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Community Health Nursing
Theories Study Guide | 2023-2024

Nightingale’s Theory of Environment Health Belief Model


Focus on impact of a person’s environment on their health. Focus is on
preventative care (washing hands, clean environment)

Health Belief Model


Assumes a person’s primary motivation in taking positive health actions is to avoid
getting a disease

Likelihood of taking action is based on:


Modifying variables (age, gender, race, economy, education)


Perceived severity and susceptibility of getting the disease


Perceived benefits vs barriers of taking action


Cues to action (advice of doctor, media campaigns)

Community based nursing vs. community oriented nursing:
The community or population us the “client” in community health nursing

Community based nursing- is focused on illness care (acute or chronic conditions) for
individuals and families.
Examples: home health nurse doing would care, school nurse administering epi-pen

Community oriented nursing: is focused on improving collective health of the

Examples: health education and promotion, disease prevention activities. No illness
Community oriented nursing = public health nursing
Community Health nursing vs. public health nursing

Community health nursing: delivers health care services to individuals, families, and
groups. Includes community based nursing (illness care for individuals and families)
AND community oriented nursing (community focused care, with emphasis on
education and disease prevention)

Public health nursing: disease prevention and health promotion of

communities and populations. They are not providing direct care to individuals!
Public health nursing = community oriented nursing.
4 Ethical Principles in Community Health nursing

Respect for autonomy: respect a patient’s right to self determination


Nonmaleficence: do no harm


Beneficence: do what is best (maximize benefits)


Distributive justice: fail allocation of resources in community


Study of spread, transmission, and incidence of disease/ injury Components:


Agent: what is causing the disease (bacteria, toxin, noise)


Host: human/ animal being affected by the disease


Environment: physical environment (water/ food supply, geography), social
experiment (access to health care, work conditions, poverty)

Incidence vs prevalence
Incidence: number of NEW cases of disease/ injury in a population during a specified period
of time
Prevalence: Number of ALL cases (new and preexisting) of disease/ injury in a population
during a specified period of time
Community Health Education:

Obstacles: age, culture, illiteracy, language barriers lack of access, lack of motivation

Learning styles:


Visual (videos, presentations)


Auditory (verbal lectures, discussions)


Tactile- kinesthetic (hands on, return demonstration)

Healthy people 2020: Includes national health goals based on major risks to health
and wellness of U.S. population (ex. Diabetes, cancer, older adults, LGBT health).

Primary vs. Secondary vs. Tertiary prevention:

Primary: prevents initial occurrence of disease


Secondary: focuses on early detection of disease, limiting severity of disease

Ex. Education, immunizations, prenatal classes
Ex. Screenings, disease surveillance, control of outbreaks

Tertiary: Maximize recovery after an injury/ illness

Ex. Rehabilitation, PT/OT, support groups

Acculturation, Ethnocentrism, Cultural Assessment, Interpreter

Acculturation: adopting the traits of a different culture

Ethnocentrism: the belief that one’s own culture is superior to all others. View world
from their own cultural viewpoint.

Cultural Assessment: ask about patient’s ethnic background, religious preference,
family structure, food patterns and health practices. Incorporate patient preferences
into care whenever possible.

Interpreter: use of family members is not recommended, interpreters need to have
knowledge of health terminology. Patient teaching materials should be available in
their primary language.

Nursing Process


Diagnosis (analysis)


Implementation (treatment)


Maslow’s Hierarchy of Needs






Prevalence Proportion: # of existing cases in the population at a specific time divided
by population total x 1000 = per 1,000

Incident Rate: # of newly diagnosed cases in the population at a specific time divided
by population total x 1000 = per 1,000

Crude Mortality Rate: Number of deaths divided by population total x 1000 = per

Infant Mortality Rate: # of infant deaths before 1 year of age in a year divided by
numbers of live births in the same year x 1000 = per 1,000

Attack Rate: # of people exposed to a specific agent who develop the disease divided
by total number of people exposed.


PRIMARY: Prevention of the initial occurrence of disease or injury


Community health nurse
▪ Nutrition education
▪ Family planning and sex ed
▪ Smoking cessation ed
▪ Communicable disease ed
▪ Health and hygiene ed
▪ Safety ed
▪ Prenatal classes
▪ Advocating for access to health care


Education class


Assess immunization status


Maintain current health records


Health promotion

SECONDARY: Early detection and treatment of disease with the goal of limiting

severity and adverse effects

Community health nurse
▪ Community assessments
▪ Disease surveillance
▪ Screening (cancer, DM, HTN, hypercholesterolemia, sensory impairments, TB, lead
exposure, genetic disorders in newborns)
▪ Control of outbreaks in communicable diseases


notify contacts of patient about exposure


isolate from pregnant woman


assess children for abuse, neglect, mental illness


provide emergency/acute care


ID kids at risk


Checking heights and weights


Screening for lead exposure


Risk for harm/suicide


Monitor workers for levels of chemical exposures at job sites


Obtain environmental health histories of individuals


Survey for health conditions that may be related to environmental and occupational


Assess homes


Vision/hearing screenings

TERTIARY: Maximization of recovery after an injury or illness (rehabilitation)


Community health nurse
▪ Nutrition counseling
▪ Exercise rehab
▪ Case management
▪ Physical and OT
▪ Support groups
▪ Exercise for htn clients


Assess kids with disabilities


Assess kids with LT health needs




Support lean up

WHO- (INTERNATIONALHEALTH ORGANIZATION) provides daily info regarding the
occurrence of internationally important diseases; establishes work standards for antibiotics
and vaccines
OSHA: Develops and enforces workplace health regulations to protect the safety and health
of workers

