Community Swiftriver

Suzanne Olsen Scenario 3 The nurse asks Suzanne to come to the lab after she is dressed for a urine pregnancy test and additional lab work. The nurse asks Suzanne's boyfriend to wait in the waiting room while Suzanne collects the urine sample and has her blood drawn. While in the lab, the nurse has the opportunity to speak with Suzanne privately. What questions should the nurse ask to follow up on the red flags the nurse recognized during the visit?

- Are you able to come and go as you please? - Have you been hurt or threatened if you tried to leave? - Do you have your identification? - Where do you sleep and eat?

Maria Sanchez Scenario 2 The nurse learns that a score of 17 on the PHQ-9 indicates moderately severe depression. What would be appropriate responses from the nurse?

- Ask Maria, "Do you feel like hurting yourself?" - Ask Maria, "Do you feel like hurting Juan?"

Maria Sanchez Scenario 1 The nurse recognizes that Maria appears anxious and is concerned about Maria's comments about breastfeeding and failing as a mother. The nurse suspects post-partum depression. Per the clinic protocol, the nurse administers the PHQ-9 post-partum depression questionnaire. Maria's evaluation demonstrates a score of 17. Which are the appropriate nursing actions?

- Assess the meaning of a score of 17 on the PHQ-9 - Report the findings to the healthcare provider

Roger McClusky Scenario 5 The Nurse Case Manager is considering community referrals and potential interventions for Roger. Which should be included in the coordinated plan of care?

- Be sure the client has an updated hearing test - Arrange Meals on Wheels - Obtain legal counsel to establish Power of Attorney for financial and health care decisions - Assess available respite care services - Refer for Custodial Care Services

Roger McClusky Scenario 1 After receiving the diagnosis of early-onset Alzheimer's Disease dementia, Roger and Lisa opt to coordinate care through a Nurse Case Manager. What are true statements regarding case management?

- Case management is a collaborative process - Nurse Case Managers function as advocates. - There is a certification examination for Nurse Case Managers - A philosophy of case management is for an individual to reach an optimal level of wellness.

Roger McClusky Scenario 3 The Nurse Case Manager recognizes the importance of church in Roger's life and asks if he would like coordinated care with the parish nurse. What are correct responses of the role and function of the parish nurse

- Changes in the client's senses can increase risk for injury - The parish nurse can conduct home visits -Parish nursing is a ministry - Parish nurses are health educators

Roger McClusky Scenario 4 The Nurse Case Manager is familiar with health concerns in rural farming communities. One of the Nurse Case Manager's concern is related to Roger's chronic pesticide exposure. What are correct statements regarding pesticide exposure?

- Chronic pesticide exposure can cause neurotoxicity, including Alzheimer's Disease dementia - Exposure to pesticides can occur when performing activities not directly related to pesticide use -Personal protective equipment can decrease pesticide exposure - Main routes of pesticide entry are contact, ingestion, and inhalation

Kenny Barrett Scenario 3 Kenny has experienced arterial thrombosis and vasculitis. He complains of pain in his lower legs and tingling in his feet. What are appropriate actions for the nurse?

- Encourage foot soaks to help resolve the symptoms - Encourage Kenny to stop smoking - Palpate the skin to assess for coldness - Assess for signs of phlebitis - Assess for signs of acrocyanosis

Jenny Smith Scenario 5 Jenny states she would like to use a long acting method of contraception and does not want more children, at least not for a few years. What are long-acting reversible contraceptive (LARC) options for Jenny?

- Etonogestrel Implants - Levonorgestrel-releasing Intrauterine Device

Jenny Smith Scenario 4 The nurse conducts patient education with Jenny about HSV. Which information should the nurse include in teaching about HSV?

- Explain to Jenny that antiviral medications can be used to decrease the frequency of HSV outbreaks. - Inform Jenny that oral HSV (cold sores) can be transmitted to the genitals through oral-to-genital contact.

