EAQ-Comminuty Care
A nursing student is listing the different levels of the health care services pyramid. Under which type of health care services should the nursing student include subacute care? 1 Tertiary care 2 Continuing care 3 Restorative care 4 Secondary acute care
1 Tertiary care The nursing student should include subacute care under tertiary care. Subacute care is not a part of continuing care, restorative care, or secondary acute care health care services.
What services do community health centers provide in preventive and primary care services? Select all that apply. 1 Day care 2 Health screenings 3 Physical assessments 4 Disease management 5 Acute and chronic care management
2 Health screenings 3 Physical assessments 4 Disease management 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.
During a health symposium a nurse teaches the group how to prevent food poisoning. Which statement by one of the participants indicates the teaching is understood? 1 "Meats and cream-based foods need to be refrigerated." 2 "Once most food is cooked, it does not need to be refrigerated." 3 "Poultry should be stuffed and then refrigerated before cooking." 4 "Cooked food should be cooled before being put into the refrigerator."
1 "Meats and cream-based foods need to be refrigerated." A cold environment limits growth of microorganisms. All food should be refrigerated before and after it is cooked to limit the growth of microorganisms. Stuffing and then refrigerating poultry promotes the growth of microorganisms because the stuffing will still be warm for a period before the refrigerator's cold environment cools the center of the bird. It is advocated that poultry not be stuffed. If it is stuffed, it should be done immediately before cooking. Cooling foods before refrigeration promotes the growth of microorganisms because microorganisms thrive in warm, moist environments.
Which activity by the community nurse can be considered an illness prevention strategy? 1 Encouraging the client to exercise daily 2 Arranging an immunization program for chicken pox 3 Teaching the community about stress management 4 Teaching the client about maintaining a nutritious diet
2 Arranging an immunization program for chicken pox 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 the 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.
The nurse teaches a health class about communicable diseases and states that the virus that causes chickenpox can also cause another disease. Which disease is the nurse describing? 1 Athlete's foot 2 Herpes zoster 3 German measles 4 Infectious hepatitis
2- Herpes zoster Invasion of the posterior (dorsal) root ganglia by the same virus that causes chickenpox can result in herpes zoster, or shingles. This may be caused by reactivation of a previous chickenpox virus that has lain dormant in the body or by recent contact with an individual who has chickenpox. Athlete's foot is caused by a fungus. German measles is caused by a virus, but not the herpes virus. Hepatitis type A is caused by a virus, but not the herpes virus.
What is the professional nurse's legal responsibility regarding child abuse? 1 Honor the request of the parents not to report the suspected abuse. 2 Report any suspected abuse to local law enforcement authorities. 3 Return the child to the legal parent even if he or she is suspected of abuse. 4 Provide the parents with a copy of the child's medical record.
2- Report any suspected abuse to local law enforcement authorities Nurses and primary healthcare providers are legally responsible for reporting suspected or actual abuse. Child protective services may obtain a court order to grant temporary guardianship if it is found that the child is in immediate danger. The other answer options do not fulfil the nurse's duty to report suspected child abuse. Test-Taking Tip: The following are crucial requisites for doing well on the NCLEX exam: (1) A sound understanding of the subject; (2) The ability to follow explicitly the directions given at the beginning of the test; (3) The ability to comprehend what is read; (4) The patience to read each question and set of options carefully before deciding how to answer the question; (5) The ability to use the computer correctly to record answers; (6) The determination to do well; (7) A degree of confidence.
The home health nurse provides education to a client with cancer of the tongue who will begin gastrostomy feedings at home. Which statement by the client indicates teaching by the nurse is effective? 1 "Before I start the procedure, I will don sterile gloves." 2 "Before I start the procedure, I will obtain my body weight." 3 "Before I start the procedure, I will measure the residual volume." 4 "Before I start the procedure, I will instill one ounce (30 mL) of a carbonated liquid."
3 "Before I start the procedure, I will measure the residual volume." Measuring the residual volume establishes whether an adequate volume of the previous feeding was absorbed. If a residual exceeds the parameter identified by the healthcare provider or is over 200 mL, a feeding may be held. This prevents adding excess feeding solution that may lead to abdominal distention, nausea, vomiting, and aspiration. Clean, not sterile, gloves are necessary to protect the client from contamination with gastric secretions. Weights are taken and reported weekly or monthly depending on the client's condition and clinical goals. A carbonated beverage may be used if the tube becomes clogged; it is not used routinely. Test-Taking Tip: Note the number of questions and the total time allotted for the test to calculate the times at which you should be halfway and three-quarters finished with the test. Look at the clock only every 10 minutes or so.
