community

TDAP vaccine for infants

no earlier than 6 wks of age, infants should receive a total of 5 vaccines by the age of 6

CDC

provides information about STI and immunizations guidelines

community health nurse is developing a plan of care for a hispanic client. which action should the nurse include?

use therapeutic touch during conversation they consider touch a show of caring and compassion encourage faith healers use hand gestures avoid using eye contact to convey respect and attentiveness to the client

Whisper test

use your fingers to close one ear while whispering some numbers into other ear

Ginkgo biloba alter the effects of what medication?

warfarin NOT: metoprolol digoxin diltiazem

EPIDEMIOLOGY other answer options and rationales

screening for dental caries is secondary prevention providing information about preventing STD is primary prevention documenting medication compliance is tertiary prevention

findings of possible neglect

taking outdated prescriptions - inadequate medical care weight loss and malnourishment

a public health nurse is participating in a community planning committee for a disaster preparedness for a local community that is at risk for hurricanes. what information should the nurse contribute to the plan?

a list of areas within the community where residents speak english as a second language the public health nurse who is most familiar with the community should contribute this information to the disaster plan to assist in aiding and evacuating residents who are at risk the joint commission mandates that all medical facilities have a response plan that includes the actions that facility staff can take in the event of a local disaster. the community plan may include notifying the facility but the staff within the facility must activate this plan a disaster plan requires readiness regardless of who is present at the time of the disaster

a nurse is assessing a new client at a public health clinic. which areas should the nurse address as part of the cultural assessment?

focuses on beliefs, values, meanings, and behavior of people within a clients cultural, ethnic, or religious group. this includes culturally-based practices that relate to health and illness not food allergies, sexual activity and immunization status

COMMUNITY HEALTH NURSE is teaching a client with active pulmonary tuberculosis about disease transmission. what information should the nurse include?

household members should take ISONIAZID prophylactically for 6 to 12 months because they are at risk for developing the disease NOT disposable utensils chest x ray for future screenings, NOT a purified protein derivative test in 3 months

a public health nurse is providing information to a client who has alcohol use disorder and is asking about treatment. which statement should the nurse identify as an indication that the client understands the information?

i can expect to get help with other aspects of my life while in treatment successful treatment of alcohol use disorder is more likely if the client receives help in other areas of his life, such as his physical health, psychological well-being, and family interactions there is no cure, requires complete abstinence and commitment to life-long sobriety medical detoxification to manage the acute physical withdrawal manifestations is the first step in treating alcohol use disorder there is no requirement for a client to complete an inpatient program before entering an outpatient program, there is an outpatient program available, but client should have a strong support system to facilitate success

a nurse manager at a community health clinic is presenting an in service for nurses about assessing clients for abuse. which statement indicates an understanding of the teaching?

i should refer a client for a rape kit examination if she reports sexual assault within the previous 24 hrs (48 hrs) to ensure accurate collection of evidence also provide information regarding support groups and resources for clients who were sexually assaulted

a nurse is providing education regarding lead exposure to a group of clients who live in a housing development built in 1968. which statement indicates an understanding of the teaching?

i will increase the amount of red meat and milk in my child's diet - iron and calcium to prevent lead absorption form their environment wet-sanding, wet mop techniques use cold water to prepare formula because the hot water dissolves lead more quickly from the pipes

a community health nurse is teaching a client who is overweight about steps to take to begin an exercise program. what statement indicates that the client understands the teaching?

i will see my doctor before beginning an exercise program. needs a PE and approval from doctor you don't need to purchase equipment aerobic exercise 30min (not an hour) every other day, or 3 to 5 times a week perform both weight lifting and aerobic to build tolerance

CASE MANAGER is planning an educational program for a client who has diabetes. which activities should the nurse include when using the psychomotor domain of learning?

observe the clients technique for drawing up insulin because is requires coordination and the use of motor skills

infectious child hood disease: rotavirus infections

peak during the winter months in children s/s fever, vomiting, and watery diarrhea

Rinne test

place the tuning fork behind the ear, and say when you no longer hear the sound hearing evaluation that compares air conduction and bone conduction of sound

Weber test

placing the tunic fork on the scalp, client should hear the sound better in one ear or the same in both ears. evaluates lateralization of sound

