Community Health Nursing Mid-term Prep – Flashcards
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Which role of the nurse is most important in achieving the goal of Healthy People 2020: "To achieve health equity, eliminate disparities, and improve the health of all groups"? A) Advocate B) Researcher C) Teacher D) Leader
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A Rationale: Nurses have a role in seeing that deficiencies in the health care system are addressed. Caring is the focus of nursing and in many cases this caring is manifested as advocacy for the client. Nurses advocate for clients to achieve health within their own abilities, opportunities, and social contexts.
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The nurse explains to the student nurse that nursing interventions for families in community-based settings are similar to those for individuals and involve three types: cognitive, affective, and behavioral. Which of the following is considered an affective intervention? A) The nurse demonstrates to a client with a colostomy how to change the drainage bag B) The nurse counsels a client to help her overcome her grief over the death of a loved one C) The nurse teaches a client how exercise will have a beneficial effect on her cardiovascular system D) The nurse teaches a teenager which foods to choose as snacks to avoid consuming empty calories
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B Rationale: Affective interventions have to do with feelings, attitudes, and values, such as occurs with grief counseling. Cognitive interventions involve the act of knowing, perceiving, or understanding, such as teaching the effects of exercise and proper nutrition. Behavioral interventions involve performing skills and demonstrating behaviors, such as changing a colonoscopy bag.
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A nurse coordinates all the services needed for the family of an infant born with cerebral palsy. The nurse's efforts focus on empowering the family to maximize self-care through health promotion, disease prevention, and increased continuity of care. What is the term for this process? A) Case Management B) Consultation C) Discharge Planning D) Screening
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A Rationale: Case management, also known as care management or care coordination, involves activities that enhance the self-care capacities of clients and families by coordinating care. Discharge planning is an accepted nursing intervention aimed at the prevention of problems after discharge. Screening identifies individuals with unrecognized health risk factors of asymptomatic diseases. During consultation, the nurse seeks information and generates solutions to problems through an interactive problem-solving process.
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A community-based nurse is providing care for an elderly male client and his family in his home. The family includes a spouse and a daughter who is living at home as well as a 10-year-old grandson. The nurse plans care for the client in the context of the family. Which of the following statements best describes this model of care? A) This model emphasizes how family structure, function, developmental stage, and interpersonal interactions influence the recovery of the client B) This model focuses on the family as a system as well as the unit of service; the individual and family are concentrated on simultaneously C) This model considers the family as it relates to the recovery of the individual client; the client is the focus and the family is the context D) This model allows the family to be seen as one of the many institutions or social systems in the community that interact with other systems for services
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C Rationale: Providing care in the context of the family occurs when the nurse considers the family as it relates to the recovery of the client. When the focus is on the family's potential impact on the recovery of the client, the nurse considers how family structure, function, developmental stage, and interpersonal interactions influence the recovery of the client. When the family is seen as the client, the nurse focuses on the family as a system as well as the unit of service. When the family is viewed as a component of society, this model allows the family to be seen as one of the many institutions or social systems in the community that interact with other systems for services.
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The nurse caring for families is aware that family functions are outcomes of family structure and are the reason families exist. Which of the following is an example of an affective family function? A) A father works two jobs to help provide for his family B) A mother schedules a dental checkup for her adolescent son C) A new mother cuddles and sings to her newborn D) A father arranges a play date for his 5-year old daughter
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C Rationale: The affective family function is the family's ability to meet the psychological needs of its members, such as bonding with a newborn. The economic function of the family involves the allocation of adequate resources for the family members. The providing for health care and physical necessities function is involved in scheduling checkups. Arranging a play date is an example of the socialization function.
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The nurse providing care in a community-based health care setting knows that prevention of disease and injury is a key component of the practice. Which of the following interventions best exemplifies disease prevention on the secondary level? A) A nurse screens school-aged children for scoliosis B) A nurse teaches new mothers how to bathe their infants C) A nurse coordinates home care for an elderly client with dementia D) A nurse teaches stress management to clients recovering from heart attacks
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A Rationale: Primary disease prevention involves prevention of the initial occurrence of the disease or injury, such as teaching hygiene for newborns. Secondary disease prevention is early identification of disease or injury with prompt intervention to limit its effects. This includes screening for disorders such as scoliosis. Teaching stress management following MI and coordinating home care are examples of tertiary disease prevention to halt further disease progress and meet help the person meet their maximum potential.
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The nurse working in community-based nursing explains to the student nurse how certain factors affect the delivery of nursing care in the community. Which of the following statements regarding communities is accurate? A) Social determinants of health are shaped by economics and politics B) Culture plays a minor role in the overall character of the community C) Community boundaries cannot limit the services available to individuals D) Social systems have little or no impact on a community's health
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A) Rationale: Social determinants of health are defined as the circumstances in which people are born, grow up, live, work, and age, and the systems put in place to deal with illness. These circumstances are shaped by economics, social policies, and politics. Social systems have an impact on a community, and consequently the health of that community. Culture contributes to the overall character of a community and, in turn, influences its health needs. A community is defined by boundaries that often determine what services are available to individuals.
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A nurse caring for migrant workers of Hispanic descent in a community clinic practices etic care that is acceptable and successful for these particular clients. Which of the following statements best describes etic care? A) It is professional care based on an understanding of the client's cultural background B)It is informal care directed an involving the client in self-care based on his or her own culture C) It is allowing the local customs of the client to dictate the type of care that is provided D) It involves using cultural blindness to treat clients from diverse background equally and fairly
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A Rationale: "Etic" refers to the outsider's views and values about a phenomenon. Etic care involves using an emic (insider's) understanding of the client's beliefs about health issues to coordinate professional (etic) care that is acceptable to the client.
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Nurses preparing for a career in community-based nursing should be aware of the current trends affecting the future of nursing education and how these trends will affect their practices. Which of the following accurately describes one of these trends? A) There are changing demographics and decreasing diversity in communities B) There is a shift to hospital-based care and increased complexity of client cases C) There are lower costs of health care using managed care practices D) There are current nursing shortages and workforce development continues
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D Rationale: Among other factors, the future of nursing education is affected by: (1) current nursing shortages, opportunities for lifelong learning, and work development; (2) changing demographics and increasing diversity; (3) higher costs of health care and the challenges of managed care; and (4) a shift to population-based care and the complexity of client care.
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A nurse initiates a regular physical activity program for residents of a nursing home. Which of the following statistics accurately portrays the incidence of existing health problems in the United States that can be influenced by regular physical exercise? A) 10 million people have type 2 diabetes B) 8.5 million people have coronary heart disease C) 50 million people have high blood pressure D) Over 25 million people are overweight
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C Rationale: Regular physical activity reduces the risk of heart disease, cancer, and diabetes. In the United States, 50 million people have high blood pressure, 13.5 million people have coronary heart disease, more than 60 million people are overweight, and 8 million people have type 2 diabetes.
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Upon graduation, a nurse chooses to practice community-based nursing instead of working in an acute care setting. Which of the following statements best defines community-based nursing? A) It is a "flowing" kind of care that does not necessarily occur in one setting B) It does not have a defined philosophy but rather is defined by the setting itself C) It is defined by the level of academic preparation needed to preform the skills D) It is all about where the nurse practices as opposed to how the nurse practices
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A Rationale: The emphasis of community-based nursing is a "flowing" kind of care that does not necessarily occur in only one setting. Community-based nursing care is directed toward specific individuals and families within a community and is designed to meet the needs of people as they move between and among health care settings. It is all about how the nurse practices, not where the nurse practices. Community-based nursing has a defined philosophy of practice that requires specific knowledge and skill. It is not defined by the setting or level of academic preparation needed to perform the care.