A nursing student lists the preventive and primary care services available in schools, primary healthcare provider's offices, occupational health clinics, community health centers, and nursing centers. Which service provided by these centers is most expensive? 1 Running errands 2 Health education 3 Disease management 4 Routine physical examinations
3 Disease management Disease management is the most expensive service provided by community health centers. Running errands is inexpensive, and if the person walks or rides a bike, can be used as a health promotion activity. 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.
A nurse helps a client to clarify health problems and choose appropriate courses of action. What competency in community-based practice is the nurse exercising? 1 Educator 2 Caregiver 3 Counselor 4 Epidemiologist
3 Counselor When a nurse is helping a client to identify and clarify health problems and choose appropriate courses of action to solve those problems, the nurse is acting as a counselor. The nurse acts as an educator by establishing relationships with community service organizations. The nurse acts as an epidemiologist when he or she is involved in case finding, health teaching, and tracking incident rates of an illness. The nurse acts as a caregiver when he or she provides appropriate, individualized nursing care for specific clients and their families.
The nurse at a health fair has taken a client's blood pressure twice, 10 minutes apart, in the same arm while the client is seated. The nurse records the two blood pressures of 172/104 mm Hg and 164/98 mm Hg. What is the appropriate nursing action in response to these readings? 1 Refer the client to a nutritionist after providing health teaching about a low-sodium diet. 2 Place the client in a recumbent position and call the paramedics for transport to the hospital. 3 Talk with the client to assess whether there is stress in the client's life and refer to a counseling service. 4 Take the client's blood pressure in the other arm and then schedule a healthcare practitioner's appointment for as soon as possible.
4 Take the client's blood pressure in the other arm and then schedule a healthcare practitioner's appointment for as soon as possible. According to the United States Department of Health and Human Services (Canada: Canadian Heart and Lung Association), both of these readings indicate hypertension and thus require further evaluation by a healthcare provider; having a baseline for both arms can assist the healthcare provider with the medical diagnosis. Teaching about a low-sodium diet is an inadequate intervention. An appointment with a healthcare provider, not a nutritionist, should be scheduled as soon as possible. There are insufficient data to support this emergency intervention (calling the paramedics). The client's elevated blood pressure needs to be evaluated by a healthcare provider and then medical therapy implemented. Although emotional stress can precipitate hypertension, physical causes should be ruled out first. Test-Taking Tip: Stay away from other nervous students before the test. Stop reviewing at least 30 minutes before the test. Take a walk, go to the library and read a magazine, listen to music, or do something else that is relaxing. Go to the test room a few minutes before class time so that you are not rushed in settling down in your seat. Tune out what others are saying. Crowd tension is contagious, so stay away from it.
The nurse at a community healthcare center focuses on providing primary preventive care. What is the focus of primary preventive care? 1 Rehabilitating the client 2 Treating early stages of disease 3 Preventing complications from illness 4 Promoting health in healthy individuals
4 Promoting health in healthy individuals Primary prevention precedes disease or dysfunction and is applied to patients considered physically and emotionally healthy. Health education programs, immunizations, and physical and nutritional fitness activities are primary prevention activities. Tertiary preventive care occurs when an individual has a permanent or irreversible disability. The client undergoing rehabilitation is receiving tertiary preventive care. Secondary preventive care focuses on individuals who are experiencing health problems. Secondary preventive care involves treating clients in the early stages of disease. It also focuses on preventing complications from illness.
A nurse is preparing to teach a mental health course at a community health center. What information should the nurse include as one of the most effective ways to limit the occurrence of mental illness in the community? 1 Developing multiple coping strategies 2 Reporting strange behaviors by others 3 Correcting myths about mentally ill people 4 Addressing genetic issues related to mental illness
1 Developing multiple coping strategies A variety of strategies gives people options when they are attempting to cope with stress. Different strategies work better in different situations. Reporting strange behaviors by others is too vague; the definition of "strange" may vary, depending on the individual. Although correcting myths about mentally ill people is useful, it will not limit the occurrence of mental illness. Although some mental disorders may have familial tendencies and may have a genetic link, this information is too limited.
