Community HESI

Which presentation of an infectious disease is acquired through an indirect transmission?
+Syphilis contracted from a sexual partner.
+ Measles resulting from a daycare center outbreak.
+Malaria following exposure in a mosquito-infested area.
+Nosocomial influenza spreading rapidly in a long-term center
Malaria following exposure in a mosquito-infested area.
Malaria contracted from a biting mosquito is an example of a vector-related, indirect transmission of the disease (C). Indirect transmission of an infectious disease involves the spread of infection through an intermediate source, such as vehicles, fomites, or vectors. (A, B, and D) are examples of direct transmission, defined as the spread of an infection through person-to-person contact and is characterized by portals of exit and entry.
A home health nurse knows that a 70-year-old male client who is convalescing at home following a hip replacement, is at risk for developing decubitus ulcers. Which physical characteristic of aging contributes to such a risk?
16% increase in overall body fat.
Reduced melanin production.
Thinning of the skin with loss of elasticity.
Calcium loss in the bones.
Thinning of the skin with loss of elasticity.
Thin, non-elastic skin (C) is an important factor in decubitus formation. Proportion of body fat to lean mass increases with age (A), and might help decrease ulcer tendency. (B) results in grey hair. (D) can contribute to broken bones, but it is probably not a factor in decubitus formation.
The nurse is developing a plan to provide quality health care for a certain community. Data obtained from which resources should be helpful to the nurse in developing a community healthcare plan for this community? (Select all that apply.)
Census data.
Risk management data.
Budgeting process information.
Available workforce in the community.
Client-satisfaction surveys.
Changes in the community’s demographic data.
Census data.
Risk management data.
Budgeting process information.
Client-satisfaction surveys.
Changes in the community’s demographic data.
Census data (A), risk management data (B), budgeting process information (C), data obtained from client-satisfaction surveys (E), and changes in the community’s demographic data (F) provide pertinent data for planning for the current and future healthcare needs of the community. Available workforce (D), although a concern, is not a factor in quality-assurance directives.
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The nursing education coordinator is creating employee orientation materials for staff nurses who plan to work at a clinic that serves a lower socioeconomic neighborhood. What information should the educator include regarding the clinic’s client population? (Select all that apply.)
Most of the clients are unemployed or disabled.
Access to mass transit may be an issue.
Clients will need reminders to bring insurance cards.
Basic physiologic needs of this population are often unmet.
Clients who are homebound will qualify for Medicaid.
Nonadherence to healthcare recommendations is likely.
Most of the clients are unemployed or disabled.
Access to mass transit may be an issue.
Basic physiologic needs of this population are often unmet.

Correct choices are (A, B, and D). The unemployed or disabled will likely comprise a majority of this clinic’s clients (A); the lack of access to mass transit may affect the population’s ability to keep health care appointments (B); and low-income clients are at risk for basic physiologic needs being left unmet (D). Most clients are not likely to have health insurance (C) because they lack the funds to pay the insurance premiums. Homebound status is not a defining qualification for public assistance, such as Medicaid (E). To state that a low-income population is more likely to be non-compliant with healthcare recommendations is an example of stereotyping (F).

