Test Bank Community Health Education Nies: Community/Public Health Nursing, 7th Edition
MULTIPLE CHOICE
1. A nurse has instructed a client several
... [Show More] times what he needs to do to get better, but the client has not followed these instructions. Which offers the best explanation for this behavior?
a. Barriers prevent action.
b. The client does not understand.
c. The client does not really care.
d. Barriers prevent desire to change.
ANS: A
Often the patient is blamed and labeled as being noncompliant. It is more helpful to wonder what barriers interfered with the patient’s ability to engage in appropriate action. It is unlikely that the client doesn’t understand or doesn’t care, rather the barriers are preventing action from being taken. Barriers may prevent the change, but not necessarily the desire to change.
DIF: Cognitive Level: Apply (Application)
2. Which best describes one of the most fundamental nursing principles suggested by Nightingale?
a. Be open to the patient’s preferences and priorities.
b. Engage in health teaching.
c. Keep the focus on individualized care for each person.
d. Meet physical needs, sucNh asRair,IfooGd, aBnd.wCateMr, first.
ANS: B
U S N T O
Although Nightingale would probably agree with each of the listed suggestions, she emphasized that health teaching is one of the most fundamental nursing principles.
DIF: Cognitive Level: Understand (Comprehension)
3. Which best describes why health education in the community is more effective than health education in a hospital or clinic?
a. Being in the patient’s home emphasizes the importance of the teaching.
b. It is easier to focus on the nurse’s words and demonstrations outside of health settings.
c. The setting is familiar and comfortable to participants.
d. There are too many interruptions in hospitals and clinics.
ANS: C
There can be interruptions and distractions anywhere, including in a patient’s home. In the community, the setting is familiar and comfortable.
DIF: Cognitive Level: Understand (Comprehension)
4. A nurse is implementing a comprehensive and entertaining educational program. Which action must the nurse complete first?
a. Be sure all the electronics (such as the computer showing the PowerPoint slides)
are working.
b. Develop an open and trusting relationship with participants.
c. Distribute evaluation materials to participants.
d. Greet each participant and welcome him or her to the event.
ANS: B
At the core of health education is the development of trusting relationships based on nurturing interactions; thus, this action must be completed before completing any other action.
DIF: Cognitive Level: Apply (Application)
5. Which best describes why community health education programs are important?
a. It provides a way to reinforce voluntary behavior changes.
b. Health education is an area that has desperately needed improvement.
c. Health education prevents the occurrence of disease.
d. It is the most cost-effective way of improving health.
ANS: A
Health education is designed to predispose, enable, and reinforce voluntary behavior conducive to health. Health education is unable to prevent disease from occurring, and it is not the most cost-effective way to improve health.
DIF: Cognitive Level: Understand (Comprehension)
6. Which is most likely to determine if a health education program will create change?
a. Amount of input and participation by learners
b. Funds available for obtaining educational resources
c. Participant attendance at Nthe RentiIre pGrogrBam.C M
d. Quality of the instructors involved in the program
ANS: A
The lasting effect of cognitive and behavioral changes is determined by learner participation. Funding, attendance, and quality of instructors are not important if learners are not encouraged to participate in the program.
DIF: Cognitive Level: Understand (Comprehension)
7. A nurse is selecting goals for an educational program. Which method should be used?
a. Ask the formal leadership of a community what the learning needs are.
b. Interview informal leaders about the learning needs of the community.
c. Use the expertise of professional nurses skilled at assessing needs.
d. The target audience must determine their needs and priorities.
ANS: D
Learners must be involved in determining their own health education needs and priorities. Both the formal and informal leadership would have useful information to share, but the crucial component is input from the target group.
DIF: Cognitive Level: Apply (Application)
8. A nurse is planning a health education program in the community. Which consideration must be made by the nurse?
a. The listed priorities of Healthy People 2020
b. The skills and abilities of the nurse educator
c. The sociopolitical cultural context of the community’s environment
d. What learning materials have already been created and are available for use
ANS: C
Community health education with the community as client is based on practical, useful, and scientifically sound methods and widely accessible technology. An effective program relates economic, political, and epidemiological factors to internal behavioral and communication factors. Thus the program activities are viewed within a sociopolitical structure especially within the local environmental settings.
