Community Health Nursing CJE Review

The student nurse is investigating different

types of practice settings. In looking at community health nursing, the student recognizes that it:

• Is the same as public health nursing

• Focuses on the incidence of disease

• Requires graduate-level educational preparation

• Includes direct care and services to subpopulations

Answer explanation

The best answer is:

→ Includes direct care and services to subpopulations.

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Community health nursing is distinct from—but complementary to—public health nursing. While public health nursing focuses broadly on population‑level interventions (e.g., surveillance, health policy, community assessment), community health nursing often delivers direct, individualized care and health education within specific subpopulations—such as home‑bound elders, schoolchildren, or clinic caseloads. It does not require a graduate degree by definition (though many programs prefer baccalaureate‑prepared nurses), nor is its scope limited solely to tracking disease incidence. Instead, community health nurses blend illness prevention, health promotion, and direct care services tailored to the needs of defined groups.

As a community health nurse assisting the client and family with nutritional needs the nurse should first:

• Identify for the client the best foods to buy

• Purchase foods at the lowest cost for the client

• Ask the client and family what they think they should eat

• Provide information on stores with the most reasonable pricing

Answer explanation

The most appropriate first step is:

→ Ask the client and family what they think they should eat.

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Before making recommendations or arranging resources, a community health nurse begins with an assessment of the client’s and family’s own knowledge, beliefs, and priorities around nutrition. By asking them what they think they should eat, the nurse uncovers existing understanding, cultural preferences, potential misconceptions, and readiness to change. This client‑centered approach ensures that subsequent education or resource referrals are individualized, relevant, and more likely to be adopted (Nies & McEwen, 2024).

Reference
Nies, M. A., & McEwen, M. (2024). Community/public health nursing: Promoting the health of populations (8th ed.). Elsevier.

Which one of the following clients from a vulnerable population currently appears to be at the greatest risk?

• A physically abused client in a shelter

• A schizophrenic client in outpatient therapy

• An older adult taking medication for hypertension

• A substance abuser who shares drug paraphernalia

Answer explanation

The client at greatest risk is:

→ A substance abuser who shares drug paraphernalia.

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Sharing needles or other drug paraphernalia places this individual at very high risk for blood‑borne infections such as HIV, hepatitis B, and hepatitis C, as well as complications from unsafe injection practices (Nies & McEwen, 2024). While physical abuse (option 1) and severe mental illness (option 2) both confer significant vulnerability, the immediate probability of acquiring life‑threatening infectious diseases through shared equipment surpasses the risks in the other scenarios. Likewise, an older adult on hypertension medication (option 3) is generally at lower acute risk when adherent to therapy under routine monitoring.

Reference
Nies, M. A., & McEwen, M. (2024). Community/public health nursing: Promoting the health of populations (8th ed.). Elsevier.

A client with a history of a gastrointestinal disorder eats a well-balanced diet that keeps his Cl symptoms suppressed. Which level of prevention corresponds to his dietary management?

• Primary prevention

• Secondary prevention

• Tertiary prevention

• Health promotion

Answer explanation

The correct answer is:

Tertiary prevention.

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Tertiary prevention involves interventions aimed at reducing the impact of established disease by minimizing complications and restoring function. In this case, the client already has a diagnosed gastrointestinal disorder, and his well‑balanced diet is a strategy to manage his condition and prevent symptom exacerbations and complications.

• Primary prevention focuses on preventing the initial occurrence of disease (e.g., immunizations, healthy lifestyle to avoid disease onset).

• Secondary prevention involves early detection and intervention (e.g., screening tests to catch disease in its early stages).

• Tertiary prevention targets reducing morbidity and improving quality of life for those with established disease through rehabilitation, self‑management education, and ongoing treatment strategies.

By using dietary management to keep his GI symptoms suppressed, the client is engaging in tertiary prevention.

Which of the following statements by the home health nurse best reflects client advocacy in response to the client’s concern over the expense of the therapy?

• “Have you considered the possibility of a renal transplant?"

• “This peritoneal dialysis is less expensive than hemodialysis."

• “You must feel awful about this situation, but this is the best course of treatment for you ”

• “Let’s call the regional dialysis center and explore options for

  reducing the cost of your home dialysis."

Answer explanation

The statement that best demonstrates client advocacy is:

→ “Let’s call the regional dialysis center and explore options for reducing the cost of your home dialysis.”

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By taking action to investigate and negotiate more affordable care, the nurse is actively supporting the client’s right to accessible treatment, addressing their financial concerns, and facilitating resource access. This embodies true advocacy—partnering with the client to overcome barriers to care.