Report notifiable communicable diseases to state depts. Of health, where they report
state to CDC

Communicable Diseases

Airborne (inhaled by susceptible host)



Chicken pox







Foodborne (bacterial, viral, parasitic infection of food)




Hep A




E. coli

Food Intoxication (toxins produced through bacterial growth, chemical contamination,
or disease-producing substances)


Staph aureus


Clostridium botulinum

Waterborne (fecal contamination of water)



Typhoid fever


Bacillary dysentery


Giardia lamblia

Vector borne

Lyme disease


Rocky mountain spotted fever



Direct contact



Infectious mononucleosis


Impetigo, lice, scabies

Secondary data: mortality/morbidity data, health surveys, medical records
I PREPARE Mnemonic

Method of determining current and past environmental exposures

I-investigate potential exposures

P- present work

R- residence

E- environmental concerns

P-past exposure

A- activities

R- REFFERALS AND RESOURCES (Environmental Protection Agency, Agency for

Toxic Substances & Disease Registry, Association of Occupational and Environmental
Clinics, MSDs, OSHA, local health department, environmental agency, poison

E- education



Individuals must be older than 65 years receiving social security, have been

receiving disability benefits for 2 years, have amyotrophic lateral sclerosis, and
receive disability benefits or have kidney failure and be on maintenance dialysis or
had a kidney transplant to qualify for Medicare


Provides health care coverage for individuals of low SES and children,

through the combined efforts of fed and state govs. Eligibility based on household size
and income, with priority given to children, preg women, and those with disability
Lead Exposure***

Diet: extra iron and calcium (more milk and red meat)

Cleaning wood floods in houses with lead: wet mop (vacuuming aerosolized particles)

Levels of prevention for client with flu

Primary- education class about flu


Secondary- notify contacts of the client about their exposure, isolate client

from pregnant women

Tertiary- give antiviral to reduce complications

Infant Guidelines

Water heater setting-should be no higher than 120 degree Fahrenheit

Crib slates- must be <6 cm apart

Pacifier during naps should be attached to clothing, not hung around clothing

Toddler Guidelines

Non-potty trained toddlers and swimming- they should be swim in a wading pool

Pregnancy/Post Pregnancy Mother Guidelines

Postpartum blues- common first week to 10 days PP


Most infectious period- coughing

Those exposed- should be treated prophylactically with erythromycin for 7 days
(family members, teachers); check immunization status of classmates


Groups who should get vaccinated- new military recruits, pts with SLE, dormitory

Preventing transmission of intestinal parasites- wipe diaper changing stations with dilute
bleach solution
Ethical Tenet

Policy development: serve citizens, not customers; meet the needs of the greatest # of

citizens first


Health Concerns/Leading Causes of Death

Perinatal conditions/congenital anomality’s


Motor vehicle/other unintentional injuries

National health goals

Reductions in: dental caries, obesity, exposure to second hand smoke


Motor vehicle/other unintentional injuries



National health goals:

Reductions in: violent crimes, initiation of tobacco use, obesity, inappropriate

weight gain


Reproductive health (childbearing, menopause, osteoporosis)

Heart disease


Malignant neoplasm (breast, cervical, ovarian, colorectal)


Heart disease

Malignant neoplasm (prostate, testicular, skin, colorectal)

Unintentional injuries

Lung disease

Liver disease

Older Adults

Heart disease

Malignant neoplasm

Cerebrovascular disease


Pneumonia and influenza

Substance use and misuse

Community Nursing

Problem-focused approach to planning, delivering, evaluating nursing care


Broad field in wide variety of settings


Promotes health & welfare of clients


Principles of Community Health Nursing

Ethical Considerations






Epidemiological Calculations


Epidemiological Triangle


The Epidemiological Process


Community-Based Health Education

Public Health Nursing
Population-focused to promote health and prevent disease

Determining needs, intervening to protect and promote health, prevent disease


Key principles


Emphasize primary prevention


Achieve great good for largest number of individuals


Recognize that client is partner in health


Use resources wisely to promote best outcomes


Systematic methods to monitor health of population


Diagnose and investigate

Policy development

Developing laws and practices to promote health of population


Inform, educate, empower people about health issues


Mobilize community partnerships


Ensure adequate health care personnel and services are accessible

Ethical Considerations
Public Health Code of Ethics

Identifies ethical practice of public health


Protecting, preserving, promoting, maintaining health


Client rights – right to info disclosure, privacy, informed consent, info confidentiality,
participation in treatment decisions


Considerations include

Preventing harm = doing no harm


Promoting good


Respecting individual and community rights


Respecting autonomy and diversity


Providing confidentiality, competency, trustworthiness, advocacy


Informer, supporter, mediator


Nurse-pt relationship is based on trust, collab, shared respect, related to. health,

considerate of thoughts/feelings

Nurses are responsible to advocate for resources/services that meet pts needs


Requires assertiveness, priority on pts values, willingness to progress through chain of

Health Promotion and Prevention

Healthy People derives from scientific data and trends from prior decade


Goals are based on issues considered major risks to health


Healthy People 2020


Every 10 years


Guide for promoting health/wellness


Help people move toward optimal health

Social Determinants of Health Care
Divided into 5 categories

Neighborhood & built environment


Social & community context


Economic stability


Health and healthcare



Culturally and Linguistically Appropriate Services (CLAS)

Standards include:

Providing language assistance and info in preferred language


Promote ongoing improvement and accountability for culturally appropriate


Congruency btwn culture and health care = essential to well-being of pt


Assess cultural beliefs and practices when developing plan of care

Understand that there are variations w/in each culture


Consider uniqueness of each pt


Become familiar w/cultures represented in local community

Cultural Competence

Learning to respect individual dignity and preferences, and acknowledging cultural


Guided by 4 provisions

Cultural preservation: maintaining traditional values and practices


Cultural accommodation: supporting and facilitating use of cultural practices
that are beneficial to health


Cultural repatterning: assisting to modify cultural practices that are NOT

beneficial to health

Cultural brokering: advocating, mediating, negotiating, intervening between

culture and health care culture

Environmental Health
Relates to quality of air, land, water, other surroundings ppl come in contact with Risks:

Toxins: lead, pesticides, mercury, solvents, asbestos, radon


Air pollution: CO2, ozone lead, aerosols, tobacco


Water pollution: wastes, mining erosion, run-off from chemicals


Contamination: food w/bacteria, radiation, antibiotics

Environmental assessment questions:

Condition of housing. Remodeling activities?