What should the community nurse teach about the risk of adolescent pregnancy? 1 Risk for premature birth 2 Risk for having a large baby 3 Risk for chromosomal defects 4 Risk for increased weight gain
1 Risk for premature birth The nurse should 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 from lack of nutrition, and exposure to alcohol, drugs, and tobacco. Test-Taking Tip: You have at least a 25% chance of selecting the correct response in multiple-choice items. If you are uncertain about a question, eliminate the choices that you believe are wrong and then call on your knowledge, skills, and abilities to choose from the remaining responses.
Which role does a nurse play when helping clients to identify and clarify health problems and to choose appropriate courses of action to solve those problems? 1 Educator 2 Counselor 3 Change agent 4 Case manager
2 Counselor As a counselor, the nurse helps clients identify and clarify health problems and choose appropriate courses of action to solve those problems. As an educator, the nurse teaches clients and their families to assume responsibility for their own health care. A nurse acts as a change agent within a family system or as a mediator for problems within a client's community; this involves identifying and implementing new and more effective approaches to problems. As a case manager, the nurse establishes an appropriate plan of care on the basis of assessment findings and coordinates needed resources and services for the client's well-being along a continuum of care. Test-Taking Tip: Reread the question if the answers do not seem to make sense, because you may have missed words such as not or except in the statement.
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? 1 Slap at the flames. 2 Log-roll the victim in the grass. 3 Pour cold liquid over the flames. 4 Remove the victim's burning clothes.
2 Log-roll the victim in the grass. Log-rolling the victim in the grass effectively extinguishes the flames and protects the client from additional injury. Slapping at the flames will not eliminate the oxygen that supports the fire and will fan the flames. Pouring cold liquid over the flames may extinguish the flames, but not as effectively as rolling in the grass. Removing the victim's burning clothes may or may not protect the client from further injury and is dangerous for the rescuer. STUDY TIP: Rest is essential to the body and brain for good performance; think of it as recharging the battery. A run-down battery provides only substandard performance. For most students, it is better to spend 7 hours sleeping and 3 hours studying than to cut sleep to 6 hours and study 4 hours. The improvement in the rested mind's efficiency will balance out the difference in the time spent studying. Knowing your natural body rhythms is necessary when it comes to determining the amount of sleep needed for personal learning efficiency.
What is the main focus of community health nursing? 1 To meet the acute care needs of a population 2 To improve the quality of health in a population 3 To influence political processes affecting public policies 4 To assess the healthcare needs of an individual or family
2 To improve the quality of health in a population Community health nursing is a nursing practice focusing on the healthcare of individuals, families and groups with 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 healthcare within the reach of the community. Factors influencing health services such as political process affecting public policies are handled by public health nursing. Community-based nursing focuses on the fulfillment of the healthcare needs of an individual or family.
The nurse is teaching a class about nutrition to a group of adolescents. Taking into consideration the prevalence of overweight teenagers, what is the best recommendation the nurse can make? 1 "Join a gym." 2 "Drink fewer diet sodas." 3 "Decrease fast food intake." 4 "Take a multivitamin daily."
3 "Decrease fast food intake." Eating a variety of healthful foods instead of a fast-food diet that is high in fat and carbohydrates helps decrease excess weight and increase energy with which to engage in physical activities. Joining a gym is expensive and unnecessary. Physical activity can be achieved in the schoolyard or at home. A multivitamin will not promote weight loss. Vitamins and minerals are best obtained in a balanced diet. Diet soft drinks do not contribute to obesity. Test-Taking Tip: Key words or phrases in the stem of the question such as first, primary, early, or best are important. Similarly, words such as only, always, never, and all in the alternatives are frequently evidence of a wrong response. As in life, no real absolutes exist in nursing; however, every rule has its exceptions, so answer with care.
A home health nurse on a first visit 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. What is the nurse's most appropriate response? 1 "I would, but my back hurts today." 2 "Okay. It will be my good deed for the day." 3 "Of course. I want to do whatever I can for you." 4 "I would like to, but it is not in my job description."
3 "Of course. I want to do whatever I can for you." Helping the client to 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 should 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. This is within the nurse's job description. STUDY TIP: A word of warning: do not expect to achieve the maximum benefits of this review tool by cramming a few days before the examination. It doesn't work! Instead, organize planned study sessions in an environment that you find relaxing, free of stress, and supportive of the learning process.