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The nurse is preparing to discharge a client with a spinal cord injury from an acute care facility in preparation for a transfer to a rehabilitation facility. Which of the following statements accurately describes a focus of this process? A) It is one dimensional and prescribed in facilitating transfer from one setting to another B) It identifies services and referrals that may be needed and passes this information along to the case manager C) It is unique in that it does not follow the nursing process, but instead focuses entirely on preventive care D) Its focus is on the client functioning as an individual and the client's unique medical needs
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A Rationale: Discharge planning is one dimensional and is prescribed in facilitating transfer from one setting to the other. It follows the nursing process and includes assessment, planning, and interventions. Discharge planning focuses on the client and family needs and abilities. The interventions involve making referrals and giving the client and family important phone numbers, names, and community services in writing, not just a referral to a case manager.
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The nurse is caring for a male client with HIV who is living unmarried with another male and has two adopted children. How would the nurse document this client's family structure? A) Nuclear Family B) Nuclear Dyad C) Single-Parent Family D) Multigenerational Family
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A Rationale: A nuclear family consists of a married couple with children, or unmarried, heterosexual, or same-sex couples with children. A nuclear dyad is a couple, married or unmarried; heterosexual or same sex. A single-parent family is one adult with children, and a multigenerational family is any combination of these family structures.
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A nurse is designing a physical activity program for a 48-year-old male client who has been diagnosed with mild hypertension. Which of the following is an appropriate long-term goal for this client? A) Jog for 15 minutes and weight train for 15 minutes, 3 days a week B) Walk briskly for 30 minutes most days of the week C) Bicycle for 1 hour every day of the week D) Walk briskly for 30 minutes every other day
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B Rationale: Moderate physical activity is recommended for 30 to 45 minutes, 3 to 5 days a week as an initial goal. An appropriate long-term goal is 30 minutes of moderate-intensity physical activity all or most days of the week.
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Which of the following nursing skills is most imperative when practicing community-based nursing? A) A nurse attends and in-service on using new IV and infusion equipment B) A nurse delegates nursing care appropriate for an LPN to perform C) A nurse collaborates with a physical therapist treating a client with paraplegia D) A nurse institutes a new format for documenting client care in the field
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C Rationale: Although all these skills are important, the most critical skills needed by a nurse practicing community-based nursing are highly developed assessment skills, effective communication skills, collaboration with the interdisciplinary team, and working with culturally diverse clients.
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A nurse demonstrates how to change the bandages on the stump of a client with a new below-the-knee amputation. This is an example of learning according to which of the following learning domains? A) Cognitive B) Psychosocial C) Psychomotor D) Affective
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C Rational: Psychomotor learning consists of acquired physical skills that can be demonstrated, such as changing bandages on a stump. Cognitive learning involves the storage and recall of new knowledge and affective learning refers to the feelings, values, and attitudes that affect learning. Psychosocial is a factor for learning readiness, not a learning domain.
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The nurse is counseling a 24-year-old working mother who has a 2-year-old and a newborn who was diagnosed with cerebral palsy. The mother states that she is overwhelmed with trying to care for her family as well as schedule work and take care of her home. The nurse formulates a diagnosis based on which of the following? A) Role overload B) Role stress C) Role conflict D) Role flexibility
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A Rationale: Role strain or overload arises when an individual is confronted with too many role responsibilities at one time. Role conflict occurs when the demands of one role conflict with or contradict another. Role flexibility occurs when other family members take on the roles of a family member in times of need. Role stress is a distractor.
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The nursing process is an important tool to guide the nurse in thinking through assessment, planning, implementation and evaluation of the nursing care plan. Which of the following describes how the nursing process is used differently by nurses practicing community-based nursing versus nurses practicing acute care nursing? A) Client teaching is more important in the hospital setting than in the community setting because of shortened hospital stays B) In community-based nursing, the nursing process is a mutual endeavor used to plan care, and also to develop therapeutic relationships with the client's family members C) Nursing diagnoses are critical in the hospital setting, but are not defined in community-based nursing D) In the hospital setting, nurses follow a plan of care from the health care provider, which does not occur in the community setting
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B Rationale: Nurses in both settings use clinical decision-making skills and clinical reasoning to identify what to assess in the client, family, and community. In contrast to care typically provided in hospitals, in the community setting the nursing process guides the nurse to a mutual care plan and helps the nurse to develop therapeutic relationships with the client, family, and caregiver. Community-based nurses may follow a plan of care from a health care provider, but they usually need to modify the care plan for the individual needs of the client and family. Client teaching is important in both settings and occurs with the client and family and/or caregiver. Nursing diagnoses or problem statements are formed for clients in both settings and interventions are identified that are reasonable and acceptable to all parties involved in the planning process.
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A nurse conducting a parenting class teaches parents the leading causes of death in different age groups. Which of the following age groups has the highest rate of death related to cancer? A) 1-4 year olds B) Under 1 year-old C) 15-24 year olds D) 5-9 year olds
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D Rationale: The leading causes of death in 5- to 9-year-olds are unintentional injuries, cancer, and congenital anomalies. For infants less than 1 year of age, the leading causes of death are congenital anomalies, disorders related to premature birth, and SIDS. In the 1- to 4-year-old group, the leading causes of death are unintentional injuries, congenital anomalies, and homicide. In the 10- to 14-year-old group, the leading causes of death are unintentional injuries, cancer, and homicide. In the 15- to 24-year-old group the leading causes of death are unintentional injuries, homicide, and suicide.
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A nurse promotes public health interventions at all possible levels of practice in the community. Which of the following is the term for this public health practice? A) Individual-focused B) Systems-focused C) Population-based D) Community-focused
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C Rationale: Public health interventions are population-based if they consider all levels of practice, including the community, the systems, and the individuals or families in that system who are known to be at risk. Community-focused interventions change community norms, attitudes, awareness, practices, and behaviors. Systems-focused interventions change organizations, policies, laws, and power structures. Individual-focused interventions change knowledge, attitudes, beliefs, practices, and behaviors of individuals.
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The nurse practicing in a community public health clinic sees the effects of fragmentation of care on client health care. Which of the following is an example of a nursing intervention to help address fragmented care? A) Encourage health care practitioners to keep formal and informal care separate B) Encourage clients to use home health care for more intense health care needs C) Encourage clients to routinely use a medical home D) Encourage clients to use a variety of providers for health care needs
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C Rationale: Clients are increasingly seen by a large variety of providers in many organizations and agencies, often resulting in fragmentation of care. Encouraging routine use of a medical home is one attempt to address fragmented care as opposed to using a variety of providers for health care needs. The use of inpatient facilities for briefer. more intense encounters should be encouraged. Continuity of care is often accomplished by combining formal and informal care.
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A home health care nurse is performing an assessment of an 18-month-old child. Which of the following normal parameters for the development of hearing and its assessment should the nurse keep in mind during the screening? A) Parents should not be concerned about their child's hearing until age 3, when hearing is fully developed B) Parents should be advised to tell the nurse if their infant is not reacting to loud noises by the age of 2 C) The child's speech patterns should be assessed separately, since hearing impairment has no impact on the development of speech D) Children are not routinely screened for hearing until three years-old; however, a parent's observations could indicate a possible hearing problem
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D Rationale: Infants and toddlers are not routinely assessed for hearing until 3 years of age. However, a parent's observations may indicate the possible presence of hearing or vision impairment. By the age of 1, infants should react to loud noises and hearing their name called. By age 2, children should repeat words and enjoy games like peek-a-boo. Speech should also be assessed because hearing impairments often become apparent when the child begins to talk.
