Community Health Ch 11-15

The client is diagnosed with Lyme disease. He states that he is not a hiker and does not remember being bitten by a tick. As part of the education plan, the nurse should state:

"A history of a tick bite is not required."

The home care agency has just received a client referral from a physician and assigned the case. Within how many hours from receiving the referral should the nurse plan to make the initial visit to this client, on the basis of typical agency policy?

24 hours

A man who lives in a homeless shelter is diagnosed with active tuberculosis (TB). The shelter keeps a list of those who are assigned beds, and the majority of those sleeping there are regulars. Which finding would indicate a positive tuberculin skin test result using a two-step process?

6-mm induration

The client wants to know how long Medicare will pay for skilled needs. How long can the nurse continue to provide this care before she must seek a renewal if skilled needs continue to exist?

60 days

A client reports symptoms of severe abdominal cramps, bloody diarrhea, and vomiting after eating commercially packaged salad. The nurse suspects Escherichia coli O157:H7. The client asks about the average time of resolution of these symptoms. What time frame should the nurse provide?

7 to 10 days

The nurse is responsible for the directly observed therapy (DOT) program in the community. Which represent the best methods to ensure compliance with clients' drug regimens? (Select all that apply.)

A) Social service support B) Housing assistance E) Treatment enablers

Which environmental factors are likely to affect the life cycle of disease pathogens and their vectors and thus disease outbreaks? (Select all that apply.)

A) Temperature C) Precipitation D) Humidity

The case manager works with a 10-year-old girl who has asthma. Because the client's family has trouble affording inhalers, the case manager researches client assistance programs through which they could receive free medications. This aspect of case management is known as:

Advocacy

In infectious disease epidemiology, just the presence of an infectious agent is not sufficient to produce an infectious disease. Which host factors determine whether a person is at risk for an infection or an infectious disease? (Select all that apply.)

Age Sex Physical and emotional health Immune status

The nurse admits a client to the hospital with the diagnosis of Escherichia coli O157:H7. The client is dehydrated and febrile. During the history phase of the admission, the client states that he doesn't know how he could have gotten sick at the local county fair—the hamburger he bought was well done. Upon further discussion, the nurse suspects the transmission may have occurred because of:

Animals roaming in the fair grounds

International health experts indicate that the avian flu is the virus most likely to cause the next pandemic. What may improve its transmissibility to the public?

Antigenic shift

In comparison with other generations, members of generation X:

Are likely to multitask and have more than one career in their lifetimes

Following a hurricane, the disaster team chooses to use a collaborative model to assess the needs of the community. Each team member is given a community analysis and assigned the task to create a tentative plan of action. Why would the use of a collaborative model hamper the progress of the assessment and plan in a disaster? (Select all that apply.)

Assessment is time-consuming. Approaches must be preestablished.

A client presents with severe diarrhea. The client tells the nurse that she went to a chicken roast at church the previous weekend. The nurse suspects a foodborne illness. Which cause of bacterial foodborne illness should the nurse most suspect in this case?

Campylobacter

Which agency has an electronic surveillance system for the early notification of community-based epidemics?

Department of Defense

A student is considering becoming a home health nurse. In researching this type of nursing, the student finds that several key factors have played a part in the development of home healthcare as it is today? These include: (Select all that apply.)

Development of health insurance Rising costs in healthcare Increase in medical and nursing specialization

Chloroquine-resistant malaria occurs in most of Africa, the Middle East, and Asia and all of the South Pacific islands. This type of disease occurrence is known as:

Endemic

The nurse works with 68-year-old client who is having great difficulty managing his blood glucose level. The nurse finds that the client is not following the diet that he had agreed to follow and is eating portions that are far too large. He apologizes and explains that he is grieving the loss of his wife, who died 2 weeks ago. The nurse shares condolences with him on his loss and explain that it is perfectly understandable to have trouble following a new diet while grieving. In this scenario, the nurse is using which principal approach in motivational interviewing?

Expressing empathy

Which exemplifies a nuclear family?

First-degree relatives who live together

Which type of assessment considers a configuration of behaviors that occur sequentially over time?

