1. Which of the following best describes community-based nursing?

a. A practice in which care is provided for individuals and families

b. Providing care with a focus on the group’s needs

c. Giving care with a focus on the aggregate’s needs

d. A value system in which all clients receive optimal care

ANS: A

By definition, community-based nursing is a setting-specific practice in which care is 

provided for “sick” individuals and families where they live, work, and attend school. The 

emphasis is on acute and chronic care and the provision of comprehensive, coordinated, and 

continuous care. These nurses may be generalists or specialists in maternal–infant, pediatric, 

adult, or psychiatric mental health nursing. Community-based nursing emphasizes acute and 

chronic care to individuals and families, rather than focusing on groups, aggregates, or 

systems.

2. Which of the following best describes community-oriented nursing?

a. Focusing on the provision of care to individuals and families

b. Providing care to manage acute or chronic conditions

c. Giving direct care to ill individuals within their family setting

d. Having the goal of health promotion and disease prevention

ANS: D

By definition, community-oriented nursing has the goal of preserving, protecting, or 

maintaining health and preventing disease to promote the quality of life. All nurses may focus 

on individuals and families, give direct care to ill persons within their family setting, and help 

manage acute or chronic conditions. These definitions are not specific to community-oriented 

nursing.

3. Which of the following is the primary focus of public health nursing?

a. Families and groups

b. Illness-oriented care

c. Individuals within the family unit

d. Health care of communities and populations

ANS: D

In public health nursing the primary focus is on the health care of communities and 

populations rather than on individuals, groups, and families. The goal is to prevent disease and 

preserve, promote, restore, and protect health for the community and the population within it. 

Community-based nurses deal primarily with illness-oriented care of individuals and families 

acorss the life span. The aim is to amanage acute and chronic health conditions in the 

community, and the focus of practice is on individual or family-centered illness care.

4. Which of the following is responsible for the dramatic increase in life expectancy during the 

20th century?

a. Technology increases in the field of medical laboratory research

b. Advances in surgical techniques and procedures

c. Sanitation and other population-based prevention programs

d. Use of antibiotics to fight infections

ANS: C

Improvements in control of infectious diseases through immunizations, sanitation, and other 

population-based prevention programs led to the increase in life expectancy from less than 50 

years in 1900 to more than 78 years in 2013. Although people are excited when a new drug is 

discovered that cures a disease or when a new way to transplant organs is perfected, it is 

important to know about the significant gains in the health of populations that have come 

largely from public health accomplishments.

5. A nurse is developing a plan to decrease the number of premature deaths in the community. 

Which of the following interventions would most likely be implemented by the nurse?

a. Increase the community’s knowledge about hospice care.

b. Promote healthy lifestyle behavior choices among the community members.

c. Encourage employers to have wellness centers at each industrial site.

d. Ensure timely and effective medical intervention and treatment for community 

members.

ANS: B

Public health approaches could help prevent premature deaths by influencing the way people 

eat, drink, drive, engage in exercise, and treat the environment. Increasing knowledge of 

hospice care, encouraging on-site wellness centers, and ensuring timely treatment of medical 

conditions do not address the focus of improving overall health through health promotion 

strategies. This is the major method that is suggested to decrease the incidence of premature 

death.

6. Which of the following is a basic assumption of public health efforts?

a. Health disparities among any groups are morally and legally wrong.

b. Health care is the most important priority in government planning and funding.

c. The health of individuals cannot be separated from the health of the community.

d. The government is responsible for lengthening the life span of Americans.

ANS: C

Public health practice focuses on the community as a whole, and the effect of the 

community’s health status (resources) on the health of individuals, families, and groups. The 

goal is to prevent disease and disability and promote and protect the health of the community 

as a whole. Public health can be described as what society collectively does to ensure that 

conditions exist in which people can be healthy. The basic assumptions of public health do not 

judge the morality of health disparities. The focus is on prevention of illness not on spending 

more on illness care. Additionally, individual responsibility for making healthy choices is the 

directive for lengthening life span not the role of the government.

