Community Nursing HESI Practice EAQ's

An older adult client states, "Disease occurs when supernatural elements enter the body." Which variable influences the client's health beliefs in this scenario? A. Spiritual factors B. Emotional factors C. Intellectual background D. Perception of functioning

(A)

The nurse is analyzing and explaining the demographics of a population under research. Which phase of the nursing process is the nurse exercising when analyzing and explaining the demographics of a population under research? A. Diagnosis phase B. Evaluation phase C. Assessment phase D. Implementation phase

(B) When the nurse is analyzing and interpreting the demographics of a study population, the nurse is exercising the evaluation phase. During the diagnosis phase, the nurse develops hypotheses related to the medication study. During the assessment phase, the nurse formulates the theoretical framework, reviews the literature, and identifies the study variables. During the implementation phase, the nurse obtains the necessary approvals, recruits subjects, and implements the study protocol.

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 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 activity by the community nurse is an illness prevention strategy? A. Encouraging the client to exercise daily B. Arranging an immunization program for chickenpox C. Teaching the community about stress management D. Teaching the client about maintaining a nutritious diet

B An illness prevention program protects people from actual or potential threats to health. A chickenpox immunization program is an illness prevention program. It motivates the community to prevent a decline in health or functional levels. A health promotion program encourages the client to maintain their present levels of health. The nurse promotes the health of the client by encouraging the client to exercise daily. Wellness education teaches people how to care for themselves in a healthy manner. The nurse provides wellness education by teaching about stress management. The nurse promotes the health of the client by teaching the client to maintain a nutritious diet.

Which risk of adolescent pregnancy would the community nurse teach? A. Risk for premature birth B. Risk for having a large baby C. Risk for chromosomal defects D. Risk for increased weight gain

A The nurse would teach the community that adolescent pregnancy often leads to premature births. Adolescent pregnancy may lead to low birth weight babies due to lack of nutrition and prematurity. Older women have difficulty in becoming pregnant and they are more likely to have babies with chromosomal defects. An adolescent mother is not at risk for increased weight gain because she is more likely to be affected by lack of nutrition and exposure to alcohol, drugs, and tobacco.

Which avoidance instruction would the public health clinic nurse use to teach prevention of toxoplasmosis? A. Contact with cat feces B. Exposure to heavy metals C. Ingestion of freshwater fish D. Excessive radiation exposure

A Toxoplasma gondii, a protozoan, can be transmitted by exposure to infected cat feces or by ingestion of undercooked, contaminated meat. Toxoplasmosis is not related to heavy metals. T. gondi is a parasite of warm-blooded animals; fish are not considered the source of contamination. Toxoplasmosis is not related to radiation.

The nurse is instructing a community group regarding risk factors for coronary artery disease. Which risk factor cannot be modified? A. Heredity B. Hypertension C. Cigarette smoking D. Diabetes mellitus

(A) Heredity refers to genetic makeup and cannot be changed. Cigarette smoking is a lifestyle habit that involves behavior modification. Hypertension and diabetes mellitus are risk factors of coronary artery disease that can be controlled with diet, medication, and exercise.

Which suggestion by the nurse is an example of primary prevention? A. "Engage in daily physical exercise!' B. "Get yearly physical examinations. C. "Attend hypertension screening programs." D. "Read about how to prevent diabetes complications."

(A) Primary prevention activities are directed toward promoting a healthful lifestyle and increasing the level of well-being, like engaging in daily physical exercise. Performing yearly physical examinations and providing hypertension screening programs are SECONDARY preventions. Emphasis is on early detection of disease, prompt intervention, and health maintenance for those experiencing health problems. Teaching a person with diabetes how to prevent complications is a TERTIARY prevention. Emphasis is on rehabilitating individuals and restoring them to an optimal level of functioning.

Which services do block and parish nursing provide for preventive and primary care services? Select all that apply. One, some, or all responses may be correct. A. Respite care B. Running errands C. Homemaker aides D. Routine physical examination E. Communicable disease control

(A) Respite care, (B) Running errands, © Homemaker aides Routine physical examinations are provided by a primary health care provider's office. Communicable disease control services are provided by occupational health.