A 13-year-old girl tells the nurse at the pediatric clinic that she took a pregnancy test and got a positive result. She confides that her grandfather, with whom she, her younger sisters, and her mother live, has repeatedly molested her for the past 3 years. When the nurse asks the girl whether she has told anyone else, she replies, "Yes, but my mother doesn't believe me." Legally, who should the nurse notify? 1 Police concerning a possible sex crime 2 Primary healthcare provider to confirm the pregnancy 3 Child protective services for immediate intervention 4 Girl's mother about the pregnancy test's positive result
3 Child protective services for immediate intervention It is the nurse's legal responsibility to report child abuse to the appropriate agency. Safety is the priority, and child protective services will provide immediate intervention. Although the police may be notified, this is not the nurse's responsibility at this time. Notifying the primary healthcare provider may be done later, but it is not the priority. The girl's pregnancy has not been confirmed; at this time it is most important to protect her and her sisters. Test-Taking Tip: Become familiar with reading questions on a computer screen. Familiarity reduces anxiety and decreases errors.
A nurse is teaching a birthing/prenatal class about breast-feeding. Which hormone stimulates the production of milk during lactation? 1 Inhibin 2 Estrogen 3 Prolactin 4 Progesterone
3- Prolactin 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.
A nurse is conducting cholesterol screening for a manufacturing corporation during a health fair. A 50-year-old man who is 6 feet (183 cm) tall and weighs 293 pounds (133 kg) puts out his cigarette and asks the nurse how to modify his risk factors for coronary artery disease. On which risk factors should the nurse help the client focus? Select all that apply. 1 Age 2 Height 3 Weight 4 Smoking 5 Family history
3- Weight 4-Smoking Obesity is a modifiable risk factor that is associated with coronary artery disease (CAD); an increased fat intake contributes to an increased serum cholesterol and atherosclerosis. Smoking, which constricts the blood vessels, is a modifiable risk factor for CAD. The incidence of CAD does increase with age. However, age is not a modifiable risk factor. Height is unrelated to the incidence of CAD. Family history is not a modifiable risk factor for CAD because one cannot control heredity. Test-Taking Tip: Be alert for details about what you are being asked to do. In this Question Type, you are asked to select all options that apply to a given situation or client. All options likely relate to the situation, but only some of the options may relate directly to the situation.
A nurse in the health clinic is counseling a college student who recently was diagnosed with asthma. On what aspect of care should the nurse focus? 1 Teaching how to make a room allergy-free 2 Referring to a support group for individuals with asthma 3 Arranging with the college to ensure a speedy return to classes 4 Evaluating whether the necessary lifestyle changes are understood
4 Evaluating whether the necessary lifestyle changes are understood 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.
The registered nurse is organizing a community health care program for administering tetanus vaccinations. Which member of the health care team is most suitable for being delegated the task of administering vaccinations? 1 Nursing aide 2 Certified technician 3 Patient care associate 4 Licensed practical nurse
4- Licensed practical nurse Tetanus vaccination is administered through the intramuscular route. The licensed practical nurse can administer oral, topical, and intramuscular medications, except for intravenous. The nursing aide, certified technician, and patient care associate are unlicensed assistive personnel whose scope of practice is limited for administering medications.
What purpose does block and parish nursing serve in preventive and primary care services? 1 Block and parish nursing provides services to older clients or those who are unable to leave their homes. 2 Block and parish nursing provides primary care to a specific client population that lives in a specific community. 3 Block and parish nursing provides nursing services with a focus on health promotion and education as well as on chronic disease. 4 Block and parish nursing provides services aimed at increasing worker productivity, decreasing absenteeism, and reducing the use of expensive medical care.
1 Block and parish nursing provides services to older clients or those who are unable to leave their homes. 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.
A client tells the nurse, "I keep reverting to my old habit of drinking soda, although I have stopped drinking as much." What stage of health behavior change has the client reached? 1 Action stage 2 Preparation stage 3 Maintenance stage 4 Contemplation stage
1- Action Stage The client in this situation has reached the action stage of health behavior change. In this stage, old habits may get in the way of new behaviors. In the preparation stage, the client understands that the advantages of the health behavior change outweigh its disadvantages. In this situation, the client has already made changes in health behavior. In the maintenance stage, the client continues the health behavior change indefinitely. In the contemplation stage, the client may be ambivalent but is more ready to accept information regarding health behavior change. Test-Taking Tip: Reread the question if the answers do not seem to make sense, because you may have missed words such as not or except in the statement.
A nurse is preparing a community health program for senior citizens. The nurse teaches the group that what physical findings are typical in older adults? 1 Increased skin elasticity and a decrease in libido 2 Impaired fat digestion and increased salivary secretions 3 Increased blood pressure and decreased hormone production 4 An increase in body warmth and some swallowing difficulties
3 Increased blood pressure and decreased hormone production With aging, narrowing of the arteries causes some increase in the systolic and diastolic blood pressures; hormone production decreases after menopause. There may or may not be changes in libido; there is a loss of skin elasticity. Salivary secretions decrease, not increase, causing more difficulty with swallowing; there is some impairment of fat digestion. There may be a decrease in subcutaneous fat and decreasing body warmth; some swallowing difficulties occur because of decreased oral secretions.