Functional health pattern

Infectious agents are biological agents capable of producing an infection or infectious disease. Which are considered biological agents? (Select all that apply.)

Fungi Bacteria Viruses Helminths

Person, place, and time characterize the description of an epidemiologic problem. Using knowledge of outbreak investigations, which occurs with propagated outbreaks?

Generating secondary infections with intervals between peaks that approximate the usual incubation period for the infection

Which are included in the five types of health risk factors that affect families? (Select all that apply.)

Genetics Age Personal health habits and lifestyle Environment

Which criteria must an individual meet to receive Medicare for home health services? (Select all that apply.)

Home bound Specific plan of care Skilled healthcare needs Intermittent care needs

What services is telehealth used to deliver? (Select all that apply.)

Home telenursing Electronic referrals to specialists in expert health facilities

Which type of agency can be either profit or nonprofit?

Hospital based

Community assessment is a critical process for the future because it can:

Identify a method to improve the health of at-risk clients

There are 12 students with confirmed cases of the H1N1 flu in grades 6 to 8 at the local middle school in the community. The community nurse advises the caregivers of the ill children to keep the children home for a minimum of 5 to 7 days. Which should be the nurse's next step?

Implement education in the school setting regarding respiratory and hand hygiene

The nurse provides care covered by Medicare for a client over 2 hours during the day, 3 days during the week, for 60 days. Which type of care is the nurse providing?

Intermittent

The nurse is approached by the health department to investigate and assess the rise in developmental disabilities in an isolated section in the community. To begin the assessment, the nurse should gather objective data from which source?

Internet—aggregate data

The nurse assesses a client in the local neighborhood clinic. He exhibits signs and symptoms of tuberculosis (TB) yet has a negative tuberculin skin test result. The nurse suspects that the physician may further test the client because he:

Is HIV positive

The home health nurse has to ensure that a safety plan is in place to address falls. Using knowledge that 55% of fall-related injuries occur with falls inside the home, a total of more than 60% of these falls occur in which two rooms?

Living room and bedroom

Which exemplifies cultural diversity?

People from South Korea, Brazil, and Nigeria all living in the same apartment complex

Which are among the key categories of indicators of health presented in Healthy People 2020? (Select all that apply.)

Physical activity Responsible sexual behavior Tobacco use

Several levels of public health surveillance are necessary to protect the nation's health. At what level are healthcare providers and health facilities required to report certain infectious diseases?

State

The new community health nurse introduces herself to the local minister and attends various neighborhood meetings. The nurse learns about the ethics, values, and culture of the neighborhood. The community is vocal about the need for public safety and the care of the homeless, especially in the winter. Which is the best rationale for considering all of the influences in the neighborhood affecting their health and well-being?

The information will help to effectively assess the community

Each employee in a small community hospital is informed that he or she needs a tuberculin skin test and of the date that the test is due. The kitchen employees tell the nurse that they don't need the test and never had to have it before. The nurse should respond with:

Tuberculosis guidelines require testing of an entire healthcare setting.

Which criteria must be met to define a water-associated disease outbreak?

Two or more people having experienced a similar illness after exposure to water

The nurse assesses a 77-year-old woman who has been caring for her husband who has Alzheimer disease in their home for the past 8 years. The client complains of exhaustion and depression. Which stressors should the nurse most suspect as the cause of this client's symptoms?

caregiver burden

The nurse is responsible for the construction of an isolation unit during an H5N1 outbreak. The unit is designated for only those clients with a confirmed diagnosis of H5N1. Which unit would be easily adapted to client needs?

12-room unit with negative air pressure units

A client arrives on the unit, diagnosed with norovirus infection from eating shellfish. The client has been vomiting repeatedly and is now severely dehydrated. Which interventions are likely to be performed for this client? (Select all that apply.)

