ATI Community Practice B

A nurse is assessing the risks and benefits of meal delivery services for an older adult client who lives alone and has no transportation. Which of the following ethical principles is the nurse demonstrating? A. Distributive justice B. Respect for autonomy C. Fidelity D. Beneficence

D. Beneficence The nurse is demonstrating the ethical principle of beneficence by determining if the client needs this service to maintain their health.

A nurse is developing an educational program about bioterrorism and smallpox. The nurse should include in the teaching that the smallpox rash is expected to first appear in which of the following locations? A. Face B. Posterior shoulders C. Abdomen D. Lower extremities

A. Face The nurse should teach that the smallpox rash is expected to first appear on the face.

A community health nurse is providing teaching about health promotion to a group of adolescents. Which of the following topics is the most important for the nurse to include in an attempt to lower adolescent mortality rates? A. Underage smoking B. Safer sex practices C. Safety belt use D. Heart-healthy diet

C. Safety belt use Automobile crashes are currently the leading cause of death among adolescents. Therefore, this topic is most important to discuss when attempting to reduce premature deaths in this age group.

A nurse is planning to teach a community group about the meningococcal vaccine. The nurse should identity that which of the following clients should receive the vaccine? A. A client who is traveling to northern Europe B. An infant who has bronchiolitis C. An infant who is 4 weeks old D. A client who is moving into a college dormitory

D. A client who is moving into a college dormitory. Individuals living in crowded areas, such as dormitories, should receive the meningococcal vaccine.

A community health nurse is providing care to a client who has stopped taking their prescribed blood pressure medication. Which of the following actions should the nurse take first? A. Advise the client that adherence to the medication regimen will promote healthy outcomes. B. Determine the client's reason for discontinuing the medication. C. Discuss the consequences of discontinuing the medication with the client. D. Educate the client about the benefits of the medication.

B. Determine the client's reason for discontinuing the medication. When using the nursing process, the first step the nurse should take is to assess the client. By determining the client's reason for discontinuing the medication, the nurse can promote adherence to treatment.

A community health nurse is planning a presentation for adults who have a family history of Alzheimer's disease. Which of the following behaviors should the nurse include as an early manifestation of Alzheimer's disease? A. Withdrawal from social activities B. Forgetting the location of common objects C. Experiencing incontinence D. Neglecting personal hygiene

B. Forgetting the location of common objects Forgetting the location of common objects is an early manifestation of Alzheimer's disease.

A community health nurse is participating in a quality improvement plan for a local health department. Which of the following techniques should the nurse use for process evaluation of the facility? (Select all that apply.) A. Focus groups B. Written audits C. Satisfaction survey D. Interviews E. Values self-study

A. Focus groups B. Written audits C. Satisfaction survey D. Interviews

An adult child of a client who is terminally ill and at the end of life approaches a hospice nurse and asks, "What can I do to help relieve my father's pain?" Which of the following interventions should the nurse suggest? A."Give your father brief hand massages." B. "Increase the illumination in your father's room." C. "Avoid using analgesics unless your father exhibits nonverbal signs of pain." D. "Administer citalopram when your father is agitated."

A."Give your father brief hand massages." Soft and brief hand massages can reduce pain and stress in palliative care settings.

An occupational health nurse in a factory is performing a routine tuberculosis screening and identifies an employee who has a positive Mantoux tuberculin test. Which of the following actions should the nurse plan to take? A.Instruct the employee that they will need to obtain a chest x-ray. B. Initiate an employee immunization program. C. Instruct the employee to wear an N95 respiratory mask. D. Administer prophylactic penicillin to other employees.

A.Instruct the employee that they will need to obtain a chest x-ray. The presence of a positive Mantoux skin test can indicate the client has been exposed to the tuberculosis organism. A chest x-ray will determine if the disease is active or dormant.

A home health nurse is evaluating a caregiver's technique for providing care to a client who has a chronic tracheostomy. Which of the following statements by the caregiver indicates an understanding of the procedure? A. "I should remove the soiled ties before replacing them with clean ones." B. "I will use tap water to clean the inner cannula." C."I should use a slip knot to secure the tracheostomy ties." D. "I will cut a four inch by four inch gauze to use as a dressing."

