transformation of intentions into actual change D. Stage 6: Stabilization and evaluation ANS: C

Rationale: The third stage is to validate the community health diagnoses. Stage 4 is where planning occurs. Stage 5 is where intervention of the community health program occurs.

PTS: 1 DIF: Moderate REF: Page and Header: 269, Reinkemeyer’s Stages of Planned Change (Box 18.1) OBJ: 1 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 18: Planning a Community Health Program KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand 9. According to Reinkemeyer’s stages of planned change, in how many of the stages does specific assessment occur?

A. One B. Two C. Three D. Four ANS: D Rationale: Stages 1, 2, 6, and 7 involve assessment. Both stages 1 and 2 are completed during the assessment presentations. During stage 6, evaluation involves assessment of whether the planned intervention was effective or not effective, and stage 7 may lead to further assessment, thereby bringing the process full circle.

PTS: 1 DIF: Easy REF: Page and Header: 269, Reinkemeyer’s Stages of Planned Change (Box 18.1) OBJ: 1 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 18: Planning a Community Health Program KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Remember 10. What is an appropriately written measurable objective for the following community health diagnosis identified by the community health worker: “Ineffective community coping related to inadequate resources for problem solving as manifested by 5% representation of all segments of the community in problem solving.”

A. To know who participates in community problem-solving activities B. To be aware of communication networks among community members C. To improve community coping by increasing community representation to 30% in 30 days D. To realize common and competing interests among community groups by next week ANS: C

Rationale: The written objective must be specific with observable outcomes in order for the community health nurse to evaluate progress. Modifiers such as know, aware, and realize are less precise terms that have many interpretations.

To increase or decrease by a specific percentage is a more precise term that has fewer interpretations. Each objective should include a time frame for attaining the change (e.g., “By June 15th …”); the direction and magnitude of the change (e.g., “Increase immunization levels to 95%”); and the method of measuring the change (e.g., “After the session, each participant will demonstrate ___”).

PTS: REF: NAT: TOP: KEY: BLM:

1 DIF: Difficult Page and Header: 276, Program Objectives OBJ: 2 Client Needs: Safe and Effective Care Environment: Management of Care Chapter 18: Planning a Community Health Program Integrated Process: Communication and Documentation Cognitive Level: Apply

11. A community health worker is taking care of a client in an outbreak of severe diarrhea in a school setting. A diagnosis of fluid volume deficit related to active fluid loss as manifested by diarrhea has been identified for the affected students and teachers. What is an appropriately written measurable objective for this diagnosis?

A. The affected students and teachers will understand the importance of drinking more fluids by tomorrow.

B. The affected students and teachers will have fewer episodes of diarrhea in 24 hours.

C. The affected students and teachers will be aware that moist mucous membranes indicate resolution of fluid volume deficit.

D. Ninety percent of the affected students and teachers will agree to increase their fluid intake to at least 1500 ml within 1 day.

ANS: D Rationale: The written objective must be specific with observable outcomes in order for the community health nurse to evaluate progress. Modifiers such as know, aware, and realize are less precise terms that have many interpretations.

To increase or decrease by a specific percentage is a more precise term that has fewer interpretations. Each objective should include a time frame for attaining the change (e.g., “By June 15th …”); the direction and magnitude of the change (e.g., “Increase immunization levels to 95%”); and the method of measuring the change (e.g., “After the session, each participant will demonstrate ___”).

PTS: REF: NAT: TOP: KEY: BLM:

1 DIF: Difficult Page and Header: 276, Program Objectives OBJ: 2 Client Needs: Safe and Effective Care Environment: Management of Care Chapter 18: Planning a Community Health Program Integrated Process: Nursing Process Cognitive Level: Apply

12. Organizations that report actual or potential health problems of the elderly have been contacted to attend a community meeting to report the findings of the community assessment. According to Reinkemeyer’s stages of planned change, when would this report be implemented?

A. Stage 1: Identification and development of a felt need and desire for the change B. Stage 2: Development of a change relationship between the community health nurse and the community C. Stage 3: Clarification or diagnosis of the community’s problem, need, or objective D. Stage 4: Examination of alternative routes and tentative goals and intention of actions ANS: A Rationale: To initiate a felt need and desire for change within a community, those organizations that report actual or potential health concerns are contacted, and a meeting is scheduled to report the findings of the community assessment; this occurs during stage 1.

PTS: 1 DIF: Moderate REF: Page and Header: 269, Reinkemeyer’s Stages of Planned Change (Box 18.1) OBJ: 1 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 18: Planning a Community Health Program KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand 13. All community organization staff members have been informed by the community health worker of the elderly community health needs and each organization has desired to become involved in the planning process. According to Reinkemeyer’s stages of planned change, when would this activity occur?

A. Stage 1: Identification and development of a felt need and desire for the change B. Stage 2: Development of a change relationship between the community health nurse and the community C. Stage 3: Clarification or diagnosis of the community’s problem, need, or objective D. Stage 4: Examination of alternative routes and tentative goals and intention of actions ANS: B Rationale: All community organization staff members have been informed by the community health nurse of the elderly community health needs and each organization has desired to become involved in the planning process; this occurs during stage 2.