DIF: Cognitive Level: Apply (Application)
9. Which is the best way to assess if learning has occurred?
a. There is an appreciation for the new knowledge and skills learned.
b. Participants passed an examination designed to measure learning.
c. Participants stayed attentive throughout the program.
d. There is a long-term change in knowledge and behavior.
ANS: D
By definition, learning is an enduring change involving modification of insights, behaviors, perceptions, or motivations. An appreciation for the new knowledge, passing an examination, and staying attentive does not address the entire scope of the learning process.
DIF: Cognitive Level: Understand (Comprehension)
10. Which led to the creation of tNhe HReaIlth BGeliBef.MCodeMl (HBM)?
a. Attempting to explain why individuals engage in health actions
b. Attempting to identify health behaviors of military spouses
c. Attempting to understand why people chose unhealthy and high-risk behaviors
d. Attempting to understand why people did not flock to free health care
ANS: D
The HBM was created to explain why people did or did not participate in health education programs to prevent or detect disease, even when the programs were free. The HBM addresses factors that provide health-enhancing behaviors. Pender’s Health Promotion Model (HPM) aims to explain why individuals engage in health actions. HPM has been used in studies identifying factors that enhance health-promoting behaviors of military spouses.
DIF: Cognitive Level: Understand (Comprehension)
11. Which needs to be considered when using the Health Belief Model (HBM)?
a. Prior behaviors
b. Perceived benefits
c. Health promoting behaviors
d. Personal benefits
ANS: B
The HBM is a value expectancy theory that addresses factors that promote health-enhancing behavior. The HBM considers perceived susceptibility, perceived severity, perceived benefits, perceived barriers, and other sociopsychological and structural variables. Self-efficacy, defined as the notion that an individual can act successfully on a given behavior to produce the desired outcome, was later added to the HBM.
DIF: Cognitive Level: Understand (Comprehension)
12. Which factor is found in the Health Belief Model (HBM) but not in Pender’s Health Promotion Model (HPM)?
a. Individual perception
b. Likelihood of action
c. Personal threat as motivator
d. Self-efficacy
ANS: C
Pender’s HPM is a competence or approach-oriented model and, unlike the HBM, does not rely on personal threat as a motivating factor. Both attempt to explain behavior, based on individual perceptions, and both include self-efficacy as a factor. (Although the HBM did not originally include self-efficacy, it was added in the revised model.)
DIF: Cognitive Level: Understand (Comprehension)
13. Which best describes the primary purpose of both the Health Belief Model (HBM) and Health Promotion Model (HPM) models?
a. To create an alternative to analyzing each individual person’s motivation
b. To find a more efficient way to explain behavior to other professionals
c. To help explain why indiviUduaSls doNorTdo not Oengage in health actions
d. To assist professionals in knowing how to intervene in client decisions
ANS: C
The models are meant to provide an organizing framework to explain why individuals engage in health actions. Therefore, they are also useful in assessing patients’ motivations and explaining their behavior.
DIF: Cognitive Level: Understand (Comprehension)
14. Which method is most consistent with Freire’s approach to empowerment?
a. Encouraging active participation and dialogue in critical reflection
b. Recognizing that the best resources to create change are found in powerful leaders
c. Reminding learners of their responsibility for their own learning
d. Using the “banking” approach with nurses sharing their expertise with patients
ANS: A
Banking education where teachers give information, which learners then regurgitate at examination time, is not useful. Problem-solving education with active participation and ongoing dialogue encourages learners to be critical and reflective about health issues.
DIF: Cognitive Level: Understand (Comprehension)
15. A nurse is teaching diabetic self-care in a small group. Which is the first action the nurse should take?
a. Assess group needs each day before beginning.
b. Create new and innovative teaching approaches for each session.
c. Implement the most effective teaching methods.
d. Listen carefully to understand participants’ issues.
ANS: D
Listening is the first phase and is essential to understanding the issues. Assessing group needs, creating new teaching approaches, and implementing effective teaching methods can be completed after listening to the issues of the participants.
