Hesi Community Health Exam Questions & Answers

HESI COMMUNITY HEALTH EXAM | QUESTIONS & ANSWERS (VERIFIED) | LATEST UPDATE | GRADED A+ The community health nurses is counseling a group of 14 year olds about safe sexual practices. Which health teaching strategy would be most effective for the nurse to use with this age group? A.Encourage group members to describe personal experiences in practicing safe sex B. Provide the group with statistical data about behaviors leading to venereal diseases C. Tell the group that for aids prevention abstinence is the best safe sex practice D. Role play situations in which the adolescent is rewarded for practicing safe sex Correct Answer: D. Role play situations in which the adolescent is rewarded for practicing safe sex A young adult man goes to an emergency treatment area after finishing a marathon run. He is weak dizzy and remains thirsty after drinking a pint of a flavored sports drink. What action should the nurse implement first? 1 A. Instruct the runner that a urine sample is needed B. Send for the automatic external defibrillator C. Determine if there are friends or family nearby D. Give the runner another pint of fluids to drink Correct Answer: D. Give the runner another pint of fluids to drink An older adult male who fractured his right hip is discharged to home one week following an arthroplasty. Which adjustment to the clients home environment is most important for the home health nurse to implement? A. Lower the temperature on the clients water heater B. Encourage the client to wear rubber soled shoes C. Ensure that an elevated toilet seat is installed D. Leave motion activated light in the living room Correct Answer: C. Ensure that an elevated toilet seat is installed The nurse is caring for four clients in a women's health clinic. Which client should the nurse assess for risk for pelvic inflammatory disease? A. 30 year old with endometriosis B. 40 year old with leiomyoma C. 50 year old perimenopause D. 20 year old with gonorrhea 2 Correct Answer: D. A 20 year old with gonorrhea The nurse is teaching a group of adults at a health fair about healthy life style choices. Which information is most important for the nurse to emphasize? A. Completely stop the use of cigarette and tobacco products B. Eat a diet high in fruits vegetables and whole grains C. Avoid the midday sun and use sunscreen D. Perform monthly self examination of breasts and testes Correct Answer: A. Completely stop the use of cigarette and tobacco products The school nurse who is reviewing immunization records of students who will start kindergarten within the next month notes that most of the students have only received on does of the measles mumps rubella vaccine. Which intervention should the nurse implement? A. Note in the student records that the second dose of the MMR vaccine should be administered prior to entering first grade B. Send notices home with the children on the first day of class advising that MMR vaccine series must be completed C. Contact kindergarten parents to remind them that the second dose of MMR is due at eh start of the school year 3 D. Speak at the next parent teacher association meeting to teach parents the benefits of immunizing their children Correct Answer: B. Send notices home with the children on the first day of class advising that MMR vaccine series must be completed A middle aged male client presents for his annual health visit at a community clinic. He is 5 ft 10 in tall weighs 250 pounds, and works as an accountant. He smokes at least one pack of cigarettes every day for the last 15 years. Which secondary prevention measure should the nurse recommend the client to follow? A. Compliance with antihypertensive and lipid lowering agents. B. Increase physical activity and diet low in saturated fat C. Smoking cessation D. Blood pressure and lipid screening Correct Answer: D. Blood pressure and lipid screening A male high school student is referred to the school nurse because he lost consciousness during gymnastics class. His neurological vital signs are with normal limits, and his blood pressure is 100/62. He is 6 ft 3 in tall wighs 135 pound and his body mass index is 16.9. which assessment data should the nurse obtain first? A. Serial bp reading every 30 minutes B. Twenty-four hour diet recall 4 C. Use of performance enhancing drugs D. Recent exposure to allergens Correct Answer: B. Twenty-four hour diet recall The nurse is planning to implement a health education program on breast screening for Hispanic women at a community center. Which component of the teaching plan best provides culturally competent care? A. Provide handouts and brochures in the English and Spanish languages B. Ask a Hispanic breast cancer survivor to present the educational class C. Include treatment modalities with survival statistics for Hispanic women D. Design flyers that target Hispanic women encouraging their attendance Correct Answer: A. Provide handouts and brochures in the English and Spanish The nurse is planning a health education program for 10-year old. Which setting is most likely to increase the preadolescent's participation in the program? A. The school classroom B. Community center C. Home of one of the children D. A local place of worship Correct Answer: A. The school classroom 5 The public health nurse receives grant funding to implement primary prevention strategies for migrant farm workers and their families. Which action should the nurse plan to include? A. Teach a class in providing first aid for heat exhaustion B. Organize free community wide tuberculosis screenings C. Distribute brochures on measures to avoid pesticide exposure D. Ask a physical therapist to speak about managing low back pain Correct Answer: C. Distribute brochures on measures to avoid pesticide exposure The parish nurse notes that an elderly male client has had a 5 lbs weight loss since his check up one month ago. The client has good hygiene, still drives a car and lives alone. To which agency should the nurse refer this client? A. The adult day care center B. The social security administration office C. The women infant and children office D. The senior citizen center Correct Answer: D. The senior citizen center The nurse is screening for hypertension at a local health fair. One of the community residents has a blood pressure reading of 138/80. Which interventions should the nurse implement for this client? (Select all that apply) 6 A. Obtain another blood pressure to verify the first reading B. Ask the client about any current antihypertensive medications C. Recommend further evaluation for possible pre-hypertension D. Encourage the client to keep doing whatever you are doing E. Assess clients life style and other risk factors for hypertension Correct Answer: A. Obtain another blood pressure to verify the first reading B. Ask the client about any current antihypertensive medications C. Recommend further evaluation for possible pre-hypertension Which intervention should the nurse implement to help prevent client from getting a vector born infectious disease? A. Demonstrate the correct way to remove ticks imbedded in the skin B. Discuss the importance of wearing insect repellent when camping C. Instruct the client to drink only bottled water when traveling abroad D. Encourage the client to get immunizations prior to international travel Correct Answer: B. Discuss the