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A nurse is counseling a 65-year-old female client who expresses a desire to quit smoking. Which of the following would be an appropriate response to this client? A) "If you smoke you have a 50% greater heart disease death rate than nonsmokers" B) "Older smokers are more likely to stay off cigarettes once they quit than younger smokers" C) "In some cases, ex-smokers who have had a heart attack can cut their risk of having another one by 25%" "Since you have been smoking most of your life, it's not important to stop now since the benefits would be minimal"
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B Rationale: Older smokers are more likely to stay off cigarettes once they quit than younger smokers since they know more about the short-term and long-term benefits of quitting. It is always good to quit smoking at any age, and ex-smokers live longer and healthier lives. People who smoke have a 70% greater heart disease death rate than do nonsmokers. In some cases, ex-smokers who have had a heart attack can cut their chance of having another one by 50%.
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Most cultures combine orientation to the past, present, and future, but one orientation usually dominates. For which of the following clients would teaching strategies for preventive care be most accepted based on his or her orientation to the future? A) A Native American male athlete prone to stress fractures B) A white American female lawyer who is experiencing job stress C) An African American male accountant who is overweight D) A Hindu business executive who is experiencing migraines
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B Rationale: Traditionally, American culture is future oriented; however, Native American and Hindu culture tend to focus on the past while African American culture focuses on the "now" and day to day activities. When discussing preventive care, persons without a future orientation should be approached differently than those with future orientation.
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The nurse is counseling a couple involved in the divorce process. Which of the following emotional responses is common during the separation stage of divorce? A) Mourning the losses associated with a separating family B) Negotiating viable arrangements for all family members C) Revealing the fact that the marriage has major problems D) Working on emotional recovery by overcoming hurt, anger, or guilt
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A Rationale: During the separation stage of divorce the family mourns the losses associated with the separation and works on resolving attachment to the spouse. In the stage of planning the dissolution of the family system, the family negotiates viable arrangements for all family members. In the divorce stage, the family continues working on an emotional recovery by overcoming hurt, anger, or guilt. In the stressors leading to marital differences stage, the family reveals the fact that the marriage has major problems.
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Nurses in community-based settings on many occasions provide teaching plans to clients with sensory deficits. Which of the following interventions reflects a recommended guideline when teaching sensory-impaired clients? A) A nurse asks a client with a hearing aid to remove the hearing aid when providing teaching B) A nurse speaks to a visually impaired client when approaching him from the front C) A nurse directs questions to the family of a client who has aphasia when taking a nursing history D) A nurse asks other people in the room to remain silent when approaching a visually impaired client
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B Rationale: For a visually impaired client, the nurse should speak to the client when approaching him and avoid speaking from behind the client. The nurse should also ask other people to introduce themselves to allow the client to hear people's voices. The nurse should always ask if the client wears a hearing aid and if it is working properly. The nurse should provide some means of conversation (such as a computer or letter board) for a client who has aphasia (language deficit).
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A nurse caring for clients in a woman's health clinic advises them on the recommended frequency of Pap smears, mammograms, and fecal occult blood testing. Which of the following is a guideline for these tests? A) Women who have been sexually active should have a Pap test every three years except if they have genital warts, multiple partners, or abnormal Pap tests B) Women over age 75 with a history of normal Pap smears may stop having Pap tests after consulting with their health care practitioner C) Starting at age 50, fecal occult blood testing should be done every other year in combination with other screening tests recommended by the practitioner D) Women over 60 years old should have a mammogram every 2 years unless a family history suggests other wise
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A Rationale: Women who have ever been sexually active should have a Pap test every three years except if they have genital wars, multiple partners, or abnormal Pap tests in the past. Women over age 65 with a history of normal Pap smears may stop having Pap tests after consulting with their health care practitioner. Women over 50 years old should have a mammogram every two years unless their family history suggests otherwise. Starting at age 50, fecal occult blood testing should be done every year in combination with other screening tests recommended by the practitioner.
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Which of the following is an example of an activity aimed at providing primary disease prevention? A) Counseling a rape victim B) Performing mental health screening C) Providing well-child care D) Teaching breast self-examination techniques
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C Rationale: Providing well-child care is an example of primary disease prevention to prevent the initial occurrence of a disease or injury. Teaching breast self-examination and performing mental health screening are examples of secondary prevention activities, and counseling a rape victim is an example of tertiary disease prevention.
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One of the components of community-based care is self-care. Which of the following nursing interventions is the best example of promoting self-care in the community setting? A) A nurse arranges for a client who smokes a pack of cigarettes a day to attend a smoking cessation program in his neighborhood B) A nurse locates physical therapy facilities for a client who is recovering from hip replacement surgery C) A nurse considers the cultural preferences of a client who has diabetes when helping to prepare a meal plan for the client D) A nurse helps a client with end-stage liver cancer who is filling out an advanced directive to make informed health care decisions
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D Rationale: Empowering individuals to make informed health care decisions is an essential component of self-care. One way of empowering individuals is through advance directives that allow clients to participate in decisions about their care or refuse treatment. Arranging a smoking cessation program for a client is an example of preventive health care. When providing care within the context of the community, the nurse considers the culture, values, and resources of the client, the family, and the community. Collaborative care among health care professionals is an essential component of community-based care rather than self-care. Arranging for needed services is an example of this continuity of care.
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A nurse caring for clients in a community health care clinic assesses clients on a daily basis for various health risks. Which of the following is a recommended guideline for these assessments? A) The nurse should immediately refer clients suspected of being a victim of intimate partner violence to a professional for counseling B) The nurse should recommend weight control if the client has a BMI of 30 or more or a BMI of 25-29 and two or more weight-related health problems C) The nurse should not assess sexual health unless the client states a concern about having a sexually transmitted disease D)The nurse should not assess the risk for suicide for a client suspected of having depression to prevent planting the idea in the client's mind
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B Rationale: The nurse should approach the topic of weight control for clients who have a BMI of 30 or more and two or more weight-related health problems. The nurse should not be afraid of assessing a client for sexually transmitted diseases or suicide risk. The nurse should also use refined assessment skills to assess for IPV.
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The nurse providing care for culturally diverse clients acknowledges the biological variations for each racial or ethnic group in the community. Which of the following is an example of a biological variation as a factor in cultural assessment A) Body language B) Personal space C) Time orientation D) Skin color
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D Rationale: Biological variations are the biological differences among racial and ethnic groups, which include skin color, and physiologic variations, such as specific disease processes. Body language is an aspect of communication. Time orientation and personal space are separate phenomenon of cultural assessment.
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A nurse is teaching parents about the recommended hours of sleep per night for their infants. Which of the following statements accurately describes the amount of sleep needed by a particular age group? A) Most toddlers sleep around 8-10 hours per day B) Most school-aged children need 8 hours of sleep per night C) Newborns generally sleep 16-20 hours a day D) Most adolescents need 7 hours of sleep a night
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C Rationale: Newborns generally sleep 16 to 20 hours per day. Toddlers sleep around 10 to 13 hours per day. Most school-age children need 10 hours of sleep at night and adolescents need 8 to 9.5 hours of sleep at night.
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A nurse is providing free cholesterol screening for adults in a neighborhood clinic. Which of the following clients is most likely to have higher cholesterol? A) A person who has just lost weight B) A female who is going into menopause C) A male in his 30's D) A female with a musculoskeletal disorder
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B Rationale: People at a higher risk for high cholesterol levels are middle-age men, women just before menopause, and anyone who has just gained weight.
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A home health care nurse is performing a psychosocial assessment of a new client who was discharged following delivery of a newborn who has Down syndrome. Which of the following questions is the best example of a psychosocial assessment question? A) Who makes the decisions in your home? B) Do you have a smoke detector on every level of your home? C) Are there any family rituals passed down from generation to generation? D) Who provides you with strength and hope?
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A Rationale: Psychosocial assessments are performed to understand the client in the context of the family. An aspect of this type of assessment is asking about the family structure and who makes the decisions in the family. Family rituals are an aspect of cultural assessment. Assessing for smoke detectors is an environmental assessment. Asking a client who provides strength and hope is a spiritual assessment.