A nurse is caring for a client attending a community-based health center and reviews the client's medical record. What should the nurse encourage the client to do? 1 Wring a sponge repeatedly when washing dishes. 2 Install faucets that require turning rather than pushing. 3 Push with the palms rather than the fingers when rising from a chair. 4 Actively use the hands for several hours each morning, sewing or knitting. CHART: (IMAGE NOT LOADING) progress note: stage 3 RA progressively causing more joint deformity stiffness and pain RN Note/Phy. Ass.: Client has unilateral drift on both hands and hallux valgus deformity of noth feet. Client report pain when walking and joing 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 LAB RESULTS: Rheumatoid factor 1:70 (positive for RA) Erythrocyte sedimentation rate: 40mm/hr; C-reactive protein 20mg/dL; WBC: 13000/ul
3 Push with the palms rather than the fingers when rising from a chair. Pushing off with the palms of the hands rather than the fingers uses the strongest joints available to rise from a chair. Pressing water from a sponge rather than wringing maintains the joints of the hands in a neutral position. Wringing a sponge requires finger flexion, which places strain on the joints of the hand. The client with ulnar drift deformities of both hands should have faucets and doorknobs that require pushing rather than turning. Pushing exerts less stress on the joints of the hands during routine activities. Turning a doorknob or faucet requires grasping and twisting motions that strain the small joints of the hands. An ulnar drift deformity limits the ability to grasp small objects. Sewing projects require gripping a needle or hook as well as repetitive motions that should be avoided because they strain the joints of the hands.
A community health nurse makes a home visit to a disabled 13-year-old client who has a 6-month-old infant sister. The infant lies quietly in her crib and rarely smiles or vocalizes; it appears that the infant barely has her basic needs met. What is the nurse's most appropriate intervention? 1 Advise the parent that the infant will be retarded if not stimulated. 2 Ask the disabled client to spend more time playing with the sister. 3 Encourage purchasing toys that are appropriate for the infant's age level. 4 Determine whether there is anyone who can help with chores and the infant's care.
4 Determine whether there is anyone who can help with chores and the infant's care. Recruiting someone to help with chores and infant care will allow the parent time to rest and will provide the infant with care and attention. Making the parent feel guilty is not therapeutic and will increase anxiety. The disabled sibling requires attention, and this responsibility may cause jealousy, rivalry, and resentment. Toys need not be employed for sensory stimulation; household objects and quality human contact can serve as well. Test-Taking Tip: Have confidence in your initial response to an item, because it more than likely is the correct answer.
A community healthcare nurse is conducting a survey about homeless children in the community. Which finding helps the nurse distinguish absolute homelessness from relative homelessness? 1 The children are under-immunized and at a risk for childhood illnesses. 2 The children are more likely to drop out of school and become unemployable. 3 The children have access to healthcare only through the emergency department. 4 The children do not have a physical shelter and may sleep outdoors or in vehicles.
4 The children do not have a physical shelter and may sleep outdoors or in vehicles. 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 from both sections of the community tend to be under-immunized 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 and be rendered unemployable. A lack of finances leads both types of homeless children to seek healthcare only in emergency conditions.
A client with dementia and a percutaneous endoscopic gastrostomy (PEG) tube is being cared for at home. Which action provides evidence that a family member is effectively managing the client's care? 1 Empty feeding bag stays attached to the tubing. 2- Tube is flushed with air after medication is given 3 Replacement of the tube is done on a weekly basis. 4 Head of the bed remains elevated after the feeding.
4 Head of the bed remains elevated after the feeding. The client's upper body must be elevated to prevent aspiration and promote digestion. Attaching the empty feeding bag to the tubing is not necessary. The end of the gastrostomy tube just needs to be covered. The tube is flushed with water, not air, before and after food or medication is given; excess air in the gastrointestinal tract can cause abdominal distention and cramping. Because the tube was inserted by a surgical procedure, it is replaced only when a problem is identified, and usually only by the healthcare provider. STUDY TIP: Do not change your pattern of study. It obviously has contributed to your being here, so it worked. If you have studied alone, continue to study alone. If you have studied in a group, form a study group.