PTS: 1 DIF: Moderate REF: Page and Header: 269, Reinkemeyer’s Stages of Planned Change (Box

18.1) OBJ: 1 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 18: Planning a Community Health Program KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand 14. After considering the results of the questionnaire about the needs of older adults in the community, the staff from several community organizations begin to discuss the possibility of offering classes on how to avoid falls in the home once a week. According to Reinkemeyer’s stages of planned change, when should this activity occur?

A. Stage 1: Identification and development of a felt need and desire for the change B. Stage 2: Development of a change relationship between the community health nurse and the community C. Stage 3: Clarification or diagnosis of the community’s problem, need, or objective D. Stage 4: Examination of alternative routes and tentative goals and intention of actions ANS: D Rationale: After considering the results of the questionnaire about elderly needs in the community, the staff from several community organizations begin to discuss the possibility of offering classes on how to avoid falls in the home once a week; this task is completed during Stage 4: Examination of alternative routes and tentative goals and intention of actions.

PTS: 1 DIF: Moderate REF: Page and Header: 269, Reinkemeyer’s Stages of Planned Change (Box 18.1) OBJ: 1 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 18: Planning a Community Health Program KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply 15. Once there has been validation of the community health diagnoses with the community, what step in planning a community-based health program should the nurse perform?

A. Identify measurable community health objectives B. Establish a sequence of actions and a time schedule C. List resources needed to accomplish the plan D. Acknowledge potential obstacles to planned and revised actions ANS: A Rationale: After validating the nursing diagnoses with the community, the community-based measurable objectives have to be identified.

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1 DIF: Moderate Page and Header: 276, Program Objectives OBJ: 2 Client Needs: Safe and Effective Care Environment: Management of Care Chapter 18: Planning a Community Health Program Integrated Process: Nursing Process Cognitive Level: Apply

16. The Heart and Stroke Foundation of Canada and the community health nurse have selected topics identified in survey questionnaire results in a class for spouses of people who have had a myocardial infarction. What does this represent in a plan for a community-based health program?

A. Community health goal B. Program activity C. Learning objective D. Collaboration ANS: B Rationale: After formulation of goals, the next step is specifying the program activities. Program activities map out the actions necessary to deliver the program and thereby reach the goal(s).

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1 DIF: Moderate Page and Header: 274, Program Activities OBJ: 2 Client Needs: Safe and Effective Care Environment: Management of Care Chapter 18: Planning a Community Health Program Integrated Process: Nursing Process Cognitive Level: Understand

17. Once goals and objectives have been written for the community-based health program, what should the nurse do next?

A. Identify resources needed to accomplish the plan B. List potential revisions that might be made to the plan C. Document the plan in a concise, standardized, and retrievable form D. Identify the community assessment strengths of the health program ANS: A Rationale: Once goals and objectives have been written, the next step is to identify available resources and any constraints to the plan.

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1 DIF: Moderate Page and Header: 277, Resources, Constraints, and Revised Plans 2 Client Needs: Safe and Effective Care Environment: Management of Care Chapter 18: Planning a Community Health Program Integrated Process: Nursing Process Cognitive Level: Apply

18. Constraints are the difference between needs and resources. Which of the following constraints is most common when planning a community-based health program?

A. Money B. Physical space C. Equipment D. Time ANS: A Rationale: Universal constraints are staff and money---agencies never have enough.

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1 DIF: Easy Page and Header: 278, Resources, Constraints, and Revised Plans 2 Client Needs: Safe and Effective Care Environment: Management of Care Chapter 18: Planning a Community Health Program Integrated Process: Nursing Process Cognitive Level: Understand

19. In partnership with the community, what step in planning a community-based health program should the nurse perform last?

A. Listing of sequence of actions and a time schedule for achieving goals B. Identification of resources needed to accomplish the plan C. Outlining of revisions to the plan as goals and objectives are achieved or changed D. Recording of the plan in a concise, standardized, and retrievable form ANS: D Rationale: Community plans must be recorded in a standardized, systematic, and concise form that clearly communicates to others the purpose and actions of the plan as well as the rationale for revisions and deletions of actions.

PTS: OBJ: NAT: TOP: KEY: BLM:

1 DIF: Moderate REF: Page and Header: 278, Recording 2 Client Needs: Safe and Effective Care Environment: Management of Care Chapter 18: Planning a Community Health Program Integrated Process: Nursing Process Cognitive Level: Apply

20. After eliciting feedback from members of the community, a multidisciplinary team of community health workers is now choosing intervention strategies. What principle should the community health workers follow during this stage of planning a community health program?

A. Strategies should be chosen that are appropriate and accessible to all members of the community.

B. Strategies should rely primarily on multimedia delivery rather than written materials.

C. No single strategy is going to be effective with every group.

D. In order to ensure success, as many strategies as possible should be adopted.

ANS: C Rationale: Not all strategies are effective on all groups or individuals. Strategies may use a variety of communication methods, including written material. The goal is to choose the most effective strategy/strategies, not to choose as many strategies as possible.

