Deck 3: Community-Based Nursing Practice

Question 1

A nurse is discussing the need to use a specific cleansing agent when redressing an infected hand.The client prefers using,"plain old soap and water." The nurse knows that the primary factor that will affect client compliance is:
1) The ease with which the client can use the special agent
2) The client's acceptance of the need for the specialized care
3) The availability and cost of the prescribed cleansing agent
4) The introduction of an incentive to prompt client to comply

Answer 1

2
Client must perceive the innovation or change as more advantageous than other alternatives or they will not make the change.Client education is essential in bringing about the change in attitude necessary for change.While the client is more likely to adapt the change if it is perceived as being easy,it is not the primary factor in achieving client compliance provided among the options available because client compliance is primarily a result of the client's understanding of the need for change.While cost to the client is a factor,it is not the primary factor in achieving client compliance provided among the options available since client compliance is primarily a result of the client's understanding of the need for change.An incentive is sometimes necessary,but it is not the primary factor in achieving client compliance provided among the options available,because client compliance is primarily a result of the client's understanding of the need for change.

Question 2

The client is being discharged from an acute care facility following a total hip replacement.She will need follow-up for her rehabilitation and exercise plan.In addition to a home health care nurse,what referral should be discussed?
1) Dietitian
2) Social worker
3) Physical therapist
4) Respiratory therapist

Answer 2

3
Directing clients to appropriate resources and improving continuity of care require the nurse to know those resources well.A physical therapist is responsible for the client's movement system and is likely to be needed following hip replacement surgery.
A social worker may or may not be necessary.A dietitian may or may not be necessary.
A respiratory therapist would not be necessary unless the client experienced a respiratory complication or had a preexisting respiratory condition.

Question 3

As a community health nurse assisting the client and family with nutritional needs the nurse should first:
1) Identify for the client the best foods to buy
2) Purchase foods at the lowest cost for the client
3) Ask the client and family what they think they should eat
4) Provide information on stores with the most reasonable pricing

Answer 3

3
With the goal of helping clients assume responsibility for their own health care,the community health nurse must assess a client's learning needs and readiness to learn within the context of the individual,the systems the individual interacts with,and the resources available for support.Asking the client about what foods he or she thinks should be eaten may help the nurse assess the client's level of knowledge regarding nutrition as well as the client's food preferences.It also enables the client to become a participant in his or her care.Telling the client what foods to buy does not encourage the client to assume responsibility for managing his or her health care.The nurse should first assess the resources available,and then encourage the client to do his or her own shopping.Providing information on food sources and stores with reasonable pricing may be appropriate after the nurse has determined what information the client requires to meet nutritional needs.

Question 4

When assessing members of a vulnerable population,the community health nurse should realize that the primary need is to:
1) Provide culturally competent assessment.
2) Organize in your mind exactly what you need to ask.
3) Create a comfortable,nonthreatening environment.
4) Be alert for indications of mental and physical abuse.

Question 5

Which of the following statements by the home health nurse best reflects client advocacy in response to the client's concern over the expense of the therapy?
1) "Have you considered the possibility of a renal transplant?"
2) "This peritoneal dialysis is less expensive than hemodialysis."
3) "You must feel awful about this situation,but this is the best course of treatment for you."
4) "Let's call the regional dialysis center and explore options for reducing the cost of your home dialysis."

Question 6

The nurse working in a free clinic often utilized by Hispanic immigrants is assessing a client who reports a cough and malaise.The client is hearing impaired,speaks very little English and is currently living in a homeless shelter.The nurse's primary concerns should be the client's:
1) Language barrier
2) Risk for tuberculosis
3) Hearing impairment
4) Lack of health care resources

Question 7

A homeless client has presented in the ED with a bacterial infection in a hand wound.The nurse has cleansed and dressed the wound,and an initial dose of an antibiotic has been administered.The client will need the antibiotic prescription filled and a dressing change in 3 days.In order to ensure that the client will receive the appropriate follow-up care,the nurse must first act as the client's:
1) Educator
2) Advocate
3) Caregiver
4) Counselor

Question 8

One of the overall goals of Healthy People 2010 is to:
1) Increase life expectancy
2) Decrease health care costs
3) Promote managed care organizations
4) Establish the credentials of service providers

Question 9

The nurse recognizes which of the following as the largest contributing factor for the rise in the need and use of home care?
1) Government funding of the home care setting has increased greatly.
2) Clients are more acutely ill when discharged from the acute care facility.
3) There are 7 days/week services for the elderly in home care agencies.
4) The existence of more single-income families has increased the need for their elderly relatives to receive care in the home.

Question 10

In assessing the structure of the community in order to identify the needs of its population,the nurse will focus on:
1) Collecting demographic data on age distribution
2) Visiting neighborhood schools to review health records
3) Interviewing clients to determine the cultural composition of the subgroups
4) Observing locations where services,such as water sanitation,are provided

Question 11

Which one of the following clients from a vulnerable population currently appears to be at the greatest risk?
1) A physically abused client in a shelter
2) A schizophrenic client in outpatient therapy
3) An older adult taking medication for hypertension
4) A substance abuser who shares drug paraphernalia

Question 12

The nurse working in a free clinic is caring for a homeless client diagnosed with paranoid schizophrenia who has reported that,"I hurt my foot running away from them.It hurts so bad I can hardly walk now." On assessment the nurse notices bruising on the client's back,arms,and thighs,a red rash on both neck and face,and poor personal hygiene,in addition to edema of the left ankle.The nurse should first realize that this client is at risk for:
1) Physical abuse and assault
2) Drug addiction relating to pain
3) Communicable immune disorders
4) Hospitalization due to mental disorder

Question 13

A client with a history of a gastrointestinal disorder eats a well-balanced diet that keeps his GI symptoms suppressed.Which level of prevention corresponds to his dietary management?
1) Health promotion
2) Primary prevention
3) Tertiary prevention
4) Secondary prevention

Question 14

The student nurse is investigating different types of practice settings.In looking at community health nursing,the student recognizes that it:
1) Is the same as public health nursing
2) Focuses on the incidence of disease
3) Requires graduate-level educational preparation
4) Includes direct care and services to subpopulations

Question 15

The nurse is assessing a client diagnosed with chronic bronchitis who has been experiencing an increase in dyspnea.The client lives within 2 blocks of a factory that emits pollution into the air.In light of this information,the nurse is primarily concerned with:
1) Performing a complete client health history and physical assessment
2) Providing the client with assess to all the required breathing treatments
3) Identifying a correlation between the pollution and the client's increased dyspnea
4) Determining the availability of alternate housing for the client away from the factory

Question 16

A community nurse has identified a need for educational programming among the residents of an assistive living facility dealing with osteoarthritis.The best example of such programming is:
1) "Planning the best exercise program for you."
2) "Recognizing how arthritis has affected your life."
3) "Proper self administration of antiinflammatory medication"
4) "Be an informed consumer-don't fall for false arthritis cures."

Question 17

To facilitate change within a community,the nurse working as an effective change agent should:
1) Inform community members how to effectively manage their health needs
2) Work with clients and groups to select alternative health care sites and treatments
3) Formulate decisions for individual clients regarding their health care options
4) Provide instruction in the way the community should address health issues

Question 18

A nurse is planning interventions for the clients of a homeless shelter.Which of the activities represents a primary level intervention regarding sexually transmitted diseases?
1) HIV screening for all residents
2) Sex education for teenage residents
3) Treatment for residents diagnosed with AIDS
4) Gynecological referrals for female residences