Water heater temperature less than 120 degrees F?


Occupation (including exposure to chemicals, toxins)?


Tobacco smoke present in home?


Quality of drinking water?

Lead exposure key points

Pre 1978 housing at risk for lead based paint!

Screen child 6 months- 5 years for blood lead levels

Avoid playing in soil right outside home

Wet mop floors (vs. vacuuming floors)

Use wet sanding technique (vs. dry sanding)

Make sure children get enough iron and calcium diet, as this decreases absorption of
lead in the body

Use cold water (vs. hot water) because lead dissolves more quickly in hot water

Medicare and Medicaid

Medicare eligibility:

Older than 65


Receiving disability for at least 2 years


Diagnosed with amyotrophic lateral sclerosis (ALS) or end stage renal disease

(ESRD) and receiving dialysis

Part A: inpatient hospital, limited SNF, home health care

Part B: outpatient care, diagnostic services, PT/OT

Part C: combines Part A and Part B provided through private insurance

Part D: prescription drug coverage (D is for Drug)

Medicaid Eligibility: those with low socioeconomic status and no other insurance,

based on household size and income
State Department of Health, stage board of nursing, local health department

State department of health: manages WIC program, CHIP, Medicaid program. Reports
notifiable communicable diseases to CDC (voluntary)

State board of nursing: license LPNs and RNs, oversees state schools of nursing,
develops state’s nurse practice act

Local health department: meets health needs of community. Reports notifiable
communicable diseases to state department of health

Community Assessment




Biological factors (race, age, gender, health/ disease status)


Social factors (education, income, crime rate)


Cultural factors (history, religion, customs)


Physical factors (geography, housing, location of health care services)


Environmental factors (climate, pollutants, topography)

Types of Data collection in community nursing

Informants interviews: direct conversations with member of community

Community forum: public meeting (participation challenges)

Secondary data: review existing data available (statistics, health records)

Participant observation: observe community activities

Windshield survey: literally drive through community and make observations

Focus groups: meet with representative sample of community

Surveys: written format (expensive, low response rate)

Windshield Survey

People: general appearance, ethnicity/race of community members. Signs of violence?
Mental illness? Drug abuse?

Place: quality of housing, access to health care facilities, types and availability of
grocery stores, public transportation, presence of schools, parks, and churches

Steps in developing and managing a community health plan

Pre planning: brainstorm ideas

Assessment: data collection

Diagnosis: analyze collected data to determine health needs of the community. Set

Planning: Plan interventions. Establish goals, identify responsibilities, develop budget.

Implementation: execute plan

Evaluation: determine effectiveness of intervention

Home Health Nurse

Provides health care in patient’s homes and assisted living facilities (including nursing

Provides patient education, direct nursing care, and care coordination (including

Assesses home for safety. Key items to look for: NO scatter rugs (carpet ok), no
clutter, adequate lighting on stairs (use of colored tape on step edges is helpful). For
Alzheimer’s patients, locks/ alarms on exit doors are appropriate.

Hospice nurses, parish nurses

Hospice nurse: provides palliative care (focus on symptom management, not curing
disease), supports patient and family with dying process.

Parish nurse: works w/ pastoral stall to improve the health and wellness of the faith
community Provides health education and facilitates support groups. Does NOT do
bedside nursing tasks.

Occupational Health Nurse

Promotes health and wellness of employees, prevents workplace illness and injury

Through surveillance, identifies risks within work environment. Identifies ways to
decrease or eliminate workplace hazards.

Keeps informed about OSHA standards.

Primary prevention: provides safety education

Secondary prevention: performs screenings • Tertiary Prevention: sets up limited duty

School Nurse

Provides direct nursing care to children at school

Provides health education

Case manager for children w/ health needs (makes referrals, schedules appointments,
coordinates services)

Primary prevention: assesses immunization status of children

Secondary prevention: provides vison and hearing screening, screens for oral health,
scoliosis, infestations. Assesses for child abuse/neglect.

Tertiary prevention: Administers medications, provides nursing care for children with
chronic diseases, assesses children with disabilities.

Key Health Concerns for:
Infants/Children: SIDS (sleep on back), injuries (wear helmets and seat belts),
communicable diseases (get immunizations)
Adolescents: motor vehicle accidents (wear seatbelts), substance abuse (including smoking),
safe sex, mental health
Women: menopause, osteoporosis, (encourage weight bearing exercise), heart disease,
diabetes, cancer prevention (get mammograms, pap smears)
Men: heart disease, cancer prevention, (get prostate cancer screening, testicular self exams),
lung disease, liver disease
Older Adults: heart disease, CVAs, COPD, pneumonia, polypharmacy, cancer, injury
prevention (including falls)
Transitions, genograms, ecomaps

Transitions: includes birth or adoption of child, death in family, major illness, divorce,
loss of income, etc.

