Community Final
spectrum of prevention
offers a systemic framework for development effective and sustainable primary prevention programs
terrorism
one way in which a small number of people who perceive that they have been unfairly treated can exert influence in a larger group or nation; defined by the US FBI as international terrorism, domestic, and the federal crime of terrorism
chemical warfare
use of chemicals such as explosives, nerve agents, blister agents, choking agents, etc.
A
A charge nurse is discussing the phases of community response to disaster with nursing staff. Which of the following statements indicates an understanding of the heroic phase of disaster response? A. "Personnel are willing to work in dangerous conditions to provide assistance." B. "Survivors come together and share stories of survival." C. "Responders experience exhaustion due to extended relief efforts." D. "Normalcy begins to return to the community."
D
A charge nurse is making a room assignment for a client who has scabies. In which of the following rooms should the nurse place the client? A. A negative-pressure isolation room B. A semi-private room with a client who has pediculosis capitis C. A positive-pressure isolation room D. A private room
A
A community health nurse in a pediatric clinic is reviewing the history of a 12-year-old client. Which of the following immunizations should the nurse expect to administer? A. Meningococcal conjugate B. Herpes zoster C. Rotavirus D. Pneumococcal polysaccharide
C
A community health nurse is conducting an educational program on various environmental pollutants. The nurse should emphasize that clients who have which of the following disorders are especially vulnerable to ozone effects? A. Osteoarthritis B. Basal cell carcinoma C. Asthma D. Hypothyroidism
B
A is nurse assisting with field triage following a motor-vehicle crash involving a bus with multiple victims. The nurse assesses a child who has an open fracture of the femur. Which of the following actions should the nurse take? A. Locate the child's parents to obtain consent for treatment. B. Place a yellow triage tag on the child. C. Notify the emergency department of the child's imminent arrival. D. Perform a complete head-to-toe assessment.
C
A nurse is among the first responders to a mass-casualty incident and does not know what type of personal protective equipment (PPE) is needed. Which of the following actions should the nurse take? A. Wait until the type of equipment needed is known. B. Decontaminate victims before intervening. C. Choose the highest level of protection equipment available. D. Use a dosimeter to measure the level of radiation in the area before intervening.
B
A nurse is assisting with triaging clients following an explosion. Which of the following clients should the nurse identify as the highest priority? A. An unconscious adult client who has a large head wound with gray matter exposed; absent respirations B. A conscious adult client who has second-degree burns on both lower legs; respiratory rate is > 30/min C. An unconscious 6-month-old infant with no respirations; no visible injuries D. A conscious adult client wearing a medic-alert diabetic bracelet; client reports feeling clammy and shaky.
A
A nurse is caring for a client who suspects recent exposure to inhalation anthrax. Which of the following findings indicate possible exposure? A. Flu-like symptoms B. Sloughing of skin C. Vesicles on the skin D. Respiratory failure
B,C,D,E
A nurse is educating community members about how to prepare for a disaster. Which of the following supplies should the nurse instruct the clients to include in a disaster preparedness kit? (Select all that apply.) A. Three quarts of water per person B. Clean clothing C. Personal identification D. Matches E. Prescription medications
B
A nurse is establishing health promotion goals for a female client who smokes cigarettes, has hypertension, and has a BMI of 26. Which of the following goals should the nurse include? A. The client will list foods that are high in calcium, which should be avoided. B. The client will walk for 30 min 5 days a week. C. The client will increase calorie intake by 200 cal per day. D. The client will replace cigarettes with smokeless tobacco products.
C
A nurse is helping to triage a group of clients at a mass casualty incident who were involved in an explosion at a local factory. Which of the following clients should the nurse tag to be the priority for care? A. A client who has severe head injuries, respiratory rate 6/min, and is unresponsive B. A client who has a simple fracture of the femur, multiple scratches on both legs, and is crying hysterically C. A client who has a piece of wood punctured into the chest wall and has an audible hissing sound coming from the wound site D. A female who is pregnant at 20 weeks of gestation, has multiple cuts and abrasions, and is walking around
D
A nurse is leading a therapeutic group for clients at an outpatient mental health clinic. Which of the following client statements indicates a problem with role transition? A. "If my husband had gone to the doctor like I told him to, he'd be alive today." B. "I am so angry with my husband's attitude. He thinks he knows everything!" C. "I want to have an intimate relationship, but I end up breaking off relationships as soon as they begin." D. "I just can't seem to find any energy to take care of my children since my husband divorced me."
