NUR 335 Community HESI. 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 ma... laise. Her vital signs are: temperature 101.8F, 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 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.) e. Request a referral for motorized wheelchair to assist with mobility. f. Keep a variety of fresh fruits and vegetables that are easily accessible. g. Put medications into a container that organized the pills by the day and time. h. Encourage participation in televised exercise classes to help strengthen muscles. i. Post a sign on refrigerator reminding the client not to eat between meals. 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? j. The history of obesity education in the community k. The level of parental concern regarding childhood obesity l. The demographic data for the student population m. An activity report from the physical education department 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? n. Teach farm workers not to smoke around farm equipment o. Work with legislators to mandate safe tractor design p. Translate written vehicle instructions into picture format q. Provide rehabilitation services to injured farm hands 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? r. Run the health clinic economically and advertise the services the clinic provides s. Organize concerned citizens to write letters and telephone state representatives t. Described to the media the valuable services provided by the community clinic u. Engage a professional lobbyist to persuade Congress of the local clinic’s value 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? v. Peripheral neuropathy w. Renal insufficiency x. Retinography y. Hyperlipidemia 2. 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 3. 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 4. 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 5. 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 6. 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 7. 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. 8. 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 9. 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 10. 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 11. The nurse is planning a series of health screening programs for elderly African-Americans. 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 12. 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 13. 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 14. 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 15. 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 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 16. 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 17. 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 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 18. 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 19. 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 20. 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 21. 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 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 22. 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. B, A, D, C – 12, 7, 10, 5 23. 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 24. 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 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 25. 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 26. 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 c. Discuss with the PTA board their perception of school events d. Review the previous school nurse’s anecdotal documents. 27. 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 28. 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 29. 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 30. 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 d. Call a meeting of citizens to inform them of the important of having their children immunized 31. 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 32. 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.” 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.” 33. 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 34. 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 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 35. 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 36. 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 c. Calls received showing interest in the program d. Number of church members who are over 65 37. 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 38. 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 39. 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 40. 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 41. 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? 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 42. 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. 43. 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? 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? 44. 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 45. 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? a. Social spacing b. Cultural repatterning c. Social organization d. Environmental control 46. 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. 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