Transitions = time of risk for family

Genograms: graphical representation of relationships within the family, patterns of
illness (i.e. “enhanced” family tree)

Ecomaps: graphical representation of family interaction with outside
groups/organizations which provides information about the family’s support network

Types of violence

Homicide: often related to drug abuse, usually victim is someone know to perpetrator.
Males at higher risk.

Rape: Intimate partner violence very common; often unreported.

Suicide: Highest in men, and those over 65 year old.

Abuse: physical abuse, sexual abuse, emotional abuse (humiliation, intimidation),
neglect (failure to provide food, shelter, emotional care, medical care, education),
economic abuse (misuse of money, failure to provide for needs of victim despite
adequate funds, theft)

Violence, Child abuse

Community factors that increase risk of violence: Unemployment, poverty, social
isolation. Child abuse is more common when spousal abuse is present.

Signs of child abuse: presence of wounds or injuries in various states of healing,
unexplained bruises/ injuries, unusual fear of others. Small round burns that could be
caused by cigarettes, forearm spiral fractures

Signs of child neglect: poor hygiene, inappropriate dress (for weather), signs of
malnourishment, withdrawal, school absences

Alcohol Abuse

Factors that affect alcohol metabolism: size/ weight of drinker, time elapsed while
drinking, gender, presence of food in stomach

Alcohol withdrawal: manifestations appear within 4-12 hours. Symptoms include:
tachycardia, hypertension, n/v, headache, anxiety/ irritability, diaphoresis, tremors,
seizures. It is important to ask patient when their last drink was!

Primary prevention: public education campaigns, school education

Secondary prevention: screen individuals for signs of abuse

Tertiary prevention: refer patients to AA or NA, promote coping and lifestyle changes

Homelessness, Veterans



Fast growing segment: families with children


Risk factors: unemployment, migrant workers, veterans, mental illness,

substance abuse, HIV/AIDS, at risk youth

Key health issues: tuberculosis, infestations (scabies/ lice), substance abuse,

HIV/AIDS, mental illness

Key health issues of veterans: mental health issues (PTSD, depression), substance

abuse, suicide, traumatic brain injury, spinal cord injury, amputations
Migrant workers

Key health risks: tuberculosis, dental disease, skin cancer, diabetes, obesity, high risk
suicide, increased work related injuries (exposure to pesticides, injuries from

Primary prevention: education on reducing exposure to pesticides, accident
prevention. Preventative care (immunizations, dental care)

Secondary prevention: screen for skin cancer, pesticide exposure, communicable

Tertiary prevention: provide ER or primary care services, including treatment of
symptoms of pesticide exposure

Communicable Diseases: Modes of Transmission

Airborne: chickenpox, measles, tuberculosis, pertussis, influenza

Foodborne: salmonella, hepatitis A (fecal oral route), E-Coli, botulism

Waterborne: cholera, typhoid fever

Vector- borne: (ex. Mosquito or tick) Lyme disease, malaria, rocky mountain spotted

Sexually transmitted: HIV, Hep B/C/D, syphilis, HPV, gonorrhea

Direct contact: lice, scabies, impetigo

Saliva: mononucleosis

Types of Immunity

Herd immunity: most community members have immunity, protecting those who can’t
(or choose not to get) immunized. Makes exposure unlikely.

Active natural immunity: body produces antibodies in response to exposure to live

Active artificial immunity: body produces antibodies in response to vaccine

Passive natural immunity: antibodies are passed form the mom to her baby thought
the placenta or breast milk

Passive artificial immunity: Immunoglobulins are administered to an individual after
they have been exposed to a pathogen

Communicable Diseases: reporting, prevention

Communicable disease reporting is mandated by state and local regulations. State
notification to CDC is voluntary.

Primary prevention: provide education re: immunization, hand hygiene, proper food
handling, risk of infectious diseases when traveling to other countries (including
Hepatitis A)

Secondary Prevention: provide screening, quarantine patients when needed, refer
suspected cases for definitive diagnosis

Tertiary prevention: monitor treatment compliance (may require direct observation

Nationally Notifiable Diseases

Lyme disease: key symptom is red bullseye ring around the area of the tick bite

Meningococcal disease: individuals should get vaccinate prior to living in a crowded
housing environment (college dorms, prisons, military housing)

Pertussis: Children w/ pertussis should stay home from school until coughing is gone.
Family members and those exposed should be treated with antimicrobials. Check
immunization status of other children in school.

TB: Treated with up to 4 antibiotics (to prevent drug resistance) for 6-12 months.
Family members need to be tested for TB. Sputum samples will be needed ever 2-4
weeks – patients are no longer infectious after three negative sputum cultures. Patients
with active TB need to wear N95 masks in public.

Disaster Management: Four levels

Disaster prevention: surveillance, inspections, immunizations, education, risk

Disaster preparedness: create disaster action plan, identify evacuation routes, create
disaster kit, identify meeting place and communication plan, perform disaster drills

Disaster response: assess extent of disaster. Perform triage, and direct those affected.
Coordinate evacuations, quarantines.

