Community Health Quizzes

The nurse in the family planning clinic reviews the health history of a sexually active 16-year-old girl whose chief concern is a thick, burning vaginal discharge accompanied by low abdominal pain. After her examination, the girl is informed that she may have a sexually transmitted infection (STI) that requires treatment. The adolescent is concerned that her parents will discover that she is sexually active. She asks the nurse whether her parents will be contacted. How would the nurse respond?

A Rationale: To prevent disclosure, family planning clinics treat these adolescents as emancipated minors who can sign their own consent forms. Federal law allows family planning clinics to maintain minors' confidentiality, although individual states may have different regulations. There is a concern that teenagers will not seek or continue treatment if they fear disclosure. Most family planning clinics receive funding and charge on a sliding scale based on income, thereby encouraging adolescents to seek treatment. Not telling the parents in exchange for the client having her sexual contacts tested could be viewed as coercion; if the STI is reportable, follow-up of sexual partners is indicated, but the adolescent will not be held responsible for ensuring that they report for testing.

Which does a community-based nurse do as a change agent? Select all that apply. A. Empowers clients and their families to creatively solve problems. B. Works with clients to solve problems and helps clients identify an alternative care facility. C. Helps clients gain the skills and knowledge needed to provide self-care. D. Empowers clients to become instrumental in creating change within a health care agency. E. Does not make decisions but helps clients reach decisions that are best for them.

A, B, D Rationale: As a change agent, the nurse empowers clients and families to creatively solve problems. As a change agent, the nurse works with clients to solve problems and helps them identify an alternative care facility. As a change agent, the nurse empowers clients to become instrumental in creating change within a health care agency. As an educator, the nurse helps clients gain the skills and knowledge needed for self-care. As a counselor, the nurse does not make decisions, but rather helps clients reach decisions that are best for them.

Which points would the nurse remember when caring for a client who has a history of suicide attempts? SATA. A. Document the measures taken to prevent suicides. B. If the client makes a suicide attempt in hospital, may lead to a lawsuit. C. Client may be detained for 21 days if judge grants an involuntary detention. D. Primary healthcare facility is responsible for failing to provide adequate supervision. E. File paperwork with court w/in 96 hrs of client's admission to the facility.

A, B, D Rationale: If a client has a history of suicide attempts, the nurse would document all suicide prevention measures within the health care facility. The documentation may be helpful if a lawsuit is filed. If the client attempts suicide in the hospital, this action may lead to a lawsuit. In the event of a lawsuit, the likely allegations against the primary health care provider are that he or she failed to supervise the client adequately and safeguard the facilities. If a client is admitted to a health care facility involuntarily, the judge may determine that the client is a danger to himself or herself or others and grant an involuntary detention for 21 days. This is not applicable for all suicide-risk clients. The nurse would file with the court within 96 hours of admission to the health care facility only if the client is admitted involuntarily.

Which findings in a client seen at the outpatient clinic support a diagnosis of an arterial ulcer? Select all that apply. A. Lack of hair B. Thickened toenails C. Copious ulcer drainage D. Diminished pedal pulse E. Brown skin discoloration

A, B, D Rationale: Prolonged lack of oxygen to hair follicles results in hair loss. Prolonged lack of oxygen to the toes results in thickened toenails. Inadequate arterial perfusion results in diminished pedal pulse quality. Copious ulcer drainage is associated with venous ulcers, whereas arterial ulcers are dry because of decreased blood flow. Brown skin discoloration is associated with venous disease.

The registered nurse is teaching about good skin health. Which instructions would the nurse give? Select all that apply. A. "Eat foods rich in vitamin B." B. "Sleep for an adequate number of hours." C. "Use alkaline soaps for better hygiene." D. "Use sunscreen of sun protection factor (SPF) 30 daily." E. "Avoid sun exposure after taking ketoconazole."