Maria Sanchez Scenario 4 The healthcare provider prescribed Maria an SSRI, sertraline (Zoloft) 50 mg. Select the correct responses about SSRIs and postpartum depression

- The full effects of treatment may take several weeks - This medication has a low incidence of side effects - Promptly report any signs of suicidal ideation - SSRIs can interact with some herbal remedies - SSRIs are safe with breastfeeding

Kenny Barrett Scenario 2 After an introduction, Kenny invites you into his home. When he walks into the house, the nurse notices he has an unsteady gait. Kenny's vital signs are BP 170/86 mmHg, T 98.8 F (37.1 C)., P 77 beats/minute, RR 25 breaths/minute, The nurse inquires about Kenny's unsteady gait. Kenny states it feels like he is walking on "pins and needle" in his right foot and that it is uncomfortable to walk on or bear weight on that foot. What interventions should the home health nurse perform related to Kenny's diagnosis and complaint?

- Explain to Kenny feeling of pins and needles may be related to Buerger's disease. - Ask Kenny to remove his shoes and socks to assess his feet - Inquire how long he has noted the symptoms

Kenny Barrett Scenario 4 The nurse recognizes rural community home health can create unique challenges and desires to advocate for change. What are correct actions the nurse should consider when advocating for change to improve health outcomes in rural areas?

- Explore technological solutions - Engage in public policy advocacy - Promote value-based care - Creating public policy change requires collaboration - Endorse polices focused on recruiting and retaining an adequate workforce in rural communities

Jenny Smith Scenario 3 Jenny presents with complaints of lower abdominal pain, generalized malaise, swollen glands, and body aches. The provider makes a presumptive diagnosis of herpes simplex virus (HSV). The nurse plans Jenny's care based on knowledge about HSV. Which statements are true about HSV?

- Herpes is caused by one of two viruses. - HSV can lie dormant in the nerve root causing no symptoms. - Known triggers for HSV include surgical trauma and stressful situations. - Women can experience cyclic HSV outbreaks with their menses. - The initial HSV outbreak is generally more severe and lasts longer than recurrent outbreaks.

Suzanne Olsen Scenario 5 Victim interaction and victim assistance can help the nurse determine if someone is a victim of sex trafficking and how to safely handle the situation. Which statements are true about sex trafficking?

- If the nurse suspects someone is being sex trafficked, the nurse should try to separate the victim from the controlling person - Screen interpreters to be sure they do not know the victim - Call the National Human Trafficking Resource Center

Kenny Barrett Scenario 1 The home health nurse conducts the first home visit with Kenny Barrett for management of hypertension and assessment of Buerger's disease. When the nurse arrives, Kenny is sitting on his front porch smoking. The home has a tarp on the roof and plywood on the front window. As the nurse is approaching Kenny, he asks, "What are you doing here, kickin' up all that dust?" What are the appropriate actions for the home health nurse?

- Introduce self to Kenny and inform him you are a home health nurse - Assess for mold in the home - Inquire about Kenny's house and its state of disrepair - Ask if Kenny feels safe

Gina Smith Scenario 4 The correctional care nurse observes for complications of alcohol withdrawal. What statements are true about symptoms and management of alcohol withdrawal?

- Minor symptoms are due to central nervous symptom hyperactivity - Withdrawal-associated seizures usually occur within 12 to 48 hours after the last alcoholic drink - Delirium tremens from alcohol withdrawal typically begin 48-96 hours after the last drink - Severe alcohol withdrawal is often associated with fluid and electrolyte abnormalities

Gina Smith Scenario 5 The correctional care nurse is called to a unit to assess an intentional cut on Gina's wrist. Gina states she intended to hurt herself but does not feel suicidal. What are important considerations for the correctional care nurse?

- Non-suicidal self-injury is a significant problem in jails and prisons - Appropriate management will require collaborative, interdisciplinary strategies - Clients engaging in self-injurious behavior may miscalculate the lethality of their behavior

Jenny Smith Scenario 2 Jenny presents with complaints of lower abdominal pain, generalized malaise, swollen glands, and body aches. What might the nurse anticipate as a diagnosis?

- Post-operative infection - Herpes Simplex - Influenza

Jenny Smith Scenario 1 Jenny is tearful when she talks about the impact the miscarriage has had on her family and her relationship with her husband. She states she is having trouble concentrating. What are the appropriate actions for the nurse?