Disaster recovery: begins when danger no longer exists. Coordinate care in shelters,

Bioterrorism, Inhaled anthrax, Smallpox

Category A: smallpox, botulism, anthrax, plague

Category B: typhus cholera

Category C: hantavirus

Inhaled Anthrax: symptoms: severe dyspnea, fever, shock, muscle aches. Intervention:
IV ciprofloxacin for those exposed (or have high risk of exposure)

Smallpox: symptoms: rash (begins on face and spreads down), high fever, headache,
vomiting. Prevention: vaccination

Consultations vs. Referrals

Consultation: Request from provider to another physician or resource who can
provide expert advice and/or services for the patient

Referral: Provider requests or recommends management of one or more of the
patient’s concerns/ issues to another provider or for support services (ex: support
groups, churches, transportation services, meal delivery services)

Case management: Responsibilities

Help the patient transition from acute to community based care

Evaluate patient’s medical needs, psychosocial issues, financial constraints

Collaborate with patient, family, insurance, companies, health care providers, medical
services/ equipment providers to meet the health care needs of the patient

Facilitate discussion of patient’s needs with an interprofessional team

Provide referrals as needed

Informatics, Telehealth, Nursing roles in Health Policy

Informatics: incorporates nursing, information technology, and communication
technology to develop and to support nursing practice and improve patient outcomes

Telehealth: Delivery of health care through technology (vs. in person). This is
particularly helpful in rural areas, where there is a lack of specialty care services

Nursing roles in health policy: Nurses can act as an advocate for changes in health
policy, lobby legislators, serve in public office, or help form coalitions (collaboration
of groups to achieve a goal)

❖ Management of Care
➢ Case Management –
▪ Care of Specific Populations: Planning Care for a Migrant Worker

Primary prevention – educate regarding measures to reduce exposure to

pesticides (hand washing after working, washing food picked from fields before
consumption, changing clothes after work); teach regarding accident prevention
measures; provide prenatal care; mobilize preventative services (dental,

Secondary prevention – create testing programs for tuberculosis and prenatal

diagnostic testing; implement screening programs (pesticide exposure, skin cancer,
chronic preventable diseases, communicable diseases, anemia [children])

Tertiary prevention – treat for manifestations of pesticide exposure; mobilize

primary care and emergency services; promote rehabilitation following work-related
musculoskeletal injuries; educate clients who have diabetes mellitus or anemia
regarding appropriate nutrition
➢ Concepts of Management –
▪ Care of Specific Populations: Priority Action for a Client Who Is Homeless

Prevent individuals and families from becoming homeless by assisting them in

eliminating factors that can contribute to homelessness – refer those who have
underlying mental health disorders to therapy and counseling; enhance parenting skills
that can prevent young people from feeling the need to run away
➢ Legal Rights and Responsibilities –
▪ Communicable Diseases, Disasters, and Bioterrorism: Reporting
Infectious Prenatal Conditions

The community health nurse engages in communicable disease surveillance,

which includes the systematic collection and analysis of data regarding infectious
diseases. Reporting of communicable diseases is mandated by state and local
regulations, and state notification to the CDC is voluntary***
❖ Safety and Infection Control –

➢ Accident/Error/Injury Prevention –
▪ Ergonomic Principles: Assessing Risk for Injury in an Occupational Setting

Using good body mechanics when positioning and moving clients promotes

safety for the client and the staff. Before attempting to position or move a client,
perform a mobility assessment. Begin with the easiest movements (range of motion)
and progress as long as the client tolerates it (balance, gait, exercise).
▪ Factors Influencing Community Health: Federal Agencies and Asbestos

Veterans’ Health Administration – finances health services for active and

retired military persons and dependents (within the U.S. Department of Veterans

U.S. Department of Health & Human Services – under the direction of the

Secretary of Health; Funded through federal taxes; consists of several agencies, such
as (Agency for Toxic Substances and Disease Registry (ATSDR): strives to decrease
harmful exposure and diseases linked to toxic substances
▪ Practice Settings and Aggregates: Evaluating Understanding of Bicycle Safety

Identifying if patient is able to verbalize or demonstrate what proper bicycle

safety looks like (wearing helmet, pads, when to cross)

Emergency Response Plan –

▪ Communicable Diseases, Disasters, and Bioterrorism: Response Phase of a Disaster

Different agencies, governmental and nongovernmental, are responsible for

different levels of disaster response. Some of the agencies with a role in disaster
response include the Federal Emergency Management Agency (FEMA), the CDC,
U.S. Department of Homeland Security (DHS), American Red Cross (ARC), Office of
Emergency Management (OEM), and the public health system.

Disaster management response includes an initial assessment of the span of the

disaster – how many people are affected? How many are injured or dead? How much
fresh water and food is available? What are the areas of risk or sanitation problems?

Disasters are classified according to type, level, and scope. If a federal

emergency is declared, the National Response Framework (NRF) is activated and
provides direction for an organized, effective national response

Home Safety – (1)

▪ Practice Settings and Aggregates: Teaching About Disposal of Insulin Syringes

Keep in a stored container. Away from children and those who could endure

harm from the syringes.

Standard Precautions/Transmission-Based Precautions/Surgical Asepsis –

Infection Control: Caring for a Client Who Has Clostridium Difficile

Use frequent and effective hand hygiene before and after care. Educate the

client about the required and recommended immunizations and where to obtain them.
The target groups include children, older adults, those with chronic disease, and those
who are immunocompromised and their families and contacts. Educate the client and
ask for a return demonstration of good oral hygiene. Encourage the client to consume
an adequate amount of fluids.
❖ Health Promotion and Maintenance –
➢ Aging Process –
▪ Factors Influencing Community Health: Counseling an Adolescent Who Is Pregnant

Educate the client on all of the options with pregnancy. Provide client with

resources to turn to for support as well as prenatal care, regular check-ups, and safety

Heart Failure and Pulmonary Edema: Teaching Clients About Managing Heart Failure

Take medications as prescribed. Follow diet prescribed by physician. Keep all

follow- up appointments. Educate patient on risk factors to look for as a result of

Pediatric Emergencies: Preventive Strategies for Sudden Infant Death Syndrome

Place the infant on the back for sleep. Avoid exposure to tobacco smoke.