B. "I will use tap water to clean the inner cannula." The caregiver can use tap water when performing tracheostomy care.

A nurse is conducting a home visit for an older adult client. The nurse should identify which of the following findings as an indicator of possible neglect? A. Lives alone B. Taking outdated prescriptions C. Has a BMI of 25 D. Presence of alcohol in the home

B. Taking outdated prescriptions The client taking outdated prescriptions is an example of inadequate medical care and is an indicator of possible neglect.

A nurse at a county health department is caring for a client who is at 28 weeks of gestation. The nurse should identify which of the following characteristics as a risk factor for future child maltreatment? A. The client refers to the unborn fetus by name. B. The client works part-time at a local restaurant. C. The client has changed providers three times during their pregnancy. D. The client has recurring nightmares about the unborn fetus.

C. The client has changed providers three times during their pregnancy. Frequently changing health care providers is a risk factor for future child maltreatment because it can indicate that the client is experiencing partner violence and is attempting to hide it from the provider. Clients who experience violence are at a higher risk for perpetuating violence against their own children.

A hospice nurse is caring for a client who is at the end of life and has developed dyspnea and noisy breathing. Which of the following actions should the nurse take? A. Suction the client's oropharynx. B. Administer the client's pain medication intramuscularly. C. Use a fan in the client's room. D. Place the client in Trendelenburg position.

C. Use a fan in the client's room. A fan moves the air, which stimulates the client's trigeminal nerve and can minimize the sensation of dyspnea.

A hospice nurse is teaching about expected grief reactions with the family of a client who has end-stage pancreatic cancer. Which of the following information should the nurse include? A. "It is common to experience a persistent state of sadness while grieving." B. "Disturbances in your self-esteem is an expected grief reaction." C. "You will feel a sense of hopelessness throughout the grieving process." D. "A component of healthy grieving is the ability to openly express your anger."

D. "A component of healthy grieving is the ability to openly express your anger." The nurse should teach the family that they will experience feelings of anger, guilt, shame, and doubt while grieving. The ability to openly express their feelings of anger is an expected grief reaction.

A community health nurse is discussing the role of a faith community nurse with a chaplain. Which of the following information should the nurse include in the discussion? A. The faith community nurse can provide pharmacological pain management for clients who have a terminal illness. B. The faith community nurse can plan workplace safety training for employees in a local factory. C. The faith community nurse can provide wound care for clients in their homes. D. The faith community nurse can facilitate substance abuse support groups.

D. The faith community nurse can facilitate substance abuse support groups. This is one of the roles of a faith community nurse.

A school nurse is conducting visual acuity testing for a school-age child using a Snellen letter chart. Which of the following actions should the nurse take? A. Allow the child to keep her glasses on during the testing. B. Have the child stand 5 feet away from the Snellen letter chart. C. Progress to the next line once the child reads two symbols correctly. D. Begin the test by instructing the child to use both eyes to read the chart.

A. Allow the child to keep her glasses on during the testing. When using the Snellen letter chart to assess a school-age child's visual acuity, the nurse should allow the child to keep her glasses on during the test.

A nurse at a county health clinic is caring for a client who has recently assumed the role of primary caregiver for their parent. Which of the following client statements indicates that they are experiencing role conflict? A. "I feel overwhelmed with not having enough time for my mom as well as my children." B. "I hope my siblings will be able to visit and help care for mom for a few days." C. "I am glad that my job is flexible, so I can accommodate my mom's needs." D. "I don't think my partner likes having to help more with the household chores."

A. "I feel overwhelmed with not having enough time for my mom as well as my children." Role conflict occurs when a client performs two or more roles that are in opposition of each other. Caring for children and a parent can cause feelings of stress for the client and lead to conflict within the family.

A public health nurse is lobbying Congress to increase funding for health screenings provided to migrant farm workers. Which of the following concepts is the nurse demonstrating? A. Advocacy B. Principlism C. Deontology D. Communitarianism

A. Advocacy This is an example of advocacy. Advocacy is supporting or seeking a specific course of action for the benefit and on behalf of a person, group, or community.