- Provide Jenny with referrals to counseling and pregnancy loss support groups. - Provide additional reading resources to Jenny. - Reassure Jenny that the miscarriage is not her fault

Suzanne Olsen Scenario 1 The nurse in the community clinic calls Suzanne from the waiting room to an examination room to obtain her health history. Suzanne's boyfriend accompanies her to the exam room. The nurse asks the boyfriend to wait in the lobby; he argues with the nurse and asks Suzanne if it is okay that he stays with her. Suzanne requests her boyfriend stay for the exam. When in the room, the nurse elicits a health history. Suzanne states her menses are irregular and that her LMP was 2 months ago. Her primary means of contraception is condoms although she admits that she does not use them consistently. Suzanne states she has persistent vaginal discharge, pain with intercourse and lower abdominal pain. She acknowledges she has had the symptoms for "about a month" and that her pelvic pain has been getting progressively worse, mostly on the right side. Suzanne states "I am scared I might be pregnant again." Select the three priority concerns for Suzanne at this time? Select the CORRECT responses

- Suzanne is scared she may be pregnant again - Suzanne is not using contraception consistently - Suzanne's boyfriend is persistent in wanting to be in the room with her

Suzanne Olsen Scenario 4 Not all victims of sex trafficking have clear physical indicators that aid identification. Which may be additional sources of evidence that the victim is being controlled either physically or psychologically?

- The victim may not exhibit any evidence of being controlled physically or psychologically - The victim may have few or no personal possessions - The victim may not know the city or state they are in - The victim may have untreated chronic illnesses - The victim may owe a large debt that the individual is unable to pay off

Kenny Barrett Scenario 5 What are appropriate risk reduction interventions for Kenny?

- Wear comfortable, well-fit shoes - Report increase in pain in lower extremities - Quit or reduce tobacco use - Encourage Active Range of Motion (ROM) - Remove obstacles on the floor

Suzanne Olsen Scenario 2 The healthcare provider requested that the nurse remain in the room for the healthcare provider exam. When the healthcare provider inquires about Suzanne's inconsistent contraceptive use, Suzanne starts fidgeting and looks at her boyfriend. He responds, "condoms are expensive." Suzanne shares that she has been treated for STIs "a couple of times." During the exam, Suzanne is submissive and tense. The nurse notices Suzanne has a tattoo of a crown on her left shoulder. Suzanne has numerous bruises on her body. The boyfriend says, "They are from packing and unpacking during the move, she is very clumsy." The healthcare provider completes the physical exam, obtains chlamydia and gonorrhea cultures, and makes a presumptive diagnosis of pelvic inflammatory disease (PID). The healthcare provider requests additional lab work and a urine pregnancy test. The nurse is concerned that Suzanne is a victim of sex trafficking. What key red flags could alert the nurse that Suzanne is in a potential trafficking situation?

-Crown tattoo on left shoulder - Recurrent sexually transmitted infections - Repeated pregnancy terminations - Multiple bruising - Persistent presence of her boyfriend

Maria Sanchez Scenario 3 Maria asks the nurse "Why me...how did I get post-partum depression?" The nurse, through the interpreter, teaches Maria about post-partum depression. What risk factors for post-partum depression should the nurse include in the instruction?

-History of depression - Low levels of social support - Breastfeeding problems -Unintended pregnancy - Traumatic birth experience

Roger McClusky Scenario 2 The Nurse Case Manager recognizes risk reduction for Roger will include education and recommendations on lifestyle behaviors, simplifying his home, and safety interventions. What are correct responses regarding education for risk reduction for clients with Alzheimer's Disease dementia?

-Loss of sensation can affect interpretation of hot, cold, or discomfort - A loss of or decrease in smell can place the client at increased risk for injury - A decrease in taste can place clients with Alzheimer's Disease at risk of putting dangerous items in their mouth - Clients with Alzheimer's Disease can lose their ability to interpret what they hear accurately

Maria Sanchez Scenario 5 Postpartum depression is a major health complication of women after delivery. Home health visits may be an essential approach for the prevention of serious consequences for the mother and the infant. Postpartum home visits can have a positive influence on postpartum depression and are an effective way to assess improvement of symptoms or recognize concerns with the mother and infant. Maria is receiving weekly visits from a home health nurse. Juan is now 5 months old. Which signs assessed by the home health nurse would indicate that Maria is functioning well at home?

-Maria is playing with Juan - Maria is taking Juan for short walks in the stroller -Maria is preparing and freezing homemade baby food

Gina Smith Scenario 3 The next day, the correctional care nurse receives a kite (slang for medical or other written requests for services by inmates) from Gina asking for something to alleviate her upset stomach and headache. Gina also reports feeling warm and that she is experiencing changes in her vision. What are appropriate responses from the correctional care nurse?