In assessing the structure of the community in order to identify the needs of its population, the nurse will focus on:

• Collecting demographic data on age distribution

• Visiting neighborhood schools to review health records

• Interviewing clients to determine the cultural composition of the subgroups

• Observing locations where services, such as water sanitation, are provided

Answer explanation

The best choice is:

Observing locations where services, such as water sanitation, are provided when “structure” is viewed to include the community’s physical and service infrastructure.

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By observing locations where essential services (like water sanitation) are provided, the nurse directly assesses the availability, distribution, and condition of community resources. Gaps or inequities in these services are structural factors that shape population health (e.g., waterborne disease risk, sanitation access) and inform priority needs.

Rationale:

• Structural determinants encompass not only who lives in the community (demographics) but also what resources and infrastructure are in place to support health (WHO, 2021).

• Mapping service sites—clinics, sanitation facilities, food markets—reveals where needs exist and how access varies across neighborhoods, guiding interventions and policy advocacy.

Reference
World Health Organization. (2021). Social determinants of health: Key concepts. WHO.

To facilitate change within a community, the nurse working as an effective change agent should:

• Inform community members how to effectively manage their health needs

• Work with clients and groups to select alternative health care sites and treatments

• Formulate decisions for individual clients regarding their health care options

• Provide instruction in the way the community should address health issues

Answer explanation

The most appropriate choice is:

Work with clients and groups to select alternative health care sites and treatments.

As a change agent, the community health nurse’s role is to empower and collaborate with community members—engaging them in identifying problems, exploring options, and co‑creating solutions (Nies & McEwen, 2024). By partnering with clients and groups to evaluate and choose alternative care sites or treatment strategies, the nurse facilitates ownership of change, enhances community capacity, and ensures interventions are culturally and contextually appropriate.

• → (simply informing) is a one‑way dissemination of information, not true collaboration.

• → (making decisions for individuals) undermines client autonomy and fails to build community capacity.

• → (directing the community on what to do) risks resistance, as change is more sustainable when the community shapes its own solutions.

Reference
Nies, M. A., & McEwen, M. (2024). Community/public health nursing: Promoting the health of populations (8th ed.). Elsevier.

The client is being discharged from an acute care facility following a total hip replacement. She will need follow-up for her rehabilitation and exercise plan. In addition to a home health care nurse, what referral should be discussed?

• Dietitian

• Social worker

• Physical therapist

• Respiratory therapist

Answer explanation

The most appropriate referral is:

Physical therapist.

After a total hip replacement, rehabilitation focuses on restoring strength, range of motion, and safe mobility. A physical therapist will develop and progress an individualized exercise and gait‑training program, instruct on use of assistive devices, and monitor for proper joint precautions to prevent dislocation (Nies & McEwen, 2024). Neither a dietitian nor a respiratory therapist is routinely indicated in uncomplicated orthopedic recovery, and while a social worker can help address psychosocial or resource needs, the priority for rehabilitation is the expertise of a physical therapist.

Reference
Nies, M. A., & McEwen, M. (2024). Community/public health nursing: Promoting the health of populations (8th ed.). Elsevier.

The nurse recognizes which of the following as the largest contributing factor for the rise in the need and use of home care?

• Government funding of the home care setting has increased greatly.

• Clients are more acutely ill when discharged from the acute care facility.

• There are 7 days/week services for the elderly in home care agencies.

• The existence of more single-income families has increased the need for their elderly relatives to receive care in the home.

Answer explanation

The best answer is:

Clients are more acutely ill when discharged from the acute care facility.

With pressures to contain costs and reduce hospital lengths of stay, patients are sent home sooner—often still requiring complex care. As a result, home care agencies must manage higher‑acuity needs in the community setting. Neither expanded funding (Option 1) nor seven‑day service availability (Option 3) alone drives demand as much as early discharge of sicker patients, and while family structure (Option 4) influences caregiver burden, it is the shift of complex care from hospital to home that most directly fuels the growth of home health services (Nies & McEwen, 2024).

Reference
Nies, M. A., & McEwen, M. (2024). Community/Public Health Nursing: Promoting the Health of Populations (8th ed.). Elsevier.

When assessing members of a vulnerable population, the community health nurse should realize that the primary need is to:

• Provide culturally competent assessment.

• Organize in your mind exactly what you need to ask.

• Create a comfortable, nonthreatening environment.

• Be alert for indications of mental and physical abuse.

Answer explanation

The most fundamental first step is:

Create a comfortable, nonthreatening environment.

Establishing trust and safety is essential when working with vulnerable populations. A welcoming, respectful atmosphere helps clients feel secure enough to share personal information, disclose sensitive issues (including potential abuse), and engage in the assessment process. Without that foundation, even the most culturally competent questions or well‑organized interview guides may fail to elicit the information needed to plan effective care.

Reference
Nies, M. A., & McEwen, M. (2024). Community/Public Health Nursing: Promoting the Health of Populations (8th ed.). Elsevier.