A, B, E Rationale: Deficiency of vitamin B 4 (niacin) and B 6 (pyridoxine) are manifested as erythema, bullae, and seborrhea-like lesions. Deficiency of biotin, a B-complex vitamin, may cause rashes and alopecia. Adequate rest increases tolerance to itching, thereby decreasing skin damage from scratching in pruritic skin diseases. Some medications potentiate the effect of the sun causing sunburns. Acidic activity of the skin protects against bacterial overgrowth. Alkaline soaps neutralize the skin thereby decreasing the protection. Sunscreen of SPF 15 should be used daily by everybody. People with history of skin cancer or problems with photosensitivity may use sunscreen with SPF of at least 30.

Which purpose does block and parish nursing serve in preventive and primary care services? A. Services provided to older clients or those unable to leave their homes. B. Primary care is provided to a specific population living in a specific community. C. Nursing services are delivered with a focus on health promotion and education as well as on chronic disease. D. Services are aimed at increasing worker productivity, decreasing absenteeism, and reducing the use of expensive medical care.

B Rationale: Block and parish nursing provides services to older clients or those who are unable to leave their homes. Community health centers provide primary care to a specific client population living in a specific community. Nurse-managed clinics provide nursing services with a focus on health promotion and education as well as on chronic disease. Occupational health services provide services that aim to increase worker productivity, decrease absenteeism, and reduce the use of expensive medical care.

The nurse advises a client to refrain from adding salt to food as a way to prevent high blood pressure. Which health care service is this? A. Tertiary care B. Primary care C. Preventive care D. Restorative care

B Rationale: When the nurse provides nutrition counseling to the client, it qualifies as primary care. In the given scenario, the nurse advises the client to refrain from adding salt in the diet to prevent high blood pressure. Tertiary care includes intensive care and subacute care. Preventive care includes blood pressure and cancer screenings, immunizations, mental health counseling and crisis prevention, and community legislation. Restorative care includes cardiovascular and pulmonary rehabilitation, sports medicine, spinal cord injury programs, and home care.

Which reactions would be expected in the action stage in bathing every day? SATA. A. I only take a bath once a week but don't see infections on my skin. B. I try to shower every day but skip sometimes b/c of my tight schedule. C. I understand that bathing regularly is good, but my bathroom is cold in the mornings. D. Pls tell me how to get into the habit of bathing daily so I can be clean and healthy. E. I want to bathe regularly but don't have time because I need to look after my kids.

B, C, E Rationale: In the action stage, the client notices that old habits are hindering him or her from engaging in new behaviors. In this scenario, the client says that he or she tries to take a daily shower but skips it sometimes because of a tight work schedule. In the second scenario, the client says that he or she understands the importance of taking baths but the bathroom is very cold. In another scenario, the client says that he or she wants to take baths but has to look after the family and doesn't have time. All these scenarios indicate that the client is in the action stage. Saying that he or she only takes one bath a week but doesn't see any skin infections indicates that the client is in the pre-contemplation stage. Saying that he or she wants to know how to get into the habit of taking regular baths indicates that the client is in the preparation stage.

The nurse is caring for a client with a poor understanding of weight-reduction strategies. Which reactions might be expected if the client is in the precontemplation stage? SATA. A. "Pls tell me how to lose weight by eating a normal diet." B. "Having a thin body means I'm healthy." C. "Who says I don't eat properly? I'm just skipping breakfast." D. "I'm trying hard to stick to the diet, but sometimes I skip breakfast." E. "Idc about following the diet plan; I just want to lose weight AS

B, C, E Rationale: In the precontemplation stage, the client does not intend to make changes in the next 6 months and may become defensive when confronted with information on the benefits of changing habits. The client who says that having a thin body indicates good health, that she skips breakfast to lose weight, or who says that she just wants to lose weight and is not concerned with following the diet chart indicates a person in the precontemplation stage. Saying that she wants to learn how to lose weight by eating a normal diet is a sign that the client is in the preparation stage. Saying that she tries to abide by the diet chart but sometimes skips breakfast is a sign that the client is in the action stage.

Which preventive and primary care service provided by a community health center is most expensive? A. Running errands B. Health education C. Disease management D. Routine physical examinations

C Rationale: Disease management is the most expensive service provided by community health centers. Running errands is relatively inexpensive, because the cost is the merely the cost of transportation. Health education and routine physical examinations are inexpensive and can usually stop complications of diseases, which prevents from having to "manage" diseases, leading to costly and expensive treatment.