A nurse is providing education regarding lead exposure to a group of clients who live in a housing development built in 1968. Which of the following client statements indicates an understanding of the teaching? A. "I will use a dry-sanding technique when preparing to repaint my front door." B. "I will vacuum our wood floors every week." C. "I will increase the amount of red meat and milk in my child's diet." D. "I will use hot tap water to prepare my baby's formula."

C. "I will increase the amount of red meat and milk in my child's diet." Children should receive adequate amounts of iron and calcium in their diets to prevent lead absorption from their environment.

A nurse is caring for a client who has a positive gonorrhea culture. Which of the following actions should the nurse take? A. Instruct the client that recent sexual partners will need to be treated. B. Instruct the client to return for a blood test in 1 month. C. Administer penicillin G 2.4 million units IM once. D. Teach the client how to apply imiquimod 5% cream to the lesions.

A. Instruct the client that recent sexual partners will need to be treated. The nurse should instruct the client that sexual partners from the past 60 days should be referred for evaluation and treatment of gonorrhea.

A school nurse is notified that a school-age child has pertussis. Which of the following actions should the school nurse take? (Select all that apply.) A. Instruct the parent to keep the child at home for 2 weeks after the initial symptoms first present. B. Encourage family members to obtain prophylactic treatment. C. Quarantine the children in the child's class. D. Recommend that the child receive a pneumococcal vaccine in 28 days. E. Check the immunization status of the child's classmates.

A. Instruct the parent to keep the child at home for 2 weeks after the initial symptoms first present. B. Encourage family members to obtain prophylactic treatment. E. Check the immunization status of the child's classmates.

A home health care nurse is teaching a client's family about preventing the transmission of Clostridium difficile. Which of the following transmission-based precautions should the nurse include in the teaching? A. Contact precautions B. Droplet precautions C. Airborne precautions D. Protective environment

A. Contact precautions The nurse should instruct the family to implement contact precautions while providing care for a client who has Clostridium difficile. Contact precautions eliminate the exposure to contaminated body fluids and items.

A community health nurse is made aware that several children, who are from the same family and did not receive immunizations, have contracted measles. Which of the following actions should the nurse take? A. Report this information to the state health department. B. Encourage the family to keep the children isolated during the incubation period. C. Speak to the guardians about getting the children immunized after they are disease free. D. Provide the infected children's names to the parents and guardians of children who might have been exposed.

A. Report this information to the state health department. The CDC lists measles as a nationally notifiable disease. Requirements for reporting diseases are state mandated, rather than federally mandated. Therefore, the nurse should report this occurrence to the state health department, which then determines if it will report to the CDC.

A community health nurse is assigned to lead a county-level environmental task force. Which of the following activities should the nurse direct the task force to complete first? A. Review community-specific epidemiological data. B. Recommend updates to local environmental policies. C. Create program goals that align with Healthy People objectives. D. Distribute environmental health education materials to community members.

A. Review community-specific epidemiological data. The first action the nurse should direct the task force to take when using the nursing process is to conduct a community assessment, which includes a review of community-specific epidemiological data. The community assessment will assist the task force in identifying environmental health concerns within the county.

A nurse on the scene following a mass casualty explosion is triaging a client who has a large, open occipital wound and the following findings: respiratory rate 6/min, agonal pattern; capillary refill time 4.5 seconds; nonresponsive to painful stimuli. Which of the following actions should the nurse take? A. Turn the client to left semi-Fowler's position and begin assessing the next client. B. Place a firm pressure dressing to the occiput and open the airway. C. Apply a cervical spine collar and perform a focused neurological exam. D. Request that the client be assessed immediately by the next available provider.

A. Turn the client to left semi-Fowler's position and begin assessing the next client. Principles of triage indicate that clients who have extensive injuries and a low-probability of survival do not receive treatment. Therefore, the nurse should provide only comfort measures before moving on to assess the next client.