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A client has a network of health care providers that deliver services at a lower fee in return for prompt payment at a pre-negotiated price. This is an example of which of the following types of group insurance plans? A) Health Maintenance Organization (HMO) B) Private Insurrance Plan C) Third-Party Payment Plan D) Preferred Provider Organization (PPO)
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D Rationale: Preferred provider organizations allow a network of providers to deliver services at a lower fee in return for prompt payment at pre-negotiated rates. Health maintenance organizations are prepaid, structured managed systems in which providers deliver a comprehensive range of health care services to enrollees. Private insurance may obtained through large nonprofit organizations or from small, private, for-profit insurance companies as third-party payment.
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A home health care nurse visits the home of an 82-year-old female client who is receiving nursing care and physical therapy following discharge from the hospital. The client has right-sided paralysis following a TIA. Upon assessment, the nurse finds that the client has lost five pounds since the last visit a week ago. The client is living alone with daily visits from her two children. Which of the following would be the most important assessment question for this client? A) Are your children still visiting you daily? B) Who is preparing your meals for you? C) Are you able to walk to the kitchen to get a snack? D)How has your physical therapy affected your appetite?
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B Rationale: Assessment is a continuous process designed to collect information used for an immediate intervention or as a foundation for additional assessments at a later time. After assessing this client for weight loss, the nurse would make further assessments to determine if the client needs help with grocery shopping, meal planning, and cooking meals. Tracking the client's eating pattern and intervening where appropriate are the most important assessments in this situation.
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In which of the following facilities would admission most likely include an assessment focusing on functional abilities and orientation to new surroundings? A) Nursing home B) Acute care setting C) Physician's office D) Psychiatric office
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A Rationale: In the nursing home, the nursing history and assessment focuses on functional abilities and orientation to new surroundings. In an acute care setting, the admission focuses on a complete nursing history, vital signs, and other physical assessments. In the physician's office, admission assessment focuses on the reason(s) for seeking medical care. The psychiatric facility admission focuses on introduction and mental health evaluation, as well as orientation to room and unit.
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A nurse recommends that a pregnant woman consume 600 ug of folic acid per day. This nurse is providing a preventive intervention for what infant complication of pregnancy? A) Low Birth Weight (LBW) B) Fetal Alcohol Syndrome C) Failure to Thrive D) Neural Tube Defects
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D Rationale: Approximately 50% of all neural tube defects may be prevented with adequate consumption of folic acid in the first trimester of pregnancy. A pregnant woman who smokes is more likely to have an LBW infant. Failure to thrive has various causes, and abstaining from alcohol is a preventive measure for fetal alcohol syndrome.
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The nurse who is caring for clients in a physician's office knows that which of the following clients is engaging in the activity that most negatively affects health? A) A client who is 20 pounds overweight B) A client who regularly has three alcoholic beverages before dinner C) A client who does not engage in physical activity D) A client who smokes a pack of cigarettes a day
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D Rationale: Smoking remains the health indicator that most negatively impacts health. Drinking, living a sedentary lifestyle, and overeating are also risk factors for health disorders, but smoking has the greatest impact on health.
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A nurse is assessing a family structure using the family systems theory. Which of the following is true regarding the principles of this family social system framework? A) Family systems tend to move from a state of equilibrium to allow for developmental changes in the family members B) The family system has a boundary that is selectively semi-permeable according to the family's wishes C) The family with closed boundaries is more apt to use community services than a family with semi-permeable boundaries D) Nurses may assist families to return to a state of equilibrium, but the system does not allow for families to move to a higher level of health
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B Rationale: The family system has a boundary that is selectively permeable according to the family's wishes, so items such as material goods, people, and information are allowed in or out according to the perceived needs of the family. The family with closed boundaries is less apt to use community services than the family with semi-permeable boundaries. Family systems tend to move to a state of equilibrium, and nurses may assist families to equilibrium and sometimes to a higher level of health.
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A nurse is caring for an 87-year-old female client who is 5' 7" and weighs 140 pounds. What is the client's Body Mass Index (BMI)? A) 21.9 B) 26.9 C) 25.0 D) 23.5
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A Rationale: BMI = weight (pounds) x 703 divided by height squared (inches squared). In this case the client is: 140 lbs. x 703 = 98420 lbs. Height squared = 67 inches x 67 inches = 4489 inches 98420 lbs. 9 4489 inches = 21.9 BMI
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Nurses working in community-based settings often concentrate on preventive care for their clients. Which of the following is an example of an intervention based on primary prevention? A) A nurse initiates a program to start free blood pressure screening in the neighborhood B) A nurse promotes a new exercise program designed for older adults in the community C) A nurse performs range-of-motion exercises for a client with debilitating arthritis D) A nurse recommends a colonoscopy for a client with a family history of colorectal cancer
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B Rationale: Primary prevention is used to prevent the initial occurrence of a disease, such as preventing obesity or heart disease through exercise. Screening for hypertension and recommending a colonoscopy are secondary preventive measures. Performing range-of-motion exercises to improve the mobility of a client with arthritis is an example of tertiary prevention.
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A nurse writes a proposal to fund and staff a mobile health clinic in a community with an at-risk low-income population. This project is an example of which of the following public health interventions? A) Advocacy B) Coalition Building C) Outreach D) Case Management
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C Rationale: Outreach locates populations of interest or at risk and provides information about the nature of the concern, what can be done about it, and how services can be obtained. Case management is working with individual clients and families to optimize self-care capabilities. Advocacy is pleading someone's case or acting on someone's behalf. Coalition building is promoting and developing alliances among organizations for a common purpose.
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The nurse working with families in the community uses Maslow's Hierarchy of Needs theory when assessing family function. Which of the following is an example of the lowest level of needs that must be met before the person can move on to higher-level needs? A) A mother breastfeeds her infant B) A mother goes back to school to obtain her GED C) A father praises his son for making his school's Dean's List D) A father makes sure his daughter wears a helmet when riding a bike
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A Rationale: The basic physiological needs (food, fluids, shelter, sleep, oxygen) must be met first. Safety (bicycle helmet), self-esteem (parental praise), and self-actualization (attaining a GED) are higher-level needs that can be met after physiological needs are met.
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Community health care nurses provide teaching to clients based on three levels of prevention. Which of the following is an example of client teaching related to the secondary level? A) A nurse teaches the parents of a newborn who experienced RDS to place their baby on his back to sleep to minimize the risk of SIDS B) A nurse provides information on anorexia to parents of a teenager diagnosed with the disorder C) A nurse volunteers at a free mobile clinic to immunize vulnerable populations in the community against influenza D) A nurse refers a client with Parkinson's disease to a support group in the community
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A Rationale: Teaching occurs at all levels of prevention. Teaching primary prevention involves preventing the initial occurrence of disease or injury (e.g., giving immunizations). Teaching secondary prevention targets early identification of, and intervention for, a health condition (e.g., SIDS). Tertiary prevention teaching involves attempts to restore health and facilitate self-care management and coping with a health condition (e.g., encouraging support groups and providing information on eating disorders).
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A nurse is caring for an 80-year-old male client who admits drinking a six-pack of beer a night to "help with the loneliness." The nurse should screen for what other co-morbid condition related to this client's alcohol use? A) Depression B) Diabetes C) High-risk behaviors D) Tobacco use
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A Rationale: Because of the comorbidity of alcohol abuse and depression, the nurse should screen for alcohol abuse in all cases where depression is expected.