-Respond to Gina's kite and conduct a nursing assessment of her symptoms - Recognize Gina's symptoms could be consistent with alcohol and/or drug withdrawal

Gina Smith, 56-year-old female who has experienced a number of significant life changes over the past year as a result of her alcohol and IV drug addiction. Medical history: Six months ago, Gina was hospitalized for alcohol addiction. At that time, she was experiencing gastric pain, elevated liver enzymes, and was prescribed disulfiram (Antabuse). Gina is taking fluoxetine for depression and anxiety. Medications: NKDA. Fluoxetine (Prozac), one tablet by mouth daily. Social history: Gina lost her job as a graphic artist because she came to work intoxicated on two occasions. Due to her unemployment and addictions, she did not pay her rent and was evicted from her apartment. Gina has been forced to spend nights either in the shelter or "couch surfing." Due to the stress of being unemployed and homeless, Gina began to drink alcohol again because it "numbs the pain." In Gina's struggle to find work to pay for her alcohol addiction, she resorted to delivering drugs for drug dealers and began using IV drugs.

Community Assessment- Increased Culture/Belief's/Spirituality- Normal Disease/Illness Prevention- Increased Education/Counseling- Increased Self-management- Increased Social Determinants of Health- Increased Surveillance- Normal Health Promotion- Increased Resource Identification- Increased Risk Reduction- Increased

Bridgett Allen, 17-year-old girl with Down Syndrome. She is a new member of a program that provides vocational training and group home residence for adolescents with disabilities. Bridgett has moved several hours from home to be part of this program. Bridgett has a history of a repair of a ventricular septal defect at age 6. Since the surgery, Bridgett has had episodes of supraventricular tachycardia (SVT) about once every few months. She generally reverts to normal sinus rhythm with non-medication-based interventions. Bridgett also has frequent ear infections. Bridgett's BMI is 33 and she is recommended to lose weight. Bridgett takes a multivitamin and birth control pills daily. It is required she be on birth control while in the group home. This is a new medication for her. Bridgett is visited by the community health nurse for health counseling and her group home counselor and other staff are provided education to assist in keeping Bridgett healthy. Bridgett is able to care for herself and her personal hygiene needs, she can assist in meal preparation, and in housekeeping chores. She sometimes struggles with impulse and emotional control. Although Bridgett has a cardiologist that follows her care, she lacks local access to primary care and other resources she used at home.

Community Assessment- Increased Culture/Beliefs/ Spirituality- Normal Disease/Illness Prevention- Increased Education/ Counseling- Increased Health Promotion- Increased Resource Identification- Increased Risk Reduction- Increased Self-Management- Increased Social Determinants of Health- Increased Surveillance- Normal

Maria Sanchez , 20-year-old female, G1 T1 P0 A0 L1. Maria had an uncomplicated pregnancy and normal spontaneous vaginal delivery at 39 weeks. She delivered a 3500 Gram male infant, Juan. Maria is at the clinic for her 6-week post-partum visit. Maria shares with the nurse she is feeling anxious and overwhelmed. Maria states she attempted to breastfeed but quit because "Juan ate all of the time and cried most of the day." Maria's grandmother requested the Curanderos visit the house to guide Le Cuarentena. Maria explains Le Cuarentena is a period of 40 days after a baby is born during which time the mother should do nothing but take care of herself and the baby. Maria said, "grandmother told me Juan has colic because I did not eat the right hot foods after Juan was born and that the breastfeeding trouble was too much during the Le Cuarentena." Maria tearfully expresses, "I failed as a mother." Medications: NKDA Prenatal vitamins and herbs from the Curanderos Social history: Maria lives in a multigenerational home with her husband, Raul; 6-week infant, Juan; her mother and grandmother. Maria and her family primarily speak Spanish; today's visit includes an agency interpreter.