A public health nurse is participating in a disaster preparedness planning committee for a local community that is at risk for hurricanes. Which of the following information should the nurse contribute to the plan? A. A list of residents who have experienced a hurricane in the past and will not need evacuation B. A list of areas within the community where residents speak multiple languages C. How to activate the local medical facilities' emergency-management plans D. The name of the individual who is necessary to implement the plan

B. A list of areas within the community where residents speak multiple languages The public health nurse, who is most familiar with the community, should contribute this information to the disaster plan to assist in aiding and evacuating residents who are at high-risk.

A community health nurse suspects an outbreak of scabies in the local area. Which of the following actions should the nurse take first? A. Educate the community about disease transmission. B. Determine the incidence rate. C. Institute prophylactic treatment. D. Discuss treatment plans with the clients' families.

B. Determine the incidence rate. The first action the nurse should take when using the nursing process is to perform an assessment. The nurse should determine the number of new cases of scabies in the community for comparison to prior incidence data in order to monitor for an increase.

A community health nurse is caring for an adolescent who is seeking help for an unplanned pregnancy. Which of the following actions should the nurse take first? A. Recommend that the adolescent meet with the school guidance counselor to discuss educational options. B. Help the client obtain a provider for prenatal care. C. Educate the client about contraceptives to prevent future unplanned pregnancies. D. Provide information on parenting classes so the client can learn about caring for a newborn.

B. Help the client obtain a provider for prenatal care. The client is an adolescent and experiencing an unplanned pregnancy, which are factors that place the client and fetus at risk for complications. Therefore, when using the safety/risk reduction approach to client care, the first action the nurse should take is to assist the client in obtaining prenatal care.

A public health nurse is monitoring medication compliance for a group of migrant workers who are being treated for tuberculosis (TB). The nurse should use information from which of the following resources to assist with this process? A. Agency for Healthcare Quality and Research (AHRQ) B. Migrant Clinicians Network (MCN) C. Centers for Disease Control and Prevention (CDC) D. U. S. Preventive Services Task Force (USPSTF)

B. Migrant Clinicians Network (MCN) Migrant workers frequently change locations and move from job to job. This can interfere with the client adhering to the 6 to 12 month TB treatment plan. The MCN is a tracking program developed so that health care providers can access prior provider information and maintain TB treatment continuity for these clients.

A community health nurse is working with a community where the incidence of violence has increased. Which of the following actions should the nurse take as a tertiary prevention strategy? A. Provide open education sessions to teach parenting skills. B. Provide victims of violence with referral information to crisis lines. C. Identify potential community risk factors for violence. D. Assess for evidence of violence during routine encounters.

B. Provide victims of violence with referral information to crisis lines. Referring victims of violence to available community resources is a tertiary prevention strategy. The community health nurse should be aware of all available community resources.

A nurse in a county health department is caring for a client who states, "I've been drinking too much in the evenings since my friend died last year." Which of the following responses should the nurse make? A. "It sounds like you are probably an alcoholic." B. "Don't you think your family is being affected by your drinking?" C. "Can I give you some information about Alcoholics Anonymous?" D. "I don't think your friend would have approved of your drinking."

C. "Can I give you some information about Alcoholics Anonymous?" The nurse is giving information to the client, which conveys a sense of caring. This also allows the nurse to provide additional information on resources that can help the client.

A home health nurse is visiting an older adult client and notes that unwashed dishes are piled up and newspapers cover the front steps. Which of the following questions should the nurse ask the client to determine if the client is socially isolated? A. "Why haven't you brought in your newspapers?" B. "Do you need help completing your housework?" C. "How often do you have visitors come to see you?" D. "Have you considered moving to an assisted living facility?"

C. "How often do you have visitors come to see you?" The nurse should ask this question because it addresses the issue of social isolation by determining the frequency of contact between the client and others.

A nurse is giving a presentation about family violence at a local community center. Which of the following information should the nurse include? A. Socially active parents and guardians are at greater risk for becoming violent. B. Partner violence occurs more frequently in lower socioeconomic households. C. Child maltreatment is more common in homes where partner violence is present. D. Children who are abused are less likely to become abusers.

C. Child maltreatment is more common in homes where partner violence is present. Child maltreatment is very common in homes where partner violence is present.