importance of wearing insect repellent when camping The nurse is working with parent teacher organization to increase safety for children walking to and from a nearby elementary school. Which action should the nurse include to help achieve this goal? 7 A. Advise the residents to keep their porch lights on during hours that children are walking to and from school B. Help the residents plan a campaign to remind people driving through the school zone to wear seatbelts at all times C. Lead a discussion about the benefits of designated safe houses located throughout the school neighborhood D. Encourage residents with older homes along the school route to get their homes inspected for excessive lead levels Correct Answer: C. Lead a discussion about the benefits of designated safe houses located throughout the school neighborhood The nurse is working with the family of a child with cerebral palsy. In order to help the nurse understand the connections among family members, resources and agencies in the community with assessment data gathering tool is best for the nurse to use? A. Genogram B. Ecomap C. Medical record D. Family tree Correct Answer: B. Ecomap Due to a limited supply the local health department needs to prioritize the distribution of influenza vaccinations. In determining which individuals should receive the limited 8 available vaccine, which person should the public health nurse ask to return to the clinic later when more vaccine is available? A. An 80 year old resident in an Alzheimer's unit B. A 65 year old aide working in a nursing home C. A 60 year old client with diabetes and agoraphobia D. An 8 year old girl with poorly controlled asthma Correct Answer: C. A 60 year old client with diabetes and agoraphobia The community health nurse determines that the average family income of a certain community is 67k per a year with a range of 27k to 102k based on this demographic information what additional information is important for the nurse to assess? A. Interventions focused on college educated individuals B. Characteristics of families in the upper middle class C. The frequency of incomes above and below the average D. The reliability of such a high average family income Correct Answer: C. The frequency of incomes above and below the average After assessing the health needs of an elementary school, the nurse determines that an increased incidence of bicycle injuries is a priority problem. The nurse develops a 2 month program with the goal to eliminate bicycle injuries in the school. The program includes educational pamphlets sent home to parents and two educations sessions by 9 the school nurse. Which action should the nurse implement to evaluate the effectiveness of the program? A. Compare the incidence of bicycle injuries at the beginning and end of the program B. Determine the type of bicycle injuries each child sustained before conducting the sessions C. Conduct an initial survey of the children to determine their knowledge of bicycle safety D. Survey parents after one month to assess their understanding of the educational pamphlet Correct Answer: A. Compare the incidence of bicycle injuries at the beginning and end of the program The community health nurse who works in a gulf coast town that caters to tourists is presenting a class to residents and business owner of the town on disaster management. Which content is most important for the nurse be included in this class? A. Hurricane preparedness for families and businesses B. Available evacuation routes from the town C. Methods used to treat water to ensure it is safe to drink D. Actions to be taken during a tornado Correct Answer: C. Methods used to treat water to ensure it is safe to drink 10 The home health nurse is evaluating client who is receiving enteral feedings by nasogastric NG tube. Which assessment finding indicates to the nurse that a change to the clients nutrition may be warranted for this client? A. Ulceration of .5 cm at left nares NG tube insertion site B. Intestinal migration of NG tube verified by aspirate ph of 7.1 C. Residual volume of 25 ml after each scheduled feeding D. Nausea occurs after each instillation of NG feeding Correct Answer: D. Nausea occurs after each instillation of NG feeding The epidemiological triad can be used to frame strategies for the prevention of farm machinery injuries. Which action should the nurse take to focus on the agent? A. Teach farm workers not to smoke around farm equipment B. Translate written vehicle instructions into picture format C. Provide rehabilitation services to injured farm hands D. Work with legislators to mandate safe tractor design Correct Answer: D. Work with legislators to mandate safe tractor design A community hit by a hurricane has suffered mass destruction and flooding. Sewage facilities are non functioning and the area is contaminated with human excreta. The nurse is developing a plan of care for clients diagnosed with cholera after an outbreak. Which intervention has the highest priority? 11 A. Administer prophylactic antibiotics as prescribed B. Provide fluid and electrolyte replacement C. Isolate all infectious diarrhea victims D. Administer cholera vaccine Correct Answer: B. Provide fluid and electrolyte replacement A prescription for discharge is written for an elderly female client who has asked to be discharged to her home. The client lives alone and is able to walk 10-15 feet with assistance. Which action should the nurse implement first? A. Arrange for a bedside commode to be delivered to the home B. Meet with case manager to plan a home safety evaluation C. Provide the client with information about medical alert devices D. Review the home medication schedule with the client and family Correct Answer: B. Meet with case manager to plan a home safety evaluation Which expected outcome statement is most relevant to the plan of care for an elderly female client who has a nursing problem of "altered nutrition less than body requirements related to social isolation" and lives alone in her own home? A. Client will participate in daily meals at a senior nutrition center B. Client will describe a menu of well balanced meals 12 C. Client understands the need for placement in a long-term care facility D. Client will receive well-balanced diet from meals on wheels Correct Answer: A. Client will participate in daily meals at a senior nutrition center A 4-year old near drowning victim who is severely disabled due to anoxia that occurred during the incident is being transferred to a long term care facility. When helping the parents select a treatment center for their child, which factor should the nurse encourage the parents to consider? A. Proximity of the facility to their home B. How many children are residents of the facility C. What type of home schooling is available at the facility D. Availability of medical care for emergencies Correct Answer: A. Proximity of the facility to their home An older male client refuses a recommended annual influenza vaccination because it made him sick last year. He tells nurse the nurse that he will take his prescription for Amantadine if he develops symptoms of the flu. Which response should the nurse provide? A. Since the client received the vaccine last year this plan should be supported B. It is best for the client to take the influenza vaccine and avoid using Amantadine C. It is unlikely the vaccine will