PUBLIC HEALTH NURSE is working in a community that has a population of 24,096. there are 2,096 existing cases of heart disease within the population. the nurse can determine which of the following form this information?

prevalence proportion can be calculated by using the number of people who were affected at a given time and the total population

audiometry

provides precise measurement of hearing ability. client wears headphones and gives a specific signal, such as pressing a button or raising a finger to indicate when tones of various intensities are heard

Intervention using community BASED approach

providing genetic counseling to the family of a newborn who has congenital cataracts focuses on illness care for families

a nurse is collecting DEMOGRAPHIC DATA as a part of a community assessment. which of the following information should the nurse include?

racial distribution

a public health nurse is developing a presentation for local day care providers about infectious childhood disease. which statement should the nurse include?

respiratory syncytial virus (RSV) is spread through contact with respiratory secretions from an infected person (within 3 ft) s/s dyspnea, coughing, and wheezing

a community health nurse is assigned to lead a county-level environmental task force. which activity should the nurse direct the task force to complete FIRST?

review community specific epidemiological data the task force is assessing the community and identifying environmental health concerns within the county

a COMMUNITY HEALTH NURSE is discussing the concept of epidemiology with a coworker. which intervention should the nurse provide as an example of the use of the principles of epidemiology?

reviewing county health records for data on cases of chickenpox reviewing health records is an example of using epidemiological principles to analyze incidence and track outcomes of interventions for a particular disease or condition

HOME HEALTH NURSE should see what patient FIRST?

school age child who was treated in the ED last night with status asthmaticus ABC AIRWAY severe asthma attack, one after another

Intervention using community BASED approach

teaching a client who has vision loss about safety in the home environment focuses on illness care for individuals

a home health nurse is conducting a follow up visit for a client who was recently discharged from an acute rehabilitation program for alcohol use disorder. which action should the nurse take?

tell the client to take Naltrexone(Disulfiram) daily Buprenorphine is prescribed for opioid withdrawal avoid tyramine with MAOIs, which is prescribed for depression Transcranial magnetic stimulation (TMS) treatment for depression

a nurse at a county health department is caring for a client who is 28 wks, the nurse identifies the following characteristics as a risk for potential future abuse of the newborn

the client changed providers three times during pregnancy

a nurse is conducting a home visit with a female client who reports a history of intimate partner abuse. the nurse should identify that the following findings place the client at GREATEST risk for domestic violence?

the client states she is leaving her partner pregnancy increases the risk, due to feelings of jealousy and responsibility, however not the greatest risk starting a new job and visiting friends increased the risk, an act of independence, but not the greatest risk

a community health nurse is discussing the role of a faith community nurse with a chaplain. which information should the nurse include in the discussion?

the faith community nurse can facilitate substance abuse support groups home health/hospice nurse can provide pharmacologic pain management for a patient with terminal illness occupational health nurse can plan workplace safety training for employees in a local factory home health/wound nurse can provide wound care for clients in their homes

always assess clients for abuse

the nurse should always assess clients for abuse at every visit because the risk for abuse can change

other answers and rationales: these would not be completed first

the nurse should direct the task force to recommend updates to local policies if needed to ensure environmental standards are being met and to advocate for health promotion within the community the nurse should direct the task force to create program goals that align with HEALTHY PEOPLE 2020 to assist in achieving national-level objectives by minimizing health issues caused by the interaction of community members with the environment the nurse should direct the task force to distribute environmental health education materials to community members in order to promote health and prevent diseases related to environmental concerns

always document abuse

the nurse should document the name of the person the client accuses of the abuse in the medical record for future reference in a possible legal case

distributive justice

the nurse would demonstrate distributive justice ethical principle by fairly determining which clients should receive meal delivery when there are a limited amount of services available

fidelity

the nurse would demonstrate fidelity by determining that the client needs the meal service and following through with initiating a referral

a palliative care nurse is teaching a client who has cancer about the services that are available for the client. which statement should the nurse identify as an indication that the client understands the teaching?