Community Assessment- Increased Culture/Beliefs/Spirituality- Increased Disease/Illness Prevention- Increased Education/Counseling- Increased Health Promotion- Increased Resource Identification- Increased Risk Reduction- Increased Self-management- Increased Social Determinants of Health- Increased Surveillance- Normal

Edward Martin , 44-year-old male recently discharged from an outpatient partial hospitalization for paranoid schizophrenia. He was experiencing delusions and causing a public disturbance. Edward was diagnosed with paranoid schizophrenia at age 28 and had one suicide attempt via overdose at age 32. Edward has had episodic hospitalizations for hallucinations and delusions resulting from non-adherence to his medication regimen. Edward's comorbidities include generalized anxiety disorder and hypertension. Medications: NKDA. Risperdal (risperidone) 3 mg one tablet twice daily by mouth Xanax (alprazolam) 0.5 mg one tablet daily by mouth. Melatonin one tablet daily one hour before bed Lisinopril 10 mg one tablet daily by mouth Surgical history: Appendectomy age 10 Social history: Edward lives alone and receives medication-monitoring services. He has worked at the meat packing plant for seven years. He received short-term disability during his outpatient partial hospitalization and is returning to work this week.

Community Assessment- Increased Culture/Beliefs/Spirituality- Normal Disease/Illness Prevention- Increased Education/Counseling- Increased Health Promotion- Increased Resource Identification- Increased Risk Reduction- Increased Self-Management- Increased Social Determinants of Health- Increased Surveillance- Increased

Charles Wheeler, Charles Wheeler is an 18-year-old male who is a senior in high school. Charles is struggling socially and academically at school. On numerous occasions Charles has been asked to leave the classroom for acting out and saying offensive things to his classmates and teachers. Charles was recently hospitalized and diagnosed Attention-Deficit/Hyperactivity Disorder (ADHD). Medications: NKDA. Adderall 20 mg daily; Zoloft 50 mg daily. Surgical history: Tonsillectomy and Adenoidectomy age 3, Appendectomy age 10 Social history: Charles lives at home with his parents in a suburban single-family home. Charles has a lot of conflict at home with his parents; his parents were frustrated with his recent hospitalization and his inability to "control himself". Charles works at an auto parts store 15 hours per week. After graduation, he plans to go to vocational school for auto mechanic.

Community Assessment- Increased Culture/Beliefs/Spirituality- Normal Disease/Illness Prevention- Increased Education/Counseling- Increased Health Promotion- Increased Resource Identification- Increased Risk Reduction- Increased Self-Management- Increased Social Determinants of Health- Increased Surveillance- Normal

Suzanne Olsen, 24-year-old female who comes to the community clinic with complaints of increased vaginal discharge, pain with intercourse, lower abdominal pain, and urinary frequency. Suzanne reports her symptoms started over a week ago. Suzanne is accompanied to the clinic by her boyfriend. Suzanne is 5 feet 6 inches tall, 117 pounds. BP 132/76 mmHg, T 100.2 F. (37.9 C.), P 88 beats/minutes, RR 18 breaths/minutes. Medical history: Suzanne's medical history is significant for five elective first trimester pregnancy terminations and two full term spontaneous vaginal deliveries. Suzanne's boyfriend states she gave the two children up for adoption. Medications: NKA. Surgical history: T & A age 5 Social history: Suzanne is new to the area and has not established a primary care provider. When asked what she does for employment, her boyfriend states because she is new to the area, she is unemployed and does not currently have insurance. He states that they are living in his apartment but are looking for another place to live.

Community Assessment- Increased Culture/Beliefs/Spirituality- Normal Disease/Illness Prevention- Increased Education/Counseling- Increased Health Promotion- Increased Resource Identification- Increased Risk Reduction- Increased Self-management- Increased Social Determinants of Health- Increased Surveillance- Increased

Jenny Smith, 23-year-old G2P1 who presents at the clinic after having a dilatation and curettage (D and C) following a spontaneous abortion at 10 weeks gestation six weeks ago. During her hospital discharge instructions, Jenny was advised to schedule a 1-2 week follow-up appointment with her provider to ensure a safe physical recovery and to discuss either birth control or to plan her next pregnancy if she desires to try again. Jenny cancelled her 2-week post-operative appointment because she "felt fine." She presents today with complaints of lower abdominal pain, generalized malaise, swollen glands, and body aches. Jenny is also requesting a long-term contraceptive option. Jenny admits her last pregnancy was not planned and "I do not want to go through that again and I don't want my family to go through it again". She is particularly concerned for her 4-year-old son who keeps asking "Where is the baby?" Jenny admits this has been very hard emotionally for her and her mom. Her significant other is generally supportive, he also grieves the loss of the pregnancy. BP 130/70 mmHg, T 98.8 F (37.1 C), P 90 beats/minute, RR 18 breaths/minute Medications: Prenatal vitamins. Allergies: Sulfa drugs Social history: Jenny lives in an apartment with her 4-year old son. Jenny is a second-grade teacher. Jenny's significant works in building construction and he was the father of the previous pregnancy. He splits his time with Jenny and with children from a previous relationship. Jenny and her mother are very close, and she talks with her mother every day.