PTS: REF: NAT: TOP: KEY: BLM:

1 DIF: Moderate Page and Header: 274, Program Activities OBJ: 2 Client Needs: Safe and Effective Care Environment: Management of Care Chapter 18: Planning a Community Health Program Integrated Process: Nursing Process Cognitive Level: Apply

Chapter 19, Implementing a Community Health Program 1. A community health worker is involved in carrying out the community-based plan.

During what phase of the nursing process does this occur?

A. Assessment B. Planning C. Implementation D. Evaluation ANS: C Rationale: Implementation is the action phase of the nursing process; it is carrying out the community-based plan.

PTS: 1 DIF: Easy REF: Page and Header: 280, Introduction OBJ: 1 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 19: Implementing a Community Health Program KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand 2. A community health worker is carrying out the community-based plan. What principle about the people of the community should the nurse follow during implementation?

A. The community health worker should delegate responsibility for implementation to community members.

B. The community health worker will care for the individuals in the community.

C. The people in the community need to feel a sense of ownership of the program.

D. The community health workers will interact professionally with people while implementing the plan.

ANS: C Rationale: The people of the community need to feel a sense of ownership of the program or event, which can come only with their full participation in the decisions regarding planning as well as their assuming some responsibility for implementation. The profession of nursing is one of nurturing, sustaining, and caring for others. It is part of our profession to do for others what they would do for themselves if they were able. Indeed, most nurses interact professionally with people during an altered health state that requires nurses to do for others, but this is not true in community health nursing.

PTS: REF: OBJ: NAT:

1 DIF: Moderate Page and Header: 281, Promoting Community Ownership 1 Client Needs: Safe and Effective Care Environment: Management of Care

TOP: Chapter 19: Implementing a Community Health Program KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply 3. What is required between agency personnel who implement a community health program and the target population of program recipients?

A. Collaboration and coordination B. Agency ownership for program C. Limited time for publicizing the program D. Limited need for coordination between these groups ANS: A Rationale: A unified program requires collaboration and coordination between the agency personnel who will implement the program and the program's recipients (the target population). Allowing plenty of time for publicizing the program (and how you perform the mechanics of publicity---the how, where, and to whom) can make a crucial difference in whether people attend and what the subsequent impact will be.

PTS: REF: NAT: TOP: KEY: BLM:

1 DIF: Easy Page and Header: 282, Implementing a Unified Program OBJ: 1 Client Needs: Safe and Effective Care Environment: Management of Care Chapter 19: Implementing a Community Health Program Integrated Process: Nursing Process Cognitive Level: Understand

4. The Canadian Community as Partner (CCAP) model defines intervention as consisting of primordial, primary, secondary, and tertiary levels. What is an example of primary prevention?

A. Mantoux tests for tuberculosis B. Screening infants for developmental delays C. Blood pressure screenings for elderly people D. Weekly adult exercise and fitness sessions ANS: D Rationale: Primary prevention improves the health and well-being of the community, making it less vulnerable to stressors. Health-promotion programs are primary prevention, as are programs that focus on protection from specific diseases. Usually, health promotion is nonspecific and directed toward raising the general health of the total community, such as conducting adult exercise/fitness sessions. Secondary prevention begins after a disease or condition is present.

Emphasis is on screening, early diagnosis, and treatment of possible stressors that may adversely affect the community's health. The Mantoux test for tuberculosis, the screening test for developmental delays, and blood pressure assessments are secondary prevention interventions.

PTS: 1 DIF: Moderate REF: Page and Header: 284, Community Health Focus NAT: Client Needs: Health Promotion and Maintenance

OBJ: 2

TOP: Chapter 19: Implementing a Community Health Program KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze 5. According to the Canadian Community as Partner (CCAP) model, what is an example of tertiary prevention?

A. Breast self-examination B. Therapy programs for abused children C. Immunization against influenza D. Mantoux test for tuberculosis ANS: B Rationale: Primary prevention improves the health and well-being of the community, making it less vulnerable to stressors. Health-promotion programs are primary prevention, as are programs that focus on protection from specific diseases. Usually health promotion is nonspecific and directed toward raising the general health of the total community, such as immunizations against certain diseases. Secondary prevention begins after a disease or condition is present.

Emphasis is on screening, early diagnosis, and treatment of possible stressors that may adversely affect the community's health. The Mantoux test for tuberculosis and breast self-examination assessments are secondary prevention interventions. Tertiary prevention focuses on restoration and rehabilitation.

Tertiary prevention programs act to return the community to an optimum level of functioning. Adequate shelters for battered women and counselling and therapy programs for sexually abused children are examples of tertiary prevention.

PTS: REF: NAT: TOP: KEY: BLM:

1 DIF: Moderate Page and Header: 285, Community Health Focus OBJ: 2 Client Needs: Health Promotion and Maintenance Chapter 19: Implementing a Community Health Program Integrated Process: Nursing Process Cognitive Level: Analyze

6. A community health worker is providing care for a school where teachers and students developed conjunctivitis (pink eye) and are taking eye drops at school.

Which level of prevention does this constitute?