A) Starting an intravenous line for fluid and electrolyte replacement B) Encouraging the client and the client's family to practice good handwashing C) Immediate disinfecting all potentially contaminated objects and surfaces

A client wants to know the best way to avoid sexually transmitted infections (STIs). The nurse should mention:

Abstinence

An 80-year-old client is being treated for chronic urinary tract infections. She has received multiple antibiotics in the past 6 months. The physician orders a urine culture. The results of the urine culture are as follows: Staphylococcus aureus >100,000 colonies and demonstrated resistance to sulfamethoxazole and trimethoprim (Bactrim), penicillin, methicillin, and erythromycin. The client is diagnosed with methicillin-resistant Staphylococcus aureus (MRSA) on the basis of the findings of her urine test. Based on the client's history, a cause of the MRSA might be microbial:

Adaptation

The nurse works with a female client who recently developed an infection of Staphylococcus aureus while in the hospital. In this case, S. aureus is which component in the chain of infection?

Agent

A client with tuberculosis sneezes in the waiting room and infects several other clients who are sitting on the other side of the room. Which mechanism of transmission is involved in this case?

Airborne

While completing a community assessment, the nurse notes that the computer companies in the community hire a disproportionate number of their employees from local suburban communities rather than the community in which the company is housed. To create an accurate assessment, the nurse should collect data on:

All of the company's employees and include those living outside the community as part of the aggregate

The nurse reviews the official document called the Scope and Standards of Home Health Nursing Practice. Using knowledge about the document providing guidelines for nurses involved in home healthcare practice, which are included in the standards of care? (Select all that apply.)

Assessment by collecting data about home care clients Diagnosis through the analysis of data Outcome identification that helps identify nurse-sensitive measures Planning nurse-sensitive interventions directed at the identified outcomes

The nurse discusses home care options with an 85-year-old client who recently fractured her humerus in a fall in her house. She is recovering well now but says the experience has made her see that it is time for her to change her living arrangements. The client can still bathe herself and cook meals on occasion but says she would like to live where nursing care is available onsite and where communal dining and recreation options are offered. Which of the following living arrangements could the nurse recommend?

Assisted living facility

A community care nurse at a healthcare agency assists in coordinating a plan for providing health services in the most cost-effective way possible to a large number of members living in the region. This work is known as:

Care management

The community health nurse works in a community recently devastated by a tornado. Many of the survivors are cared for in their homes. Care is needed for those who are ill, recovering, or in hospice. To provide the most holistic and effective care to the community, the nurse should:

Collaborate with other health care workers and the clients

Many in the community have developed cancer. The EPA has discovered a leak of biohazardous waste from a local factory that has leached into the water table. The area is decontaminated and cleaned. The community identifies the need for a local hospice for those with cancer who are dying. Area communities participate in the fund drive. This type of community effort may best be described as:

Community of solution

The nurse assesses a community undergoing change. Five years ago, a series of setbacks caused the local foundry to close. Through interviews, the nurse discovers that generations of families worked at the foundry. Research indicates that no other businesses have been able to provide work for those who no longer work at the foundry. Developmental data gathered through this research into the community's history will help the nurse: (Select all that apply.)

Determine what resources were available before the foundry closed Determine what variables may have enhanced or detracted from community development Understand cultural changes within the community over time

Nursing students in an enclosed classroom begin to become ill with a gastrointestinal illness. The public health department identifies this occurrence as an emerging epidemic and isolates the population that is ill. According to microbial adaptation, those who survive the illness will then do which of the following?

Develop improved defenses against reinfection

The community health nurse is responsible for the general health of the community on multiple levels. The nurse discovers an increase in the number of sick days used by children aged 7 to 11 years at the local elementary school in recent weeks. Research indicates that the families of asthmatic children tend to be less educated and less likely to comply with current treatment plans. Using the epidemiologic approach, the next step in the care plan should be to:

Develop school-based education programs for both the children and their caregivers

The community health nurse works in a region where severe acute respiratory syndrome (SARS) has just been reintroduced into the environment. Which measure is imperative for the nurse to take to prevent spread of the disease?

Enhanced infection control measures

The clinic clients respond negatively to the need for a yearly flu shot. They ask why the medical communities don't just create one shot that will last for several years. Which explanation should the nurse give?

Genetic changes make the flu virus resistant to the flu shot from year to year.

The community health nurse explores pedestrian access to all healthcare facilities in the community. Which tool would be most helpful in performing this task?