this type of care can help me with pain control - palliative care provides support and management of disease process regardless of the prognosis, including pain management and thats what these cancer patients need provides support to all members of the clients family and support system can receive long-term palliative care, and once it's short term the client can receive hospice care (pt does not need to have less than 6 months to live)

a nurse on the scene following a mass casualty explosion is triaging a client who has a large, open occipital wound and the following findings RR 6/min, agonal pattern cap refills 4.5 seconds non responsive to painful stimuli which action should the nurse take?

turn the client to left semi fowlers position and begin assessing the next client

COMMUNITY HEALTH NURSE is working to meet the health care needs of residents in a rural community. which of the following characteristics should the nurse identify as a barrier to health care resources for this population?

unavailability of outreach services

Diphtheria, tetanus and acellular pertussis (DTap) (don't confuse with Tdap)

by 1 yr the child should have already received three doses of DTap; at 2 months, 4 months and 6 months. the child should receive a fourth dose at 15 months

activities the SCHOOL NURSE identifies as a primary prevention strategy

demonstrate hand washing techniques to promote health and prevent disease from developing

COMMUNITY HEALTH NURSE suspects an outbreak of scabies in the local area. what action should the nurse take FIRST?

determine the incident rate, new cases of scabies in the community

Intervention using community BASED approach

developing a plan of care for a client who was newly diagnosed with glaucoma focuses on illness care for individuals

safety plan

developing a safety plan is a priority for a client who is a recipient of abuse regardless of the type, such as physical or psychological. the nurse should provide the client with information about resources that can help, such as shelters and support groups

infectious child hood disease: fifth disease (erythema infectiosum)

do not include bloody diarrhea. rash that gives the client a slapped-face appearance that progresses from the face to the body s/s fever, myalgia, nausea, vomiting and lethargy

client has AIDS and experiencing rapid weight loss. which action should the nurse take FIRST?

examine the clients oral mucous membranes encourage the client to consume 1.2 to 2 g/kg of protein daily, increase 25% of calorie intake, teaching about findings to report to the provider, but it is not the first action

LYME DISEASE

i can take penicillin/ or tetracycline for 10 to 14 days to manage lyme disease in the early stages -no immunizations -bite from an infective ixodid tick -can have lesions with mild-flu like s/s like fever, fatigue, and malaise E.coli s/s -abdominal pain and diarrhea

a community health nurse is conducting a needs assessment of a community. the nurse should identify that which method will yield direct data?

Informant interviews of the community leaders. secondary data: health surveys medical records morbidity/mortality statistics

a nurse in a rural health clinic is caring for a client who has heart failure. the client states, "i'm not going to take anymore heart medicine." which response should the nurse make?

"can you tell me more about your decision to stop your medicine?"

a home health nurse is scheduling client visits for the day. which client should the nurse plan to visit first?

(urgent vs nonurgent) a client who has diabetes mellitus and reports new erythema to the left foot - RISK FOR INFECTION hip spica cast with pruritus (ITCHING) - it can wait

contact precautions

-C diff -MRSA -VRE (vanco reistant) -impetigo (school infection that causes red sores on face)

Ibuprofen (NSAID) adverse effects

-GASTRIC ULCERS -tachycardia -dysthymias (depression) -HYPOglycemia -oliguria -dysuria -hematuria

a nurse is preparing to administer vaccines to a 1yr old child. which of the following vaccines should the nurse give?

-Measles, mumps, rubella (MMR) (first 2 doses) -Varicella (VAR) (first 2 doses)

droplet precautions

-diphtheria -measles -mumps -rubella -PERTUSSIS wear surgical mask within 3 ft

a community health nurse is participating improvement plan for a local health department. which of the following techniques should the nurse use for process evaluation of the facility?

-focus groups -written audits -satisfaction survey -interviews (the health department services evaluation is involved)

airborne precautions

-varicella (chickenpox) -pulmonary tuberculosis -measles negative airflow room N95 mask

temperature of a fever

100.4 F 38 C

herpes zoster vaccine

60 yrs and older

Risk for Hypertension

African American BMI greater than 30

a nurse is assessing the risks and benefits of meal delivery services for an older adult client who lives alone and has no transportation. which ethical principle is the nurse demonstrating?

BENEFICENCE by determining if the client needs this service to maintain his health

a nurse is developing a GENOGRAM (family tree) for a client to determine education needs. which health risk information should the nurse expect to obtain with this tool?