A. Primary B. Secondary C. Tertiary D. Chronic care ANS: B

Rationale: Primary prevention improves the health and well-being of the community, making it less vulnerable to stressors. Health-promotion programs are primary prevention, as are programs that focus on protection from specific diseases. Secondary prevention begins after a disease or condition is present and focuses on treatment screening, early diagnosis, and treatment of possible stressors that may adversely affect the community's health. Secondary prevention addresses the current health problem and interventions. Tertiary prevention focuses on restoration and rehabilitation. Tertiary prevention programs act to return the community to an optimum level of functioning.

PTS: REF: NAT: TOP: KEY: BLM:

1 DIF: Moderate Page and Header: 284, Community Health Focus OBJ: 2 Client Needs: Health Promotion and Maintenance Chapter 19: Implementing a Community Health Program Integrated Process: Nursing Process Cognitive Level: Analyze

7. When should the community health nurse begin the evaluation strategy of a community health program?

A. During implementation of the program B. Before the program is implemented C. After the implementation of the program D. When promoting health partnerships only with schools ANS: B Rationale: Before a program is implemented, the manner in which it is to be evaluated must be established.

PTS: OBJ: NAT: TOP: KEY: BLM:

1 DIF: Easy REF: Page and Header: 291, Summary 2 Client Needs: Safe and Effective Care Environment: Management of Care Chapter 19: Implementing a Community Health Program Integrated Process: Nursing Process Cognitive Level: Apply

8. A community health worker considers specific interventions for population-based practice when developing plans for a unified program to address the problems identified in the community. What is the best description of a unified program?

A. A focus on individuals and families takes precedence over the needs and concerns of the community as a whole.

B. Budget and staff resources are limited to those the community can afford to allocate to the program.

C. The community is responsible for marketing the program to the target population.

D. There is cooperation among agency personnel, community leaders, and the target population.

ANS: D

Rationale: A unified program requires collaboration and coordination among the agency personnel who will implement the program, the program’s recipients (the target population), and the community. Allowing plenty of time for publicizing the program (and how you perform the mechanics of publicity---the how, where, and to whom) can make a crucial difference in whether people attend and what the subsequent impact will be.

PTS: REF: NAT: TOP: KEY: BLM:

1 DIF: Moderate Page and Header: 282, Implementing a Unified Program OBJ: 2 Client Needs: Safe and Effective Care Environment: Management of Care Chapter 19: Implementing a Community Health Program Integrated Process: Nursing Process Cognitive Level: Understand

9. A community health worker is implementing a program aimed at fostering sexual health among young adults. How should the community health worker best ensure community ownership of the program?

A. Conduct the interventions associated with the program in public locations B. Enlist members of the community in the planning and implementation of the program C. Provide multiple opportunities for participants to provide input and feedback D. Ensure that the structure and content of the program are evidence based ANS: B Rationale: Facilitating active involvement by community members is one of the most effective ways to promote community ownership. A public location and multiple opportunities for feedback are likely valid components of a program but are not likely to create a sense of ownership. An evidence-based framework is similarly important, but does not promote ownership.

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1 DIF: Moderate Page and Header: 281, Promoting Community Ownership 2 Client Needs: Safe and Effective Care Environment: Management of Care Chapter 19: Implementing a Community Health Program Integrated Process: Nursing Process Cognitive Level: Apply

10. A community health worker who is participating in a tobacco-reduction program is responsible for bringing together and liaising with other community organizations and mobilizing resources that are needed to plan and implement the program.

This community health worker’s role is best described as: A. the prime implementer.

B. the program health promoter.

C. the facilitator or coordinator.

D. the agency partner.

ANS: C

Rationale: The facilitator or coordinator brings together and coordinates the community organizations and resources that are needed to plan and implement a community development initiative.

PTS: REF: OBJ: NAT: TOP: KEY: BLM:

1 DIF: Easy Page and Header: 282, Promoting Community Ownership 2 Client Needs: Safe and Effective Care Environment: Management of Care Chapter 19: Implementing a Community Health Program Integrated Process: Nursing Process Cognitive Level: Analyze

11. Many community-based programs lack a clear focus on community health. What criterion identifies a program that has an appropriate community health focus?

A. The program addresses the larger family and community context in addition to individual needs.

B. The program is implemented in a setting that can be accessed by all or most of the members of the community.

C. The program addresses a community diagnosis that applies to majority of individuals in the community.

D. The program is delivered by nurses with a community health, rather than acute care, background.

ANS: A Rationale: Programs with a true community health focus take the larger systems of family and community into context. Community-oriented and community-focused programs seek to improve the health of groups of people to benefit the quality of life and well-being of the community at large. The setting, the background of nurses, and relevance to many residents do not guarantee a community focus.

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1 DIF: Moderate Page and Header: 283, Community Health Focus OBJ: 2 Client Needs: Safe and Effective Care Environment: Management of Care Chapter 19: Implementing a Community Health Program Integrated Process: Nursing Process Cognitive Level: Understand

12. As part of a larger program, a community health worker has prepared a multimedia presentation about bullying that aims to increase elementary students' awareness and provide them with tools to respond appropriately to bullying. This intervention is an example of: A. education.

B. tertiary prevention.

C. engineering.

D. enforcement.

ANS: A

Rationale: The focus of this intervention is on the provision of information and skills. Consequently, it would be characterized as an educational intervention.