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A nurse is assessing a frail elderly male client for placement using the Blaylock Discharge Planning Risk Assessment Screen and gives the client a score of 15. What would be the nurse's next intervention related to this score? A) Discharge the client to his home B) Refer the client to the discharge planning coordinator C) Refer the client to a social worker D) Transfer the client to an assisted living facility
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B Rationale: On the Blaylock Discharge Planning Risk Assessment Screen, a score of 11 to 19 places the client at risk for extended discharge planning. A score of 10 means the client is at risk for home care resources. A score over 20 means the client is at risk for placement other than home. If the score is greater than a 10 refer the patient to the discharge planning coordinator or discharge planning team
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The nurse caring for clients in a nursing home knows that falls are a leading cause of death among the elderly. Which of the following statistics accurately states the incidence and consequences of falls in the elderly? A) In the United States, 1 of every 3 people over age 65 falls each year B) Half of people over age 75 who fall and fracture a hip die within 2 years C) Exercise in the elderly is not recommended due to the risk for falling D) By 2020 the cost of fall injury is expected to rise to 50 billion dollars
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A Rationale: In the United States, one of every three people over age 65 falls each year. Half of people over age 75 who fall and fracture a hip die within a year. By 2020 the cost of fall injury is expected to rise to 32 billion dollars. Regular exercise in the elderly is recommended, as it can strengthen muscles and stamina and prevent osteoporosis and consequent falls.
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A nurse is caring for a 45-year-old client from Japan who underwent a stent placement following a myocardial infarction. The client only speaks Japanese and the nurse calls in an interpreter to work with them. Which of the following is a recommended guideline for working with interpreters? A) Ask several questions at once and allow the interpreter to convey them to the client B) If possible, a relative of the client should be asked to interpret C) In possible, an interpreter of the same gender as the client should be used D) Request that the interpreter translate exactly what is said, without interrupting
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C Rationale: In general, an interpreter of the same gender as the client is preferred. The nurse should ask one question at a time and allow the interpreter time to convey the question. Qualified professional interpreters instead of relatives should be used. The interpreter should be invited to ask for clarification as needed, even if it means interrupting.
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The nurse working in the community-based setting follows the nursing process when providing client teaching. Which of the following steps of the learning process provides for reimbursement of the teaching provided? A) Evaluation B) Documentation C) Planning D) Assessment
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B Rationale: Documentation of teaching is important as a legal record, as communication of teaching and learning for other health care professionals, and for determination of eligibility for care needed and reimbursement for care and teaching provided.
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A school nurse is teaching safety issues in a lecture for parents of school-age children. Which of the following topics would the nurse describe as having the biggest impact on preventing loss of life and injury in children? A) Using appropriate automobile restraints B) Learning basic life-saving skills C) Using smoke detectors in the home D) Locking up poisonous substances
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A Rationale: Although all these topics are important to cover, the one topic that prevents the most loss of life and injury is using appropriate restraints when riding in an automobile. Child safety seats reduce the risk of death in passenger cars by 71% for infants and 54% for preschool children.
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The nurse explains to the novice nurse how community-based nursing differs from nursing care provided in hospital settings. Which of the following statements accurately describes one of these differences? A) In the community setting, the nurse is in charge of all aspects of client care whereas in the hospital setting the client directs the care B) In the community setting, the nurse is the primary facilitator of self-care as opposed to being solely a care provider C) In the hospital setting, a holistic assessment is facilitated by the collaboration of many professionals, which is not available in the community setting D) In the community setting, the client's environment must be changed to facilitate care, which is not an issue in the hospital setting
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B Rationale: Because the client and family are involved in nearly all aspects of care the majority of the time, the community-based nurse is primarily a facilitator of self-care as opposed to being the sole care provider. In the community setting, the delivery of care must be considered within the family and environment. A holistic assessment often occurs through the collaboration of many professionals.
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A nurse asks a homebound client what type of activities she enjoys to determine if these activities can be brought to the client. Which of the following aspects of the client's environment is the nurse assessing? A) Physiologic and survival needs B) Self-esteem and self-actualization needs C) Love and belonging needs D) Safety and security needs
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B Rationale: An environmental assessment assesses for self-esteem and self-actualization needs, such as activities the client enjoys. An example of a love and belonging need is having a friendly, competent caregiver. Physiologic and survival needs are physical needs that need to be met, such as food and shelter. Safety and security needs include mobility and fall prevention.
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A client who is being discharged from an acute-care facility sits down with the nurse and agrees how, when, and where outpatient treatments will occur. What is the term for this type of agreement? A) Concordance B) Collaboration C) Adherence D) Self-efficacy
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A Rationale: Concordance is an agreement between the nurse and the client about whether, when, and how treatments will occur. Adherence refers to the client following the prescribed treatment. Self-efficacy refers to the ability of the client to influence events that affect his or her life. In the collaborative process, the client chooses a goal, and the nurse and client negotiate a specific plan to reach that goal.
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A family nurse assesses a family to determine its developmental stage. The nurse notes that the family's first child is moving out of their home. What developmental stage does this represent? A) Aging family B) Middle-aged parents C) Launching center D) Teenage
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C Rationale: The launching center stage of the family life cycle occurs from when the first to the last child leaves home. The "teenage" stage occurs when the oldest child is 13 to 20 years old. The middle-aged parents stage occurs from empty nest (when no children are living at home) to retirement. The aging family stage occurs from retirement to moving out of home.
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The nurse practicing in a community setting is aware that as new groups enter the community, acculturation may occur. Which of the following is an example of this concept? A) A Portuguese family moves into a neighborhood that is predominantly Portuguese to continue their cultural practices B) An Asian couple refuses to allow their children to play with the neighborhood children C) The children of a traditional Muslim family chooses to practice the norms and values of the community as a whole D) An Ethiopian man who came to America on a work visa learns to take the bus to work
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D Rationale: Individuals within a group may adhere to the traditional culture, as occurs with the Portuguese and Asian family. Or, they may choose to adapt to the dominant culture in varying degrees through acculturation, as is seen with the Ethiopian man. The children of the Muslim family have assimilated into the existing culture.
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A nurse is teaching elderly clients in a senior center how to modify their homes to prevent falls and promote safety. Which of the following is a recommended guideline when providing community-based teaching to the older learner? A) Face the client and speak in a low, slow voice so lip-reading is possible B) Meet in a quiet, dimly lit room where there is no background noise C) Encourage dependent decision making to ensure family and/or caregiver support D) Relate new information to the current time frame as opposed to past experience
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A Rationale: The nurse should face the client and speak in a low, slow voice so lip-reading is possible. The nurse should relate new information to past experiences if possible and encourage independent decision making to support ego integrity. The nurse should meet the client in a quiet, well-lit room with no background noise.
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Nurses use the assessment step of the nursing process when planning client care. Which of the following best describes the focus of client assessment in the community-based setting? A) Providing ongoing monitoring of acute conditions and planning appropriate nursing interventions B) Providing a baseline to evaluate physiologic, psychological, and functional capacity of the client C) Ensuring continuity of discharge planning based on the functional capacity of the client D) Determining the pathology of the client's disease state and initiating therapeutic interventions
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B Rationale: In the hospital and community setting, assessment is a dynamic, ongoing method that uses observations and interactions to collect information, recognize changes, analyze needs, and plan care. In the community, the nurse uses assessment to provide a baseline to evaluate the physiologic, psychological, and functional capacity of the client and identify environmental factors that may affect the client's health status. In the hospital setting, assessment is used to provide ongoing monitoring of acute conditions and plan appropriate interventions, as well as to ensure continuity of discharge planning. Physicians primarily use assessment to determine pathology and appropriate therapeutic interventions.
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The nurse researches current health trends and statistics in the United States to identify vulnerable populations. Which of the following is a critical indicator of the health of a population? A) Elderly poverty rates B) Infant mortality rates C) Child poverty rates D) Percentage of individuals with chronic diseases
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B Rationale: Infant death is a critical indicator of the health of a population because it reflects the overall state of maternal health, as well as the quality of and access to primary health care for pregnant women and infants. Infant mortality in the United States ranks the highest among industrialized nations.
