Stanhope: Community Health Nursing in Canada, Second Canadian Edition

Chapter 11: WORKING WITH VULNERABLE POPULATIONS

Test Bank

MULTIPLE CHOICE

1.Which one of the following is the designation given to groups at high risk of having poor health outcomes?

a. Cumulative risk groups

b. Health disparity groups

c. Resilient populations

d. Vulnerable populations

ANS: D

Specific populations who are more vulnerable—that is, at-risk populations who are more susceptible to poor health because of socioenvironmental factors—are often referred to as vulnerable populations.

DIF: Cognitive Level: Knowledge REF: p. 310 OBJ: 1

TOP:CRNE Competency: Professional Practice

2.Which one of the following is the best intervention a community health nurse (CHN) can initiate to increase lasting resilience among new immigrants?

a. Directing clients to English-as-a-second-language courses

b. Giving immigrant clients money to help them get settled

c. Identifying areas in the city where housing is less expensive

d. Soliciting donations for food, clothing, and other needs

ANS: A

Resilience refers to the ability of the client to successfully cope when faced with a threat or hardship. Individuals with low resilience are more inclined to have feelings of hopelessness and may choose suicide as a method to resolve these feelings. Support needs to be provided to those with decreased resilience in order to enhance problem-solving skills and give a greater sense of personal autonomy. When the CHN places emphasis on client strengths and assets rather than client deficits and susceptibility, resilience is more likely to increase.

DIF: Cognitive Level: Analysis REF: p. 311 OBJ: 4

TOP:CRNE Competency: Health and Wellness

3.Which of the following interventions by the CHN would best serve a vulnerable population?

a. Addressing multiple health concerns, including preventive education, when clients present for treatment of an illness

b. Establishing a system of networks so that clients may be referred to different services such as preventive care, acute illness care, and chronic treatment

c. Providing acute care services that focus on the client’s main health concern and setting up appointments at discharge for other concerns

d. Referring clients to specialists to address specific health concerns

ANS: A

When working with vulnerable populations, it is a good idea to arrange to have as many services as possible available in a single location and at convenient times. This “one-stop shopping” approach to care delivery is helpful for populations experiencing multiple social, economic, and health-related stresses. This becomes especially important if clients have problems accessing health care services.

DIF: Cognitive Level: Analysis REF: p. 348 OBJ: 5

TOP:CRNE Competency: Health and Wellness

4.Which definition accurately reflects the meaning of the term health inequities?

a. Health inequities are the accumulation of multiple factors that lead to poor health.

b. Health inequities occur when people are more inclined to become ill and usually do not seek appropriate care.

c. Health inequities are unfair differences in health that could be avoided with reasonable action.

d. Health inequities are wide variations in health status and services among certain population groups.

ANS: C

Health inequities refers to differences in health that could be avoided if reasonable action was taken, and therefore these differences are considered to be unfair and socially unjust.

DIF: Cognitive Level: Comprehension REF: p. 310 OBJ: 2

TOP:CRNE Competency: Health and Wellness

5.Which of the following is a primary cause of vulnerability?

a. Breakdown of family structures

b. Poverty

c. Prejudice

d. Social isolation

ANS: B

Poverty is a primary cause of vulnerability. The lack of financial resources may cause some people to not seek preventive health services. This leaves them vulnerable and with increased risk of experiencing the effects of preventable illnesses.

DIF: Cognitive Level: Knowledge REF: p. 311 OBJ: 7

TOP:CRNE Competency: Professional Practice

6.Which level of prevention is a CHN practising when she offers homeless clients yearly tuberculosis (TB) screening and free treatment for those who test positive?

a. Primary prevention

b. Secondary prevention

c. Tertiary prevention

d. Secondary and tertiary prevention

ANS: B

Screening homeless persons for TB and providing medications to those who test positive are examples of secondary prevention. The TB screening identifies the disease in its early stages. Medications work to prevent further development of the disease.