Community Assessment- Increased Culture/Beliefs/Spirituality- Normal Surveillance- Normal Disease/Illness Prevention- Increased Education/Counseling- Increased Health Promotion- Increased Resource Identification- Increased Risk Reduction- Increased Self-management- Increased Social Determinants of Health- Normal

Genevieve (Genny) Osaka, 14-month-old infant. When she was 4-months old, she was in a motor vehicle accident while unrestrained leading to a C-4 spinal fracture and spinal cord injury. Genny lives with her mother who is a single parent and is an expert in her care. Genny has been relatively healthy since the accident. Genny has a tracheostomy and is on mechanical ventilation. She has a jejunostomy tube for feedings and medications, is on an intermittent urinary catheterization program, and receives suppositories to ensure regular bowel movements. Genny makes eye contact. She is delayed in her speech and has no movement or sensation below the level of her injury. Genny's mother is eager to return to work since the accident and has found a childcare facility that provides care to children requiring highly skilled care. Genny's mother plans to look for a job once Genny is settled into the new childcare. The mother and community health nurse provide training about Genny's individual care to the staff at the childcare center. Genny is prone to orthostatic intolerance and temperature instability. Genny receives multivitamins and lansoprazole. Genny has increased weight in the last few months so Genny is to have a nutrition consult to adjust caloric intake of her enteral feedings. Genny has an oral feeding aversion and refuses to take oral foods or fluids. Genny's mother expresses concern over the cost of the childcare center in addition to all of the other healthcare expenses. Genny's mother should make an adequate salary when she finds a job as a computer software designer, but she is concerned about insurance capitation and is interested in learning about public supports and resources.

Community Assessment- Normal Culture/Beliefs/ Spirituality- Normal Disease/Illness Prevention- Increased Education/ Counseling- Increased Health Promotion- Increased Resource Identification- Increased Risk Reduction- Normal Self-Management- Increased Social Determinants of Health- Increased Surveillance- Normal

Kenny Barrett, Kenny Barrett is a 64-year-old male recently hospitalized for management of undiagnosed hypertension. It was determined Kenny's hypertension and lower extremity pain was related to vasculitis. Kenny was diagnosed with Buerger's Disease. Medications: Atenolol 50 mg daily. Tylenol 325 mg prn pain. NKDA Surgical history: Kenny's surgical history is positive for a cholecystectomy and inguinal hernia repair. Social history: Kenny is widowed. He lives alone in a two-bedroom home in a rural community. Kenny recently retired and does not work outside of the home. He admits to struggling financially and being dependent on his savings until he can receive social security. He smokes one pack per day. The pain in his lower extremities prohibits his engagement in exercise. Community Assessment: Kenny lives in a rural community with limited resources. Kenny's home is on a dirt road, the nearest neighbor is "one country mile" away. Kenny lives seven miles from the farm co-op where he can purchase fresh vegetables and milk. To purchase items not available from the co-op, Kenny must go to "town" nearly thirty miles from his home. There is a family physician in town, however, the nearest hospital and specialty clinics are 80 miles. Kenny receives his prescriptions via mail. Kenny travels via his car, which is unreliable.

Culture/Beliefs/Spirituality- Normal Health Promotion- Increased Resource Identification- Increased Surveillance- Normal Community Assessment- Increased Disease/Illness Prevention- Increased Education/Counseling- Increased Risk Reduction- Increased Self-management- Increased Social Determinants of Health- Increased

Genevieve (Genny) Osaka Scenario 5 Genny is prone to orthostatic intolerance. The mother and community health nurse provide education to the childcare staff about means to prevent Genny from experiencing this problem. Which strategies should they reinforce with the childcare workers to avoid this condition?