Prevent overheating. Use a firm, tight-fitting mattress in the infant’s crib.
Remove pillows, quilts, and stuffed animals from the crib during sleep. Ensure that
the infant’s head is kept uncovered during sleep. Offer pacifier at naps and night.
Encourage breastfeeding. Avoid co-sleeping. Maintain immunizations up-to-date.
➢ Health Promotion/Disease Prevention –
▪ Health Promotion of Infants (2 Days to 1 Year): Evaluating Parent Understanding of Infant

Newborn infants should be placed in a federally approved car seat at a 45

degree angle to prevent slumping and airway obstruction. The car seat is placed rear
facing in the rear seat of the vehicle and secured using the safety belt. The shoulder

harnesses are placed in the slots at or below the level of the infant’s shoulders. The
harness should be snug, and the retainer clip placed at the level of the infant’s armpits.

Instruct parents that their newborn will require a checkup by a provider within

72 hr of discharge. This is especially important for breastfed newborns to evaluate
weight and hydration status.

Overview of Community Health Nursing: Planning Primary Prevention Programs

Prevention of the initial occurrence of disease or injury – nutrition education;

family planning and sex education; smoking cessation education; communicable
disease prevention education; education about health and hygiene issues to specific
groups (day care workers, restaurant workers); safety education (seat belt use, helmet
use); prenatal classes; providing immunizations; advocating for access to health care,
healthy environments.

Practice Settings and Aggregates: Alterations in Immunization Schedules

There are some circumstances where immunizations may need to be altered

and steered off of the original schedule. Assess the immunization status of all
children. Maintain current records of required immunizations.

Practice Settings and Aggregates: Secondary Prevention Activities for Workers in a
Manufacturing Plant

Identifying workplace hazards, early detection through health surveillance and

screening, prompt treatment, counseling and referral, and prevention of further
❖ Psychosocial Integrity –
➢ Coping Mechanisms –
▪ Continuity of Care: Priority Action for Case Manager During Discharge Planning

Initiate necessary consults or notify the provider of the client’s needs so the

provider can initiate a consult. Seek expertise from health care professionals
representing a variety of disciplines

Continuity of Care: Priority Assessment for a Client Following a Traumatic


Discharge planning is an essential component of the continuum of care and is

an ongoing assessment that anticipates the future needs of the client. Discharge
planning requires ongoing communication between the client, nurse, providers,
family, and other members of the interprofessional team. The goal of discharge

planning is to enhance the well-being of the client by establishing appropriate options
for meeting the health care needs of the client. Discharge planning begins at
➢ End of Life Care –

Practice Settings and Aggregates: Understanding Hospice Care

Hospice care focuses on enhancing the quality of life through the provision of

palliative care, supporting the client and family through the dying process, and
providing bereavement support to the family following the client’s death.
➢ Family Dynamics –

Suicide: Assessing a Client Who Reports Depression

Assess carefully for verbal and nonverbal clues. It is essential to ask the client

if he is thinking of suicide. This will not give the client the idea to commit suicide.
Suicidal comments usually are made to someone that the client perceives as
supportive. Assess for potential suicide risk using a standardized assessment tool, such
as the SAD PERSONS scale. Comments or signals can be over (direct) or covert
(indirect). Assess the client’s suicide plan.
➢ Stress Management –

Factors Influencing Community Health: Implementation Measures to Reduce
Environmental Hazards

Primary prevention: Individual – educate individuals to reduce environmental

hazards. Community – educate groups to reduce environmental hazards. Advocate for
safe air and water. Support programs for waste reduction and recycling. Advocate for
waste reduction and effective waste management.

Secondary prevention: Individual – survey for health conditions that can be

related to environmental and occupational exposures. Obtain environmental health
histories of individuals. Monitor workers for levels of chemical exposures at job sites.
Screen children 6 months to 5 years old for blood lead levels. Community – survey for
health conditions that can be related to environmental and occupational exposures.
Assess neighborhoods, schools, work sites, and the community for environmental

1. During a home health visit a school age child who has muscular dystrophy confides in the
nurse that he was struck by his parents. which of the following actions should the nurse take
1. report the incident to local authorities
2. check the child for injuries
3. refer the parent to a social service agency
4. enroll the parent in anger management classes.
Answer: 2. check the child for injuries
2. a nurse is planning a program about healthy eating at an elementary school where most
students select French fries and pizza at lunch every day. which of the following actions
should the nurse plan to take first?
1. give positive feedback to students who make appropriate choices.
2. help students recognize the value of making healthy food choices
3. provide students with resources about making wise choices independently
4. determine student’s motivation to learn about healthy food choices.
Answer: 4. determine student’s motivation to learn about healthy food choices.
3. a nurse manger in local community health agency is creating a job description for a new
nurse who will practice community oriented nursing. which of the following should the nurse
include in the job description? (select all that apply)
1. investigate potential health and environmental issues
2. initiate support groups for parents of autistic children
3. provide wound care for clients in their homes
4. participate in local health surveillance activities
5. provide health related education to community groups
Answer: 1. investigate potential health and environmental issues
2. initiate support groups for parents of autistic children
4. participate in local health surveillance activities
5. provide health related education to community groups
4. a community health nurse is planning an educational program for a group of women who
are postmenopausal. which of the following outcomes is appropriate for this program?
1. clients will schedule bone density screening