The nurse on the adolescent unit is planning to discuss smoking prevention. Which is the most effective approach to use? A. Sharing personal experiences with a smoking-cessation program B. Showing pictures of the effects of smoking on the cardiopulmonary system C. Presenting information on how smoking affects appearance and odor of the breath D. Citing statistics about the relationship between smoking and cardiopulmonary diseases

C Rationale: Establishing an identity is the major developmental task of the adolescent; to achieve this task, the adolescent needs to conform to group norms that include appearance and acceptance. Appealing to this need may achieve more success than other teaching strategies. Sharing personal experiences with a smoking-cessation program is a teaching strategy that may be successful with an older, more secure group of people. Adolescents tend to believe that they are invincible and probably will not relate to the teaching strategy of showing pictures of the effects of smoking on the cardiopulmonary system. They are also concerned about the present, not the future. Because adolescents believe they are invincible, they would not relate to a teaching strategy based on statistics about the harmful effects of smoking.

A senior high school student asks the school nurse which immunizations will be included in the precollege physical. Which vaccine would the nurse tell the student to expect to receive? A. Hepatitis C (HepC) B. Influenza type B (HIB) C. Measles, mumps, rubella (MMR) D. Diphtheria, tetanus, pertussis (DTaP)

C Rationale: Individuals born after 1956 should receive one additional dose of MMR vaccine if they are students in postsecondary educational institutions. Currently there is no vaccine for hepatitis C. The HIB immunization is unnecessary. If the student received an additional DTaP at age 12, it is not necessary. A booster dose of tetanus toxoid (Td) should be received every 10 years.

While assessing a client who experienced an accident, the nurse found that the client is unable to move the eyeballs laterally. Which nerve damage led to this condition in the client? A. Optic nerve B. Facial nerve C. Abducens nerve D. Oculomotor nerve

C Rationale: The abducens nerve is the VI cranial nerve, which helps in lateral movement of the eyeballs. Damage to this nerve limits lateral movement of the eyeball. Injury to the optic nerve causes changes in visual acuity. Injury to the facial nerve results in loss of facial expressions and loss of taste perception from the anterior third of the tongue. Injury to the oculomotor nerve limits the extraocular movements and pupillary responses.

Which client body temperatures are indicative of moderate hypothermia? Select all that apply. A. 80°F (26.7°C) B. 84°F (28.9°C) C. 88°F (31.1°C) D. 92°F (33.3°C) E. 96°F (35.6°C)

C, D Rationale: Moderate hypothermia is a body temperature between 86°F and 93.2°F (30°C-34°C). Clients with body temperatures between 88°F and 92°F (31.1°C-33.3°C) have moderate hypothermia. Mild hypothermia is a body temperature between 93.2°F and 96.8°F (34°C-36°C). Clients with body temperatures of 96°F (35.6°C) have mild hypothermia. Body temperature below 86°F (30°C) indicates severe hypothermia.

Which activities would the nurse include when teaching adults about activities that increase the risk of developing bladder cancer? Select all that apply. A. Jogging 3 miles (4.8 km) a day B. Drinking three cans of cola a day C. Smoking two packs of cigarettes a day D. Working with dyes used in rubber every day E. Using a jackhammer and chainsaw every day

C, D Rationale: The occurrence of bladder cancer is related to smoking. Dyes in rubber and hair dyes are environmental carcinogens; working with them daily increases an individual's risk of bladder cancer. Jogging is unrelated to the development of cancer of the bladder. Ingestion of cola has not been linked to cancer of the bladder. Vibrations may result in musculoskeletal or kidney problems but are unrelated to cancer of the bladder.

An older adult client accustomed to taking enemas to avoid constipation is admitted to an LTC facility and is bedbound. Which nursing action would be included in the initial plan of care to prevent the client from developing constipation? A. Arrange to have enemas prescribed for the client. B. Obtain a prescription for a daily laxative for the client. C. Place a commode by the bedside to facilitate defecation. D. Offer a large glass of prune juice with warm water each morning.