A nurse manager at a community health clinic is presenting an in-service for nurses about assessing clients who have experienced violence. Which of the following statements by a nurse indicates an understanding of the teaching? A. "I do not need to ask about violence at future visits once I determine that a client is not at risk." B. "I should not document the name of the person the client accuses of the violence in the client's medical record." C. "I should wait until I see signs of physical violence before I help the client develop a safety plan." D. "I should determine whether a client who has been sexually assaulted requires a rape kit examination."

D. "I should determine whether a client who has been sexually assaulted requires a rape kit examination." Clients who report sexual assault within a certain time frame should undergo a rape kit examination. In some cases, collection must be obtained within 24 hr of the occurrence. However, the time frame can vary based on the type of assault. The nurse should also provide information regarding support groups and resources for clients who were sexually assaulted.

A community health nurse is conducting a program regarding crime reduction strategies for older adult clients at the senior center. Which of the following statements indicates an understanding of the information? A. "When I am in my car, I will keep my personal items on the seat beside me." B. "When I open my front door, I will ask for identification if the person is someone I do not know." C. "I should store my purchases in the back seat when I am out shopping." D. "I should remove the identification tag that is on my key ring."

D. "I should remove the identification tag that is on my key ring." The nurse should inform the clients to remove any identification tag on their key ring. If keys are lost along with identifying information, then the client is left vulnerable to home invasions.

A community health nurse is working in a mobile health care clinic. Which of the following clients should the nurse assess first? A. A client who has a superficial partial-thickness burn to the hand B. A client who has a temperature of 38.3° C (101° F) C. A client who has COPD and an oxygen saturation of 90%

D. A client who has a new onset of confusion and slurred speech When using the urgent vs. nonurgent approach to client care, the nurse should determine that acute changes in mental status and speech might indicate the client is experiencing a neurological problem that requires immediate intervention. Therefore, the nurse should assess this client first.

A school nurse is discussing levels of prevention with a teacher. Which of the following activities should the nurse identify as a primary prevention strategy? A. Provide nutritional counseling for students who have diabetes. B. Report suspected child neglect to the proper authorities. C. Conduct vision and hearing screening for kindergarten enrollment. D. Demonstrate proper handwashing techniques.

D. Demonstrate proper handwashing techniques. This is an example of primary prevention, the goal of which is to promote health and prevent diseases from developing.

A public health nurse is planning a community health promotion program for hypertension prevention. Which of the following interventions should the nurse include as a tertiary prevention strategy? A. Provide education about risk factors for hypertension. B. Conduct a hypertension screening clinic for the community. C. Teach clients who have a family history of hypertension how to monitor blood pressure. D. Implement an exercise program for clients who have hypertension.

D. Implement an exercise program for clients who have hypertension. The nurse should implement tertiary prevention strategies for clients who have hypertension to promote the highest level of functioning possible, which can include regular exercise to maintain an active lifestyle.

Community leaders have requested a meeting with a community health nurse to discuss creating a mobile meals program. Which of the following information should the community health nurse assess first? A. The leadership support of the community B. The accessibility of residences C. The availability of volunteers D. The need for the program

D. The need for the program When using the nursing process, the nurse should first assess the need for the mobile meals program. This action allows the nurse to collect data on the client, which is the community, and meets the first step of program planning. The needs of the community will determine all other steps of the planning process.

A community health nurse is working to meet the health care needs of residents in a rural community. Which of the following characteristics should the nurse identify as a barrier to health care resources for this population? A. Less autonomy in providing client care B. Disinterest by members of the population in providing input for community health programs C. Lack of cohesiveness among community members D. Unavailability of outreach services

D. Unavailability of outreach services Lack of availability of outreach services is a barrier to health care for residents in rural areas.

A nurse is preparing to administer medication to a client who has active tuberculosis. Which of the following precautionary measures should the nurse take? A. Wear gloves. B. Wear protective eyewear. C. Use disposable equipment. D. Use an N95 respirator.

D. Use an N95 respirator. A client who has active tuberculosis requires airborne precautions to prevent the spread of droplet nuclei smaller than 5 microns. The nurse should wear an N95 respirator when administering medication to prevent transmission of the infection.