PTS: OBJ: NAT: TOP: KEY: BLM:

1 DIF: Easy REF: Page and Header: 285, Education 2 Client Needs: Safe and Effective Care Environment: Management of Care Chapter 19: Implementing a Community Health Program Integrated Process: Teaching/Learning Cognitive Level: Understand

13. A community health worker is participating in the planning and implementation of a program that has the goal of increasing community members' physical activity levels. What aspect of this program is an example of social marketing?

A. Finding evidence in the literature about the links between sedentary lifestyles and subsequent health problems B. Holding a focus group to elicit input from community members about appropriate and effective strategies C. Having a graphic designer create an engaging logo and using it on a variety of materials D. Beginning the evaluation of the program alongside the implementation phase ANS: C Rationale: Using the promotional techniques of the advertising industry is an aspect of social marketing. The other cited activities are valid components of a well-executed program, but are not examples of social marketing.

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1 DIF: Moderate REF: Page and Header: 286, Education 2 Client Needs: Safe and Effective Care Environment: Management of Care Chapter 19: Implementing a Community Health Program Integrated Process: Nursing Process Cognitive Level: Analyze

14. During a health promotion program, a multidisciplinary team of community health workers is using a social marketing strategy. The team has just finished developing a series of smartphone applications that will form a component of the program. What is the next step that the team should take in the social marketing process?

A. Test the applications among a representative group of community members B. Make the applications available online for download by the team C. Create print materials to complement the electronic resources D. Evaluate the success and failure of the program by engaging youth ANS: A Rationale: After social marketing materials are developed, they should be tested among a representative group of community members.

PTS: 1 OBJ: 2

DIF:

Moderate

REF: Page and Header: 287, Education

NAT: TOP: KEY: BLM:

Client Needs: Safe and Effective Care Environment: Management of Care Chapter 19: Implementing a Community Health Program Integrated Process: Communication and Documentation Cognitive Level: Apply

15. A community health program is integrating the principles of social marketing into promotion and delivery. These principles should include which activity?

A. Choosing an approach that is not technology dependent B. Choosing an individual focus rather than community focus C. Allowing a gradual rollout of the program, not a planned launch D. Targeting a specific audience that has common characteristics ANS: D Rationale: A social marketing approach necessitates market segmentation; based on an analysis of the initial data and the community, the target audience is divided into discrete units with common characteristics. Social marketing is often technology dependent and requires a carefully planned, community-oriented approach.

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1 DIF: Moderate REF: Page and Header: 287, Education 2 Client Needs: Safe and Effective Care Environment: Management of Care Chapter 19: Implementing a Community Health Program Integrated Process: Communication and Documentation Cognitive Level: Apply

16. A school-based community health program has an engineering focus. In the implementation of a community health program, what is the primary goal of engineering?

A. Identifying the reasons for people’s behaviour B. Creating an environment that is conducive to change C. Changing the relationship between the individual and the community D. Integrating evaluation with the implementation of a program ANS: B Rationale: Engineering is the process of creating an environment that is supportive for change---that is, making the healthy choice the easy choice.

Engineering does not focus primarily on the reasons for behaviour, the relationship between individuals and the community, or the evaluation process.

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1 DIF: Easy REF: Page and Header: 288, Engineering 2 Client Needs: Safe and Effective Care Environment: Management of Care Chapter 19: Implementing a Community Health Program Integrated Process: Nursing Process Cognitive Level: Understand

17. The provincial health ministry is funding a program and is reviewing the team’s program goals to ensure they are consistent with provincial health goals. What will they be looking for in program goal statements?

A. That the goals are consistent with the history and current context of the community of interest B. That the goals are reflected in the program’s objectives and activities C. That the goals will reflect the values of the government D. That the goals meet the needs of individual members of the community ANS: A Rationale: The goals of population health promotion are to reduce or eliminate disparities in health experienced by different groups of people, improve quality of life, and add years to life expectancy by strengthening communities and community action on the determinants of health.

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1 DIF: Moderate Page and Header: 282, Setting Community and Population Health Goals 2 Client Needs: Safe and Effective Care Environment: Management of Care Chapter 19: Implementing a Community Health Program Integrated Process: Nursing Process Cognitive Level: Understand

18. A community health nurse is aware that the implementation of community health programs may include education, engineering, and enforcement. What activity is an example of enforcement?

A. Levying fines on people who smoke in no-smoking public areas B. Teaching teenagers about the harmful health consequences of smoking C. Advocating for increased provincial taxes on tobacco products D. Lobbying the owners of small stores to stop selling cigarettes ANS: A Rationale: Lack of compliance with legislation (such as laws prohibiting smoking around entrances) may necessitate enforcement. Education and advocacy may support and surround enforcement efforts, but these are not examples of enforcement itself.

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1 DIF: Easy Page and Header: 289, Enactment and Enforcement OBJ: 2 Client Needs: Safe and Effective Care Environment: Management of Care Chapter 19: Implementing a Community Health Program Integrated Process: Nursing Process Cognitive Level: Analyze

19. The leader of a safety campaign has been contacted by a media outlet and been asked for an interview. What should the community health worker do before accepting the invitation?

