PNR208/ PNR 208 Exam 1: (Latest 2026/ 2027 Update) Concepts of Community-Based Nursing: Community Health Review| Test Bank| Grade A| 100% Correct (Verified Solutions) – Fortis

INSTANT PDF DOWNLOAD — This official test bank for PNR 208 Exam 1 at Fortis College covers Concepts of Community-Based Nursing for the 2026/2027 academic year first examination. It contains verified questions and answers with detailed rationales in multiple-choice, select-all-that-apply (SATA), ordered response, and clinical scenario formats aligned with practical nursing program standards. COMMUNITY-BASED NURSING CORE CONCEPTS (EXAM 1 FOCUS) DEFINITIONS AND DISTINCTIONS Community-Based Nursing (CBN) – A setting-specific practice in which care is provided for individuals and families where they live, work, and attend school. The focus is on illness care (management of acute and chronic conditions) in community settings. CBN emphasizes care coordination for individuals across the lifespan with an emphasis on wellness, health promotion, and disease prevention. The goal is to manage acute and chronic health conditions while promoting self-care and independence. Community-Oriented Nursing (Public Health Nursing) – A population-focused practice with the goal of preserving, protecting, or maintaining health and preventing disease to promote quality of life. The primary focus is on the health care of communities and populations rather than individuals. This includes community diagnosis, health surveillance, and policy development. Key Distinction – Community-based nursing is illness-oriented (managing existing health problems) and individual/family-focused, while community-oriented nursing is health promotion/disease prevention-oriented and population-focused. Public Health Core Functions – Assessment: systematic data collection on the population, monitoring health status, and identifying health problems. Policy Development: developing laws and practices to promote health, using scientific knowledge to make decisions. Assurance: ensuring that essential community-oriented health services are available, including providing personal health services when otherwise unavailable. Essential Public Health Services – Monitor health status, diagnose and investigate health problems, inform/educate/empower people, mobilize community partnerships, develop policies/plans, enforce laws/regulations, link people to services, assure competent workforce, evaluate effectiveness, and research for new insights. NURSING PROCESS IN COMMUNITY HEALTH Community Assessment – The systematic collection of data about a community including: population demographics (age, gender, race/ethnicity, socioeconomic status, education, occupation), geography and environment (housing, transportation, water/air quality, waste disposal, green space), social structure (schools, churches, community organizations, political system, media, businesses), health resources (hospitals, clinics, health departments, mental health services, pharmacies, dental care, home health agencies, long-term care facilities). Data sources include: primary data (windshield surveys – observations while driving/walking, key informant interviews, participant observation, focus groups); secondary data (census data, vital statistics (birth, death, marriage, divorce), health records, disease registries, hospital discharge data, school records, police reports, social service records, previous community health assessments). Windshield survey: systematic observation of a community by driving or walking through it, noting housing conditions, people, traffic, businesses, schools, churches, parks, recreational facilities, clinics, hospitals, health department, parking availability, sidewalks, street conditions, lighting, safety, cleanliness, noise levels, presence of industry, pollution, evidence of substance use or crime. Nursing Diagnosis in Community Health – Focuses on community health problems rather than individual problems. Format: Risk of [problem] among [population] related to [etiological factors] as evidenced by [signs/symptoms/risk factors] . Example: "Risk of increased obesity rates among school-aged children related to lack of safe recreational facilities and limited access to fresh fruits and vegetables as evidenced by 40% obesity rate (above national average) and low-income housing area with no grocery store within 1 mile." Interventions – Programs, policies, and services designed to address community health problems. Includes health education, screening programs, immunization clinics, case management, advocacy, referral and follow-up, coalition building, policy development, environmental modification, and community organizing. Evaluation – Systematic assessment of program effectiveness, including process evaluation (was the program implemented as planned?) and outcome evaluation (did the program achieve its objectives?). VULNERABLE POPULATIONS AND HEALTH DISPARITIES Vulnerable Populations Definition – Groups at increased risk for poor physical, psychological, or social health outcomes due to barriers accessing health care, exposure to risk