7. Which of the following actions would most likely be performed by a public health nurse?

a. Asking community leaders what interventions should be chosen

b. Assessing the community and deciding on appropriate interventions

c. Using data from the main health care institutions in the community to determine 

needed health services

d. Working with community groups to create policies to improve the environment

ANS: D

Although the public health nurse might engage in any of the tasks listed, he or she works 

primarily with members of the community to carry out core public health functions, including 

assessment of the population as a whole and engaging in promoting health and improving the 

environment. The interventions of asking community leaders which interventions should be 

chosen, asessing the community and deciding on appropriate interventions, and using data 

from health care institutions do not demonstrate the engagement of the community when 

making decisions about what the community actually wants and needs.

8. Which of the following public health nurses most clearly fulfills the responsibilities of this 

role?

a. The nurse who met with several groups to discuss community recreation issues

b. The nurse who spent the day attending meetings of various health agencies

c. The nurse who talked to several people about their particular health concerns

d. The nurse who watched the city council meeting on local cable television

ANS: B

Any of these descriptions might represent a nurse communicating, cooperating, or 

collaborating with community residents or groups about health concerns. However, the nurse 

who spent the day attending meetings of various health agencies is the most representative, 

because in public health, concerns are addressed from a broader perspective. In public health, 

broad concerns of the community should be addressed. Concerns are broader than recreation, 

individual concerns are not as important as aggregate priorities, and watching television (a 

one-way form of communication) is less effective than interacting with others.

9. Which of the following best defines aggregate?

a. A large group of persons

b. A collection of individuals and families

c. A collection of people who share one or more characteristics

d. Another name for demographic group

ANS: C

An aggregate is defined a collection of people who share one or more personal or 

environmental characteristics. Members of a community can be defined in terms of either 

geography (e.g., a county, a group of counties, or a state) or a special interest (e.g., children 

attending a particular school). These members make up a population. The term population

may be used interchangeably with the term aggregate. A large group of persons, a collection 

of individuals and families, and another name for demograhpic group are not accurate 

definitions of the term aggregate.

10. A registered nurse was just employed as a public health nurse. Which question would be the 

most relevant for the nurse to ask?

a. “Which groups are at the greatest risk for problems?”

b. “Which patients should I see first as I begin my day?”

c. “With which physicians will I be most closely collaborating?”

d. “With which nursing assistants will I partner the most?”

ANS: A

Asking which groups are at greatest risk reflects a community-oriented perspective. The 

incorrect responses reflect a focus on individuals rather than a community-oriented 

perspective.

11. Making sure that essential community-oriented health services are available defines which of 

the core public health functions?

a. Policy development

b. Assessment

c. Assurance

d. Scientific knowledge-based care

ANS: C

Assurance includes making sure that essential community-oriented health services are 

available in the community. The definition does not fit the terms assessment, policy 

development. Scientific knowledge-based care is not a core function of public health.

Assessment is systematic data collection on the population, monitoring the population’s health 

status, and making information available about the health of the community. Policy 

development refers to efforts to develop policies that support the health of the population, 

including using a scientific knowledge base to make policy decisions.

12. When talking to a women’s group at the senior citizens’ center, the nurse reminded them that 

the only way the center would be able to afford to provide transportation services for them 

would be for them to continue to write letters to their local city council representatives 

requesting funding for such a service. What was the nurse trying to accomplish through this 

action?

a. Ensure that the women did not expect the nurse to solve their problem.

b. Demonstrate that the nurse understood the women’s concerns and needs.

c. Express empathy, support, and concern.

d. Help the women engage in political action.

ANS: D

Public health nurses engage themselves and others in policy development and encourage and 

assist persons to communicate their needs to those with the power to take action. The nurse is 

demonstrating the role of advocate through this action, it goes beyond merely understanidng 

the women’s concern, and instead mobilizes them to take action. This action does not 

demonstrate the nurse showing empathy rather the nurse is empowering these women.