A. Confirm that the reporter or interviewer will portray the campaign in a positive light

B. Create a list of anticipated questions, possible responses, and key campaign messages C. Ask the interviewer to provide a list of questions he or she will be asking the campaign leader D. Ensure that he or she follows correct organizational protocols about media requests ANS: D Rationale: When in contact with the media, it is important to follow organizational protocols. Most organizations have specific policies and/or personnel for such requests.

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1 DIF: Easy REF: Page and Header: 289, Engineering 2 Client Needs: Safe and Effective Care Environment: Management of Care Chapter 19: Implementing a Community Health Program Integrated Process: Communication and Documentation Cognitive Level: Apply

Chapter 20, Evaluating a Community Health Program: Collaborative Action Evaluation 1. When defining evaluation, one of the most important questions related to participation is: A. What is the program about?

B. Who controls the evaluation?

C. What are the outcomes of the program?

D. Why is an evaluation needed?

ANS: B Rationale: Evaluation is integrated into a program when it is working with Collaborative Action Evaluation (CAE). The outcomes, needs, and purpose of the program are part of the evaluation process and will be determined by the team. In defining evaluation, knowledge and methods are important, but the fundamental question is who controls the evaluation. Traditional perspectives look to outside experts to create the evaluation whereas CAE looks to the team, practitioners, participants, and stakeholders to conduct the evaluation.

PTS: 1 DIF: Moderate REF: Page and Header: 293, Introduction OBJ: 4 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 20: Evaluating a Community Health Program: Collaborative Action Evaluation KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Remember 2. What evaluation principle, explicated by the W. K. Kellogg Foundation, specifies that community-based and community-focused programs must be rooted in the actual community, based on an assessment of that community, and that programs must include an evaluation to measure those criteria of importance to the community?

A. Strengthen programs B. Use multiple approaches C. Design evaluation to address real issues D. Create a participatory process ANS: C Rationale: The W. K. Kellogg Foundation specifies that program organizers must design evaluation to address real issues. Community-based and community-focused programs, rooted in the “real” community and based on an assessment of that community, must design an evaluation to measure those criteria of importance to the community.

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TOP: Chapter 20: Evaluating a Community Health Program: Collaborative Action Evaluation KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand 3. What principle, explicated by the W. K. Kellogg Foundation, is important in enhancing the skills, knowledge, and attitudes of both professionals and nonprofessionals?

A. Allow for flexibility B. Build capacity C. Create a participatory process D. Use multiple approaches ANS: B Rationale: The evaluation principle of building capacity is important in enhancing the skills, knowledge, and attitudes of both professionals and nonprofessionals. It is important to allow for flexibility because evaluation approaches must not be rigid and prescriptive, or it will be difficult to document the incremental, complex, and often subtle changes that occur. Use of multiple approaches is important because evaluation methods are numerous and varied. No single approach is favoured, but the method chosen must be congruent with the purposes of the program. Congruent with the theoretical foundations of working with the community as partner, program evaluation is based on principles explicated by the W. K. Kellogg Foundation, including creating a participatory process.

PTS: 1 DIF: Difficult REF: Page and Header: 295, Evaluation Principles OBJ: 1 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 20: Evaluating a Community Health Program: Collaborative Action Evaluation KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand 4. A community health worker has been asked to form an evaluation team. What should the community health worker do to begin the process?

A. Make a list of his/her own biases and assumptions B. Approach the head of the health unit C. Find community participants D. Make a list of problems in the program ANS: A Rationale: A main aspect of Collaborative Action Evaluation (CAE) is the position of the evaluator. Though a team will be formed, it is best for every person involved in the formative stage to understand his or her own biases. The evaluator must do this before approaching others. In the following stages, the inquiry team will determine the questions and process.

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1 DIF: Moderate Page and Header: 296, Evaluation Traditions and Paradigms 4 Client Needs: Safe and Effective Care Environment: Management of Care

TOP: Chapter 20: Evaluating a Community Health Program: Collaborative Action Evaluation KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply 5. A community health worker is completing an evaluation of a health program.

What type of evaluation is concerned with the immediate effect of a program on a target group?

A. Formative B. Impact C. Outcome D. Process ANS: C Rationale: Outcome or summative evaluation is concerned with the immediate impact of a program on a target group. Process or formative evaluation answers the question: Are we doing what we said we would do?

PTS: 1 DIF: Easy REF: Page and Header: 295, Evaluation Principles OBJ: 2 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 20: Evaluating a Community Health Program: Collaborative Action Evaluation KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand 6. During the evaluation process, a community health nurse collects information and knows that evaluation criteria must be timely and comprehensive. What type of evaluation is applied during the preprogram stages of a community health program?

A. Formative B. Impact C. Outcome D. Process ANS: A Rationale: Outcome or summative evaluation is concerned with the immediate impact of a program on a target group. Process or formative evaluation answers the question: Are we doing what we said we would do? Some authors make a distinction between formative and process evaluation by using process to denote evaluation conducted during the program, whereas formative may be applied at the program formation or preprogram stages.