make the client sick in two consecutive years 13 D. If symptoms of the flu develop the client should obtain the influenza vaccination Correct Answer: B. It is best for the client to take the influenza vaccine and avoid using amantadine A male client comes to the public health clinic requesting information about which immunizations he should receive prior to visiting a developing nation. Which immunization should the nurse recommend as a priority for this client? A. Tetanus toxoid vaccine B. Influenza vaccine C. Hepatitis B vaccine D. Hepatitis A vaccine Correct Answer: D. Hepatitis A vaccine A government office worker is seen in the emergency room after opening an envelope containing a powder like substance which is being tested for anthrax. Which discharge instruction should the nurse provide the client concerning inhalation anthrax? A. Return to the emergency room if flu like symptoms develop within 42 days B. Notify co-workers to get the anthrax vaccine at the public health department C. Isolation from friends and family members is recommended for 3 weeks D. Cleanse all surfaces touched with pre-moistened anti-bacterial wipes 14 Correct Answer: A. Return to the emergency room if flu like symptoms develop within 42 days After assessing the health care needs of an elementary school the nurse determines that an increased prevalence of pediculosis capitis is a priority problem. The nurse develops a 2 month program with the goal to eradicate the conditions in the school. The program includes educational pamphlets sent home to parents and regular assessment of children by the school nurse. What action should the nurse implement to evaluate the effectiveness of the program? A. Evaluate the teachers ability to identify pediculosis capitis 2 months after initiation of the program B. Conduct an initial examination of each child in the school to obtain baseline data C. Survey parents 3 weeks after pamphlets are sent home to assess their understanding of the condition D. Measure the prevalence of pediculosis capitis among the children after four months Correct Answer: D. Measure the prevalence of pediculosis capitis among the children after four months An older female client tells the home health nurse that she has no money, and since she does not deserve to eat, she has not asked anyone to bring her food. What information is most important for nurse to obtain? 15 A. Client thoughts about wanting to hurt herself B. Medication history for antipsychotic agents C. Availability of family members to provide meals D. Community resources to provide financial aid Correct Answer: A. Client thoughts about wanting to hurt herself The public health nurse is called to investigate a report of several cases of chickenpox at a day care center. The day care worker states that five children have been sent home over the past two weeks with fever and itchy blisters. Which intervention should the nurse implement first? A. Validate that the children sent home did develop chickenpox B. Report the presence of a viral endemic at the day care center C. Confirm the number of children with symptoms D. Determine how many people have been exposed Correct Answer: A. Validate that the children sent home did develop chickenpox The nurse is documenting the medical history of a young adult male client who was recently diagnosed with type 1 diabetes mellitus. He smokes 2 packs of cigarettes daily and his father died of a heart attack at the age of 45. Which annual screening is most important for the nurse include? A. Peripheral neuropathy 16 B. Retinopathy C. Renal insufficiency D. Hyperlipidemia Correct Answer: D. Hyperlipidemia A graduate nursing student requests information, including laboratory findings and chest x-ray results, about all clients with symptoms of h1n1 who have been seen during the last month in a community health clinic. Which action should the charge nurse take? A. Ask if permission has been obtained from the research committee B. Ask the student to sign a standard waiver form C. Obtain written authorization from clients to release the information D. Provide the information for research purposes only Correct Answer: C. Obtain written authorization from clients to release the information A community health nurse is applying for a federal grant to support a smoking cessation educational program. In which order should the nurse prioritize these nursing activities? Arrange in order top to bottom Select and train the data collection personnel Review and analyze the data Consider pros and cons of different methods of data gathering 17 Determine the target aggregate that will be served by the program Correct Answer: 1. Determine the target aggregate that will be served by the program 2. Consider pros and cons of different methods of data gathering 3. Select and train the data collection personnel 4. Review and analyze the data A nurse is planning a nutrition class for a group of senior citizens at a community center and wants to emphasize the amount and types of fat in some foods versus others. What is the best teaching method for the nurse to use? A. Ask each senior to bring a food for others to taste, then estimate the fat contained in these foods B. Display posters with foods and tell the seniors about the fat content C. Determine foods most often eaten by this group and discuss the nutritional panel of each product D. Show a movie about cooking with foods that are low in fat but delicious Correct Answer: C. Determine foods most often eaten by this group and discuss the nutritional panel of each product Last year the nurse implemented a tertiary prevention program for osteoporosis in an adult long-term care facility. What annual statistic indicates that the program was effective? 18 A. Reduce mortality from falls B. Lowered number of bone density exams conducted C. Decreased incidence of hip fractures D. Increased prevalence of osteoporosis Correct Answer: C. Decreased incidence of hip fractures School teachers notify the schools nurse that a group of children of the migrant farm workers often miss school or sleep during classes. The nurse learns that the children range in age from 12 to 14 years old and work in an orchard with their parents until 2200 every night. Which action should the nurse implement? A. Notify child protective services and local law enforcement of truancy concerns B. Schedule classes to teach the children and parents about adolescent health concerns C. Arrange a meeting with the manager of the orchard to discuss child labor concerns D. Organize focus groups with the children's parents regarding educations concerns Correct Answer: D. Organize focus groups with the children's parents regarding educations concerns When visiting a community health clinic a clients blood pressure is measured at 146/94. What information should the nurse provide the client? A. Participate in an exercise program for six weeks 19 B. Obtain a blood pressure daily for two weeks C. Increase dietary intake of omega 3 D. Begin a low sodium diet immediately Correct Answer: B. Obtain a blood pressure daily for two weeks The nurse is developing a program about the risk factors of acquiring human immunodeficiency virus for the group of young adults at a community health center. Which life style behavior should the nurse include in the presentation that poses a risk for HIV? A. Participation in blood donations for a