Geographic information systems

During a home visit of a client with high blood pressure with whom the nurse has developed a strong therapeutic relationship, the nurse learn that the client keeps a large salt shaker near the stove and heavily salts whatever he is cooking. He also keeps a salt shaker on the dinner table and adds more salt when eating. The nurse suggests removing the salt shaker near the stove and only lightly salting food when eating as a way to help reduce the client's sodium intake. This intervention would most likely achieve the goals for assessment associated with which nursing theory?

Health as Expanding Consciousness

When an infectious agent enters the host and begins to multiply, an infection occurs. The time between exposure to an infectious agent and the manifestation of symptoms in the host is known as:

Incubation period

The community health nurse can receive a referral to a home health agency at any time. Which phases are included in a home visit? (Select all that apply.)

Initiating a visit Preparation Actual visit Termination of the visit

The nurse conducts a community assessment in a town once supported by multiple paper factories. The factories closed 2 years ago and most of the population is now out of work. The school nurse notes that 68% of the students are behind schedule in their physicals and immunizations. On the basis of this community assessment, the nurse should recommend:

Initiation of neighborhood clinics at low or no cost to the community

The case manager for a 12-year-old boy who is obese and prediabetic. To help the client develop a diet that will promote weight loss and control of his glucose level, the case manager decides to consult with a dietician, who provides several current journal articles that present findings on various diets. This aspect of case management is known as:

Interdisciplinary collaboration

The nurse is conducting a 15-minute interview with a family. On the basis of the five leading principles for interviewing, appropriate actions for the nurse to take include: (Select all that apply.)

Listening actively as the family members speak Constructing an ecomap of the family Asking family members to prioritize their needs and to express their expectations regarding nursing care Pointing out the strong relationships they enjoy in their family and explaining how they will help them cope with the health issue of concern

A client arrives at the clinic reporting diarrhea and flu-like symptoms. On questioning, the client tells the nurse about a family gathering she attended recently where she had some smoked seafood. Which foodborne illness should the nurse most suspect in this client?

Listeria monocytogenes

The community is concerned about public safety and the care of their elders living at home. When the nurse assesses the community, the nurse finds there is potential to solve their problems within the community setting without outside resources. The plans to meet the community needs are accepted by the members of the community. Which action has been most successfully demonstrated in your assessment of this community?

Make the assessment process empowering to the community

The client reports diarrhea, fever, and abdominal cramps 24 hours following exposure to raw eggs while cooking. An efficient and effective homemade oral rehydration solution is to stir:

One level teaspoon of salt and eight level teaspoons of sugar into one quart or liter of clean drinking water

Reasons blended families are becoming more widespread include an increase in the number of: (Select all that apply.)

People who remarry following a divorce Recognized gay and lesbian relationships Couples cohabiting with children from prior relationships

A student nurse asks if an infectious disease is the same thing as a communicable disease. The nurse explains that an infectious disease is not necessarily a communicable disease. Which must a communicable disease have that an infectious disease does not have to have? (Select all that apply.)

Portal of exit from the infected person Means of transmission Portal of entry to a susceptible host

The nurse has recently been appointed to a community-based advisory board of an agency that is interested in providing fiscally sound, high-quality care for clients they decide will be their service population. Any profit margin that is acquired is reinvested in the operations of the home healthcare service. Which type of agency is this?

Private/voluntary

The nurse recently took a position in a national chain of home healthcare agencies directed at caring for clients who are on home hemodialysis. The services provided are often paid for privately by families, and any profit margin is used to benefit the owner of the agency. Which type of agency is this?

Proprietary

The case manager works with a client who has type 2 diabetes and heart disease. In this role, which actions should the nurse take in managing the client's diseases? (Select all that apply.)

Provide weekly coaching sessions by telephone for blood glucose management. Demonstrate use of a glucose meter to the client. Review heart-healthy and diabetic-friendly food options with the client and his family.

Which best describes the function of the grand nursing theory in nursing practice?

Relates human experience to nursing practice and nursing care

The community health nurse is using a genogram to aid in the family assessment. What aspect of family connections and relationships is included in the genogram?