factors, or limited resources. Examples: poverty and homelessness (homeless individuals and families, those living in poverty, underinsured/uninsured), mental illness (those with serious mental illness (SMI) – schizophrenia, bipolar disorder, major depression, severe anxiety disorders, personality disorders), substance use disorders (alcohol, opioids, cocaine, methamphetamine, prescription drug misuse), chronic illness/disability (physical disabilities, developmental disabilities, chronic diseases), cultural minorities (immigrants, refugees, non-English speakers, racial/ethnic minorities), age-related vulnerability (infants, children, older adults), marginalized groups (LGBTQ+, incarcerated individuals, sex workers). Risk factors: poverty (lack of financial resources for health care, nutritious food, safe housing, transportation), lack of health insurance (or underinsurance, high deductibles, limited coverage), geographic isolation (rural areas, limited public transportation), language barriers (limited English proficiency, lack of interpreters), low health literacy (difficulty understanding health information, navigating system), social isolation (lack of social support, limited social networks), discrimination/stigma (racial/ethnic discrimination, stigma associated with mental illness, substance use, HIV/AIDS, sexual orientation). Health Disparities – Differences in health outcomes or health care access among population groups. Social determinants of health: conditions in which people are born, grow, live, work, and age – economic stability (poverty, employment, food security, housing stability), education (literacy, language, early childhood education, higher education), social and community context (social cohesion, discrimination, incarceration), health and health care (access to care, health literacy, quality of care), neighborhood and built environment (housing quality, transportation, water quality, air pollution, access to healthy foods). Eliminating health disparities is a goal of Healthy People 2030. Health Disparities in Vulnerable Populations – Higher rates of chronic disease (diabetes, hypertension, heart disease, obesity), higher rates of communicable disease (TB, HIV/AIDS, hepatitis, STIs), higher infant mortality and low birth weight, lower life expectancy, greater disability and functional impairment, higher mortality from preventable causes, less access to preventive services (screening, immunizations, prenatal care). Health care access barriers: lack of transportation, inability to pay (uninsured/underinsured, high copays/deductibles), lack of health insurance coverage, limited clinic hours (incompatible with work schedules), long wait times for appointments, lack of child care, language barriers, cultural differences, mistrust of health care system, discrimination, health literacy deficits. CULTURAL COMPETENCE AND CULTURALLY CONGRUENT CARE Culture – Shared values, beliefs, norms, traditions, and practices of a group of people, transmitted across generations through language, socialization, and shared experiences. Culture is learned, shared, adaptive, dynamic, and integrated. Subculture: a subgroup within a larger culture with distinctive values, beliefs, and practices. Includes ethnicity, race, religion, socioeconomic status, age, sexual orientation, geographic region, occupation, and disability status. Cultural Competence – The ability to provide effective care to clients from diverse cultural backgrounds by understanding and respecting their beliefs, values, and practices . It involves integrating cultural awareness, knowledge, skills, encounters, and desire into practice. The process of becoming culturally competent is ongoing; it evolves over one's career. Requires self-awareness of one's own cultural biases (cultural humility). Cultural competence is essential for providing patient-centered care in diverse communities. Cultural Humility – A lifelong process of self-reflection, self-critique, and commitment to understanding and addressing power imbalances in the patient-clinician relationship. Unlike cultural competence (which implies mastery), cultural humility acknowledges that one can never be fully competent about another's culture and continuously seeks to learn and partner with patients, families, and communities. LEARN Model for Cultural Assessment – Listen to the patient's perception of the problem (from their cultural perspective). Explain your perception of the problem (from biomedical perspective). Acknowledge similarities and differences between the two perspectives. Recommend a treatment plan (negotiate mutually acceptable approach). Negotiate agreement on treatment plan (compromise, adapt biomedical plan to fit patient's cultural context). ESFT Model (Explanatory Models, Social Factors, Fears, Therapeutic Contract) – Explanatory models: understanding the patient's beliefs about the cause, nature, and expected course of their illness. Social factors: assessing the patient's social context (family, work, support network, financial resources). Fears: identifying patient's concerns about the illness and treatment (about treatment side effects, about diagnosis implications, about cost, about stigma). Therapeutic contract: negotiating a mutually agreed-upon treatment plan (considering patient's beliefs, resources, and concerns; adapting biomedical recommendations to fit patient's context). Cultural Assessment Components – Ethnic background and language preference, health beliefs and practices, dietary preferences and restrictions (religious or cultural dietary laws), religious or spiritual practices that may affect care, family structure and decision-making patterns, communication style (eye contact, personal space, touch, emotional expression). Reactions to pain and suffering, death and dying rituals, healing traditions and use of complementary/alternative therapies, attitudes toward Western medicine and health care providers, past experiences with health care system (positive or negative, discrimination, mistrust). Common Cultural Considerations – Eye contact: in some cultures, direct eye contact may be considered disrespectful (Native American, Asian, Arab, Latin American cultures). Personal space: may vary (Latin American, Middle Eastern, Southern European cultures prefer closer proximity; Northern European, Asian, North American cultures prefer more distance). Touch: may be restricted (some Muslim and Orthodox Jewish cultures avoid touch between unrelated men and women, some Asian cultures avoid touching head or feet). Time orientation: monochronic (linear time, punctuality emphasized – Northern European, North American) vs. polychronic (flexible time, relationships prioritized over schedules – Latin American, Middle Eastern, African, Southern European). Family involvement: in many cultures, extended family is central to decision-making, including health decisions (Asian, Hispanic, African, Middle Eastern, Native American). The patient may expect family members to speak for them, and it may be disrespectful to ask the patient not to involve family. Gender preferences: some cultures prefer same-gender providers (Muslim, Orthodox Jewish, some Asian and Hispanic cultures). Religious practices: may affect dietary restrictions (no pork for Muslims and Jews; no beef for Hindus; no caffeine for Mormons; kosher dietary laws for Orthodox Jews), fasting (Ramadan for Muslims, Yom Kippur for Jews, Lent for Christians), prayer or meditation requirements, end-of-life care preferences (disfavor autopsies, organ donation, or life support; desire for specific rituals at death), reproductive health restrictions. HEALTH POLICY, LEGISLATION, AND ADVOCACY Key Legislation Impacting Community Health – Social Security Act of 1935: created Old Age Assistance (OAA), Unemployment Insurance, Aid to Families with Dependent Children (AFDC). Medicare (Title XVIII of Social Security Act, 1965) : federal health insurance for elderly (age 65+) and disabled. Part A: hospital insurance (automatic, premium-free for those who paid Medicare taxes). Part B: medical insurance (optional, premium required, covers physician services, outpatient, durable medical equipment). Part C: Medicare Advantage (private managed care plans). Part D: prescription drug coverage (private plans) required since 2006. Medicaid (Title XIX of Social Security Act, 1965) : federal-state partnership providing health coverage for low-income individuals (children, pregnant women, parents, disabled, elderly in nursing homes). Federal requirements (mandatory populations: children under 6 with family income under 133% FPL, pregnant women under 133% FPL, SSI recipients (disabled), certain Medicare beneficiaries (low-income)). Optional populations: states may cover others (older adults, disabled, parents at higher income levels, medically needy spend-down). Children's Health Insurance Program (CHIP, 1997) : expanded coverage for uninsured children in families with income too high for Medicaid but too low for affordable private insurance, pregnant women also covered (CHIP perinatal). Patient Protection and Affordable Care Act (ACA, 2010) : expanded Medicaid to 138% FPL (states could opt out, SCOTUS ruling made optional, many states expanded, some not), health insurance marketplaces (exchanges) for individuals and small businesses, premium tax credits and cost-sharing reductions for low-middle income individuals, required coverage for pre-existing conditions (no denials, no exclusions, no higher premiums), young adults can stay on parents' insurance until age 26, preventive services covered with no cost-sharing (no copay, no deductible, no coinsurance) including well-child visits, immunizations, preventive screenings (BP, cholesterol, cancer, diabetes, STI), contraception, breastfeeding support, depression screening, required essential health benefits (10 categories: ambulatory, emergency, hospitalization, maternity/newborn, mental health/substance use (parity required), prescription drugs, rehabilitative/habilitative services, lab, preventive/wellness, pediatric services including oral and vision), individual mandate (requirement to have insurance or pay penalty) eliminated effective 2019, employer mandate (large employers