C
A nurse is participating in a biological disaster simulation where citizens are exposed to pneumonic plague. Which of the following isolation precautions should the nurse plan to use while caring for these clients? A. Airborne B. Contact C. Droplet D. Protective
A
A nurse is performing triage for a group of clients following a mass casualty incident (MCI). Which of the following clients should the nurse plan to care for first? A. A client experiencing a tension pneumothorax B. A client who has a closed upper extremity fracture C. A client who has full-thickness burns over 80% of his body D. A client who has agonal respirations
B,C,E
A nurse is planning a staff education session regarding biological weapons of mass destruction. Which of the following should he plan to include in the session? (Select all that apply.) A. Sarin B. Smallpox C. Anthrax D. Hydrogen cyanide E. Botulism
D
A nurse is preparing a community health program for adults at risk for cardiovascular disease. Which of the following should the nurse include as a modifiable risk factor? A. Diagnosis of diabetes mellitus B. Family history of cardiac disease C. Increasing age D. Cigarette smoking
A,D
A nurse is preparing a response protocol for botulism as a bioterrorism agent. The nurse should prepare the protocol based on which of the following information? (Select all that apply.) A. Botulism can produce paralysis within 12 to 72 hr following exposure. B. Notify the Centers for Disease Control and Prevention (CDC) when more than three cases are confirmed. C. Botulism is acquired through direct contact with an infected person. D. Vomiting and diarrhea are expected findings following exposure. E. Botulism is a toxin found in castor beans.
D
A nurse is preparing to administer ciprofloxacin to a client. The nurse should identify that the medication is treatment for exposure to which of the following agents? A. Smallpox B. Sarin gas C. Ebola virus D. Anthrax
A,D,E
A nurse is providing staff education about smallpox as a bioterrorism threat. Which of the following statements indicates an understanding of this agent? (Select all that apply.) A. "Smallpox is transmitted person to person." B. "Infection is characterized by severe respiratory distress." C. "Smallpox vaccination ensures lifelong immunity." D. "Naturally occurring smallpox has been eradicated from the world." E. "Smallpox is often confused with varicella."
A
A nurse is reinforcing teaching with a group of adolescent females who are pregnant about expected changes related to pregnancy. Which of the following client statements indicates understanding of the teaching? A. "It is normal to have a white vaginal discharge." B. "I should recognize fetal movement by 12 weeks." C. "I will take fluid pills if my ankles begin to swell." D. "My nipples and areolae will become pale as my breasts enlarge."
A
A nurse is reviewing the guidelines for reporting nationally notifiable infectious diseases. Which of the following diseases should the nurse plan to report to the Centers for Disease Control and Prevention (CDC)? A. Lyme disease B. Cytomegalovirus C. Streptococcus pharyngitis D. Toxoplasmosis
D
A nurse is reviewing treatment protocols for clients exposed to bioterrorism agents. For which of the following agents should the nurse plan to administer a vaccine following exposure? A. Anthrax B. Botulism C. Plague D. Smallpox
B
A nurse is the triage officer in the emergency department when four clients arrive following a factory explosion. Which of the following clients should the nurse care for first? A. A conscious adult client who reports shortness of breath, has a respiratory rate of 24/min, and capillary refill of < 2 seconds B. An unconscious adult client who has a sucking chest wound, respirations of 38/min, and capillary refill of < 2 seconds C. A conscious adult client who has a dislocated right shoulder, respiratory rate of 18/min, and capillary refill of < 2 seconds D. An unconscious adult client who has no respirations, capillary refill is > 2 seconds, and paramedics have already tried to reposition airway without results
A
A nurse is triaging clients injured during a tornado. The nurse assesses a client who has an open fracture of his arm. Which of the following actions should the nurse take? A. Place a yellow tag on the client's upper body. B. Place a red tag on the client's upper body. C. Perform a rapid head-to-toe assessment. D. Have the client's wife drive him to the hospital.
C
A nurse is triaging victims of a multiple motor-vehicle crash. The nurse assesses a client trapped under a car who is apneic and has a weak pulse at 120/min. After repositioning his upper airway, the client remains apneic. Which of the following actions should the nurse take? A. Start CPR. B. Place a red tag on the client's upper body and obtain immediate help from other personnel. C. Place a black tag on the client's upper body and attempt to help the next client in need. D. Reposition the client's upper airway a second time before assessing his respirations.