A nurse is preparing a community education program about health care needs during pregnancy. The nurse should include that which of the following vaccines is safe to administer to a client who is pregnant? A. Herpes zoster B. Tetanus, diphtheria, pertussis (Tdap) C. Varicella D. Measles, mumps, and rubella

B. Tetanus, diphtheria, pertussis (Tdap) The nurse should include that a client who is pregnant should receive the Tdap vaccine between 27 and 36 weeks of gestation.

A case manager at a home health agency is obtaining equipment for a client's home use. Which of the following actions is a violation of client confidentiality? A. The case manager used a computer at the agency with an automatic sign-off mechanism. B. The case manager left a clipboard with the client's prescription information face up on the office desk. C. The case manager sent a fax to the equipment company on a machine using programmed speed dial. D. The case manager shared the client's name with the equipment company.

B. The case manager left a clipboard with the client's prescription information face up on the office desk. When using a clipboard, the case manager should place the clipboard on the desk face down so that a client's personal health information is not visible to other individuals.

A community health nurse is teaching a client who is overweight about steps to take to begin an exercise program. The nurse should identify that which of the following statements is an indication that the client understands the teaching? A. "I will need to purchase exercise equipment before I can start." B. "I should try to perform aerobic exercise for an hour a day, 5 days a week." D. "I should avoid participating in weight-lifting exercises."

C. "I will see my doctor before beginning an exercise program." The client should see their provider before beginning an exercise program. The client should receive a complete physical exam and obtain approval for exercise.

A nurse is preparing an educational program about influenza for a group of community health nurses. Which of the following activities should the nurse include as an example of tertiary prevention? A. Offer classes to elementary school teachers about handwashing. B. Provide information to occupational nurses about the reasons for employees to not come to work. C. Administer antiviral medications within 48 hr to clients who have manifestations of influenza. D. Provide immunizations at long-term care facilities.

C. Administer antiviral medications within 48 hr to clients who have manifestations of influenza. Tertiary prevention involves ways to reduce the complications of illness, which includes administering antiviral medications to clients who already have influenza.

A nurse is assessing a new client at a public health clinic. Which of the following areas should the nurse address as part of the cultural assessment? A. Immunization status B. Sexual activity C. Illness practices D. Food allergies

C. Illness practices A cultural assessment focuses on beliefs, values, meanings, and behavior of people within a client's cultural, ethnic, or religious group. This includes culturally-based practices that relate to health and illness.

A community health nurse is conducting a needs assessment of a community. The nurse should identify that which of the following methods will yield direct data? A. Health surveys B. Medical records C. Informant interviews D. Morbidity/mortality statistics

C. Informant interviews The nurse should identify that informant interviews with community members or leaders will provide direct data. This information can help the nurse identify services needed by the community.

A nurse in a community center is preparing to administer a tuberculin skin test to multiple clients to screen for tuberculosis. Which of the following actions should the nurse take? A. Prepare the outer aspect of the upper arm for the injection. B. Insert the needle at a 45° angle. C. Inject 0.1 mL of purified protein derivative. D. Create a wheal that measures about 15 mm in diameter.

C. Inject 0.1 mL of purified protein derivative. The nurse should inject 0.1 mL of purified protein derivative to form the wheal.

A school nurse is serving on a community disaster planning committee looking at school shooting scenarios. Which of the following actions should the nurse plan to take during the response phase? A. Conduct ongoing assessments to identify potential hazards. B. Provide disaster training to school personnel. D. Serve as a liaison between available community resources and those in need.

C. Perform triage and provide hands-on care as needed to victims. During the response phase of disaster planning, the school nurse's role can include triage, providing hands-on care, coordinating the first-aid response team, and serving as a counselor to those in need.

A public health nurse is working in a community that has a population of 24,096. There are 2,096 existing cases of heart disease within the population. The nurse can determine which of the following from this information? A. Mortality rate B. Attack rate C. Prevalence proportion D. Incidence proportion

C. Prevalence proportion The prevalence proportion can be calculated by using the number of people who were affected at a given time and the total population.