1. A nurse is assessing a new client. Which of the following information should the nurse include
in the cultural portion of the assessment?
a. Food preferences
b. Employment status
c. History of illnesses
d. Sexual
...
1. A nurse is assessing a new client. Which of the following information should the nurse include
in the cultural portion of the assessment?
a. Food preferences
b. Employment status
c. History of illnesses
d. Sexual orientation
Rationale: Food preferences are a part of cultural assessment.
2. A nurse is preparing an educational program about influenza for a group of community health
nurses. Which of the following activities should the nurse include as an example for tertiary
prevention?
a. Offer classes to elementary school teachers about handwashing.
b. Provide information to occupational nurses about the reasons for employees to not
come to work.
c. Administer antiviral meds within 48 hr to clients who have manifestations of
influenza.
d. Provide immunizations at long-term care facilities.
Rationale: Tertiary prevention involves ways to reduce the complications of illness, which
includes administering antiviral medications to clients who already have influenza.
3. Anurse is collecting demographic data as a part of a community assessment. Which of the
following info should the nurse include?
a. Racial distribution
b. Family genograms
c. Number of open water sources
d. Presence of condemned buildings
Rationale: Racial distribution is part of demographic data.
4. A community health nurse suspects an outbreak of scabies in the local area. which of the
following actions should the nurse take first?
a. Determine the incidence rate
b. Institute prophylactic treatment
c. Educate the community about disease transmission
d. Discuss treatment plans with clients' families
Rationale: The first action the nurse should take when using the nursing process is to
determine the number of new cases of scabies in the community.
5. A public health nurse is planning care for four clients. Which of the following interventions
NR442 HEALTH
should the nurse recognize as tertiary prevention?
a. Providing chemoprophylaxis for malaria to a client who is traveling to mosquitoinfested countries
b. Administering antibiotics to a client who has AIDS and was diagnosed with
pneumocystis jiroveci
c. Performing a serological screening for HIV for a client who is pregnant
d. Participating in partner notification for a client who has an STI ‘=
Rationale: Administering antibiotics to a client who has AIDS and was diagnosed with
Pneumocystis jiroveci is an example of tertiary prevention.
6. A home health nurse is assessing an older adult client who is taking captopril to treat heart
failure. Which of the following findings should the nurse identify as an adverse effect of this
medication?
a. dry cough
b. weight gain
c. ataxia
d. photophobia
Rationale: Captopril prevents the conversion of angiotensin I to angiotensin II, causing
bradykinin to accumulate. The client may experience coughing as a result of bradykinin
accumulation.
7. A home health nurse is caring for a client who has breast cancer. Which of the following
assessment findings should the nurse identify as an indication that the client is coping
effectively?
a. Inability to concentrate
b. Makes eye contact
c. Excessive sleeping
d. Lack of interest in food
Rationale: The nurse should recognize that making eye contact is a characteristic of effective
coping.
8. A public health nurse is providing information to a client who has an alcohol use disorder and
is asking about treatment. Which of the following statements should the nurse identify as an
indication that the client understands the information?
a. "I will not have to completely stop drinking alcohol if I go into an inpatient treatment
program."
b. "Once I make it through detoxification, I will be free of my addiction."
c. "I am not eligible for an outpatient program until I have completed an inpatient
program first."
d. "I can expect to get help with other aspects of my life while in treatment."
Rationale: 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.
9. The daughter of a client who is terminally ill and at the end of life approaches a hospice nurse
and asks what she can do to help relieve her father’s pain. Which of the following interventions
should the nurse suggest?
a. Give the client brief hand massages.
b. Increase the illumination in the room.
c. Place a warm cloth on the client's forehead.
d. Administer citalopram when the client is agitated.
Rationale: Soft massage and brief hand massages can reduce pain and stress in palliative care
settings.
10. A community health nurse is developing a plan of care for a client who is hispanic. which of
the following actions should the nurse include in the plan?
a. maintain direct eye contact when speaking with the client
b. avoid using hand gestures when working with the client
c. discourage the client from using a faith healer
d. Use therapeutic touch during conversation
Rationale: A client who is Hispanic might view touch as a gesture of caring and compassion.
11. A nurse is caring for a client who has AIDS and is experiencing rapid weight loss. which of
the following actions should the nurse take first?
a. Examine the client's oral mucous membranes.
b. Encourage the client to consume 1.2 to 2.0 g/kg of protein daily.
c. Recommend the client increase her daily calorie intake by 25%.
d. Teach the client about findings that should be reported to the provider.
Rationale: The first action the nurse should take when using the nursing process is to assess
the client. The nurse should examine the client's oral mucous membranes for painful lesions,
such as candidiasis.
12. A school nurse is discussing levels of prevention with a teacher. which of the following
activities should the nurse identify as a primary prevention strategy?
a. Provide nutritional counseling for students who have diabetes.
b. Report suspected child neglect to the proper authorities.
c. Conduct vision and hearing screening for kindergarten enrollment.
d. Demonstrate proper handwashing techniques.
Rationale: This is an example of primary prevention, the goal of which is to promote health and
prevent diseases from developing.
13. A school nurse is conducting hearing screening procedures in an elementary school. Which
of the following instructions should the nurse provide when performing the Rinne test?
a. "After I place the tuning fork on your scalp, tell me if you hear the sound better in one
ear or the same in both ears."
b. "Use your finger to close one ear while I whisper some numbers into your other ear."
c. “After I place this tuning fork behind your ear, tell me when you no longer hear
the sound."
d. "You'll wear headphones and press the button when you hear a sound."
Rationale: This is the appropriate instruction for a Rinne test, a hearing evaluation that
compares air conduction and bone conduction of sound.
14. A public health nurse is developing a presentation for local daycare providers about
infectious childhood diseases. which of the following statements should the nurse include?
a. "Respiratory syncytial virus is spread through contact with respiratory
secretions from an infected person."
b. "Rotavirus infections in children peak during the summer months."
c. "Children who have fifth disease will exhibit bloody diarrhea."
d. "Antiviral medications shorten the duration of shigella infection."
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