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A nurse working in a community health care clinic travels around the community to identify data related to the people, places, and social systems that define that community. The nurse uses this information to improve the health of the individuals using the clinic. What type of assessment tool is this nurse using? A) Informant interviews B) Participant observations C) Windshield survey D) Existing data
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C Rationale: A windshield survey is designed to assist the nurse traveling the neighborhood to identify data related to the people, places, and social systems that define that community. This information may help identify trends, stability, and changes affecting the health of the community members. Informant interviews involve interviewing key informants or members of the general public. During participant observations the nurse observes formal and informal community activities to determine significant events and occurrences. Existing data is used to assess people, places, or social systems.
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A female nurse is providing care for a 29-year-old male Muslim client who fractured his pelvis in an automobile accident. What dimension of cultural knowledge should the nurse keep in mind when providing care for this client? A) In the Muslim culture, physical touching and expression is valued and expected B) In the Muslim culture, close face-to-face conversations are the norm C) In the Muslim culture, it is highly distressing for a male client to be assessed by a male nurse D) In the Muslim culture, contact between males and females who are not married to each other is inappropriate
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D Rationale: In the Muslim culture, contact between unrelated males and females is forbidden. In Muslim culture, it would be distressing for a male nurse to care for a female patient, but not for a male patient. Close face-to-face conversations are the norm In Middle Eastern cultures, and physical touching and expression is valued in the Mexican culture.
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A nurse is preparing for a next-day home visit of a client discharged from a birthing center 12 hours after a normal delivery of a healthy baby girl. Which of the following is a characteristic of home care that differs from nursing care in the hospital setting? A) The focus is on the client individually B) Family support is critical in achieving client outcomes C) The resources needed for this client are predetermined D) The client will assume a highly dependent role
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B Rationale: In the home setting, family support is critical in accomplishing client outcomes, whereas in the hospital setting family support is helpful in accomplishing client outcomes but not a necessity. The resources for hospital stays are predetermined, but are highly variable in the home setting. In the home setting the client assumes an autonomous role as opposed to a dependent role. The focus of home care is on the client in the family setting, not just the client individually in a hospital setting.
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A nurse is counseling a 35-year-old male client who has a BMI of 35 (obese) and who has type 2 diabetes. Which of the following is the best example of assessing this client's readiness for a weight-control program? A) What changes are you ready to make in your eating habits right now? B) Are you embarrassed by the way you look and feel right now? C) Are you aware that being obese is a risk factor for type 2 diabetes? D) Do you feel you have lost control over your eating habits?
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A Rationale: The nurse should ask questions to assess a client's readiness to control weight, such as what changes he is willing to make in eating habits or physical activity level. The nurse should address the client's chief complaints independent of weight first and avoid judgmental comments such as "lost control" or "embarrassed".
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A nurse is preparing a pamphlet for distribution in the community regarding sexually transmitted diseases (STDs) in teenagers and young adults. Which of the following is a point that should be covered in this pamphlet? A) Most new HIV infections occur in people between 13 -21 years of age B) Teens and young adults are less likely than others to have multiple partners C) Comprehensive sex education should begin in high school D) Talking openly about sex with teens makes them more likely to try it
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A Rationale: The incidence of STDs has skyrocketed and most new HIV infections occur in people between 13 and 21 years (National Center for HIV/AIDS, 2010). Teenagers and young adults are more likely than others to have multiple partners. Talking openly and frankly about sex with teens may allow them to see how it is a choice to be sexually active that need not be made at this age. Comprehensive sex education should begin in primary school.
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Nurses accomplish the goals of health promotion by working with individuals in all types of care settings. Which of the following is an example of this type of health promotion? A) A nurse participates in a campaign to create a law that all bikers wear safety helmets B) A nurse volunteers at a free health clinic to provide immunizations for low-income families C) A school nurse provides rallies for students to show how eating healthy and exercising can be "fun" activities D) A nurse counsels teenagers on methods to prevent contracting sexually transmitted infections
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C Rationale: Health promotion is the science and art of helping individuals change their lifestyle to move toward a state of optimal health. This is accomplished through creating supportive environments to enhance awareness and change behavior to support good practices, such as eating healthy and exercising. Providing immunizations and counseling about preventing STIs are examples of disease prevention. Helping to create a helmet law is an example of a health protection strategy.
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A nurse is assessing a 2-year-old male child for vision disorders. Which of the following examples of assessment techniques would be appropriate for this client? A) Ask the mother if the child returns her smile B) Ask the child if he can see pictures in a book C) Ask the mother if the child tilts his head to look at things D) Observe whether the child's eyes follow the mother when she leaves the room
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C Rationale: Nurses should assess the vision of infants and toddlers by asking the mother certain assessment questions. For a toddler, the nurse should ask the mother if the child tilts his head to look at objects, covers an eye when looking at objects, squints, frowns or blinks frequently, or holds objects very close or far away to look at them. The other assessments are appropriate for an infant older than 6 weeks.
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The nurse caring for elderly clients in a nursing home researches nursing interventions aimed at health promotion and disease prevention for the elderly. Which of the following statements accurately reflects the current health status of older adults in the United States? A) The elderly population in the United States is growing B) Since 1900, the percentage of people over 65 has doubled C) As people age, they are more likely to live with a partner or family member D) People who live to age 65 can expect to live around 10 more years
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A Rationale: The elderly population in the United States is growing. Life expectancies at ages 65 and 85 have increased over the past 50 years. People who live to age 65 can expect to live an average of nearly 18 more years. Since 1900, the percentage of people 65 years and older has tripled with the aging of baby boomers. As people age, they are more likely to live alone.
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During an annual physical, the nurse is reviewing the immunization record of a 22-year-old female client. The client has no record of immunizations and does not remember being immunized. Which of the following is a recommended immunization for this client? A) One dose of influenza vaccine annually B) 4 doses of Measles, Mumps and Rubella (MMR) C) 2 doses of Tdap, then boost with Td every 10 years D) 2 doses of HPV vaccination
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A Rationale: The 19- to 26-year-old should have one dose of influenza vaccine annually, 3 doses of HPV (if female), 1 dose of Tdap boosted with Td every 10 years, and 1 or 2 doses of MMR.
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The nurse is counseling parents about common chronic diseases of childhood and their prevention. Which of the following would the nurse state as the single most common chronic disease in children? A) Dental caries B) Juvenile diabetes C) Ear infections D) Asthma
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A Rationale: Dental caries represent the single most common chronic disease of childhood, occurring five times as frequently as the second most common disease (asthma). Unless identified and cared for early, caries are irreversible.
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An African American nurse is providing care in a health clinic in a primarily Hispanic neighborhood. What is the first step in intervening appropriately with clients from another culture? A) Practicing cultural blindness B) Promoting ethnocentrism C) Preventing stereotyping D) Practicing cultural awareness
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D Rationale: The first step in providing culturally competent care is to understand one's own cultural background, influences, and biases. Only with cultural awareness can nurses appreciate and be sensitive to values, beliefs, life practices, and problem-solving methods of a client's culture. Cultural blindness occurs when the nurse does not recognize his or her own beliefs or practices, or those of others. Ethnocentrism is the idea that one's own ideas or beliefs are the best way to behave, which has a negative effect on cultural awareness. Preventing stereotyping (generalizing about others) is important, but is not the first step in this process.
question
A nurse providing care in a community health care clinic initiates a grant proposal to help identify pregnant women in the community who are not receiving prenatal care and provide this care on a sliding scale based on income. In which of the following nursing interventions is this nurse involved? A) Health teaching B) Consultation C) Collaboration D) Case finding
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D Rationale: Case finding is a set of activities nurses working in community settings use to identify clients who are not currently receiving nursing care but could benefit from it. Health teaching is the communication of information and skills that change the knowledge and attitudes of clients and their families. Collaboration involves two or more individuals or agencies to achieve a common health goal for a client. Consultation is an interactive problem-solving process between the nurse and client.