PTS: 1 DIF: Easy REF: Page and Header: 295, Evaluation Principles OBJ: 2 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 20: Evaluating a Community Health Program: Collaborative Action Evaluation KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand 7. In a participatory context, evaluators are primarily looking for:

A. eliminating externals influences.

B. cause and effect.

C. inclusiveness.

D. formation.

ANS: C Rationale: Cause and effect are difficult to determine. This is why orthodox methods tried to develop models that would eliminate external variable and make the cause--effect link clear. Collaborative Action Evaluation (CAE) looks to include more participants and accepts the complexity of the environment. In doing so, cause and effect may be less clear but the pragmatic results are more effective.

PTS: 1 DIF: Easy REF: Page and Header: 298, Collaborative Action Evaluation OBJ: 3 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 20: Evaluating a Community Health Program: Collaborative Action Evaluation KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Remember 8. Collaborative Action Evaluation (CAE) is a carefully organized search, inquiry, or examination of an issue or question that is characterized by the systematic collection and analysis of data to create new knowledge or understanding. What should a nurse most emphasize in CAE research?

A. Cooperation B. Sustainability C. Cocreation D. Process ANS: C Rationale: The main emphasis in CAE is on the cocreation of knowledge. This will ensure that knowledge gained is effective and sustainable because it is understood and owned by all participants. The evaluator and researchers must have an equal relationship with all participants and stakeholders.

PTS: 1 DIF: Easy REF: Page and Header: 299, Characteristics of CAE OBJ: 4 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 20: Evaluating a Community Health Program: Collaborative Action Evaluation KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply 9. The orthodox method of evaluation has changed dramatically. Which of the following is a main assumption of the orthodox view of evaluation?

A. The community is a partner B. Many people must participate in the evaluation C. Evaluation of a program should exclude those involved in delivery D. An inquiry team should form the evaluation ANS: C

Rationale: The orthodox tradition generally excludes the people who deliver programs from the evaluation process. Typically, when we talk about evaluation, we refer to it as “program evaluation”. We talk as if it is the program alone that is to be evaluated, without reference to the people delivering or receiving it.

Collaborative Action Evaluation (CAE) involves the community as a partner, involves as many stakeholders as possible and is best conducted by an inquiry team of key stakeholders.

PTS: 1 DIF: Moderate REF: Page and Header: 297, Evaluation Traditions and Paradigms OBJ: 4 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 20: Evaluating a Community Health Program: Collaborative Action Evaluation KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand 10. A community health worker is evaluating a community health program using Collaborative Action Evaluation (CAE). What question is most appropriate to ask when reviewing the progress of the health program?

A. Is there a need for the program?

B. Are program activities following the intended plan?

C. What are the costs of a program?

D. Were the program objectives met?

ANS: B Rationale: The component of evaluation is progress and consistent with CAE when asking the question “Are program activities following the intended plan?”; relevancy when asking the question “Is there a need for the program?”; cost-efficiency when asking the question “What are the costs of a program?”; and effectiveness or outcome when asking the question “Were program objectives met?”

PTS: 1 DIF: Moderate REF: Page and Header: 294, Defining Evaluation OBJ: 1 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 20: Evaluating a Community Health Program: Collaborative Action Evaluation KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply 11. Traditions of evaluation range from orthodox to participatory. What type of change are those working with Collaborative Action Evaluation (CAE) looking for?

A. Incremental B. Behavioural C. Understanding D. Systemic ANS: D

Rationale: CAE as a tradition is focused on systematic change. The orthodox view looks for behavioural change and the interpretive view looks for understanding.

The shift in the view of what an evaluation can and should do is a major aspect of CAE. PTS: 1 DIF: Moderate REF: Page and Header: 297, Traditions of Evaluation (Table 20.2) OBJ: 4 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 20: Evaluating a Community Health Program: Collaborative Action Evaluation KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand 12. When participating in a Collaborative Action Evaluation (CAE) project, on what key concept should the inquiry team primarily focus their research?

A. Problems with the existing program B. Cost-effectiveness of the existing program C. Assets of the existing community D. Models of other similar programs ANS: C Rationale: The assets of the existing community can be built upon and empower existing tools in the real world. Focusing on problems does not empower the community or program. Cost-effectiveness is related to the measurement of the cost of the program, external models and other similar programs may not share the same context.

PTS: 1 DIF: Moderate REF: Page and Header: 297, Assets OBJ: 4 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 20: Evaluating a Community Health Program: Collaborative Action Evaluation KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply 13. The major assumptions of Collaborative Action Evaluation (CAE) include which of the following? Select all that apply.

A. Statistical analysis is essential to understanding the effects and outcomes of a program B. Phenomena can only be understood in context C. Worthwhile learning is often private and obscure D. Evaluators are subjective partners with participants and stakeholders E. Many things that exist are not empirically verifiable ANS: B, C, D, E

Rationale: The assumptions dominant in CAE show that statistics must be understood in context and can often only be understood in context, therefore, statistical analysis may be useful but not essential. The assumptions that phenomena must be considered in context, that learning often occurs in private, and that evaluators’ are in subjective collaboration are all central assumptions of CAE. The model also acknowledges that many things that exist are not empirically verifiable.