Biological - a family genogram tracks the incidence of disease over multiple generations of a family and will identify biological risk factors

Rotavirus vaccine

CDC recommends administering vaccine during the childs FIRST YEAR at 1 yr the child should have received the RV vaccine in a two or three dose series starting at 2 months of age

manifestations of primary syphilis

CHANCRE (painless genital ulcer) secondary manifestations: -malaise -maculopapular rash on palms and soles of the feet -lymphadenopathy

Gonorrhea medication

Ceftriaxone 250mg IM

CASE MANAGER is developing a discharge plan for a client who has a spinal cord injury and is in a rehabilitation facility. what should the nurse do FIRST?

DETERMINE the clients ability to perform self care

a public health nurse is monitoring medication compliance for a group of migrant workers who are being treated for TB. the nurse should use information from the following resources to assist with this process?

Migrant clinicians Network (MCN) migrant workers move a lot this can interfere with the 6 to 12 months treatment plan. the MCN is a tracking program developed so that health care providers can access prior provider information and maintain TB treatment continuity for the migrant population

a nurse is caring for a 16yr old client who has a new diagnosis of human papillomavirus (HPV). which action should the nurse take?

Teach the client how to apply imiquimod (Aldara, Zyclara) 5% cream to the lesions at bedtime for up to 16 weeks no need to report PAP test no blood work

Protective environment

Used for highly susceptible, immunocompromised patient such as Transplant, chemotherapy, major burns, and leukemia

a nurse in a pediatric clinic is providing care to several clients. the nurse should recognize that which of the following conditions is included on the nationally notifiable infectious conditions list

VARICELLA NOT: -erythema infectiosum -scarlet fever -molluscum contagiosum

HPV vaccine

a child should receive a three dose series at 11 or 12 years of age

a community health nurse is assessing a group of clients for risk factors of abusive behaviors. which findings should the nurse identify as a risk factor for developing violent behavior?

a client states he witnessed his mother physically mistreat his father clients who have prior exposure to violence have a greater potential for continuing the violent and abusive behavior

a hospice nurse is teaching about expected grief reactions with the family of a client who has end-stage pancreatic cancer. which information should the nurse include?

a component of healthy grieving is the ability to openly express your anger HOPE not hopelessness (its an indication of clinical depression) self-esteem is NOT altered (its an indication of clinical depression) emotions fluctuate, NOT persistent (its an indication of clinical depression)

teaching for a client who was newly diagnosed with Hep C

abstain from sexual intercourse until antibody test are negative (transmitted through sex, body fluids) NOT airborne consume high carb diets no post exposure prophylactic treatment

a nurse is preparing an educational program about influenza for a group of community health nurses. what example is a example of tertiary prevention?

administer antiviral medications within 48 hours to client who have manifestations of influenza secondary: ways to prevent the spread of infection- -frequent hand washing -isolating individuals who have manifestations of illness primary: prevent the occurrence of illness- -providing immunizations to susceptible populations

pneumococcal polysaccharide vaccine (Pneumovax 23)

administer to children over 2 yrs old only if they have a specific medical indication that puts him at high risks for this infection

Captopril: ACE inhibitor can high blood pressure and heart failure

adverse effect: DRY COUGH NOT: ataxia photophobia weight gain

a school nurse is conducting visual acuity testing for a school age child. what action should the nurse take?

allow the child to keep her glasses on during the testing stand at least 10 ft away and the chart should be placed at the child's eye level progress to the next line once she is able to read at least 4 symbols on the current line cover the right eye first and then move to the left eye. final step, use both eyes

infectious child hood disease: shigella infections

antibiotics (not antiviral) shorten the length of a shigella infection and decrease mortality rates s/s fever and anorexia, watery or bloody diarrhea

a nurse is giving a presentation about family violence at a local community center. which information should the nurse include?

child abuse is more common in homes where intimate partner abuse is present there is no link between: -race and abuse -socioeconomic level and abuse children who are abused are more likely to become abusers

how to prevent the spread of Hepatitis A virus

clean your bathroom fixtures with a chlorine bleach it is resistant to soap avoid sharing toothbrush/towels avoid sexual contact until antibody test is negative, 4-6 weeks