DIF: Cognitive Level: Apply (Application)
16. A nurse who is providing education spends more time being quiet than giving information. Which best explains this behavior?
a. The nurse had previously reviewed the day’s material.
b. The nurse is demonstrating respect for the participants.
c. The nurse is encouraging group discussion.
d. The nurse is listening to the group’s dialogue to identify problems.
ANS: D
The exchange of ideas and concerns creates a problem-posing dialogue and identifies root problems or generative themes. The group members themselves create relevant action plans that are congruent with their own reality. Therefore to be effective, the nurse must listen to ensure that teaching reflects what the group wants to learn. Demonstrating respect, encouraging group discussion, and being prepared are all important roles of the nurse, but the reason why the nurse is quiet is to listen and understand the issues the group faces.
DIF: Cognitive Level: Apply N(AUpRplSicaItiNonG) TB.COM
17. Which best describes the goal of participatory action research?
a. Analytical epidemiological findings
b. Careful descriptive research studies
c. Experimental studies using both experimental and control groups
d. Social change resulting from stakeholders’ strategies
ANS: D
The goal of participatory action research is social change. The strategies reached collectively by the involved stakeholders lead to changes within the group and the community.
Participatory action research does not produce analytical epidemiological findings, descriptive research studies, or experimental studies.
DIF: Cognitive Level: Understand (Comprehension)
18. A nurse is asked, “Why are you so rarely in the department office?” Which would be the most appropriate response?
a. “I have to be where the people are.”
b. “I prefer to write my reports in my car immediately after my intervention.”
c. “I thought I was paid to be in the community, not the office.”
d. “I try to avoid paperwork as much as possible.”
ANS: A
One of the underlying premises of community health is to “start where the people are.” Therefore, the nurse must spend a great deal of time and effort in the community interacting with community members and must be where the people are. Writing reports in the car, avoiding paperwork, and simply stating one is being paid to be in the community do not demonstrate the nurse’s connection to the community.
DIF: Cognitive Level: Apply (Application)
19. A very busy day is planned at a community health fair, and a nurse spends time greeting and meeting each person who walks in. Which best describes the rationale for this action?
a. To distribute evaluation forms immediately so the participants can fill in the appropriate answers after each interaction with a professional
b. To immediately establish a friendly relationship and a level of trust
c. To make sure everyone knew who was sponsoring this free event
d. To most efficiently send the person to the area consistent with his or her apparent health need
ANS: B
The core of health education is the therapeutic and healing relationship between the nurse and clients. Inclusion and trust must be established before creating change. The nurse enhances inclusion by greeting clients on arrival in a warm fashion. Distribution of evaluation forms, informing participants of program sponsorship, and sending clients to the appropriate area of the health fair are not as important as the need for establishing a relationship.
DIF: Cognitive Level: Apply (Application)
20. A nurse is trying to improve on providing culturally effective care in the community. Which behavior would be most effectiUve tSo mNeet Tthis goaOl?
a. Being willing to change communication patterns to increase client comfort
b. Demonstrating expertise in recognizing physiological differences caused by ethnicity
c. Exhibiting sensitivity to individual differences resulting from culture and experiences
d. Expressing the importance of valuing diversity and differences
ANS: C
Unfortunately, voicing the need for valuing diversity is not always consistent with behavior. It is often useful to change communication patterns to increase client comfort, although the nurse must sometimes refuse to fulfill client demands. However, it is always crucial to exhibit sensitivity to individual concerns, cultural background, or previous life experiences.
DIF: Cognitive Level: Apply (Application)
21. A nurse is using the Framework for Developing Health Communications to create a health program in the community. Which is the first step the nurse would take?
a. Determine factors related to the health problems, such as low socioeconomic status or educational level
b. Assess health resources available (e.g., money, staff, materials)
c. Establish goals and objectives that are prioritized and time specific
d. Target the program to meet the audience’s learning needs as they perceive them
ANS: D
Understanding the intended audience’s learning needs and targeting the program or message to the audience is key to activating effective health education. After understanding the audience’s needs, it will be important to determine the factors related to health problems, assess health resources available, and establish goals and objectives.