PTS: 1 DIF: Moderate REF: Page and Header: 298, Assumptions Underlying CAE OBJ: 4 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 20: Evaluating a Community Health Program: Collaborative Action Evaluation KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand 14. A community nurse is asked to form an inquiry team for an evaluation of nursing practices in her health unit. After examining potential biases, what should the nurse do next?

A. Establish key questions B. Contact other nurses C. Identify all key stakeholders D. Research past evaluations ANS: C Rationale: An inquiry team is made up of all key stakeholders. This team then creates the questions for the evaluation. Other nurses are just one facet of this team. Past evaluations may be deemed important but they are not part of the formation of the team.

PTS: 1 DIF: Moderate REF: Page and Header: 301, CAE Process OBJ: 4 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 20: Evaluating a Community Health Program: Collaborative Action Evaluation KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply 15. The Collaborative Action Evaluation (CAE) process is most accurately described as: A. iterative and cyclical.

B. focused and linear.

C. solitary and research oriented.

D. formative and summative.

ANS: A Rationale: The process of CAE is cyclical and iterative. Reflecting, planning, and acting are ongoing processes that are inserted into the process repeatedly. The process is not linear and it occurs within a group of stakeholders. Only some of the evaluation will be solitary. Formation and summation are similarly part of the process but do not describe the CAE process as a whole.

PTS: 1 DIF: Moderate REF: Page and Header: 300, CAE Process OBJ: 4 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 20: Evaluating a Community Health Program: Collaborative Action Evaluation KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand 16. An inquiry team has set questions for the evaluation of their program and they now need to collect data. The main characteristic of the method they choose should be that it is: A. efficient.

B. innovative.

C. behavioural.

D. participatory.

ANS: D Rationale: The main guiding principle is that the process be participatory.

Behavioural research seeks to identify and change behaviour, which the Collaborative Action Evaluation (CAE) process is not concerned with unless the inquiry team has deemed it necessary. Innovation and efficiency are not among the main criteria.

PTS: 1 DIF: Moderate REF: Page and Header: 302, Phase 2: Reflecting and Planning OBJ: 5 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 20: Evaluating a Community Health Program: Collaborative Action Evaluation KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply 17. Ethics in Collaborative Action Evaluation (CAE) are centred on the principles of confidentiality, anonymity, and volunteerism. How is the concept of volunteerism best described?

A. Having confidence in the agreed process of the evaluation B. Having the right to withdraw from the evaluation process C. Protecting the identity of the participants D. Ensuring information is communicated transparently ANS: B Rationale: Ethics are a central part of CAE. In order to remain ethical, all of the answers are correct. The principle of volunteerism, however, means that the participants are aware that they have the option to withdraw from the process at any time.

PTS: 1 DIF: Moderate REF: Page and Header: 303, Evaluation Ethics in CAE OBJ: 4 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 20: Evaluating a Community Health Program: Collaborative Action Evaluation KEY: Integrated Process: Nursing Process

BLM: Cognitive Level: Understand 18. In order to ensure a sustainable result of Collaborative Action Evaluation (CAE), the nurse should prioritize what outcome?

A. The CAE should make all stakeholders better off as a result of the process.

B. The planners should ensure safety standards are met.

C. The program should be cost effective.

D. The CAE should generate new programs.

ANS: A Rationale: The CAE aims to make all participants better off as a result of the process. This perspective ensures that participation is useful to the stakeholders.

Safety, cost, and new programming may occur but they are secondary considerations. To gain sustainability, the programmers should also build capacity and ensure long-term support.

PTS: 1 DIF: Moderate REF: Page and Header: 300, Sustainable Contributions OBJ: 4 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 20: Evaluating a Community Health Program: Collaborative Action Evaluation KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply 19. At what stage of a program should an evaluation take place?

A. At the end B. After several months have gone by C. Throughout the program D. When the inquiry team has decided ANS: C Rationale: An evaluation process is most effective if it is ongoing. The Collaborative Action Evaluation (CAE) requires that evaluations are an ongoing aspect of the program. Most evaluations that happen in the end or after several months do not impact the program and have not impact on making the program ongoing and effective.

PTS: 1 DIF: Easy REF: Page and Header: 295, Evaluation Principles OBJ: 1 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 20: Evaluating a Community Health Program: Collaborative Action Evaluation KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply 20. An inquiry team is ready to disseminate results. What consideration should the team prioritize?

A. The cost of disseminating the information B. The effect that the information will have on the community C. Getting the information to as large an audience as possible D. Finding the best method to communicate with each of the stakeholder groups

ANS: D Rationale: The method of dissemination should be different for each of the groups involved. Information for nurses will not be effective to communicate with other clients. Therefore, during the Collaborative Action Evaluation (CAE) process, methods for information dissemination should be generated and should be specific and targeted. Getting information to a large group is less important than making sure the information is effectively communicated.

PTS: 1 DIF: Moderate REF: Page and Header: 304, Planning for Dissemination of Results OBJ: 5 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter 20: Evaluating a Community Health Program: Collaborative Action Evaluation KEY: Integrated Process: Communication and Documentation BLM: Cognitive Level: Apply