Relationships across two or more generations

The school nurse notifies the community nurse that there have been five confirmed cases of pertussis in the sixth-grade classes. In addition to responding to the cluster of cases, the community nurse should immediately:

Research the vaccine compliance in the school

The case manager for two families with children who have type 2 diabetes is struck by the differences between the families. In one family, the parents are intentional about providing fruits and vegetables for their child to eat, regularly remind him to check his blood glucose level, and make sure that he engages in some sort of outdoor activity every afternoon. In the other family, the kitchen is stocked primarily with potato chips and processed snack foods, the child does not monitor her glucose level consistently, and she spends her afternoons texting or watching videos on the sofa. By this comparison, the case manager realizes how critical the family is in forming the attitude the child has toward caring for his or her own health. Which grand nursing theory does this experience best illustrate?

Self-care Agency

When the community collaborates in a plan to create services and education to enhance their health and well-being, the plan is most likely to:

Shift the focus from dependency to empowerment

The nurse investigates a family's health routines and rituals as part of the overall family assessment. Which exemplify family health routines? (Select all that apply.)

Siblings all brushing their teeth together before bed every night Taking a walk together around the neighborhood after dinner each evening

The nurse is selecting a health appraisal related to alcoholism to assess health risk in a client. Which are examples of information that should be included in the appraisal? (Select all that apply.)

Signs and symptoms of alcoholism Recommended daily limit of alcoholic drinks consumed per day Examples, such as frequently drinking an alcoholic beverage in the morning Information on local substance abuse programs

Who primarily regulates the provisions of home healthcare? (Select all that apply.)

State government Federal government

The community health nurse assesses the neighborhood in which the clients live. When observing the physical environment, the nurse notes that most of the homes in the neighborhood are well kept and the children playing in the yards are wearing clean clothing. The children appear well nourished. The nurse determines that the neighborhood has little need for a well-child clinic. This assessment is based on:

Subjective data

A client presents with several ulcerative sores on his penis that are firm, round, and painless. He also has rough, reddish brown spots on his palms and the bottoms of his feet. He acknowledges that he is sexually active with multiple partners and is inconsistent in his use of a condom. Which sexually transmitted infection should the nurse most suspect in this client?

Syphilis

The nurse takes care of a dependent family member whose husband is in the military. Which government funding is most likely going to be used for home healthcare services for this client?

TRICARE

Four employees at a local restaurant have positive purified protein derivative (PPD) tuberculin skin tests and have been diagnosed with latent tuberculosis (TB) infection. Which employee would be at the greatest risk for contracting active TB disease?

Takes immunosuppressants

The community health nurse learns that there are statistically high levels of obesity and elevated cholesterol in the community. In addition, the community has a disproportionately high number of fast food restaurants, compared with surrounding communities. Which would be the most appropriate next step, based on these data?

Target education and support programs

Using knowledge of the parish or faith community nurse, which interventions are likely to perform on the basis of the key roles of this type of nurse? (Select all that apply.)

Teaching a class to faith community members on managing high blood pressure Providing counsel on preventing upper respiratory illness to member Referring a faith community member to a nutritionist for dietary counsel

Three years after exposure to a virulent form of the flu, a population faces the same flu strain. The public health department recognizes that there are members of the population who have not been exposed to the flu strain. Which is most likely to happen?

The unexposed population is not likely to contract the illness

There are several approaches to family assessment that use particular concepts that nurses typically encounter in practice. These models provide an organized framework with which to conduct a family assessment. Which is the aim of the family assessment in the Life Span Development approach?

To identify family health practices within a social and historical context

Which rationales are appropriate for performing community assessments in the school setting? (Select all that apply.)

To learn about an outbreak of lice To assess effectiveness of children with type I diabetes managing insulin shots at school To provide education on preventing the spread of influenza

The nurse conducts a community assessment. The community is large and the members range from affluent executives to poor migrant workers. To most accurately assess the community, the nurse should:

Use multiple methods or perspectives

In a 15-minute family interview, after asking a question, the nurse pauses and remains silent while the grandmother, whose English is limited, replies to the question. The nurse makes eye contact with her and nods while she talks. When she is finished, the nurse asks a few follow-up questions. Which principle to maximize information during an interview is demonstrated in this behavior?