C
A nurse is working with an emergency response team in caring for a group of people who may have been exposed to anthrax while doing farm work, but are not exhibiting manifestation of illness. Which of the following is the appropriate action for the nurse to take? A. Place the clients in isolation. B. Initiate client decontamination. C. Administer antibiotic therapy. D. Treat clients with an antitoxin.
A
A nurse is working with an interdisciplinary disaster committee to develop a community-wide emergency response plan in the event of a nonbiological or chemical incident. The nurse should include which of the following agencies to be notified immediately after calling 911? A. Office of Emergency Management (OEM) B. Federal Emergency Management Agency (FEMA) C. American Red Cross (ARC) D. U.S. Department of Homeland Security (DHS)
D
A nurse working for a home health agency is assessing an older adult male client. Which of the following findings is the priority for the nurse to address? A. Swollen gums B. Pruritus C. Urinary hesitancy D. Dysphagia
D
A public health nurse is teaching a group of nurses about smallpox. Which of the following statements by one of the nurses indicates understanding of the teaching? A. "There are rare, occasional occurrences of smallpox." B. "Vaccination against smallpox provides lifelong immunity." C. "Smallpox lesions appear in various stages of healing." D. "Unlike chickenpox, the vesicles of smallpox are more abundant on the face."
C
A school nurse is teaching a group of nurses newly hired to work in the school system about pediculosis capitis (head lice). Which of the following information is appropriate to include in the teaching? A. Family pets can contribute to the transmission of lice. B. Children from lower socioeconomic areas are more likely to have lice. C. Nits that are shed into the environment are capable of hatching for up to 10 days. D. Infestation often appears as grayish brown, threadlike burrows along the skin behind the ears.
A
A school nurse receives a call that some children and teachers report being exposed to an undetermined noxious gas odor presenting in the classrooms and are experiencing dizziness. Which of the following actions should the nurse take? A. Have students evacuated from the school and establish a triage area in the school parking lot. B. Move individuals who are reporting symptoms to one of the affected classrooms and create a triage area inside the room. C. Arrange for client transportation to the nearest emergency department and tell the group triage will occur there. D. Transport all children and school personnel to the nearest medical facility using school buses.
C
An occupational health nurse in the clinic of an industrial plant is developing a guidebook for clinic workers. Which of the following actions should the nurse include as a secondary prevention strategy? A. Teach plant workers about proper lifting techniques. B. Set up an influenza immunization campaign. C. Help plant workers identify signs of carpal tunnel syndrome. D. Collaborate with physical therapists to develop programs for injured employees to return to work.
B
An older adult client who lives alone tells a clinic nurse that he is unable to drive himself to the store and is afraid to cook on the stove. Which of the following community resources should the nurse recommend for this client? A. Hospice care B. Meals on Wheels C. A rehabilitation facility D. Temporary Assistance for Needy Families (TANF)
obesity
BMI of 30 or higher; 34.9% of adults; men>women
secondary prevention
Early diagnosis and prompt treatment before disease becomes advanced and disability severe
new and reemerging diseases
H1N1, Ebola, Zika, West Nile
mandated reporters
People who have responsibility for the welfare of children, such as nurses, doctors, teachers, counselors, and certain other professionals; required by law to report suspected cases of neglect, abuse, etc
federally qualified health centers
Provide care to underserved populations through Medicare, Medicaid, or a sliding fee scale
antibiotic-resistant strains
TB, MRSA, HIV
role of the public health nurse
a nurse who works to promote and protect the health of an entire population
safety-net healthcare provider
a provider that by mandate or mission organizes and delivers a significant level of health care and other health-related services to the uninsured, medicaid, and other vulnerable populations
planned change
a purposeful, designed effort to effect improvement in a system with the assistance of a change agent; 8 steps: recognize symptoms, diagnose need, analyze alternative solutions, select a change, plan the change, implement change, evaluate change, stabilize change
quality indicators
of client outcomes are the quantitative measures of a client's response to care; they are worthwhile processes that enable the nursing staff to evaluate the results of the care they provide
tertiary prevention
actions taken to contain damage once a disease or disability has progressed beyond its early stages; rehabilitation and primary prevention (health promotion, education, health protection)
windshield survey
activity often used by nursing studetns in public health courses and by new staff members in community health; become familiar with town
bioterrorism
anthrax, smallpox, plague, botulism, Ebola
health promotion
behavior motivated by the desire to increase well-being and actualize human health potential; it's a priority in community health nursing practice; there are three strategies: enable, mediate, and advocate
bulimia nervosa
binge eating and self-induced vomiting or diarrhea, laxatives or diuretics, exercise, dieting, fasting, concern about body shape; low self-esteem, not being in control