DIF: Cognitive Level: Understand (Comprehension)
22. A nurse wants to make sure that the teaching materials and the communication channels being planned for use during an educational program will be effective. Which action should the nurse take?
a. Create materials based on the goals of the program, assuming a low literacy level
b. Determine the reading level of the audience and the materials to be distributed
c. Only use materials that have been professionally developed by a commercial group
d. Pretest the materials with members of the target group to obtain feedback
ANS: D
Pretest the materials to obtain feedback about the understandability and acceptability of the materials with this particular audience. Learning in advance what works and what does not saves time and effort later. The best way to determine literacy level and congruency of available resources with the target group’s needs is by pretesting the materials.
DIF: Cognitive Level: Apply (Application)
23. Which best describes the operational definition of “health literacy” in the United States?
a. Being able to read and write at the fifth-grade level
b. Being able to accurately complete a health self-assessment questionnaire
c. Knowing how to access aNnUd RusSe IinNfoGrmTaBti.onCtOo Mmake health decisions
d. Knowing one’s right to obtain health care services
ANS: C
Literacy as a whole is typically defined as being able to read and write at the fifth-grade level. Health literacy, however, is defined as being able to access, understand, and use information to make health decisions. Only the latter type of literacy empowers clients to best act on their own behalf.
DIF: Cognitive Level: Understand (Comprehension)
24. When handed the consent form to sign before treatment could be given, a client looked at the nurse and said, “I’m sorry; I forgot my glasses today.” Which action should be taken by the nurse?
a. Ask if the client can use a magnifying glass to better see the form
b. Suggest the client bring his glasses or someone else with him to assist with the forms
c. Tell the patient why the form was necessary and point to where the patient should sign
d. Wonder if the patient might have difficulty with reading and therefore summarize the content of the form for the client
ANS: D
The Institute of Medicine report related that millions of U.S. adults are unable to read and act on health instructions and messages. Among the recommendations is a need for clear communication with clients. Because the underlying issue may be reading, the other responses are not appropriate suggestions for this nurse–client interaction.
DIF: Cognitive Level: Apply (Application)
25. A nurse is trying to determine a client’s reading level. Which action should be taken by the nurse?
a. Ask the client how he or she would rate his or her ability to read.
b. Ask the client to assess his or her own health literacy and give examples.
c. Determine the number of years of formal education the client completed.
d. Use a literacy assessment tool, many of which are in the literature.
ANS: A
Any of the responses might be effective at assessing literacy, but the single question asking how often help might be needed is the fastest and easiest. Nurses are limited in the time available for assessment. One question is easier for a client than a complete assessment tool. Asking about years of education can be dismaying to someone who did not complete many years of formal schooling. Clients may not understand the question when asked to assess their own health literacy.
DIF: Cognitive Level: Apply (Application)
26. During a health education program, a nurse continues to ask questions and encourages attendees to contribute examples from their own lives relevant to the discussion. Which best
describes the rationale for theNnuRrse’Is acGtionB? .C M
a. To avoid having to prepareUmoSre mNateTrial relaOted to the topic
b. To let the participants feel appreciated and knowledgeable
c. To allow the participants to learn by doing through active participation
d. To apply Freire’s principles of learning
ANS: C
One of the key concepts of community organizing practice is the principle of participation, which essentially means that active participation—or learning by doing—results in a greater likelihood of change in behavior and attitude.
DIF: Cognitive Level: Apply (Application)
27. A nurse is helping clients to change their behavior. Which would be most effective?
a. Counseling through the Ask, Advise, Assess, Assist, and Arrange approach
b. Encouraging them to interact with others who also need to change their behavior
c. Showing them how the inappropriate behavior is hurting their friends and family
d. Using subtle rewards when small steps are taken toward the appropriate behavior
ANS: A
Ask, Advise, Assess, Assist, and Arrange is the five As approach to counseling as seen, for example, in smoking cessation programs. The other responses are not as comprehensive as the five A approach to counseling.