local blood bank center B. A history of receiving autologous blood transfusion C. Travel to places where drinking water is contaminate D. Self report of illegal intravenous drug abuse Correct Answer: D. Self report of illegal intravenous drug abuse Tuberculosis screening at a federal prison reveals that two male inmates have positive skin test. What action is most important for the nurse to take? A. Start the two men on anti-tubercular medications B. Screen the prison guards for TB C. Refer the two men for chest x-rays D. Re-screen the entire prison population in 6 weeks 20 Correct Answer: C. Refer the two men for chest x-rays The school nurse is conducting an audit of incident reports for adolescent students. Which finding is the best indication that the healthy people 2020 objectives are being addressed? A. The absenteeism rate has increased greatly over the past two years B. During the last year fewer firearms were retrieved on school property C. The number of requests for pregnancy testing is higher than last year D. Decline in the number of the students enrolled in school during the year Correct Answer: B. During the last year fewer firearms were retrieved on school property A male construction worker presents at the industrial clinic with a fever and a cough. He states I think I have that sudden acute respiratory syndrome that's been in the news. What is important for the nurse to do first? A. Take the clients temperature and a pulse rate B. Place a surgical mask on the client and nurse C. Ask the client about recent travel or exposure D. Obtain a description of his sputum and cough Correct Answer: C. Ask the client about recent travel or exposure 21 During a home health visit the nurse notices that an older male client with type 2 diabetes mellitus is wearing loose cloth slippers. The client reports that he cannot comfortably wear other shoes because his toenails get in the way. The nurse inspects the clients feet and finds long thick nails that curl down under some of the toes. Which action should the nurse take? A. Demonstrate proper foot care to the client and his family B. Have a home health aide assist client with hygiene weekly C. Schedule an appointment for the client with podiatrist D. Trim the clients toenails gradually over several visits Correct Answer: C. Schedule an appointment for the client with podiatrist In reviewing the objectives for Healthy people 2020 the nurse determines that the community has a significant problem in preventing dental caries among children to bring about change that addresses this identified community health problem. Where is the best place to initiate a prevention program? A. Community youth center B. Hospital emergency departments C. The local shopping mall D. Women infant and children office Correct Answer: D. Women infant and children office 22 A nurse is talking with the mayor about the characteristics of the city. Within the mindset of the healthy cities movements what information should the nurse request from the mayor? A. The role the federal government plays in providing health care services B. The role local government plays in health decision making C. A list of free preventative services are provided to high school students D. The average salaries for health care workers in the town Correct Answer: B. The role local government plays in health decision making The public health nurse is working in an agriculture based community near the united states Mexico border. Which aggregate should the nurse identify as the highest need for local public health services? A. Migrant workers who plant and harvest field crops B. School aged children who are not bilingual C. Elderly population in the community who are on fixed incomes D. Adolescents who are exposed to intense sun and hot environments Correct Answer: A. Migrant workers who plant and harvest field crops A teenage boy with a history of recurring atopic dermatitis tells the school nurse that he wants to play high school football. Which action should the nurse take? 23 A. Encourage the teenager to join the swim team instead of the football team B. Notify the parents of the problems associated with perspiration for those with eczema C. Tell the teenager to shower with a non perfumed soaps immediately after practice D. Inform the football coach of the teenagers skin condition and its manifestations Correct Answer: C. Tell the teenager to shower with a non perfumed soaps immediately after practice A male migrant farm worker who lives in a mobile home with several other workers visits the migrant health care center. He reports increasing episodes of dizziness headaches abdominal cramps and difficulty breathing what nursing action has the highest priority? A. Gather information about clients recent exposure to pesticides B. Obtain a blood sample to assess for lead paint exposure C. Determine the number and age of persons living in the mobile home D. Ask about the length of his workday and frequency of rest breaks Correct Answer: A. Gather information about clients recent exposure to pesticides An established community has a history of being skilled in identifying and managing problems. What role should the community health nurse assume in program development for this community? A. Community leader or facilitator 24 B. Data organizer C. Group gatekeeper D. Technical expert or advisor Correct Answer: D. Technical expert or advisor An older adult client visits the community health clinic and reports the onset of pain, redness and swelling of the right eye. Which question is most important for the clinic nurse to ask the client? A. Do you have any discharge from the eye B. Have you started any new prescriptions C. Are all of your immunizations current D. How often do you wash your hands Correct Answer: A. Do you have any discharge from the eye Several employees who have a 10 year or longer smoking history ask the occupational health nurse for assistance with smoking cessation. The nurse develops a 2 month program that includes weekly group sessions on lifestyle changes and use of wove the counter nicotine substitute products. Which measurement provides the best indication of the programs effectiveness? A. Survey employees to determine how many are smoking 2 months after the end of the program 25 B. At the end of the program test the employees knowledge of OTC nicotine substitute products C. Ask the employees to inform the group if they stop smoking and if they start smoking again D. Design a questionnaire that identifies lifestyle changes that contribute to smoking cessation Correct Answer: A. Survey employees to determine how many are smoking 2 months after the end of the program An adult male client with recurrent ascites from cirrhosis tells the home health nurse that he has no appetite or energy. The nurse should provide what diet suggestions for this client? (Select all that apply) A. Eat concentrated sweets for a quick energy boost B. Avoid adding salt to foods when cooking or at the table C. Try to eat at least six small meals daily D. Limit helpings of fresh fruits and vegetables E. Choose small helping of lean protein such as legumes Correct Answer: B. Avoid adding salt to foods when cooking or at the table C. Try to eat at least six small meals daily E. Choose small helping of lean protein such as legumes 26 On a repeat home visit to see an 84 year old widow the nurse discovers