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

B, C, D See table 10.1 - Continuum of Healthcare Organizations: Primary organizations = purpose = entry into system, health maintenance, chronic care, tx of temporary nonincapacitating malfunction Secondary organization = purpose = px of disease complications Tertiary organization = purpose = rehabilitation, long-term care

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 Disease management is the most expensive service provided by community health centers. Running errands is relatively inexpensive, because the cost is 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.

Which resource or facility has enabled rural hospitals to have increased access to specialist consultations? A. Mediare B. Medicaid C. Telemedicine D. Critical access hospital

C Telemedicine uses advanced technology to connect rural hospitals to specialists for consultation. Many big city health care systems are branching out and merging with rural hospitals to provide better health care. Medicare is a federally administered health insurance program for people 65 years of age or older. Medicaid is a federally funded, state-operated program that provides health insurance to low-income families. Critical access hospitals are rural hospitals with no more than 25 inpatient beds. These hospitals provide emergency care to stabilize clients before they are transferred to a larger hospital.

Which goal is the main focus of community health nursing? A. To meet the acute care needs of a population B. To improve the quality of health in a population C. To influence political processes affecting public policies D. To assess the health care needs of an individual or family

Community health nursing is a nursing practice focusing on the health care of individuals, families, and groups within a community. Its main focus is to improve the quality of life and health of a population by preserving, protecting, promoting, or maintaining health. The acute and chronic care of an individual or family is provided by community-based nursing. Instead of focusing on institutional care, community-based nursing brings health care within the reach of the community. Factors influencing health services, such as a political process affecting public policies, are handled by public health nursing. Community-based nursing focuses on the fulfillment of the health care needs of an individual or family.

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 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.

A community health care nurse is conducting a survey about homeless children in the community. Which finding helps the nurse distinguish absolute homelessness from relative homelessness? A. The children are underimmunized and at risk for childhood illnesses. B. The children are more likely to drop out of school. C. The children have access to health care only through the emergency department. D. The children do not have a physical shelter and may sleep outdoors or in vehicles.

D Public health organizations use the term absolute homelessness to describe people who have no physical shelter. These children sleep outdoors, in vehicles, abandoned buildings, or other places not intended for human habitation. Relative homelessness describes those who have a physical shelter but one that does not meet the standards of health and safety. Children experiencing both absolute and relative homelessness tend to be underimmunized and are at risk for childhood illnesses. Both types of homeless children are unable to meet residency requirements for public schools and are more likely to drop out of school. A lack of finances leads both types of homeless children to seek health care only in emergency conditions.

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) Tobacco cessation 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 si 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.

A nursing student is listing factors that may improve the quality of life of clients in the community with chronic leg ulcers. Which factor listed by the nursing student needs correction? A. "Offer suggestions to improve a client's level of independence. B. "Inform clients that the cost of care may be expensive and that the level of pain may increase." C. "Instruct clients that as their wounds heal, their capability and desire to socialize with others may increase." D. "Understand that some clients have depression and anxiety related to the chronic nature of their wounds."

(B) Nursing wound care specialists would inform the client that as the wound heals, the cost of care may decline and pain may decline or resolve. Nursing wound care specialists who visit clients' homes would offer suggestions to improve their level of independence. Nursing wound care specialists would inform clients that as wounds heal, their capability and desire to socialize with others might increase. Nursing wound care specialists would understand that some clients might have depression and anxiety related to the chronic nature of their wounds.

The nurse is teaching campfire safety to a group of community members and includes information about what to do if a person catches on fire. The nurse teaches the most effective method for putting out the flames. Which information from the group members indicates successful learning? A. Wrap hand with towel and slap at the flames. B. Instruct the victim to roll on the ground. C. Pour cold liquid over the flames. D. Remove the victim's burning clothes.