D Rationale: Prune juice and warm water can be administered by the nurse to promote defecation. Prune juice irritates the bowel mucosa, stimulating peristalsis. Fiber in the diet increases fecal volume, which stimulates intestinal motility and the reflex for defecation. Enemas should be avoided because they can promote dependency and can result in electrolyte imbalance. The routine use of laxatives promotes dependency. The client is bedbound and is unable to use a commode.

The nurse administers a pneumococcal vaccine to a 70-year-old client. The client asks, "Will I have to get this every year like I do with the flu shot?" How would the nurse respond? A. "You need to receive the pneumococcal vaccine every other year." B. "The pneumococcal vaccine should be received in early autumn every year." C. "You should get the flu and pneumococcal vaccines at your annual physical examination." D. "It is unnecessary to have any follow-up injections of the pneumococcal vaccin

D Rationale: The CDC recommends that adults be immunized with pneumococcal vaccine at age 65 years or older with a single dose of the vaccine. If the pneumococcal vaccine was received before 65 years of age, or if there is the highest risk of fatal pneumococcal infection, revaccination should occur 5 years after the initial vaccination. The pneumococcal vaccine should not be administered every 2 years. The pneumococcal vaccine should not be administered annually.

Which of these actions would the nurse perform to provide preventive and primary care to adults during a health camp? Select all that apply. A. Discussing vaccinations B. Discussing family planning C. Mentioning adult daycare services D. Instructing the health camp about self-care at home E. Instructing the health camp about road safety measures

A, B, E Rationale: While providing preventive and primary care, the nurse may discuss vaccinations and family planning. Road safety measures such as seat belts, airbags, and helmets are also part of a primary health care program. Daycare services are associated with restorative care. Instructions about home self-care are also part of restorative care.

The nurse is teaching a group of adults about the signs and symptoms of colorectal cancer. Which common clinical manifestations would the nurse include in the teaching program? Select all that apply. A. Anemia B. Rectal pain C. Rectal bleeding D. Change in bowel habits E. Severe abdominal distention

A, C, D Rationale: The most common signs are anemia, rectal bleeding, and a change in stool consistency or shape or change in bowel habits. Abdominal, not rectal, pain can occur. Severe abdominal distention does not occur.

Which important step(s) would the community nurse take when dealing with older adults with a confusional states problem? Select all that apply. A. Provide a protective environment. B. Monitor blood pressure and weight. C. Recommend applicable community resources. D. Demonstrate proper hygiene to the primary caretaker. E. Educate about polypharmacy and drug-drug and drug-food interactions.

A, C, D Rationale: When dealing with older adults with a confusional states problem, the nurse would ideally provide a protective environment for the client. In addition, the nurse would recommend applicable community resources like adult day care, home care aides, and homemaker services. When dealing with community-dwelling older adults with a confusional states problem, the nurse would assist with adequate personal hygiene, nutrition, and hydration. When dealing with the community-dwelling older adults with a hypertension problem, the nurse would monitor blood pressure and weight. When dealing with the community-dwelling older adults with a medication use and abuse problem, the nurse would educate about polypharmacy and drug-drug and drug-food interactions.

Which are physiologic symptoms assessed in a client with sleep deprivation? Select all that apply. A. Ptosis and blurred vision B. Agitation and hyperactivity C. Confusion and disorientation D. Increased sensitivity to pain E. Decreased auditory alertness

A, E Rationale: Ptosis may result from a loss of elasticity of the eyelids, which is a physiologic symptom of sleep deprivation. Decreased auditory alertness and blurred vision are also physiologic symptoms of sleep deprivation. Agitation, hyperactivity, confusion, disorientation, and increased sensitivity to pain are psychologic symptoms of sleep deprivation.

Which services do community health centers provide in preventive and primary care services? Select all that apply. A. Daycare B. Health screenings C. Physical assessments D. Disease management E. Acute and chronic care management

B, C, D Rationale: Health screenings, physical assessments, and disease management services are provided by community health centers in preventive and primary care services. Day care and acute and chronic care management services are provided by nurse-managed clinics.