Use of therapeutic conversation

At an international nurses' conference, nurses from all around the world make contact. The various communities represented at this conference most likely: (Select all that apply.)

Vary significantly in composition Are challenged in their attempts to identify its members Thought of as members of a global community

The student-nurse discusses transmission that involves contact of a susceptible host with a vehicle. Based on the chain of infection links, which exemplifies a vehicle?

Water

The community health nurse is reviewing guidelines for the 15-minute assessment to keep the interview focused and family centered. Which questions and considerations for the family assessment can be asked for the question "Who is part of the family?" (Select all that apply.)

What is the nature of individuals' connections to one another? Does the individual live alone or have no living family members? What influences from the family of origin are present in daily life?

The nurse assesses a family in which the wife and mother has recently been diagnosed with breast cancer. Which factors will likely affect the family's response to the health risk that this diagnosis presents? (Select all that apply.)

What the husband and wife learned about dealing with serious illness in their families of origin Whether the family is covered by health insurance How the children tend to cope with stressful situations The response of fellow members of the family's mosque

The community health nurse has limited time for family assessments because of demanding caseloads or staffing shortages. Using your knowledge that focused family interviews of 15 minutes or less can yield a wealth of information, which is an example of an activity that will acknowledge the family's strengths?

share any genograms and ecomaps that illustrate relationships with family members

The nurse prepares to enter the room of a client with suspected Ebola virus disease (EVD). Which pieces of personal protective equipment (PPE) should the nurse wear? (Select all that apply.)

A) Fluid-resistant gown B) Gloves D) Mask E) Goggles

A nurse is studying the Institute of Medicine's convergence model to learn how four types of interrelated and overlapping microbe-human interactions can lead to emerging/reemerging infectious diseases. These four types of interactions are: (Select all that apply.)

A) Genetic and biological B) Physical/environmental D) Ecological E) Social, political, and economic

Which factors place an individual at high risk for acquiring a sexually transmitted infection (STI)? (Select all that apply.)

A) Having multiple sexual partners D) Having a sexual partner who has had an STI

Tent communities are constructed in a rural community by the American Red Cross after a disaster. Because of overcrowding, surrounding states create accommodations for the displaced and homeless. The survivors are accommodated in the cities of four Southern states. Which factors may increase the possibility of disease emergence in the cities? (Select all that apply.)

A) Poor hygiene C) Poor sanitation

The community health nurse is assessing stressful life events in a family. Which exemplifies a life event related to illness and family care strains?

A 63-year-old woman's sense of responsibility as the oldest among her siblings for taking care of her chronically ill parents

A client is fearful of being infected with the Ebola virus. To which reliable source of family risk reduction information should this client turn?

A conversation the client has with his healthcare provider

As the occupational health nurse in a factory finds that five employees out of 30 have positive tuberculin skin test results. One employee on the 3-to-11 shift has been diagnosed with active tuberculosis (TB). She asks if this means that the whole factory has been exposed. The nurse replies that the probability of infection depends upon: (Select all that apply.)

A) Concentration of infectious droplet nuclei in the air B) Duration of exposure to the infected person C) Proximity to the infected person

Ten documented cases of West Nile virus (WNV) have occurred recently in the community. To reduce the transmission of the virus, the nurse should educate the members of the community to: (Select all that apply.)

B) Avoid contact with mosquitoes D) Eliminate standing water

There is an outbreak of Middle East respiratory syndrome coronavirus (MERS-CoV) in the community. The nurse is responsible for the dissemination of the education plan adopted by the public health department. Key components of the plan should include: (Select all that apply.)

B) Respiratory hygiene C) Hand hygiene D) Droplet precautions for visitors in contact with affected clients

A 16-year-old client visits the community health clinic with concerns that she may have a sexually transmitted infection (STI). She asks whether STIs are treatable. STIs that are easily treated and curable include: (Select all that apply.)

C) Chlamydia D) Gonorrhea E) Syphilis