that the client is unkempt, smells of stale urine and does not recognize her neighbors or the nurse. What action should the nurse take first? A. Complete a physical and mental exam of the client B. Call the clients pharmacy to determine what medications she is taking C. Seek the family's assistance in caring for the client D. Call adult protective services to obtain emergency nursing home placement Correct Answer: A. Complete a physical and mental exam of the client During a two-week postoperative follow-up home visit, a female client who had gastric bypass surgery exhibits abdominal tenderness, shoulder pain, and describes feelings of malaise. Her vital signs are: temperature 101.8°F, blood pressure 100/50, heart rate 104 beats/minute, and respirations 18 breaths/minute. Which action should the nurse take? A. Determine the client's current oxygen saturation rate. B. Instruct the client to drive to the hospital for admission C. Recheck the client's vital signs in 30 minutes D. Have the client transported via ambulance to the hospital Correct Answer: D. Have the client transported via ambulance to the hospital 27 An older man has become increasingly forgetful, frequently eats large quantities of food from refrigerator, and cannot remember when he takes his medications. He has limited mobility to weight-related osteoarthritis in both knees. When assisting the client's wife with a plan care for the home, which interventions should the nurse suggest? (Select all that apply.) A. Request a referral for motorized wheelchair to assist with mobility. B. Keep a variety of fresh fruits and vegetables that are easily accessible. C. Put medications into a container that organized the pills by the day and time. D. Encourage participation in televised exercise classes to help strengthen muscles. Correct Answer: B. Keep a variety of fresh fruits and vegetables that are easily accessible. C. Put medications into a container that organized the pills by the day and time. D. Encourage participation in televised exercise classes to help strengthen muscles. The school nurse is assessing heights, weights, and body mass indexed (BMI) of the students who are entering high school. Because a majority of the students are found to be overweight, the nurse plans to develop a program that addresses obesity in this age population. Before initiating this program, what additional information is most important for the nurse to obtain? A. The history of obesity education in the community B. The level of parental concern regarding childhood obesity 28 C. The demographic data for the student population D. An activity report from the physical education department Correct Answer: A. The history of obesity education in the community The epidemiological triad can be used to frame strategies for the prevention of farm machinery injuries. Which action should the nurse take to focus on the agent? A. Teach farm workers not to smoke around farm equipment B. Work with legislators to mandate safe tractor design C. Translate written vehicle instructions into picture format D. Provide rehabilitation services to injured farm hands Correct Answer: B. Work with legislators to mandate safe tractor design The public health nurse is creating a plan to increase state funding for a local health clinic. Which strategy is likely to be most effective in obtaining funding for the clinic? A. Run the health clinic economically and advertise the services the clinic provides B. Organize concerned citizens to write letters and telephone state representatives C. Described to the media the valuable services provided by the community clinic D. Engage a professional lobbyist to persuade Congress of the local clinic's value Correct Answer: D. Engage a professional lobbyist to persuade Congress of the local clinic's value 29 The nurse is documenting the medical history of a young adult male client who was recently diagnosed with Type 1 diabetes mellitus (DM). He smokes 2 packs of cigarettes daily and his father died of a heart attack at the age of 45. Which annual screening is most important for the nurse include? A. Peripheral neuropathy B. Renal insufficiency C. Retinography D. Hyperlipidemia Correct Answer: D. Hyperlipidemia The nurse provides teaching to a group of evacuees in a mass casualty center after a natural flooding disaster. Which information should the nurse including in the teaching plan? (Select all that apply.) A. Wash all fruits and vegetables thoroughly in running tap water. B. Identify all sexual contacts since the evacuation process C. Take all doses of prophylactic prescriptions for diarrhea D. Clean hands using soap, clean water, or waterless antibacterial solutions E. Drink only boiled water or bottled oral rehydration solutions Correct Answer: C. Take all doses of prophylactic prescriptions for diarrhea D. Clean hands using soap, clean water, or waterless antibacterial solutions E. Drink only boiled water or bottled oral rehydration solutions 30 A nurse is planning a nutrition class for a group of senior citizens at a community center and wants to emphasize the amount and types of fat in some foods versus others. What is the best teaching method for the nurse to use? A. Display posters with foods and tell seniors about fat content B. Determine foods most often eaten by this group and discuss the nutritional panel of each product C. Show a movie about cooking with foods that are low in fat but delicious D. Ask each senior to bring a food for others to taste, then estimate the fat contained in these foods Correct Answer: B. Determine foods most often eaten by this group and discuss the nutritional panel of each product An adult male who has diabetes is laid off from his job of 15 years where he had health care benefits. By law, he is provided with Consolidated Omnibus Budget Reconciliation Act (COBRA) benefits. What is likely to be his greatest concern in planning for his health care during the next year? A. Paying for his health care B. Obtaining quality medical care C. Selecting a primary care provider D. Having required lab work completed 31 Correct Answer: A. Paying for his health care A prescription for discharge is written for an elderly female client who has asked to be discharged to her home. The client lives alone and is able to walk 10 to 15 feet with assistance. What action should the nurse implement first? A. Review the home medication schedule with the client and family B. Arrange for a bedside commode to be delivered to the home C. Meet with the case manager to plan a home safety evaluation D. Provide the client with information about medical alert devices Correct Answer: C. Meet with the case manager to plan a home safety evaluation The nurse at a migrant health center notes an increased incidence of dermatitis in seasonal farm workers at a local fruit farm. In response to this finding, it is most important for the nurse to obtain which information as a part of a community assessment? A. Availability of fresh water for washing hands after work B. Air pollution levels in the surrounding community C. Number of hours of worker's exposure to direct sunlight D. Percentage of poisonous plants in the work fields Correct Answer: A. Availability of fresh water for washing hands after work 32 A teenage boy with a history of recurring atopic dermatitis (eczema) tells the school nurse that he wants to play high school