vector-borne pathogens
dengue fever
primary prevention
health promotion and education, health protection; used for those with risk factors for disease
plague
hemoptysis
child abuse
serious physical or emotional harm, sexual abuse or exploitation; an act or failure to act which presents an imminent risk of serious harm; maltreatment to a child either physical, emotional, general neglect, medical neglect, physical punishment, battering
child factors
younger age, female, race/ethnicity, perceived problems (behavior/disability), puts at risk for abuse
outcome criteria
measurable standards that community members use to measure success as they work toward improving the health of their community
oral rehydration therapy
the use of oral rehydration salts are used to prevent or correct dehydration (not to treat the source of the diarrheal illness)
child maltreatment
child abuse; shaken baby syndrome; failure to thrive
disability adjusted life year
combination of years of life lost because of premature mortality and years of life lived with disability adjusted for the severity of the disability
herd immunity
community immunity; immunity level present in a particular community; indirect protection for those who haven't been vaccinated; infants, immunosuppressed, allergic to vaccine, organ transplants
eating disorders
complex, chronic illnesses primarily affecting young women; cause is not clear; anorexia nervosa, bulimia nervosa, binge eating
palliative care
consists of comfort and symptom management and does not provide a cure; includes emotional symptoms
tuleremia
cough not bloody
biological warfare
using biological agents to cause multiple illnesses and death (anthrax, botulinum, bubonic plague, ebola, smallpox)
anorexia nervosa
weight loss, emaciation, body image disturbance, fear of gaining weight; teen onset, women > men, electrolyte imbalance, anemia, cardiac arrhythmias
community health worker
when professional health providers are scarce, the community identifies a local respected, responsible person; serves the people in large health matters; provides 1 to 2 hours of health service per day, may or may not be compensated; trained to promote health and prevent common illnesses
collaborator
working jointly with others in a common endeavor; cooperating as partners
global burden of disease
world health organization coined this term to discuss concerns about cost of healthcare, it studies the numerically verified numerous long-held assumptions about disparities in the burden of disease worldwide, esp with children
radiation
bloody diarrhea
health disparities
are a serious concern for overall health in the US and globally; environmental factors are basic determinants of health and well-being
parental behavior
external locus of control, poor self-esteem, poor impulse control, and antisocial (leads to child maltreatment)
environment
loneliness, lack of social support, isolation (puts at risk for abuse)
active immunity
long term; resistance that can be acquired naturally or artificially (host infection or vaccine)
aggregate
mass or grouping of distinct individuals who are considered as a whole and who are loosely associated with each other
jakarti declaration
this was the first health promotion conference held in a developing country (jakarta, indonesia) participants acknowledged "health is a basic right and is essential for social and economic development"
the us public health service corp
6500 specially trained public health members who serve US with goal of protecting and promoting the health of US; nurses focus on providing care, conducting research, or reviewing new medications; can be deployed to protect nation
A
A charge nurse is discussing staff nurses' responsibilities in preplanning for response to a disaster. Which of the following responsibilities should the nurse include in the discussion? A. Identify community resources that are available. B. Evaluate the impact of a disaster on the community. C. Assess survivors of a disaster for levels of psychological stress. D. Link victims with support agencies to help with food, clothing, shelter, and counseling needs.
D
A community health nurse is developing a pamphlet about breast self-examination (BSE) for a local health fair. Which of the following instructions should the nurse include? A. Expect some breast dimpling or discharge with age. B. For those who have a menstrual cycle, perform a BSE every month, 2 or 3 days before menstruation. C. Using the palm of the hand, feel for lumps using a circular motion. D. Breasts can be examined in the shower with soapy hands
A,B,D,E
A community health nurse is providing a community education program about disaster preparedness. Which of the following should the nurse recommend that clients include in their family's disaster readiness supply kit or "go bag"? (Select all that apply.) A. Pencil and paper B. Whistle C. Antibiotics D. Copies of insurance cards E. Household bleach
A
A community health nurse is reviewing the levels of disease prevention. Which of the following activities is an example of tertiary prevention? A. Providing treatment for clients who have chronic obstructive pulmonary disease B. Performing screening for sexually transmitted infections C. Administering influenza immunizations at a local health fair D. Testing new nurses for exposure to tuberculosis.
B
A nurse is preparing to care for a client who has suspected exposure to plague as a result of bioterrorism. Which of the following actions should the nurse plan to take first? A. Prepare for drainage of lesions. B. Initiate contact precautions. C. Notify the Centers for Disease Control and Prevention (CDC). D. Decontaminate the client.