While discussing the science of nursing, the nurse identifies the domain of nursing theory. Which linkages should the nurse provide to describe nursing’s paradigm?
The person, the environment or situation, and health.
Stress reduction, self-care, and a systems model.
Curative care, restorative care, and terminal care.
Self-actualization, fundamental needs, and belonging.
The person, the environment or situation, and health.
Nursing theories serve to describe, explain, predict, or prescribe nursing care measures. Any science has a domain, which is the view or perspective of the discipline. The elements of nursing’s paradigm direct the activity of the nursing profession, including knowledge development, philosophy, theory, educational experience, research, practice, and literature identified with the profession. Nursing identified its domain in a paradigm that includes four linkages: the person, health, environment/situation, and nursing (A). (B, C, and D) are not linkages of the domain.
Which topic should the nurse include in planning a secondary prevention project for the local retirement community?
Safety measures in the home.
Adult immunization program.
Rehabilitation after surgery.
Vision and hearing screening.
Vision and hearing screening.
Health screenings (D) are the mainstay of secondary prevention, which focuses on health promotion, which includes screening, early detection and diagnosis of disease. (A and B) are primary prevention topics which include health-promoting activities designed to reduce the likelihood of a specific illness occurring. Tertiary prevention includes interventions aimed at disability limitation and rehabilitation (D) from disease, injury, or disability.
A nurse organizes a community action group to help resolve health problems in a low income neighborhood with a large population of recent immigrants from Africa. What problem should the nurse address first?
High rate of unemployment.
Low immunization rate of children.
Provision of substandard health care.
Access to bilingual care providers.
Low immunization rate of children.
In the early phase of a community group, it is important for the group to experience success in resolving a problem so that they feel encouraged and empowered to continue working together. (B) is the problem easiest to tackle. While (A and C) are important, they are complex problems to address, and it is crucial for the group to experience success on a smaller scale issue so that they will be encouraged to attempt resolving more complex problems in the future. (D) is important, particularly with Hispanic immigrant populations, but not as important as initial group success to this non-Hispanic majority.
What action is best for the community health nurse to take if the nurse suspects that an infant is being physically abused?
Follow agency protocols to report suspected abuse.
Report suspicions to the local child abuse reporting hotline.
Educate the child’s caregivers about growth and development issues.
Call the police department to have the child removed from the home.
Follow agency protocols to report suspected abuse.
Nurses are mandated to report all suspected cases of child abuse and neglect, and it is best to follow agency protocols to protect the nurse and child’s safety (A). (B) is available for the general public, but in this case it is best for the community health nurse to follow the agency policy. While (C) can contribute to abuse and neglect, the situation warrants immediate action to protect the child and follow the law. (D) could jeopardize the safety of the nurse, the child, or others in the home.
A nurse working in a community health setting is performing primary health screenings. Which individual is at highest risk for contracting an HIV infection?
A 17-year-old who is sexually active with numerous partners.
A 45-year-old lesbian who has been sexually active with two partners in the past year.
A 30-year-old cocaine user who inhales the drug and works in a topless bar.
A 34-year-old male homosexual who is in a monogamous relationship.
A 17-year-old who is sexually active with numerous partners.
(A) is at greatest risk for developing sexually transmitted diseases, including HIV, because the greater the number of sexual partners one has, the greater the risk for contracting STDs. (B) represents the group with the lowest number of infected persons because there is little transfer of body fluid during sexual acts. (C) would not be sharing needles, so contracting STDs is not necessarily a risk. A male homosexual in a monogamous relationship has a decreased risk of contracting HIV–as long as BOTH partners are monogamous and neither is infected (D).
During an initial clinic visit, the nurse is taking the history for a client who wants to confirm her pregnancy. The client’s last child has a history of low-birth-weight (LBW). Which additional finding is most important for the nurse to consider?
Cigarette smoking.
African-American ethnicity.
Poor nutritional status.
Limited maternal education.
African-American ethnicity.
The client’s previous history of a LBW infant and the non-modifiable risk factor of ethnicity are the most important risk factors for this pregnancy because the incidence of (LBW) infants is twice as high for African-American (B) births than Caucasian births. The modifiable risk factors of (A, C, and D) are related to infant morbidity, but (B) is most important because it is non-modifiable.
The nurse administers a booster dose of DTaP (diphtheria, tetanus, and pertussis) vaccine to an infant. Which level of prevention is the nurse implementing?
Primary prevention.
Tertiary prevention.
Secondary prevention.
Primary nursing.
Primary prevention.

Primary prevention (A) involves activities that focus on reducing the potential for illness before it occurs, such as immunizations. Tertiary prevention (B) minimizes the consequences of a disorder or illness through aggressive management or rehabilitation. Secondary prevention (C) includes early diagnosis and implementing interventions aimed at a cure or reducing the progress of a disease. Primary nursing (D) describes a method of nursing management and nursing care assignments, not a healthcare strategy.

The home health nurse is admitting a client with Parkinson’s disease to the home healthcare service. In planning care for this client, which nursing diagnosis has priority?
Impaired physical mobility related to muscle rigidity and weakness.
Ineffective coping related to depression and dysfunction due to disease progression.
Ineffective breathing pattern related to respiratory muscle weakness.
Fear related to constant possibility of experiencing seizures.
Impaired physical mobility related to muscle rigidity and weakness.
Parkinson’s disease is a progressive neurologic disorder affecting the brain centers that are responsible for control and regulation of movement. The chief clinical manifestations are impaired movement, muscular rigidity, resting tremor, muscle weakness, and loss of postural reflexes (A). Depression and dysfunction are appropriate nursing diagnoses but are not the primary diagnosis (B). Client’s with Parkinson’s usually do not experience (C or D).
The nurse is assessing a Vietnamese child during a home health visit and identifies round swellings on the child’s back. The child’s mother says she rubbed the edge of a coin on her child’s oiled skin. The nurse should recognize that this behavior is prompted by which cultural belief?
The child’s behavior was not acceptable.
The purpose is to rid the body of disease.
This method is commonly used for discipline.
Temper tantrums are commonly managed using this method.
The purpose is to rid the body of disease.

Coining, a Vietnamese practice, may produce welt-like swellings from rubbing a coin lengthwise on oiled skin to rid the body of disease (B). Certain cultural practices that address illness may be considered abusive by another culture and misunderstood by uninformed professionals. (A, C, and D) are not correct interpretations.