13. The public health nurse has a clear vision of what needs to be done and where to begin to 

improve the health of the community. Why would the nurse spend time meeting with 

community groups to discuss the most important task to be addressed first?

a. To increase the group’s self-esteem

b. To maintain communication links with the groups

c. To make the groups feel good about their contribution

d. To work with the groups, not for the groups

ANS: D

Historically, health care providers have been accused of providing care for or to people 

without actually involving the recipients in the decisions. Public health nursing is a “with the 

people”—not a “to the people” or “for the people”—approach to planning. The purpose of 

meeting with community groups is not to increase their self-esteem or make them feel good 

about their contribution, rather it is to allow them to act for themselves to solve the problems 

they are facing. The first task of working with the group should occur before addressing 

maintaining communication links.

14. The nurse often has to make resource allocation decisions. Which of the following best 

describes the criterion the nurse should use in such cases?

a. The specific moral or ethical principle related to the situation

b. The cheapest, most economical approach

c. The most rational probable outcome

d. The needs of the aggregate rather than a few individuals

ANS: D

The dominant needs of the population outweigh the expressed needs of one or a few people. 

All of the choices represent components of a decision that the nurse might consider in 

determining the needs of the aggregate.

15. Which of the following actions best represents public health nursing?

a. Assessing the effectiveness of the high school health clinic

b. Caring for clients in their home following their outpatient surgeries

c. Providing care to children and their families at the school clinic

d. Administering follow-up care for pediatric clients at an outpatient clinic

ANS: A

A public health or population-focused approach would look at the entire group of children 

being served to determine whether available services are effective in achieving the goal of 

improving the health of the school population. Caring for clients and their families focuses on 

individuals and families and not on the entire population. Public health focuses on care of 

populations.

16. Two nurses plan to walk under a huge downtown bridge where various homeless persons live. 

Why would the nurses go to such an unsafe area?

a. To assess the needs of the homeless who live there

b. To demonstrate their courage and commitment

c. To distribute some of their own surplus clothes to those who can use them

d. To share with various churches and other charities what is needed

ANS: A

In most nursing practices, the client seeks out and requests assistance. In public health 

nursing, the nurse often reaches out to those who might benefit from a service or intervention, 

beginning with assessment of needs. The other answers reflect responses where the nurse is 

trying to give assistance to this population that may or may not be helpful or welcomed.

MULTIPLE RESPONSE

1. Which of the following variables have led to a stronger commitment to population-focused 

services? (Select all that apply.)

a. Economic turmoil and demand for high-technology care

b. Emergence of new or drug-resistant infectious diseases

c. Emphasis on overall health care needs rather than only on acute care treatment

d. Threat of bioterrorism

ANS: B, C, D

As overall health needs become the focus of care in the United States, a stronger commitment 

to population-focused services is emerging. Threats of bioterrorism, anthrax scares, and the 

emergence of modern-day epidemics have drawn attention to population-focused safety and 

services. Economic turmoil and demand for high-technology care have not contributed to a 

stronger commitment to population-focused services, rather it has occurred as overall health 

needs have become the focus of care.

2. Which of the following actions demonstrate effective public health nursing practice in the 

community? (Select all that apply.)

a. Epidemiologic investigations examine the environment for health hazards.

b. New services are organized where particular vulnerable populations live.

c. Partnerships are established with community coalitions.

d. Staff members at the public health agency continue to increase in number.

ANS: A, B, C

Evidence that public health nurses are practicing effectively in the community would include 

organizing services where people live, work, play, and learn; working in partnerships and with 

coalitions; and participating in epidemiologic studies. Increasing number of staff does not 

have a relationship to the effectiveness of public health nursing practice.

3. Why are nurses increasingly providing care in clients’ homes rather than in hospitals? (Select 

all that apply.)

a. Home care is less expensive.

b. It is much more efficient to give care in the home.

c. Nurses prefer to give home care with individual attention.

d. People prefer to receive care in their homes rather than in hospitals.

ANS: A, D

An increasing number of clients are receiving care in the home because it is less expensive 

and clients prefer to receive care in familiar and comfortable settings. It is not more efficient 

nor more convenient, since travel time has to be considered. Nurses differ as to their preferred 

employment setting.