B
A public health nurse is assessing an older adult client who lives with a family member. The nurse identifies several bruises in various stages of healing. The client and family member explain that the bruises are a result of clumsiness. However, based on the distribution of the bruises, the nurse suspects abuse. Which of the following actions should the nurse take first? A. Document the bruises in the client's chart. B. Report the findings to a supervisor. C. Provide the client with a crisis hotline number. D. Discuss respite care with the client's family.
family characteristics
disorganized, violence and marital conflict, financial problems, social isolation (leads to abuse)
substance related disorders
encompasses 10 separate classes of drugs; all that are taken in excess have in common direct activation of the brain reward system, which is involved in the reinforcement of behaviors and the production of memories. Such intense activation of the reward system is produced that normal everyday activities can sometimes be neglected.
direct transmission
immediate transfer of infectious agents from a reservoir to a new susceptible host; direct contact with source (biting, touching, intercourse, blood, secretions, coughing, sneezing); pertussis, measles
triple aim
improving population health, reducing healthcare costs, and providing improved patient outcomes
psychomotor domain
includes visible, demonstrable performance skills that require some kind of neuromuscular coordination; learn skills such as infant bathing, temperature taking, breast/testicular self exam, etc
indirect transmission
infectious agent is transported in contaminated materials; fomites (toys, tissue) vectors (animals, insects) food and water
nuclear warfare
involves the use of nuclear devices as weapons and can take several forms
americans with disabilities act
legal protection for peoples with disabilities who suffer with discrimination; signed into law in 1990
continuum of care
model where programs are developed to assist persons to transition from emergency to transitional to permanent housing; emergency shelters provide temporary overnight shelter, whereas transitional housing provides up to 24 months
health literacy
motivation and ability (cognitive and social skills) to obtain, process, and understand basic health information and services needed to make appropriate health decisions
advocate
pleading the client's cause or acting on their behalf
fetal alcohol syndrome
pre and post natal birth deficits (less than 10th percentile); facial dysmorphology (thin upper lip, short palpebral fissures, smooth philtrum), CNS dysfunction: small size, facial abnormalities, poor coordination, hyperactivity, difficulty in school (math)
enabling factors
promote or facilitate the behavior based upon availability (of resources); the accessibility of resources, laws, and government support for the health behaviors or for the health program as well as skills
reinforcing factors
provide a continued motivation to repeat or persist in the behavior; the knowledge, values, beliefs, and attitudes of the family and friends of the target population; it also includes authority figures such as teachers or managers, as well as agency and community decision-makers, as these individuals also influence the target population
school based health centers
provide ready access to health care for large numbers of children and adolescents during school hours, reducing absences from school due to health care appointments; provide a variety of services in a user-friendly manner at a convenient location; school nurses influence children's health, but often still need to refer them to PCP
predisposing factors
provide the rationale or motivation for subsequent behavior; include the knowledge, beliefs, values, attitudes, and confidence of the target population that influence their behavioral choices
palliative intervention
relieve suffering without curing underlying disease
binge eating
repeated episodes of uncontrolled eating; eat quickly; eat large amounts alone; difficulty expressing feelings, controlling impulses, feels depressed about overeating
passive immunity
short-term resistance; passed mother to newborn; immunoglobulin
nightingale
standard for proper education and supervision of nurses in practice
empathy
the ability to communicate understanding and to vicariously experience the feelings and thoughts of others (put in client's shoes)
elder abuse
the mistreatment and exploitation of older adults; may involve neglect, physical, sexual, emotional, or financial; financial is most common
community based nursing
the prototype of CBN can be seen within the historical development of home care nursing (reduce suffering and promote healing)
vulnerability
the social determinants of health can define a person's ________ including where they were born, age, ethnicity, and social class; barriers can make a person _____; these include employment, housing, food instability, education, discrimination, incarceration, health literacy, environment, and access to healthcare
potential inappropriate meds
those that senior citizens should avoid due to either their ineffectiveness or because the potential adverse effects overshadow the proposed benefits; they also should be avoided if other safe drugs are available
shelter in place
used as an alternative to evacuation; people may be asked to remain indoors in homes, businesses, schools, or public buildings; plan on having 72 hours worth of necessities
benchmarking
uses continuous, collaborative, and systemic processes for measuring and examining internal programs strengths and weaknesses; includes studying another's processes in order to improve one's own; comparing outcomes to other's