(B) STOP, DROP, and ROLL is the sequence the victim needs to do to extinguish the flames. Instructing the client, if possible, is priority. Rolling the victim in the grass effectively extinguishes the flames and protects the victim from additional injury. Slapping at the flames will not eliminate the oxygen that supports the fire and will fan the flames. Slapping the flames may also burn the person that is trying to extinguish the fire. Pouring cold liquid over the flames may extinguish the flames, but not as effectively as rolling in the grass. The water may be difficult to pour over all areas, whereas rolling will quickly touch all areas needing to be extinguished. Removing the victim's burning clothes may or may not protect the client from further injury and is dangerous for the rescuer.

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

(B) "Have an annual urinalysis." Blacks 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 often enough to identify 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, but it is usually not monthly.

Which characteristic is most common to those living in poverty? A. Open expression of anger B. Long-term feeling of powerlessness C. Willingness to postpone gratification D. Compliance with health recomendations

(B) Long-term feeling of powerlessness People living in poverty feel powerless because they do not have the buying power or social status to effect change. Their anger is covert and not direct; in addition, the anger rarely resolves their situation, resulting in feelings of powerlessness and hopelessness. Economically deprived people are less likely to postpone gratification because they focus on the present, not the future. Health recommendations may be misunderstood, confusing, or perceived as of little value and are frequently ignored.

Which interventions should the nurse take to ensure the well-being of a community-dwelling older adult with hypertension? Select all that apply. One, some, or all responses may be correct. A. Suggest that the client have annual Papanicolaou (Pap) smears and mammograms B. Promote dietary modifications by using varied techniques C. Assess the client's current lifestyle and promote lifestyle changes D. Monitor the client's blood pressure and weight, and establish blood pressure screening programs E. Teach the client about correct body mechanics and the availability of mechanical appliances

(B), (C), and (D)

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), and (E) 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.

A nurse is caring for a client attending a community-based health center and reviews the client's medical record. Which recommendation would the nurse provide to the client? ---- CLIENT CHART: Healthcare provider progress note: Client has stage III rheumatoid arthritis, which is progressively causing more joint deformity, stiffness, and pain. Nurse's history and physical assessment: Client has ulnar drift on both hands and hallux valgus deformity of both feet. Client reports pain when walking and joint stiffness for several hours in the morning, particularly the small joints of the hands and feet. Joints of the hand reflect s/s of inflammation (heat, swelling, tenderness). Laboratory results: Rheumatoid factor (RF): 1:70 (positive for RA) Erythrocyte sedimentation rate (ESR): 40 mm/hour C-reactive protein (CRP): 20 mg/dL WBC: 13,000/microL ---- A. Wring a sponge repeatedly when washing dishes B. Install faucets that require turning rather than pushing C. Push with the palms rather than the fingers when rising for a chair D. Actively use the hands for several hours each morning, sewing or knitting

(C) Pushing off the palms of the hands rather than the fingers uses the strongest joints available to rise from a chair.

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 vaccine after this dose.

(D) The Centers for Disease Control and Prevention recommend 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 (every other year). The pneumococcal vaccine should not be administered annually.

How does the nurse play the role of a "change agent" in a community-based nursing practice? A. By helping clients identify and clarify health problems B. By establishing relationships with community service organizations C. By establishing an appropriate plan of care, based on assessment of clients D. By identifying and implementing new and more effective approaches to problems

(D) The nurse acts as a CHANGE AGENT by identifying and implementing new and more effective approaches to problems. As a change agent, the nurse can empower individuals and their families to creatively solve problems or become instrumental in creating change within a health care agency. Nurses act as CASE MANAGERS when they ask clients to identify and clarify health problems. Nurses act as EDUCATORS when they establish relationships with community service organizations. Nurses act as COUNSELORS when they establish an appropriate care plan based on the client's assessment.

The nurse notes that a client is in the habit of skipping breakfast and lunch and educates the client on the harmful effects of not getting enough nutrition. Which responses are signs that the client has reached the action stage of health behavior change? Select all that apply. One, some, or all responses may be correct. A. "I still tend to skip breakfast when I'm in a hurry to get to work." B. "I can't compromise my career for the sake of good eating habits." C. "know that it's not good to skip meals, but my health seems fine." D. "I've been having my breakfast and lunch on time for the past 6 months. E. "I follow a proper eating schedule, but sometimes it gets in the way of my work."