Which competencies are important in the rural setting? Select all that apply. A. Spiritual values B. Emergency care C. Family dynamics D. Physical assessment E. Clinical decision-making

B, D, E Rationale: A shortage of health care resources in rural areas is a serious problem, and most rural hospitals experience a shortage of primary health care providers. Nurses in rural hospitals must be competent to provide emergency care for clients until they are stabilized and transferred to a bigger hospital. The nurse in the rural health care setting must be competent in physical assessment, which includes comprehensive data collection pertinent to the client's health. The nurse would be competent in applying evidence-based practice for making appropriate clinical decisions. Knowledge of spiritual values and family dynamics is an important aspect of nursing care. However, it is not the most important competency while practicing in a rural health care setting.

When the nurse is screening clients for hypertension, which finding would indicate a need to refer a client to a health care provider? A. Report of pain as the blood pressure cuff is inflated B. Systolic blood pressure result higher than 120 mm Hg C. Diastolic blood pressure reading greater than 89 mm Hg D. Loud Korotkoff sounds as the blood pressure cuff is deflated

C Rationale: According to current guidelines, a diastolic blood pressure of 80 to 89 mm Hg is indicative of hypertension, indicating a possible need for treatment. Arm pain with cuff inflation is common because the cuff places pressure on the arm and decreases blood flow to the arm. Systolic pressures of 120 to 129 mm Hg indicate elevated blood pressure according to some current guidelines, but do not indicate a need for referral to a health care provider. Rather, the nurse would suggest lifestyle changes and checking blood pressure more frequently. Loudness of Korotkoff sounds is not an indicator of pathology or need for treatment.

Which is the most appropriate communication strategy for the nurse working with adolescents in a clinic in a large city health center? A. Relating on a peer level B. Using typical teenage language C. Establishing a relationship over time D. Having discussions in concrete terms

C Rationale: Several meetings with an adolescent provide an opportunity to develop trust and establish a relationship. Relating on a peer level is unrealistic because the nurse is not an adolescent's peer. Using teenage language is not necessary and may even impede the establishment of a relationship. It is not necessary to use concrete terms, because the adolescent is capable of abstract thought.

After obtaining client blood pressures of 172/104 mm Hg and 164/98 mm Hg during a blood pressure screening, which action would the nurse take next? A. Provide health teaching about a low-sodium diet. B. Call the paramedics for transport to the hospital. C. Suggest ways to decrease the client's stress level. D. Refer the client to a primary health care provider.

D Rationale: According to the current hypertension guidelines, both of these readings indicate hypertension and thus require further evaluation by a health care provider. Teaching about a low-sodium diet is an inadequate intervention for this client's stage 2 hypertension. Because the client is asymptomatic, there is no need for transport to a hospital. Although reduction of stress may affect blood pressure, the client's stage 2 hypertension will require further evaluation by a health care provider.

Which instruction is beneficial for an aging African-American client with hypertension? A. "Check the pulse daily." B. "Have an annual urinalysis." C. "Record blood pressure weekly." D. "Visit an ophthalmologist monthly."

B Rationale: African-American clients have 20% less blood flow to the kidneys because of high sodium consumption. This causes anatomical changes in the blood vessels, thereby increasing the risk of kidney failure. Instructing the client with hypertension to have an annual urine examination would be beneficial. If the client has protein in the urine, this is a sign of high blood pressure and can signify kidney damage. Checking the pulse daily poses no harm to the individual but does not determine if the client has hypertension. Recording the blood pressure weekly is not a good indicator of an aging African-American client with hypertension. The client's blood pressure should be taken at least daily to determine if the client has problems. If the client has an eye-related problem, visiting an ophthalmologist should be suggested.

Which purpose does a community health center serve in preventive and primary care services? A. Outpatient clinics that provide primary care to a specific population B. Aim to increase worker productivity, decrease absenteeism, and reduce the use of costly medical care C. Emphasize program management, interdisciplinary collaboration, and community health principles D. Include a complete program designed for health promotion and accident or illness prevention in the workplace

A Rationale: Community health centers are outpatient clinics that provide primary care to a specific population, such as clients with young children or clients with diabetes. Occupational health services aim to increase worker productivity, decrease absenteeism, and reduce the use of costly medical care. School health services emphasize program management, interdisciplinary collaboration, and community health principles. Occupational health services include a complete program designed for health promotion and accident or illness prevention in the workplace.