Chapter 02: The History of Public Health and Public and Community Health Nursing

Stanhope: Foundations for Population Health in Community/Public Health Nursing, 

5th Edition

MULTIPLE CHOICE

1. A nurse is considering applying for a position as a public health nurse. Which of the following 

would be a reason this position would be appealing?

a. Its autonomy and independence

b. Its focus on acute care and immediately visible outcomes

c. Its collaboration with other health care professionals

d. Its flexibility and higher wages

ANS: A

Public health nursing is known for its autonomy and independence. In many instances, there 

are limited other health care professionals and staff with whom to interact. In-patient acute 

care nurses focus on acute care with outcomes known fairly quickly. Acute care nurses 

collaborate frequently with other health care professionals. Depending on the position there 

may be more flexibility, but typically public health nurses do not receive higher wages.

2. The Elizabethan Poor Law of 1601 is similar to which current law?

a. Welfare

b. Food stamps

c. Medicaid

d. Medicare

ANS: C

The Elizabethan Poor Law guaranteed medical care for poor, blind, and “lame” individuals, 

similar to Medicaid. Welfare and food stamps do not provide for medical care. Medicare 

provides medical care to primarily the elderly population.

3. How did the Industrial Revolution result in previous caregiving approaches, such as care by 

families, friends, and neighbors, becoming inadequate?

a. Economic and political wars resulted in frequent death and injuries.

b. Incredible plagues consistently and constantly swept the European continent.

c. Migration and urbanization resulted in increased demand for care.

d. Caregivers could easily find other employment, so they demanded to be paid.

ANS: C

Care became inadequate because of the social changes in Europe, with great advances in 

transportation, communication, and other technologies. The increased mobility led to 

migration and urbanization, which in turn led to increased need for care. The Industrial 

Revolution was a time of great advances in technology, transportation, and communication, 

not a time of economic and political unrest or a time where incredible plagues occurred in 

Europe. Caregivers during this time period were typically poorly educated and untrained, so 

there was not an issue related to wages or employment.

4. A colonist is working in the public health sector in early colonial America. Which of the 

following activities would have likely been completed?

a. Establishing schools of nursing

b. Developing vaccines to administer to large numbers of people

c. Collecting vital statistics and improving sanitation

d. Developing public housing and almshouses

ANS: C

Collecting vital statistics and improving sanitation are examples of activities from the early 

colonial America. Establishing schools of nursing, developing vaccines to administer to large 

numbers of people, and developing public housing and almshouses all happened after the 

colonial period.

5. Why did American citizens become interested in establishing government-sponsored boards 

of health?

a. They were afraid of infectious diseases such as yellow fever.

b. The government could force the poverty-stricken to accept care.

c. Such boards could tax and thereby ensure adequate funds to pay for care.

d. Such a system would allow for accurate records of births and deaths.

ANS: A

Threat of disease, especially yellow fever, led to public interest in establishing 

government-sponsored, or official, boards of health. The threat of disease was the impotus for 

creation of the boards of establishing boards of health. The primary interest of the boards of 

health was to provide public health services for the entire population and not only those who 

were poverty-stricken. The primary purpose of the boards of health was not to collect accurate 

vital statistics or receive tax dollars rather its purpose was to ensure the health of the 

population.

6. A nurse was employed by the Marine Hospital Service in 1800. Which of the following 

interventions would the nurse most likely have completed?

a. Setting policy on quarantine legislation for immigrants

b. Establishing hospital-based programs to care for the sick at home

c. Identifying and improving environmental conditions

d. Providing health care for merchant seamen

ANS: D

Providing health care to seamen was an early effort by the federal government to improve 

public health. The purpose of the Marine Hospital Service was to secure its maritime trade 

and seacoast cities. Quarantine legislation was enacted by legislation during this time period, 

but the nurse would not have been responsible for setting these policies. Nursing care for 

clients in the home began in the first half of the 1800s through a variety of agencies including 

the Ladies’ Benevolent Society of Charleston South Carolina. Identifying and improving 

environmental conditions was a focus of the public boards of health, not necessarily 

specifically a role of the nurse.

7. What was the outcome of the Shattuck Report?

a. Efforts to control alcohol and drug abuse, as well as tobacco use, were initiated.

b. Environmental sanitation efforts became an immediate priority.

c. Guidelines for modern public health organizations were eventually developed.

d. Local and state governments established boards of health after its publication.

ANS: C