Chapter 4 pt. 2

A new graduate nurse asks a nurse manager working at the community health center, "I've heard people talk about community health nursing and community-based nursing. Is there a difference?" Which response by the nurse manager would be appropriate?

"Community health nursing involves care for entire populations whereas community-based nursing focuses on individuals and families in that population." explaination In contrast to community health nursing, which focuses on whole populations within a community, community-based nursing is centered on the health care needs of individuals and families. Nurses practicing community-based nursing provide interventions to manage acute or chronic health problems, promote health, and facilitate self-care. Nursing care provided within a community must be culturally competent and family centered.

A client with persistent nausea is diagnosed with somatization. What is the appropriate nursing action when the client reports nausea?

sit with the client and ask them about their feelings explaination Somatization is manifesting an emotional stress through a physical disorder. Treating the nausea with an antiemetic will not get at the root cause of the emotional issue. Contacting the primary care provider is not appropriate, as the diagnosis of somatization is present. Explaining that the physical symptoms are all in the client's head is not therapeutic. Sitting with the client to explore what is really going on is most appropriate nursing response.

A nurse is assessing a family and identifying where the family is in the family life cycle. During this assessment, the nurse applies Duvall's theory. Which theory forms the basis for Duvall's theory?

Erikson's theory of psychosocial development explaination Duvall (1985) identified critical family developmental tasks and stages in a family life cycle. Duvall's theory, based on Erikson's theory of psychosocial development, states that all families have certain basic tasks for survival and continuity, as well as specific tasks related to developmental stages throughout the life of the family. Freud, Kohlberg, and Piaget are not associated with Duvall's theory.

A young couple who have been married less than a year are having difficulty with adjusting to parenting. What is a contributing factor to this level of maladjustment?

Limited time in learning to be a marital partner explaination Tasks that the family does not complete at any one developmental stage can produce chronic difficulties as the family struggles to master tasks at the next stage. The couple is struggling due to them only being together married for less than a year and the difficulty of a having a child in this short time frame. Nothing in the stem alludes to the couple having issues with the stress of education, job, and parenting nor economic difficulties or involvement with significant others.

A nurse is providing care for client who experienced a stroke. Which nursing intervention reflects the tertiary level of prevention?

provide care transition at discharge for speech therapy explaination Tertiary prevention minimizes the consequences of a disorder through aggressive rehabilitation or appropriate management of the disease. An example is speech therapy to help restore ability. Blood pressure and mental status exams are examples of secondary prevention associated with the acute stroke. Discussing family history is also secondary prevention in terms of assessing for further risk factors.

A nurse working with patients in a community is aware that which is a true statement related to environmental factors in that community?

Barriers to accessing health care within a community may include lack of transportation. explaination Environmental barriers to accessing health care within a community include lack of transportation, distance to services, and location of services. Lack of health care insurance is an economic barrier to service, not an environmental barrier. The quality of air and water differ across communities and are not the same. Environmental factors not only focus on the harmful effects on health, but also include the beneficial effects on health.

A nurse is working at a community clinic that serves mostly families with young children. What would be a priority intervention for clients in this developmental stage?

Setting up parenting classes explaination Duvall (1977) identified critical family developmental tasks and stages in a family life cycle. Duvall's theory, based on Erikson's theory of psychosocial development, states that all families have certain basic tasks for survival and continuity as well as specific tasks related to developmental stages throughout the life of the family. The question asks about a community clinic that serves mostly families with young children and the priority intervention for clients in this developmental stage. Setting up parenting classes is the only answer that addresses the stated developmental stage. Families with adolescents and young adults would be at the appropriate developmental stage for providing sex education and alcohol/drug information. The community clinic would not focus on screening for congenital defects.

A family assessment of a father, mother, and four children has suggested the presence of several risk factors. Which aspect of the family's structure and function would be considered a psychosocial risk factor?

The parents have a tumultuous relationship, with frequent separations in the past. explaination Conflict is an example of a psychosocial risk factor. Chemical dependency is considered a lifestyle risk factor, whereas a lack of adequate housing is an environmental risk factor. Lack of electricity is an economic risk factor.

Which statement is true regarding Friedman's theory of family-centered nursing care?

The role of the family is essential in every level of nursing practice. explaination Friedman and associates identified the importance of family-centered nursing care, based on four rationales. First, the family is composed of interdependent members who affect one another. If some form of illness occurs in one member, all other members become part of the illness. Second, a strong relationship exists between the family and the health status of its members; therefore, the role of the family is essential in every level of nursing care. The third rationale is that the level of health of the family and, in turn, each member can be significantly improved through health-promotion activities. Finally, illness of one family member may suggest the possibility of the same problem in other members; through assessment and intervention, the nurse can assist in improving the health status of all members.

After assessing a group of clients, the nurse identifies issues related to unmet self-esteem needs. The nurse focuses interventions to meet this need for which client? Select all that apply.

Client who has undergone a below-the-knee amputation Client who has facial scarring resulting from a significant burn injury Client who no longer can work secondary to a brain injury explaination Self-esteem needs include the need for a person to feel good about himself or herself, to feel pride and a sense of accomplishment, and to believe that others also respect and appreciate those accomplishments. When a person's role changes, such as being unable to work secondary to a brain injury, self-esteem can be seriously altered because the person's responsibilities and relationships also change. A change in body image, such as a below-the-knee amputation or facial scarring from a burn injury, may also affect self-esteem. Fear about surgery or worry about the future reflect safety and security needs.

A client says, "I live in a small community on the northwest side of the city." Why does the nurse consider it significant that the client reports living in a community rather than a neighborhood?

Community indicates people who share similar characteristics. explaination Communities are thought to contain persons who share similar characteristics, whether it be social interaction, cultural or ethnic ties, or geographic area. Communities may be larger or smaller that a geographic neighborhood and are not defined by geography. Communities exist because they meet basic human needs.

A community-based nurse acts as a case manager for a small town about 60 miles from a major healthcare center. What is the most important factor of community-based nursing for this nurse to be knowledgeable about?

Community resources available to clients explaination A community-based nurse must be knowledgeable about community resources available to clients as well as services provided by local agencies, eligibility requirements, and any possible charges for the services. The other answers are incorrect because they are not the most important factor for a community-based nurse to be knowledgeable about.

Place the following examples of interventions to meet human needs in order from the most basic, highe- priority needs to the lower-priority needs based on Maslow's hierarchy.

A nurse provides nutrition for a client through a feeding tube. A nurse places a No Smoking sign on the door of a client who is receiving oxygen. A nurse includes family members in the care of a client. A nurse helps a client focus on the client's strengths following a diagnosis of breast cancer. A nurse prepares a room for a clerical visit requested by a client. explaination Maslow's hierarchy provides a framework for nursing assessment and for understanding the needs of clients at all levels, so that interventions to meet priority needs become a part of the plan of care. A nurse would first prioritize the nutritional needs of the client. This is Level 1, physiological needs. The next task to be prioritized would be placing a No Smoking sign on the door of a client who is receiving oxygen. This is Level 2, safety and security needs. The next task would be including family members in the care of the client. This is Level 3, love and belonging needs. The next task would be helping a client focus on the client's strengths following a diagnosis of breast cancer. This is Level 4, self-esteem needs. The last task would be preparing a room for a clerical visit requested by the client. This is Level 5, self-actualization needs