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The nurse providing teaching in the home care setting knows that in order to be reimbursed by Medicare or third-party payors the teaching must meet certain criteria. Which of the following is an example of a questionable teaching activity that may not be paid? A) A nurse teaches a diabetic client how to inject insulin B) A nurse teaches a client with a broken neck how to care for a halo device C) A nurse teaches a client how to organize multiple medications into a pill box D) A nurse teaches a client with a new colostomy how to care for the stoma
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C Rationale: Questionable teaching includes the administration of oral medications or teaching for the client who is capable of independent ambulation, dressing, feeding, and hygiene. Teaching care for a new colostomy and administration of insulin is generally covered, as well as teaching the patient how to use and care for braces, splints, and orthotics.
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A nurse is teaching a new mother about the advantages and disadvantages of breastfeeding a newborn. Which of the following would the nurse report? A) Breastfeeding should be supplemented with iron-rich formula to prevent anemia B) Breastfeeding decreases the rate of respiratory infections in newborns C) Breastfeeding must be monitored as the newborn is more likely to be overweight D) Breastfeeding prolongs the return to pre-pregnancy weight in the mother
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B Rationale: Breastfeeding is the most complete form of nutrition for infants, with various benefits including health, growth, immunity, and development. Breastfed babies have a lower incidence of diarrhea, respiratory infections, and ear infections and are less likely to be overweight. Breastfeeding promotes the return of pre-pregnancy weight. Breastfeeding should not be supplemented with formula feeding.
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A nurse is using surveillance to improve the health of a culturally diverse community. Which of the following interventions might this nurse perform? A) Collecting and analyzing health data to plan and implement health care services in a free clinic B) Placing ads in the local newspaper to announce a new recreation program for the community population C) Interacting with community members in a town meeting to provide health screening to uninsured children D) Identifying individuals in the community with unrecognized health risk factors, such as homeless people
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A Rationale: Surveillance is used to describe and monitor health events through ongoing and systematic collection, analysis, and interpretation of health data. This process is used to plan, implement, and evaluate public health interventions. Identifying individuals in the community with unrecognized health risks factors, such as homeless people is a function of screening. Interacting with the community to solve problems such as uninsured children is a function of consultation. Using public marketing is social marketing.
question
Some of the leading causes of death and disability in the United States can often be prevented by making lifestyle changes. Staying active, eating right, and not smoking are preventive measures for which of the following leading causes of death in the United States? A) Heart disease B) Unintentional injuries C) HIV/AIDS D) Mental disorders / Suicide
answer
A Rationale: About two thirds of all mortalities and morbidities result from three behaviors: tobacco use, poor dietary patterns, and smoking. Heart disease and cancer are the leading causes of death in adults, and staying fit, eating right, and not smoking are key strategies to preventing these diseases.
question
The nurse uses the health-illness continuum as a model for practice in the community-based health care setting. Which of the following accurately represents the philosophy of this model of health? A) Improvement in health is seen as an outcome related to available medical services B) technology drives care in this model C) It considers health rather than illness as the essence of care D) Care is directed at resolving immediate health problems
answer
C Rationale: The health-illness continuum considers health rather than illness as the essence of care, which requires a shift in thinking. Improvement in health is not seen as an outcome of the amount and type of medical services or the size of the hospital. Treatment efficacy rather than technology drives care in this model. Care provided in acute care facilities is directed at resolving immediate health problems, whereas in this model the focus is on maximizing individual potential for self-care.
question
The nurse caring for clients in a nursing home is advising a new resident couple regarding safe sex practices. Which of the following is an appropriate teaching point for this couple? A) Both partners should be tested for STD's prior to having sex B) In the United States, the incidence of HIV is minimal in the older population C) Older men should not be encouraged to use performance-enhancing drugs D) As men get older, impotency is not a problem unless it was in the past.
answer
A Rationale: Having safe sex is important for people of all ages, and both members of new couples should be tested for STDs prior to having sex. In some areas of the country, HIV is on the rise in the elderly population. As men age, impotence increases with some chronic diseases contributing to the cause. Pharmaceutical and mechanical options are available to enhance sexual enjoyment.
question
The nurse formulates learning objectives for clients being treated in a long-term health care facility. Which of the following is an example of an affective learning objective? A) The client will state three healthy snacks to substitute for sweets by 10/24/12 B) The client will demonstrate the proper method of crutch walking by 10/24/12 C) The client will express a desire to start a smoking cessation class by 10/24/12 D) The client will ambulate the length of the hallway by 10/24/12
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C Rationale: An affective learning objective relates to learning activities that enhance the acceptance of and the adjustment to illness and subsequent treatment (e.g. the client expressing a desire to stop smoking). Stating three healthy snacks to substitute for sweets is a cognitive objective. Ambulating the length of a hallway and demonstrating crutch walking are psychomotor learning objectives.
question
The nurse working in a hospital knows that the client's diagnosis is categorized according to the federal DRG coding system instituted in the early 1980s. Which of the following is an outcome of this prospective payment system? A) Improved efficiency means less revenue for the hospital B) The length of client hospital stays has increased C) More and more health services are being provided outside the hospital D) Hospital readmission for clients has decreased
answer
C Rationale: Over time, more and more services are being provided outside the hospital because it is more cost-effective. Improved efficiency means more revenue for the hospital because of shorter stays and use of fewer resources. Since shorter stays are financially favorable for hospitals, clients are discharged "quicker and sicker," resulting in an increase in readmissions.
question
It is important for the community-based nurse to assess the family or kinship patterns of the groups within the community being served. Which of the following is the best method to assess family structure? A) Ask the client who is the head of the family B) Ask the client who is in his or her family C) Describe the typical family and ask the client how his or her family differs D) Ask the client how many parents and how many children comprise the family
answer
B Rationale: The family is the basic unit of society, but there are many meanings of "family." In order to avoid misunderstanding, it is appropriate for the nurse to ask the client directly who is in his or her family. The nurse should note if the client views "family" as only the nuclear family or also includes the extended family.
question
A nurse provides a referral to an occupational therapist for an elderly client with limited mobility related to rheumatoid arthritis. Which of the following is an example of a service that would be provided by this specialist? A) Teaching a client how to use a grabber to reach higher objects B) Teaching the client how to use a walker to ambulate C) Performing range-of-motion exercises to strengthen the client's muscles D) Assisting the client to take a shower and get dressed
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A Rationale: An occupational therapist helps the client adjust to limitations by teaching new vocational skills or better ways to perform activities of daily living. Performing range of motion exercises and teaching the use of a walker are roles of the physical therapist. Assisting the client with hygiene is a role of the home health aide.
question
Disparities in American health care are well documented, and numerous federal initiatives have been undertaken to reduce these disparities. Which of the following is the best example of two factors that are intrinsically related and underlie many of these health disparities? A) Culture and health behaviors B) Environment and genetics C) Gender and religion D) Economics and education
answer
D Rationale: Income and education are intrinsically related and underlie many of the heath disparities (lack of equity) in the United States. People with the worst health status are among those with the highest poverty rates and least education. Environment, genetics, and health behaviors also play a role in the major causes of death in the United States. Gender, religion, and culture may influence health status, but are not major causes of the disparity in health care.
question
A nurse is teaching safety guidelines to a group of parents participating in a parenting class. Which of the following teaching points follows the recommended safety guidelines for child safety? A) Keep hot water temperatures below 120 F B) Use a car safety seat until the child is at least 30 pounds C) Keep the child safety seat in the front passengers side seat D) Be sure their are screens in all windows
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A Rationale: The hot water temperature should be set at 120 degrees F. A child safety seat should be used until the child is at least 40 lbs and should be placed in the middle of the back seat. Window guards and netting should be used to prevent falls from windows. Screens alone do not always prevent a fall.