football. Which action should the nurse take? A. Encourage the teenager to join the swim team instead of the football team B. Notify the parents of problems associated with perspiration for those with eczema C. Tell the teenager to shower with a non-perfumed soaps immediately after practice D. Inform the football coach of the teenager's skin condition and its manifestations. Correct Answer: C. Tell the teenager to shower with a non-perfumed soaps immediately after practice The wife of an older adult man who has had diabetes mellitus for the past 10 years reports to the home health nurse that her husband fell yesterday while taking his daily walk in the neighborhood. He has a bruised hand and a small abrasion on his left knee. The nurse assess that his neurologic vital signs are stable. To reduce risk for future falls, which assessment is most important for the nurse to obtain? A. Current blood sugar level B. Degree of paresthesia in feet C. Wound healing of knee abrasion D. A1c glycosylated hemoglobin Correct Answer: B. Degree of paresthesia in feet 33 The home health nurse visits a young male client with AIDS who has Kaposi's sarcoma and peripheral neuropathies. His parents, who are the care-takers, tell the nurse that their son sleeps most of the times. The nurse assess that the client is semi-conscious with stable vital signs, cries out in pain when turned or moved, has a Duragesic pain patch in place, and skin lesions that are closed and dried. Which intervention should the nurse implement? A. Remove the Duragesic patch as directed by prescription B. Give a complete bed bath to further assess the client C. Discuss end-of-life decisions with the client's parents D. Call for ambulance transportation to the hospital immediately Correct Answer: C. Discuss end-of-life decisions with the client's parents An assessment conducted last year of the health needs of children who attended a middle school indicated that bicycle injuries were a priority problem, so the nurse developed a bicycle safety program. Six weeks after completion of the program, a survey was sent to parents and students. Which finding is the best indicator that the program was effective? A. The number of students wearing bicycle helmets increased by 10% B. 50% of the parents reported that their children are aware of bicycle safety C. The number of students riding bicycles to school increased by 25% D. 80% of the parents identified the need for an annual bicycle safety program 34 Correct Answer: A. The number of students wearing bicycle helmets increased by 10% The nurse is planning a series of health screening programs for elderly AfricanAmericans. Which health problem should the nurse target for this population? A. Peripheral vascular disease B. Sickle cell anemia C. Decreased visual acuity D. High blood pressure Correct Answer: D. High blood pressure The nurse is serving on a medical center committee to update goals and protocols based on current national standards. Which goal most directly addresses the Healthy People 2020 initiative? A. Decrease incidence of professional boundary violations B. Reduce emergency room wait times for indigent clients C. Encourage the use of the 5 rights of delegation D. Standardize communication for shift-to-shift report Correct Answer: B. Reduce emergency room wait times for indigent clients 35 A homeless client with alcohol dependency will be dismissed from the emergency department in 24 hours. The nurse notes that a tuberculin skin test was prescribed by the healthcare provider. What intervention is most important for the nurse to implement prior to discharge? A. Identify how the client will follow-up to have the results read. B. Give the client written information about the tuberculosis test C. Determine if the client understands the purpose of the tuberculin test D. Explain to the client results should be read between 48 and 72 hours Correct Answer: A. Identify how the client will follow-up to have the results read. A Hispanic mother insists on using special candles to treat her child's ear infection. The nurse should demonstrate cultural accommodation by making which request? A. Use the prescribed antibiotics and if there is no improvement, use the candles B. Give the prescribed antibiotics in addition to using the candles. C. Do not use the candles because of the risk of fire and subsequent burns to the child. D. Provide the prescribed antibiotics instead of using the candles Correct Answer: B. Give the prescribed antibiotics in addition to using the candles. The nurse is making a home visit to female client with end stage heart disease. She has a living will and states that she refuse to ever go back to a hospital. During the visit, the nurse notes that the client is pale and short of breath while speaking. The nurse 36 discovers 3+ pitting edema in both ankles and bilateral pulmonary crackles. Which intervention should the nurse implement first? A. Explain the need for hospitalization B. Obtain a peripheral oxygen saturation level C. Elevate her feet above the level of her heart D. Apply 2L of oxygen per nasal cannula Correct Answer: B. Obtain a peripheral oxygen saturation level The nurse must delegate some aspects of a homebound client's care to a home health aide. Which intervention should the nurse delegate to the home health aide? A. Evaluate a pressure sore B. Apply a prosthetic device C. Perform a sterile dressing change D. Assess the client's need for an elevated toilet seat Correct Answer: B. Apply a prosthetic device After assessing the health care needs of an elementary school, the nurse determines that an increased prevalence of pediculosis capitis is a priority problem. The nurse develops a 2-month program with the goal to eradicate the condition in the school. The program includes educational pamphlets sent home to parents and regular assessment 37 of children by the school nurse. What action should the nurse implement to evaluate the effectiveness of the program? A. Measure the prevalence of pediculosis capitis among the children after four months B. Survey parents 3 weeks after pamphlets are sent home to assess their understanding of the condition. C. Conduct an initial examination of each child in the school to obtain baseline data D. Evaluate the teachers' ability to identify pediculosis capitis 2 months after initiation of the program Correct Answer: A. Measure the prevalence of pediculosis capitis among the children after four months The nurse is conducting routine assessments of clients at an ambulatory clinic. Which assessment warrants immediate interventions by the nurse? A. Hepatovax B was prescribed for a client who is allergic to yeast B. An INR of 2 was obtained for a client taking warfarin (Coumadin) C. HIV screening was requested by a client having unprotected sex with two individuals D. Nafcillin (Unipen) was taken for ten days by a client whose infected wound is healing Correct Answer: a. Hepatovax B was prescribed for a client who is allergic to yeast 38 During a home visit, a client tells a home health nurse that he was recently diagnosed with viral conjunctivitis. The client reports eye pain and swelling. What instructions should the nurse provide? A. Avoid straining or sneezing B. Apply a cool compress C. Keep the room well lighted D. Drink plenty of fluids Correct Answer: B. Apply a cool compress To promote heart healthy eating during a school