Select - Apply infant sized compression stockings prior to position changes. - Using a tilt table daily to increase Genny's tolerance to position changes. - Slowly raise the head of the bed prior to placing her in the infant seat. - Explore swings and standing frames that allow Genny to be upright.

Gina Smith Scenario 1 Gina was brought into the correctional facility facing a felony charge for drug distribution and trafficking. The law enforcement officer's report indicated Gina was stopped for erratic driving had a blood alcohol level of 0.15%. Her drug test in pending. Gina is demonstrating a loss of coordination and is argumentative. The correctional care nurse conducts the intake interview and assessment. What are primary considerations for the correctional nurse?

Select - Assess for symptoms of alcohol withdrawal - Test for blood-borne pathogens - Conduct a body cavity search for drugs - Protect Gina from self-injury - Prepare for the detoxification process

Gina Smith Scenario 2 Correctional care nurses are critical in the continuum of care for people who are incarcerated. Which statements are true about correctional care nurses and their role?

Select - Correctional nurses are typically the first point of contact in healthcare of inmates - Correctional nurses have an autonomous role and scope of practice - Correctional care nurses require an understanding of vulnerable populations

Genevieve (Genny) Osaka Scenario 4 Genny is on a clean intermittent catheterization program in her bladder routine. She is to be catheterized every four hours during the day and one-two times during the night. The childcare workers will be performing the catheterizations at the childcare center. Genny's mother and the community health nurse reinforce the techniques they use to accomplish this task with Genny. They instruct the childcare worker to assemble equipment for the procedure. Which equipment is appropriate for this procedure?

Select - Hand antiseptic. - A receptacle to hold the urine from the catheterization.

Genevieve (Genny) Osaka Scenario 3 The community health nurse conducts a developmental assessment of Genny. The nurse compared Genny's achievement of developmental milestones with an infant who does not have a spinal cord injury. Which developmental milestones would the nurse anticipate in a child Genny's age who has not experienced a spinal cord injury?

Select -Use of pincer grasp. - Babbling and word-like verbalizations. - Hand-to-hand transfer of objects.

Edward Martin Scenario 5 Which therapies or interventions would be considerations for Edwards's plan of care to increase medication adherence?

Select: - Cognitive-behavioral therapy - Motivational interviewing - Cognitive adaptation training - Adherence/compliance therapy - Support services to address logistic barriers

Edward Martin Scenario 1 Edward will be going back to work at the meat packing plant after taking short-term disability while receiving outpatient partial hospitalization. The occupational health nurse at the meat packing plant where Edward works focuses on promotion and restoration of health, prevention of illness and injury, and protection from work-related and environmental hazards. Select the CORRECT interventions for the occupational health nurse to implement in preparing a safe return to work for Edward.

Select: - Conduct health surveillance - Case management - Identify work-related stress and self-care strategies - Evaluation of short-term disability compensation - Provide strategies for addressing co-workers' interest

Genevieve (Genny) Osaka Scenario 2 One education area the nurse wants to share with the childcare workers is the unique needs of a child with a spinal cord injury when they have an elevated temperature. If Genny is found to have a fever, in addition to calling the mother, and potentially the healthcare provider, the community health nurse instructs the childcare workers about appropriate interventions. Which actions would be included in this teaching?

Select: - Ensure that Genny is well-hydrated. - Provide antipyretics as prescribed. -Be aware of client's inability to cool the body through diaphoresis. - Lightly sponge the skin with lukewarm water during febrile periods.

Bridgett Allen Scenario 3 Bridgett is prescribed the birth control pill for the first time. The staff at the group home will be administering her medications each morning before work. Bridgett is prescribed a progestin-only birth control pill. The community health nurse provides education for the staff. Which statements by a group home staff member indicate a good understanding of teaching?

Select: - It is important that her birth control pill be given the same time each day. - These pills have fewer side-effects than other birth control pills.

Edward Martin Scenario 2 Edward met with the occupational health nurse prior to returning to work to discuss his case management. During the meeting, Edward states he is worried about managing his symptoms and that his job at the meat packing plant is important to him. Edward admits he is having difficulty staying focused, which is required in his position at the plant. He discloses he needs to maintain his employment financially to pay bills and for his insurance benefits. The occupational health nurse addresses potential workplace accommodations, work-related stress, and self-care strategies. What are considerations for Edwards's case management?