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A nurse is caring for a 48-year-old male client recently diagnosed with lung cancer. The client has a wife and two children living at home. Which of the following is considered the fundamental component to providing continuity of care for this family? A) Referring the client to cancer specialists B) Establishing a trusting nurse-client relationship C) Assessing the client's financial resources D) Teaching the client self-care measures
answer
B Rationale: The nurse-client relationship is the fundamental component in developing continuity of care. Counseling is established through the nurse-client relationship and woven into all aspects of the plan as the foundation of care coordination. The other options are aspects of the care plan that may need to be addressed, but are not considered the foundation of continuity of care.
question
A home health care nurse discusses the incidence of adults with limitation in activities of daily living (ADLs) and instrumental activities of daily living (IADLs) with a physical therapist. Which of the following statistics accurately portrays the percentage of adults in the United States with these types of limitations? A) Approximately 20% of adults over 75 years old have limitations in IADLs B) Approximately 30% of adults over 75 years old have limitations in ADLs C) Approximately 10% adults aged 65-74 have limitations in ADLs D) Approximately 15% of adults aged 65-74 have limitations in IADLs
answer
A Rationale: Approximately 20% of adults over 75 years old have limitations in IADLS. Approximately 10% of this age group have limitations in ADLs. About 3% of adults aged 65 to 74 have limitations in ADLs, and about 7% have limitations in IADLs.
question
The nurse working in a culturally diverse community-based setting knows that a person's cultural belief system influences his or her health attitudes, beliefs, and practices. Which of the following clients would be more likely to look for a supernatural counterforce to get rid of a health problem? A) An Asian woman who has breast cancer B) An Eastern European client who is experiencing seizures C) A client of Caribbean culture who is diagnosed with lung cancer D) An Arab client who is scheduled for a postatectomy
answer
C Rationale: The magico-religious view, practiced by people from Hispanic and Caribbean cultures, sees illness as having a supernatural force. People with this perspective will look for a counterforce to rid them of the problem. People of Arab or Asian descent may ascribe to the hot and cold theory based on the balance of the four humors.
question
Competencies for nurses working in the community setting include skill and knowledge in assessment, program planning, communications, cultural competency, public health science, management, and leadership. Which of the following examples of competencies best reflects the use of public health science skills? A) A nurse researches the availability of free health care clinics and transportation for low-income families in a nearby community B) A nurse plans a series of parenting classes for an inner city neighborhood and decides which clients should be invited to attend C) A nurse plans and organizes care for an elderly client who has dementia and is living at home with her daughter D) A nurse interviews a client with advanced Parkinson's disease to determine which care should be initiated, continued, altered, or discontinued
answer
A Rationale: Nurses understand factors contributing to health promotion and disease prevention (such as free health care clinics) and factors contributing to the use of health services (such as transportation) by using basic public health science skills. Planning and organizing care for a client involves the use of management skills. The nurse uses program planning skills to plan parenting classes, and interviewing clients to plan care is related to the use of assessment skills.
question
Which of the following interventions might the nurse perform in the home health care setting when providing tertiary prevention? A) Informing a client about smoking cessation classes offered in the community B) Referring a caregiver to a program designed to prevent caregiver burnout C) Teaching range-of-motion exercises to a client who is recovering from a stroke D) Providing teaching materials about diabetes in a family's native language
answer
C Rationale: Tertiary prevention focuses on rehabilitation, management of chronic conditions, or postsurgical care at home. Informing a client about smoking cessation classes is a form of secondary prevention. Referrals for classes and providing teaching materials are examples of prevention on the primary level.
question
The nurse is performing a functional assessment on Mrs. Ruiz, an elderly female client discharged from the hospital following hip replacement surgery. Mrs. Ruiz is temporarily living with her daughter and her daughter's two school-age children, but would like to return to her own home. Which of the following is the best example of a question to assess this client for functional status? A) Have you been experiencing any cramping in your legs? B) Are you able to dress yourself independently? C) Have you noticed any oozing or pain at the incision site D) How would you rate your pain on a scale of 1 to 10
answer
B Rationale: Function assessment is performed to determine if the client needs the assistance of another person for daily function, such as dressing, bathing, and cooking meals. Pain assessment, assessment for infection, and DVT may impact functional ability but are not direct functional assessment parameters.
question
A nurse is caring for clients in a mostly Puerto Rican community. Which of the following is an example of using a cultural care accommodation modality to treat a teenage client who is pregnant? A) Be familiar with religious symbols and protective care symbols that may be used B) Develop a nutrition outreach program for expectant mothers in the community C) Use the Spanish language to include the teenager's mother in the care plan D) Treat the mother and daughter with respect and maintain eye contact
answer
C Rationale: Using the Spanish language is a cultural care accommodation modality, which is an assistive, supportive, or enabling technique to help people of a certain culture adapt to others for a beneficial outcome. Treating the clients with respect and being familiar with their religious symbols are forms of cultural care preservation and/or maintenance. Developing a nutrition outreach program is a cultural care repatterning or restructuring modality.
question
A nurse is performing a mini nutritional assessment for 78-year-old Mr. Parker. He is in good health (no psychological distress or recent acute illnesses) and lives in an assisted-living facility. Upon assessment, the nurse learns that Mr. Parker has experienced a moderate decrease in his food intake, has lost 6 pounds in the last 3 months, is able to go out, and has no neuropsychological problems. His body mass index is 20 and calf circumference is 30. How would the nurse document Mr. Parker's score on this assessment tool? A) 10 points = at risk of malnutrition B) 13 points = normal nutritional status C) 7 points = malnourished
answer
A Rationale: When assessing nutrition using the mini nutritional assessment tool, a score of 12 to 14 points = normal nutritional status, 8 to 11 points = at risk of malnutrition, and 0 to 7 points = malnourished.
question
The family nurse knows that providing nursing care to families is a logical development of the holistic approach to the care of the client. Which of the following accurately describes a consideration when caring for clients in the context of their families? A) A change in one part of a family system does not usually change other parts of the system B) Communication patterns between family members do not affect the natural functioning of the family C) A family's structure and organization cannot be understood in isolation from the rest of the family system D) It is important to first isolate the client from the family to fully understand the client
answer
C Rationale: A family's structure and organization, or a part of that family, cannot be understood in isolation from the rest of the family system. A change in one part of a family system affects other parts of the family. Communication patterns between family members are essential to the functioning of the family.
question
A nurse is teaching preventive measures to adults in an assisted living facility. Which of the following is a recommended guideline for adult health screening? A) Women ages 50-74 should have a mammogram every year B) Men ages 50-75 should have an annual PSA screening for prostate cancer C) People ages 35-75 should undergo a colonoscopy every 5 years D) All women should have an annual pap smear starting at age 18 or when sexually active
answer
D Rationale: All women should have an annual Pap smear starting at age 18 or when they become sexually active. After three normal Pap smears they may be tested less frequently according to their practitioner. The U.S. Preventive Services Task Force (2010) recommends that women ages 50 to 74 have a mammogram every 2 years. Experts do not universally support the PSA screening for all men regularly, since the test can be abnormal for reasons other than prostate cancer. People ages 50 to 75 should be screened regularly for colorectal cancer, though not necessarily every 5 years.
question
A nurse is counseling elderly clients in a mental health facility. Which of the following statistics should the nurse keep in mind when devising a plan of care for these clients? A) Aging has little or no effect on the emergence of mental health issues B) Older Americans are disproportionately likely to die from suicide C) Only severe depression responds well to treatment D) The incidence of depression is lower for clients receiving home health care
answer
B Rationale: Older Americans are disproportionately likely to die from suicide; they make up only 12% of the population, but account for 16% of suicide deaths. Many issues related to mental health emerge as people age. This may be related to loss of health, family, friends, and spouse. The incidence of depression is higher in clients receiving home health care and even higher in hospitalized clients. All depression should be treated, and there are many options for treatment.