Which topic is most important for the nurse to teach in a community health promotion class for middle-aged adults? A. Tobacco cessation B. Infection prevention C. Alcohol abstinence D. Pain management

A Rationale: Tobacco use is a major risk factor for cardiovascular disease, which is the most common cause of death in middle-aged and older adults. In addition, tobacco use is a risk factor for multiple types of cancer, and cancer is the second leading cause of death in middle-aged and older adults. Prevention of infection is also an important topic, but it is not as likely to cause death in this age group as tobacco use. Alcohol abstinence would be an important topic to discuss with groups at risk for alcohol abuse, but abstinence is not recommended for all middle-aged adults. Pain management would be an important topic to discuss with clients who have chronic pain, but it is not the most important topic to teach to all middle-aged adults.

Which action would the home health nurse suggest to decrease risk for injury for an older adult with peripheral arterial disease? A. Move into an assisted living community. B. Lower the thermostat setting on the hot water tank. C. Reduce fluid intake to less than 2500 mL/day. D. Limit physical activity to a short daily walk.

B Rationale: Because peripheral arterial disease may decrease the ability to feel extremes of heat and increases risk for burn injuries, lowering the temperature of the hot water tank can reduce injury risk. There is no indication that this client needs assistance with any activities of daily living, so there is no need to move the client to an assisted living community. Reduction of fluid intake is not indicated for clients with peripheral arterial disease. Walking is encouraged because it improves blood flow and encourages collateral circulation to the legs.

Which type of crisis has occurred when a sudden terrorist act causes the deaths of thousands of adults and children and negatively affects their families, friends, communities, and the nation? A. Situation-maturational B. Situational C. Maturational D. Adventitious

D Rationale: An adventitious crisis is a crisis or disaster that is unplanned and accidental; its subcategories include natural disasters, national disasters, and crimes of violence. A situational-maturational crisis is not a typical category in crisis theory. If 2 events occurred around the same time—for example, retirement (maturational crisis) and the unexpected death of a spouse (situational crisis)—the client would have to deal with both issues. A situational crisis results from an external source and the loss is often unexpected. A maturational crisis occurs as an individual moves into a new stage of development and prior coping styles are no longer effective; maturational crises are usually predictable.

Which sexually transmitted infection is associated with developing gummas? A. Chlamydia trachomatis infection B. Trichomoniasis C. Gonorrhea D. Syphilis

D Rationale: Gummas are associated with tertiary syphilis. They are tumors of a rubbery consistency that break down and damage the heart and nervous system and skin. The spirochete in late stages can lead to mental and physical disability. Primary syphilis is characterized by chancres. Infections that result from Chlamydia trachomatis are sometimes asymptomatic and often is associated with pelvic inflammatory disease. Redness, itching, and burning are associated with trichomoniasis, as is a frothy, foul-smelling discharge. Gonorrhea may be asymptomatic or associated with a yellow urethral or penile discharge.

The nurse in the health clinic is counseling a college student who recently was diagnosed with asthma. Which aspect of counseling would the nurse focus on? A. Teaching how to make a room allergy-free B. Referring to a support group for individuals with asthma C. Arranging with the college to ensure a speedy return to classes D. Evaluating whether the necessary lifestyle changes are understood

D Rationale: Understanding the disorder and the details of care are essential for the client to be self-sufficient. Although teaching is important, a perceived understanding of the need for specific interventions must be expressed before there is a readiness for learning. Referring to a support group is premature; this may be done eventually. Although ensuring a speedy return to classes is important, involving the college should be the client's decision.

Which nursing activities are examples of primary prevention? Select all that apply. A. Preventing disabilities B. Correcting dietary deficiencies C. Establishing goals for rehabilitation D. Assisting with immunization programs E. Facilitating a program about the dangers of smoking

D, E Rationale: Immunization programs prevent the occurrence of disease and are considered primary interventions. Stopping smoking prevents the occurrence of disease and is considered a primary intervention. Preventing disabilities is a tertiary intervention. Correcting dietary deficiencies is a secondary intervention. Establishing goals for rehabilitation is a tertiary intervention.