2. clients will arrange for mammograms every 3 years
3. clients will start hormone replacement therapy
4. clients will significantly decrease caloric intake
Answer: 1. clients will schedule bone density screening
5. a nurse is working with a care manager for a client who participates in a health
maintenance organization. the nurse should identify that a health maintenance organization
provides which of the following payment structures.
1. the client is participating in a fee for service health care insurance program
2. the provider is paid a fixed sum for the client on a monthly or yearly basis
3. the client pays the insurer a percentage of the total costs for each service rendered by the
4. the provider bills the client directly for a predetermined percentage of the cost of services
Answer: 2. the provider is paid a fixed sum for the client on a monthly or yearly basis
6. a client who has diabetes mellitus asks a home health nurse to help her adapt some of her
traditional cultural foods to fit her meal plan. which of the following is the first action the
nurse should take when assisting this client?
1. provide the client with a printed recipe
2. observe the client during preparation of traditional foods
3. use cookbooks to include traditional foods in meal plans
4. explain diabetes exchange list
Answer: 2. observe the client during preparation of traditional foods
7. a home health nurse manager is caring for a client who has methicillin resistant
staphylococcus aureus. which of the following actions should the nurse take?
1. remove fresh flowers from the client’s home
2. wear a mask when within 3 feet of the client
3. encourage the client to use a hepa filter in the house
4. double bag soiled dressing in polyethylene bags.
Answer: 4. double bag soiled dressing in polyethylene bags.

8. an occupational health nurse is discussing health promotion with a client who has a history
of obesity. which of the following comments indicates the client is using rationalization as a
coping mechanism?
1. i have lots of health problems from being obese
2. I am obese it’s in my genes
3. i have difficulty resisting the items in vending machines
4. i know you don’t like me because i am obese
Answer: 2. I am obese it’s in my genes
9. a nurse is conducting a community assessment. which of the following information should
the nurse include as part of the windshield survey?
1. demographic data
2. mortality rate
3. informant interviews
4. housing quality
Answer: 4. housing quality
10. a community health nurse is educating a parent about the importance of hepatitis B
immunization. which of the following explanations should the nurse give the parent about the
1. one dose of the immunization gives children lifelong protection from hepatitis B
2. hepatitis B spreads easily among children through casual contact
3. many people who acquire acute hepatitis B develop chronic hepatitis
4. people who have had a hepatitis B infection still need the immunization
Answer: 3. many people who acquire acute hepatitis B develop chronic hepatitis
11. a first response team is working at the location of a bombing incident. a nurse triaging a
group of clients should give treatment priority to which of the following clients.
1. a client who has superficial partial thickness burn injuries over 5% of his body
2. a client who has a femur fracture with a 2+ pedal pulse
3. a client who is ambulatory and exhibits manic behavior
4. a client who has a rigid abdomen with manifestations of shock.
Answer: 4. a client who has a rigid abdomen with manifestations of shock.

12. a nurse is working with a community health care team to devise strategies for preventing
violence in the community. which of the following interventions is an example of tertiary
1. presenting community education programs about stress management
2. developing resources for victims of abuse
3. urging community leaders to make nonviolence a priority
4. assessing for risk factors of intimate partner abuse during health examinations
Answer: 2. developing resources for victims of abuse
13. public health nurse take
1. alert the family members of coworkers about possible exposure to anthrax
2. place the employee under quarantine for 14 days
3. refer coworkers who might have been exposed to a provider for prophylactic antibiotics
4. instruct the client to wear a mask at work
Answer: 3. refer coworkers who might have been exposed to a provider for prophylactic
14. a community health nurse is providing teaching to a group of clients who have alcohol
use disorder. which of the following findings should the nurse include in the teaching as a
manifestation of alcohol withdrawal?
1. bradycardia
2. hypothermia
3. increased appetite
4. insomnia
Answer: 4. insomnia
15. a nurse is caring for a client who is homeless. which of the following actions should the
nurse take first?
1. determine the clients understanding of her living situation
2. assist the client to develop goals for obtaining shelter
3. discuss the risks of being homeless with the client
4. develop client teaching using a variety of strategies
Answer: 1. determine the clients understanding of her living situation

16. A nurse is planning a primary prevention strategy for reducing obesity in a community.
Which of the following strategies should the nurse use?
Answer: educate children about nutrition and exercise at a daycare center
17. A community health nurse is developing health promotion activities for a community.
Which of the following is the highest priority action?
Answer: participate in community assessment to identify community health problems
18. A home health nurse is scheduling client visits for the day. Which of the following clients
should the nurse plan to visit first?
Answer: a 79-year-old client with an exacerbation of COPD
19. A state public health nurse is asked to determine which country has the most people living
in it with a diagnosis of Alzheimer’s disease. Which of the following measures will determine
this information?
Answer: analytic epidemiology
20. A community health nurse is reviewing laboratory results for his case load of clients.
Which of the following is the highest priority finding?
Answer: a sputum specimen that is positive for tuberculosis
21. A nurse is triaging victims of a commuter train crash. Which of the following clients
should be transported to the Emergency Department first?
Answer: an ambulatory client whose nose is bleeding and who reports feeling dizzy
22. A community health nurse is caring for clients in a culturally diverse community. Which
of the following actions demonstrates accurate cultural knowledge about a specific cultural
Answer: include both hot and cold food items on a Hispanic client’s menu
23. A nurse is caring for a client who has questions about his treatment plan. Which of the
following should the nurse perform as a client advocate (select all that apply)?
Answer: 1. provide education to the client about the diagnosis
2. inform the client about the provider’s responsibility to provide information

3. assist the client in preparing questions for the provider affirm the client’s decision about the
treatment plan
24. A nurse is working with a client who is homeless. Which of the following is the first step
that the nurse should take to advocate for this client?
Answer: refer the client to a public homeless shelter
25. A nurse is providing education to a group of adolescents who are pregnant and attending
high school. Which of the following information should the nurse include in this teaching?
Answer: caffeinated beverages should be replaced with caffeine-free
26. A community health nurse is writing an emergency response plan for a day care. Which of
the following should be included in the plan?
Answer: immunization protocol for various biological agents
27. A community health nurse is preparing to teach accident and injury prevention. Which of
the following would be the priority topic for a family with a 10-year-old child?
Answer: use if seat belts in automobiles
28. A child is brought to the school nurse by her teacher who thinks the child may have
contracted rubeola. Which of the following findings supports this diagnosis?
Answer: kolpik spots in the oral mucosa
29. A home health nurse is performing an eye assessment and vision screening on an older
adult client recently assigned to her care. Which of the following findings indicates a need for
an intervention?
Answer: slightly yellow sclera
30. Which of the following is an example of the responsibilities of public health nursing?
Answer: informing state health officials of a potential meningitis outbreak
31. A nurse is providing a staff development program on HIPPA regulations to the staff at a
community health clinic. Which of the following comments by one of the attendees would
indicate a need for further teaching?