Select: - Medication adherence - Social skills training - Education on symptom identification

Edward Martin Scenario 4 A coworker reports to the occupational health nurse that they have observed increased strange behavior from Edward while he is on the product line. What would be an appropriate response for the occupational health nurse?

Select: - Remove from the line - Ask Edward to come to the occupational health clinic for further evaluation - Report symptoms to Edward's healthcare provider his health care - Inquire about the specific symptoms Edward's co-workers observed

Genevieve (Genny) Osaka Scenario 1 Genny's mother is a single parent and shares her financial concerns with the community health nurse. Genny's mother expresses that her inability to work since Genny's accident has depleted her economic resources. The community health nurse praises Genny's mother for the care she provides to her daughter and teaches Genny's mother about potential financial supports for which the family may be eligible until Genny's other secures and start a job. Which resources would be appropriate for Genny and her mother?

Select: - Women Infants and Children. - Temporary Assistance for Needy Families. - Social Security. - Children's Health Insurance Program. - Medicaid.

Bridgett Allen Scenario 4 Bridgett expresses to the community health nurse that the group home staff have "too many rules" and "don't let me do what I want." The community health nurse is aware of Bridgett's adolescent-oriented need for independence and control. The community health nurse works with the group home staff to assist in creating programs that may foster safe independence. Which strategies should the nurse include in the initial development of these programs?

Select: -Establishing behavioral contracts with group home residents - Allow Bridgett and other residents to make some choices about their living arrangements, including meals, bedtimes, etc. - Create a reward system to motivate adherence to group home rules. - Involve all residents in the establishing of ground rules and the reward system.

Bridgett Allen Scenario 2 One evening, during a resident meeting at the group home, Bridgett becomes pale and states "I feel all floppy. It's my heart beating like crazy again." Which non-medication-based interventions may be safely taught to Bridgett to revert from supraventricular tachycardia (SVT) to a normal sinus rhythm?

Select: -Hold your breath and "bear down." -Put an ice bag on your face. - Blow on your thumb like a trumpet.

Bridgett Allen Scenario 5 Bridgett is comfortable in the group home and the community health nurse addresses Bridgett's weight. Bridgett has gained more weight since living at the group home. The staff relay that Bridgett has poor impulse control with food and tends to eat any food that is available. She appears to do well during the workday, but impulsively eats in the evening when she is not closely monitored. Which strategies may be effective for the nurse to recommend to Bridgett?

Select: - Eat healthy, low-calorie snacks in the evenings. - Write down foods eaten in a food journal. - Get involved in a nightly walking program.

Edward Martin Scenario 3 The occupational health nurse investigates factors that may contribute to poor medication compliance for Edward. What are factors could contribute to poor medication compliance for Edward?

Select: - Medication side effects - Low level of social involvement - Financial constraints - Living alone - Lack of awareness about illness

Bridgett Allen Scenario 1

Select: -The entire ten-day course should be taken. -The client and staff may note diarrhea during the course of the medication.

Roger McClusky, 70-year-old male recently diagnosed with Alzheimer's Disease dementia following evaluation of forgetfulness, difficulty processing new information, and increased confusion. With his declining memory and hearing impairment Roger's daughter, Lisa, is concerned about his ability to care for himself and is interested in care options to assist him in staying in his home. Medications: NKDA, memantine (Namenda) one tablet daily. Social history: Roger lives alone in a two-bedroom home in a rural community. Roger came to the community as a migrant worker 40 years ago and worked as farm help for a local farmer providing manual labor in the fields. Roger is active in his church and attends with the men's Bible study weekly. His daughter lives nearby and visits Roger multiple times per week. Community Assessment: Roger lives in a small rural community with a small downtown. On the Main Street there is a grocery store, a family-owned pharmacy and milk shake shop, gas station, diner, second-hand store, and an outreach family practice clinic. There are two churches, one on the north side and one on the west end of town. The houses are spaced "a country mile," separated by farmland and fields. Most of the side roads are gravel. There are no public transportation options.

Self-management- Increased Community Assessment- Increased Culture/Beliefs/Spirituality- Increased Disease/Illness Prevention- Increased Education/Counseling- Increased Health Promotion- Increased Resource Identification- Increased Risk Reduction- Increased Surveillance- Normal Social Determinants of Health- Increased