A and E A client in the action stage of health behavior change is actively engaged in strategies to change behavior. However, old habits may get in the way of actions that are related to new behavior. If the client indicates that even though changes in health behavior have taken place, the client still tends to skip breakfast sometimes or the eating schedule sometimes gets in the way of work, these indicate the action stage. In the precontemplation stage, the client does not intend to make any changes in health behavior in the next 6 months. A client in the contemplation stage of health behavior will be more likely to accept the information. When a client has been having breakfast and lunch on time for the past 6 months, it indicates the change in health behavior has lasted quite some time, and the client is in the maintenance stage.

Which action does a community-based nurse do as a change agent? Select all that apply. One, some, or all responses may be correct. 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, and D 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 point about community health nursing made by the student nurse needs correction? A. "The focus is on preserving, protecting, promoting, or maintaining health. B. "The emphasis is to improve the quality of health and life within that community. C. "Community health nursing does not provide direct or indirect care services to subpopulations in a community." D. "Community health nursing can be described as nursing practice in the community, with the primary focus being the health care of individuals, families, and groups in that community

C Community health nursing provides direct care services to subpopulations within a community. Community health nursing is focused on preserving, protecting, promoting, or maintaining health. Community health nursing emphasizes improvement of the quality of health and life within that community. Community health nursing is nursing practice in the community, with the primary focus being the health care of individuals, families, and groups in the community.

A home health nurse checks the client's vital signs and obtains a blood sample for an international normalized ratio (INR). After these tasks are completed, the client asks the nurse to straighten the blankets on the bed. Which response by the nurse is correct? A. "I would, but my back hurts today." B. "Okay. It will be my good deed for the day"" C. "Of course. I want to do whatever I can for you." D. "I would like to, but it is not in my job description."

C Helping the client meet physical needs is within the role of the nurse; arranging blankets on the client's bed is an appropriate intervention. The nurse's comfort needs should not take precedence over the client's needs; the nurse would not assume responsibility for the role of care provider if incapable of providing care. This act is not a good deed but fulfills the expected role of the nurse; this response sounds grudgingly compliant. Straightening the blankets is within the nurse's job description.

Which characteristic makes a crisis access hospital (CAH) different from an intensive care unit (ICU)? A. Offers 24-hour emergency care B. Offers health care to acutely ill people C. Provides temporary care for 96 hours or less D. Provides the most expensive health care delivery

C A CAH is a rural hospital that provides temporary care for 96 hours or less to stabilize clients before they are transferred to a larger hospital. An ICU or a critical care unit is a hospital unit in which clients receive close monitoring and intensive medical care. Both CAH and ICU offer 24-hour emergency care. The CAH and ICU care for acutely ill clients by monitoring them on multiple devices. An ICU is the most expensive health care delivery site, because the nurse cares for only one or two clients at a time.

The nurse is teaching a parenting class. Which suggestion would the nurse make about managing the behavior of a young school-age child? A. Avoid answering questions B. Give the child a list of expectations C. Be consistent about established rules D. Allow the child to plan the day's activities

C Because of a child's short attention span and distractibility, consistent limit setting by parents is essential toward providing an environment that promotes concentration, prevents confusion, and minimizes conflicts. Questions should be answered, but the answers should not be judgmental. A list of expectations may be overwhelming at this age. Parents need to assist children with routine tasks; children this age may not be concerned with time frames.

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 (DaP)

C 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 DaP at age 12, it is not necessary. A booster dose of tetanus toxoid (Td) should be received every 10 years.

The nurse is teaching a birthing/prenatal class about breast-feeding. Which hormone stimulates the production of milk during lactation? A. Inhibin B. Estrogen C. Prolactin D. Progesterone

C Prolactin is the hormone that initiates and produces milk during lactation. Inhibin prevents the secretions of follicle-stimulating hormone and gonadotropin-releasing hormone. Estrogen and progesterone are the sex hormones produced by the ovaries.