Answer: “Demographic data that identify a client can be released without consent”
32. A nurse administers a tuberculin skin test to a client who is HIV positive. Which of the
following indicates a positive reaction to the test?
Answer: Induration at infection site of 8 mm
33. After presenting several teaching sessions to a group of high school students about the
harmful effects of tobacco use, a nurse valuates the teaching to be effective when a student
states which of the following?
Answer: “As long as I stop smoking while I am young, none of those diseases will affect me”
34. A home health nurse is educating a client diagnosed with COPD about home oxygen use.
Which of the following statements by the client indicates a need for additional teaching?
Answer: “I should use wool blankets on my bed when oxygen in use”
35. A nurse is providing teaching to the wife of a client who has had a stroke regarding
health-related services that will be provided in the home. Which of the following statements
by the wife indicates that the teaching has been effective?
Answer: “The physical therapist will teach my husband exercises to increase hand dexterity”
36. A nurse is assisting with the development of a disaster management plan for a local
community. During which of the following times should an evacuation plan be disclosed to
the public?
Answer: During disaster preparedness activities
37. A community health nurse is teaching a client who has tuberculosis about modes of
disease transmission. The nurse recognizes that the client understands the concept when the
client makes which of the following statements?
Answer: “I will wear a mask when I’m in an enclosed area with other people”
38. A nurse is caring for a client who asks “can I decide not to continue with chemotherapy?”
The nurse responds, “This is your choice and I’ll support whatever decision you make.” The
nurse’s response is an example of which of the following ethical principles?
Answer: Autonomy

39. A community health nurse is working with a family in which only the children speak
English. The nurse should select a translator who is:
Answer: Skilled in health-related interpretation
40. A community health nurse working with a migrant population recognizes that which of
the following is necessary to provide care to this population?
Answer: Offering health screenings at a community center
41. Which of the following activities is the responsibility of a case manager?
Answer: Evaluate cost effectiveness of client treatments
42. While addressing community leaders at a forum for establishing community improvement
initiatives, a public health nurse identifies which of the following groups as the fastest
growing segment of the homeless population?
Answer: Families with children
43. A nurse is working in an occupational health setting. Which of the following is a primary
prevention activity for the nurse?
Answer: Conducting smoking cessation classes
44. A parish nurse is visiting an older adult client who was recently widowed. The client tells
the nurse that he no longer has a way to get to the grocery store or the doctor. Which of the
following responses by the nurse is appropriate?
Answer: “How would you feel about me contacting a local service that helps older adults
with transportation?”
45. A case manager nurse is caring for a client being discharged post total hip arthroplasty.
Which of the following activities is an example of the nurse functioning in the negotiator
Answer: Discussing payment options with various pharmacies

46. A community health nurse is evaluating an outbreak of hepatitis A among adult clients in
his community. Which of the following should the nurse do to identify the cause of the
Answer: Identify restaurants where the clients have recently eaten
47. A nurse working for a home hospice organization recognizes that clients must meet which
of the following criteria to qualify for hospice care?
Answer: Documented need for palliative care
48. A nurse is providing education to a troop of local Boy Scouts regarding first aid for
venomous snake bites in the event that transport to the hospital is delayed. Which of the
following would be appropriate information to include in teaching about bites to an
Answer: Apply a constricting band above the bite while maintaining circulation below the
49. In reviewing goals of “healthy people” nurse determines the community has a significant
problem preventing dental caries in children. To bring about change:
Answer: WIC program intake offices
50. A nurse is providing teaching to a community group regarding smallpox. Which of the
following is an appropriate response in relation to why people who received a single
vaccination prior to 1980 are no longer considered protected?
Answer: The vaccine does not confer life-long immunity
51. A community health nurse is conducting a community assessment. Which of the
following data should be included as a component of the assessment?
Answer: Resources available to address health care issues
52. A school nurse is creating a plan to address an increase in violence among high school
students. Which of the following is a secondary prevention strategy that the schools nurse can
Answer: Surveying students to identify risk factors for bullying

53. A school nurse is assessing the spinal alignment of students at a grade school. Which of
the following findings indicates a child should be assessed further for scoliosis?
Answer: Unilateral scapular hump when the child bends at the waist
54. A nurse is preparing to provide postmortem care for a client who is Chinese American.
Which of the following should the nurse consider when providing care?
Answer: The family will remain with the body until burial
55. A community health nurse is teaching a client who has active tuberculosis about disease
management. Which of the following information should be included in the teaching?
Answer: Provide sputum cultures until three come back negative
56. A public health nurse has received a report of several infants who attend the same daycare
being diagnosed with respiratory syncytial virus (RSV). Which of the following actions
should the nurse take first?
Answer: Provide the staff with information regarding measures to minimize disease

Document Details

  • Subject: Nursing
  • Exam Authority: ATI
  • Semester/Year: 2023

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