DIF: Cognitive Level: Apply (Application)
MULTIPLE RESPONSE
1. Which best describes what Knowles says is especially typical of adult learners? (Select all that apply.)
a. Barriers such as low self-esteem must be ignored when sharing information.
b. Learning is based on what knowledge will be needed in the future.
c. Learning draws on the learner’s previous life experiences.
d. They need to know why professionals think this knowledge is important.
e. Sharing experiences with others enriches and motivates learning.
f. They want information related to current developmental tasks.
ANS: C, E, F
Knowles suggests all learners want to know why they need to learn material. Material related to previous life experiences, current developmental tasks, or dealing with current challenges is useful and accepted by adult learners. Material chosen by professionals based on what might happen in the future or that ignores barriers such as lack of resources or low self-esteem will not be retained. Active participation through discussion with others helps involve and motivate adult learners.
DIF: Cognitive Level: Understand (Comprehension)
2. Which can be found in both the Health Belief Model (HBM) and Pender’s Health Promotion Model? (Select all that apply.)
a. Cues to action
b. Demographics
c. Perceived barriers
d. Perceived benefits
e. Perceived severity
f. Perceived susceptibility
ANS: A, B, C, D
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A review of the tables will show that only the HBM includes both perceived severity and perceived susceptibility. All other factors are found in both models.
DIF: Cognitive Level: Understand (Comprehension)
3. Which variables are missing from both the Health Belief Model (HBM) and Health Promotion Model (HPM)? (Select all that apply.)
a. Ignoring the impact of being socially and politically disenfranchised
b. Inaccessibility of health services
c. Nurse’s responsibility to give power and control to the individual and the community
d. Omitting the influence of social, structural, and physical environmental factors
e. Reality of negative outcomes if appropriate behavioral changes are not made
f. Recognizing the influence of families on the individual’s decisions
ANS: A, B, D
The models are very useful in relation to changing individual behaviors, but they do not address the complex relationships among social, structural, and physical factors in the environment, such as lack of social support systems or inaccessible health services. Changes are needed to improve care for socially and politically disenfranchised groups. Knowledge is always within a social context and is always bound to power relationships. A nurse cannot assign power and control to an individual. The individual must take on power, although perhaps with the nurse’s guidance.
DIF: Cognitive Level: Understand (Comprehension)
4. A nurse involved with a community group told peers that the group was learning networking, negotiating, lobbying, and information seeking. Which provides the best explanation for why the nurse is not working toward a noticeable improvement in health status for the group? (Select all that apply.)
a. The nurse cannot improve the health of the group alone.
b. There are ways that these skills will be useful throughout the participants’ life span.
c. The nurse is focused on teaching, not direct interventions.
d. There are no immediate solutions to the current health problems in most communities.
e. The nurse is still trying to obtain free health care for the group participants.
f. There are not enough resources to change the health status of the group.
ANS: B, D
Nurses use empowerment strategies when helping people develop skills in problem solving, critical thinking, networking, negotiating, lobbying, and information seeking to enhance
health. Because health problems have social and political aspects, group members must develop action strategies. HealUth pSroblNemsTare comOplex and do not usually have easy and
immediate solutions. The nurse is using these strategies to promote involvement by the members of the community group to help change their health status in the future. These strategies do not focus on teaching, rather on group empowerment. These strategies do not suggest that the nurse is trying to obtain free health care for the group members or that there are limited resources available to change the health status of the group.
DIF: Cognitive Level: Apply (Application)
5. A nurse is teaching a coworker about effective strategies to use when providing health education. Which suggestions would most likely be included? (Select all that apply.)
a. Be encouraging and give positive feedback for helpful comments
b. Include details about each aspect of the information
c. Decide what the client needs to know
d. Review and summarize the key points at periodic intervals
e. Incorporate demonstrations, illustrations, and real-life examples
f. Use medical terminology so clients can look up more information later
ANS: A, D, E
The nurse must determine what the client wants to know, not what the nurse believes the client needs to know. The nurse should not go into excess detail but focus on a few concepts or key points, that is, stick with the essentials; use clear and concise language while avoiding technical terms; encourage participants by use of questions related to their life experiences; use demonstrations and real-life examples to illustrate major points and summarize the key points to help the audience retain the material.
DIF: Cognitive Level: Apply (Application)
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