fair, the nurse presents information about a "Mediterranean-based" approach to eating. To assess learning, the nurse sponsors a contest and asks the children to create a rhyme that shows food that should be limited. Which selection should the nurse choose as the winner of the contest? A. Fish on a dish B. Meats and sweets C. Greens and beans D. Berries and cherries Correct Answer: B. Meats and sweets The public health nurse is called to investigate a report of several cases of chickenpox (varicella virus) at a day care center. The day care worker states that five children have 39 been sent home over the past two weeks with fever and itchy blisters. Which intervention should the nurse implement first? A. Confirm the number of children with symptoms B. Determine how many people have been exposed C. Report the presence of a viral endemic at the day care center D. Validate that the children sent home did develop chickenpox Correct Answer: D. Validate that the children sent home did develop chickenpox Four students come to the school clinic simultaneously, seeking help from the school nurse. In which order of priority should the nurse provide care to these students? (Arrange the client with the highest priority first, on top, and lowest priority last, on bottom.) A. A 7-year-old who has type 1 diabetes mellitus and is experiencing extreme hunger and shakiness B. A 12-year-old with history of asthma who is wheezing and complaining of shortness of breath. C. A 5-year-old who is crying uncontrollably because of an incontinent bowel episode. D. A 10-year-old with bleeding lacerations on both knees after falling in gym class. Correct Answer: B. A 12-year-old with history of asthma who is wheezing and complaining of shortness of breath. 40 A. A 7-year-old who has type 1 diabetes mellitus and is experiencing extreme hunger and shakiness D. A 10-year-old with bleeding lacerations on both knees after falling in gym class. C. A 5-year-old who is crying uncontrollably because of an incontinent bowel episode. 12, 7, 10, 5 The parish nurse notes that an elderly male client has had a 5 pound weight loss since his check-up one month ago. The client has good hygiene, still drives a car, and lives alone. To which agency should the nurse refer this client? A. The Adult Day Care Center B. The Senior Citizen Center C. The Women, Infant, and Children office D. The Social Security Administration office Correct Answer: B. The Senior Citizen Center While presenting a workshop titled, "Improving Access to Health Services" to community leaders, the community health nurse is asked by a city council member to explain the reason for addressing this issue. Which statement provides the best response? A. The committee for "Healthy People 2020" has identified "access" as a national goal 41 B. The Institute of Medicine includes "access" as one of its priority recommendations. C. The Community Health Improvement Process is used for issues in high risk populations. D. The Center for Disease Control has identified this problem as a variable in morbidity Correct Answer: A. The committee for "Healthy People 2020" has identified "access" as a national goal The school nurse is assessing a group of middle school students for signs of scoliosis and discovers a female student with a noticeable unequal symmetry of the upper and lower back. Which intervention is most important for the nurse to implement? A. Make a referral to have the scoliosis further evaluated B. Ask the student about her ability to participate in sports C. Measure the degree of the thoracic and lumbar curvature D. Review student's health record for a recent growth spurt Correct Answer: A. Make a referral to have the scoliosis further evaluated A newly hired school nurse conducts a "windshield" survey of the geographic area served by the school. Which method is best for the nurse to use to objectively validate the findings obtained? A. Obtain mortality data for the geographic area B. Talk with teachers about their concerns for the students 42 C. Discuss with the PTA board their perception of school events D. Review the previous school nurse's anecdotal documents. Correct Answer: D. Review the previous school nurse's anecdotal documents. The local health department needs to prioritize the distribution of influenza vaccinations due to a limited supply. In determining which individuals should receive the limited available vaccine, which person should the public health nurse ask to return to the clinic later when more vaccine is available? A. A 60-year-old with diabetes and agoraphobia B. An 80-year-old resident in an Alzheimer's unit C. A 65-year-old aide working in a nursing home. D. An 8-year-old girl with poorly-controlled asthma Correct Answer: A. A 60-year-old with diabetes and agoraphobia A nurse designs a series of four weekly classes for client with Type 2 diabetes. Which information should the nurse use as an outcome evaluation for the classes? A. Parking convenience for attendees continued to be a major concern B. Demonstrating by the use of a blood glucose meter was an effective teaching strategy C. Fasting blood glucose average readings were 20% lower at the end of the classes D. Discussion of food exchanges and calories was a well attended class 43 Correct Answer: C. Fasting blood glucose average readings were 20% lower at the end of the classes On a repeat home visit to see an 84-year-old widow, the nurse discovers that the client is unkempt, smells of stale urine, and does not recognize her neighbors or the nurse. What action should the nurse take first? A. Complete a physical and mental exam of the client B. Call Adult Protective Services to obtain emergency nursing home placement. C. Seek the family's assistance in caring for the client D. Call the client's pharmacy to determine what medications she is taking Correct Answer: A. Complete a physical and mental exam of the client The community health nurse believes that immunization rates in a lower-socioeconomic section of the city are probably below the target set by the state health department. What action should the nurse take first to intervene with this health problem? A. Join a political action group that focuses attention on the issue in the local news media B. Partner with a local children's hospital in setting up free "shot" clinics in the neighborhood C. Review current epidemiological population data that might document a low immunization rate 44 D. Call a meeting of citizens to inform them of the important of having their children immunized Correct Answer: C. Review current epidemiological population data that might document a low immunization rate An older adult male with a history of type 2 diabetes mellitus (DM2) is seen in the community health clinic for an annual physical examination. Which nursing action should be included in assessing for long-term complications of diabetes? (Select all that apply.) A. Obtain venous sample for liver enzymes B. Obtain urine specimen to assess for albumin C. Test lower extremities for changes in sensation D. Auscultate for adventitious breath sounds E. Palpate pedal pulses and foot temperatures Correct Answer: C. Test lower extremities for changes in sensation E. Palpate pedal pulses and foot temperatures A nurse identifies the clinic receptionist as having the role of gatekeeper for the clinic. What statement by the receptionist is indicative of a gatekeeper in a community setting? A. "You may talk with the RN if you need information about how clients purchase car seats." 