COMMUNITY NURSE is working in a mobile health care clinic. which client should the nurse ASSESS FIRST?

client who has a new onset of confusion and slurred speech

Meningococcal vaccine, who should receive the vaccine?

client who is moving into a college dormitory. individuals living in crowded areas 11 - 12 yrs and then giving a booster dose at age 16 minimum age is 6 weeks (NOT 4 WEEKS) not recommended for an infant who has bronchiolitis individuals traveling to northern Europe are not at an increased risk for meningococcal meningitis

activity showing the client a video on how to monitor glucose levels

cognitive domain of learning because it includes learning new information and applying it in a different way

activity with giving the client a pamphlet about foot care

cognitive domain of learning because it includes reading and learning new information

activity reviewing a color diagram of the food pyramid with the client is

cognitive domain of learning because it involves the client understanding and applying information

a PUBLIC HEALTH NURSE is developing a visual health program by using a COMMUNITY ORIENTED approach. which of the following interventions should the nurse include?

consult with the local school nurse to schedule yearly vision screenings for students focuses on the health care of a POPULATION rather than illness care for individuals

educating a group of high school students about recommended dietary guidelines.

consume less than 300 mg/day of dietary cholesterol consume less than 10% of daily calories from saturated fatty acids decrease refined grains (white flour, white bread, white rice) consume 1300 mg/day calcium - promote skeletal growth and bone mineralization which is necessary during adolescence

a nurse is conducting an educational session at an assisted living facility for a group of clients who has osteoporosis. which statement should the nurse include in the teaching?

increase calcium- leafy green vegetables, milk fortified with vitamin D, cheese and yogurt use weight bearing exercises to strengthen and protect bones. this can help prevent injury and fractures increase folate- legumes, seeds, liver, and orange juice spend 10 to 15 minutes exposed to sunlight three times each week to produce vitamin D

a public health nurse is planning an educational program for a group of nurses at a community health department about pertussis infection. what information should the nurse include?

individuals transmit the pertussis bacteria through airborne droplets - transmission occurs when an individual who has an infection with pertussis coughs and expels droplets larger than 5 microns if you've had pertussis before you still need to get the vaccine

a nurse in the ED is caring for a client who is homeless and has hypothermia. which action should the nurse take?

initiate a referral to the facility's social worker or to an agency that can assist hime with finding housing only involve the law enforcement when there is a legal issue don't ask "why"! and false reassurance

a nurse in a community center is preparing to administer a TB skin test to multiple clients to screen for TB. what action should the nurse take?

inject 0.1 mL (5 tuberculin units) of purified protein derivative (PPD) prepare the inner aspect of the forearm for the injection 5 to 15 degree angle (not 45 degree) create a wheal that is approximately 6mm in diameter (not 5)

Positive TB Mantoux (PPD) test. what action should the nurse take?

instruct the employee to prepare a list of close personal contacts report the name to the health department the health department will contact the employee so then the close personal contacts can be notified of the exposure

OCCUPATIONAL HEALTH NURSE is planning to use an interpreter during an educational session with a group of migrant workers who do not speak the same language. what actions should the nurse take?

instruct the interpreter to guide the nurse in providing information in a culturally-sensitive manner choose an interpreter who speaks the workers language and dialect evaluate the interpreters approach to clients prior to the educational session gain trust and no paraphrasing

U.S Preventive Service Task Force (USPSTF)

is an organization that reviews preventative services and suggest appropriate services for primary medical care and topics for research

a nurse in a rural community is planning education for a young adult client who is a migrant farm worker. which actions should the nurse include?

provide environmental health information. migrant workers are at risk for exposure to pesticides and other hazardous materials refer the client for a TB screening. TB is higher among migrant farm workers due to crowded living conditions and substandard housing provide skin cancer information due to working outdoors recommend a dental health screening because it is a primary health risk for migrant farm workers provide forms to apply for medicare is incorrect, to be eligible they must meet an age and be permanently disable

Agency for Healthcare Quality and Research (AHRQ)

provides evidence-based clinical guidelines for client care, such as pain management, cancer screening and diabetes mellitus treatment

autonomy

the nurse would demonstrate autonomy by asking the client if he wants this service and respecting his choice