DIF: Cognitive Level: Comprehension REF: p. 347, Levels of Prevention box

OBJ:5TOP:CRNE Competency: Health and Wellness

7.A CHN is orienting a new recruit to a health clinic that primarily serves vulnerable populations. Which of the following statements by the CHN indicates a need for additional information?

a. “If a client who does not speak English comes in, you must obtain an interpreter right away.”

b. “We try to take care of as many problems as possible in one visit, so when you check the client in, ask about additional concerns.”

c. “You will like working with Filipino immigrants because they have close-knit family structures.”

d. “You will need to assist the client by scheduling any referral or follow-up appointments.”

ANS: C

Assumptions are not helpful. Each person and family should be assessed individually. No two people or groups are alike. Both good and bad stereotyping can create problems. For example, even though Filipino families are generally close knit, by assuming that all Filipino families are this way, clinic care providers will likely miss recognizing such issues as family violence.

DIF: Cognitive Level: Analysis REF: p. 348 OBJ: 5

TOP: CRNE Competency: Nurse–Client Partnership

8.While screening for diabetes at a community clinic, a CHN found out that a new client had type 2 diabetes. The CHN then provided counselling, referred the client to an endocrinologist for initial assessment and treatment, helped with arrangements for financial assistance, arranged transportation, and booked a follow-up appointment. What role is this type of service most representative of?

a. Case management

b. Client advocacy

c. Holistic care

d. Wrap-around services

ANS: A

Case management involves linking clients with services and providing direct community health nursing services, including teaching, counselling, screening, and immunizing. Linking health services is accomplished by making appropriate referrals and by following up with clients to ensure that the desired outcomes from the referral were achieved.

DIF: Cognitive Level: Analysis REF: p. 350 OBJ: 5

TOP:CRNE Competency: Health and Wellness

9.CHNs at a clinic for homeless persons are concerned that clients rarely return for follow-up after their TB skin (Mantoux) tests. Which policy would be the most appropriate one for addressing this situation?

a. Call all homeless clients 48 hours after testing to remind them to return to the clinic for follow-up.

b. Have the homeless persons read the test result themselves and then mail in the results on a postage-paid card coded to protect privacy.

c. Readminister the test if the client returns later than scheduled for follow-up.

d. Routinely refer all homeless clients for chest X-rays.

ANS: B

Secondary preventive activities are aimed at reducing the prevalence or pathological nature of a condition. They involve early diagnosis, prompt treatment, and the limitation of disability. CHNs can work with homeless and near-homeless aggregates to provide education about existing services and strategies for influencing public policy that will provide more comprehensive services for homeless and near-homeless persons. If necessary, CHNs should develop a method for homeless individuals to read the reaction to the TB skin test themselves and send the results to the facility where the skin test was administered.

DIF: Cognitive Level: Analysis REF: pp. 352–353; p.347, Levels of Prevention box

OBJ:3TOP:CRNE Competency: Professional Practice

10.Which of the following actions should a CHN take when using the case management approach with vulnerable populations?

a. Be willing to enter into a long-term relationship with families.

b. Direct and control the client’s care because the CHN knows what is most needed.

c. Encourage families to become self-sufficient and less dependent on nursing personnel for advice and referrals.

d. Rotate assignments periodically, to prevent attachment and codependency.

ANS: A

Case management is a process that enhances continuity and appropriateness of care. When using case management with vulnerable populations, the CHN can offer the greatest benefit when she or he is willing to develop long-term relationships with the families served. Long-term relationships create trust and ensure continuity of care. Care involves a partnership between the CHN and the client. CHNs who direct and control the client’s care cannot establish a trusting relationship and may inadvertently foster a cycle of dependency and lack of personal health control measures.

DIF:Cognitive Level: AnalysisREF:p. 351, How To box

OBJ: 5, 8 TOP: CRNE Competency: Nurse–Client Partnership