45 B. "Over 85% of the clients treated at this clinic are women of Hispanic of Asian heritage." C. "The clinic standards are determined by those set forth by American Academy of Obstetrics." D. "Monthly, we see more than 200 women for prenatal visits and venereal disease for treatment." Correct Answer: A. "You may talk with the RN if you need information about how clients purchase car seats." The nurse is developing a health class curriculum for students aged 11 through 14 years of age. Which content topic is most important for the nurse to emphasize in the curriculum for these students? A. Reduction of risk-taking behaviors B. Promotion of healthy dietary habits C. Participation in physical exercise D. Recognition of personal identity Correct Answer: A. Reduction of risk-taking behaviors A client is admitted to the emergency department with flu-like symptoms. Which intervention should the nurse to obtain to rule out exposure to anthrax-spores? A. Determine the client's occupation 46 B. Inquire about previous vaccination for smallpox. C. Obtain a twenty-four diet history D. Identify the client's personal contacts over the past week Correct Answer: A. Determine the client's occupation A male migrant farm worker who lives in a mobile home with several other workers visits the Migrant Health Care Center. He reports increasing episodes of dizziness, headaches, abdominal cramps, and difficulty breathing. What nursing action has the highest priority? A. Ask about the length of his workday and frequency of rest breaks B. Gather information about the client's recent exposure to pesticides C. Determine the number and age of persons living in the mobile home D. Obtain a blood sample to assess for possible lead pain exposure Correct Answer: B. Gather information about the client's recent exposure to pesticides A nurse has started a group for senior citizens in a church setting. The group decides that their first project will be to begin a program for home-bound members. Which program outcome is the best measure of the project's effectiveness? A. Average annual income for the home bound members B. Number of home-bound seniors who are visited 47 C. Calls received showing interest in the program D. Number of church members who are over 65 Correct Answer: B. Number of home-bound seniors who are visited 1. During a visit to the community health clinic, a 45-year-old native American female, who has a body mass index (BMI) of 35, complains of changes in her vision. Which condition is most important for the nurse to be aware of based on family history? A. Alcoholism B. Tuberculosis C. Cataracts D. Diabetes mellitus Correct Answer: D. Diabetes mellitus One hundred families in a community refuse to have their children immunized because of religious beliefs. When one documented case of whooping cough occurs within this aggregate, which intervention should the nurse implement? A. Quarantine the one hundred family aggregate B. Immunize all members of the one hundred families C. Quarantine all family members of the child with whooping cough D. Immunize all children under age 5 in the one hundred family aggregate Correct Answer: C. Quarantine all family members of the child with whooping cough 48 A 93-year-old client with a number of co-morbidities is assessed by the home health nurse. What problem is most important for the nurse to investigate further? A. Social isolation B. Medication interactions C. Urinary incontinences D. Caregiver stress Correct Answer: B. Medication interactions Which interventions should the nurse implement to help prevent a client from getting a vector-born infectious disease? A. Encourage the client to get immunizations prior to international travel. B. Discuss the importance of wearing insect repellent when camping C. Instruct the client to drink only bottled water when traveling abroad D. Demonstrate the correct way to remove ticks imbedded in the skin Correct Answer: B. Discuss the importance of wearing insect repellent when camping A home health nurse is reviewing the laboratory results for several clients with a history of heart failure (HF). Which client finding should the nurse report to the healthcare provider immediately? 49 A. Total cholesterol 190 mg/dl. B. B-type natriuretic peptide 550 pg/ml. C. Glycosylated Hemoglobin of 7% D. Potassium 3.7 mEq/L Correct Answer: B. B-type natriuretic peptide 550 pg/ml. The community health nurse who works in a town that has a large chemical plant is concerned about the occurrence of a natural disaster related to chemical exposure. Which action is most important for the nurse to take? A. Evaluate company safety procedures for prevention of chemical exposures B. Elicit the company's participation in a disaster preparedness program. C. Determine the antidotes for the chemicals produced by the company D. Inform employees of their potential risk for a chemical exposure incident. Correct Answer: B. Elicit the company's participation in a disaster preparedness program. A community group proposes building a new well-child clinic because this year's demographics reflect that a large percentage of the population is less than 19 years of age. Which question indicates that the nurse understands the potential gaps in these data? A. What is the distribution of males to females within this population? 50 B. What percentage of the population was under 19 years of age in each of the 5 previous years? C. How will the large percentage of under 19-year-olds affect the community's dependency ration? D. How can the income level of the families within the community be determined? Correct Answer: B. What percentage of the population was under 19 years of age in each of the 5 previous years? During a community health screening fair for older adults, the nurse observes that a woman has pale, bluish feet. With sores on both lower extremities that are healing poorly. Which intervention should the nurse implement? A. Create a list of foods that promote wound healing. B. Send client to the emergency room for treatment. C. Refer to healthcare provider for complete evaluation D. Instruct client to apply antibiotic ointment to sores Correct Answer: C. Refer to healthcare provider for complete evaluation The nurse caring for a 62-year-old African-American male client arranges a time for the client's wife, 80-year-old mother, three children, and sister to meet with the healthcare provider to discuss the client's medical condition. Which cultural variation is the nurse including when providing care for this client? 51 A. Social spacing B. Cultural repatterining C. Social organization D. Environmental control Correct Answer: C. Social organization The RN care-manager at the public department is making a home visit to a client with four children under the age of 6. The client is a single mother and the family is living below poverty level. Which intervention should the nurse include as a primary level prevention measure? A. Enroll the client in the Women, Infant, and Children program B. Counsel the client on available birth control methods C. Provide the client with a listing for local healthcare providers. D. Provide the client with the local bus schedule. Correct Answer: A. Enroll the client in the Women, Infant, and Children program 52