The nurse is working in a community clinic that serves a population comprised mainly of migrant families. In planning the use of resources for secondary prevention, which activity should be the priority?
Skin testing for tuberculosis.
Glucose monitoring for diabetes.
Blood work for cardiovascular disease.
Height and weight for altered nutrition
Skin testing for tuberculosis.
Secondary prevention focuses on health promotion, which includes screening, early detection and diagnosis of disease. Among migrant families, tuberculosis rates are unusually high and should be a priority focus for secondary prevention (A). Although (B, C, and D) are important screenings, the incidence and the risk for spread of tuberculosis is a priority in this population.
Which topic should the nurse include in planning a primary prevention class for adolescents?
Risk factors for heart disease.
Dietary management of obesity.
Suicide risks and prevention.
Coping with stressful situations.
Suicide risks and prevention.
Primary prevention focuses on health promotion and prevention of injury and illness. Since suicide is a leading cause of death in adolescents, including (C) is essential. Health screenings and interventions are designed to increase the probability of early diagnosis and treatment, so (A, B, and D) are important secondary prevention topics for adolescents.
What action is best for the community health nurse to take if the nurse suspects that an infant is being physically abused?
Follow agency protocols to report suspected abuse. Correct
Report suspicions to the local child abuse reporting hotline.
Educate the child’s caregivers about growth and development issues.
Call the police department to have the child removed from the home.
Follow agency protocols to report suspected abuse.

Nurses are mandated to report all suspected cases of child abuse and neglect, and it is best to follow agency protocols to protect the nurse and child’s safety (A). (B) is available for the general public, but in this case it is best for the community health nurse to follow the agency policy. While (C) can contribute to abuse and neglect, the situation warrants immediate action to protect the child and follow the law. (D) could jeopardize the safety of the nurse, the child, or others in the home.

An occupational health nurse is reviewing a 20-year-old trend in the United States that has resulted in an increase in certain medical conditions due to the rapid expansion of an urban industrial workforce. Which medical conditions are specifically identified with this trend? (Select all that apply.)
Asthma.
Alcoholism.
Lung cancer.
Lead poisoning.
West Nile virus infection.
Hepatitis B virus infection.
Asthma.
Lung cancer.

Asthma (A) and lung cancer (C) are triggered or worsened by airborne substances, such as tobacco smoke, ozone, and other particles and/or chemicals, so these conditions are specifically associated with the increase in urban industrial workforce growth. Alcoholism is a related condition (B), but it is not specifically associated with urban industrialization. (D), while identified as a potential risk for workers in some urban industries, has not significantly increased in recent years, so it is not related to the expansion of urban industrial workplaces over the past 20 years. (E and F) are not related to the increase in the urban industrial workforce.

Which intervention should the public health nurse implement when attempting to address one of the leading health indicators of Healthy People 2020?
Lead a weekly water aerobics class for the elderly at a community center.
Teach a class on cultural awareness to nursing students at the university.
Design and implement a no smoking campaign at the local high school.
Write a grant to help provide glucometers to individuals who cannot afford one.
Design and implement a no smoking campaign at the local high school.
The activity in (C) addresses reduced cigarette smoking by adolescents, which is the focus of Tobacco use as a leading health indicator for Healthy People 2020. Regular exercise (A) is a leading indicator but it recommends daily exercise for 30 minutes a day, not weekly. (B and D) are not leading indicators of Healthy People 2020.
A college student asks the nurse in the Campus Student Health Center about obtaining medication for motion sickness before a scuba diving trip. What instruction should the nurse give the student regarding the use of prescription-strength scopolamine (Transderm-V)?
Take the oral preparation 30 minutes before diving.
Apply the skin patch behind the ear 12 hours before your trip.
Use the medication at the first feeling of nausea on the boat.
Apply a new skin patch every 6 hours to the chest or abdomen.
Apply the skin patch behind the ear 12 hours before your trip.
Medications used to control motion sickness must be taken prior to the onset of nausea and vomiting. They are most effective if taken 12 hours before (B) expected travel or activity. (A, C, and D) do not describe correct administration procedures for prescription-strength scopolamine (Transderm-V).
**Delete**
Malaria following exposure in a mosquito-infested area.
Malaria contracted from a biting mosquito is an example of a vector-related, indirect transmission of the disease (C). Indirect transmission of an infectious disease involves the spread of infection through an intermediate source, such as vehicles, fomites, or vectors. (A, B, and D) are examples of direct transmission, defined as the spread of an infection through person-to-person contact and is characterized by portals of exit and entry.
The multidisciplinary home health care team is discussing a female client diagnosed with Parkinson’s disease. The home health care nurse reports the client is getting worse and her husband is no longer able to care for her in the home. Which action should the home health nurse implement first?
Request a chaplain to counsel with the couple.
Assign a home health care aide to provide care daily.
Talk to the husband about placing his wife in a nursing home.
Contact the client’s children to discuss the situation.
Assign a home health care aide to provide care daily.
The nurse should first ensure the client’s safety by providing assistance in the home (B), which will help both the client and her husband until other arrangements can be made. A chaplain (A) provides spiritual guidance. social After assigning home health care, the nurse should discuss possible options for care, such (C or D).
The nurse is preparing to discharge an elderly, recently widowed female client following a mild stroke. At this time she is able to walk with the aid of a walker. As part of the discharge planning, what referral is most important for the nurse to make?
Pastoral care.
Meals-on-Wheels.
Grief support group.
Physical therapy.
Meals-on-Wheels.

Since this client lives alone and uses a walker, food preparation is a potential problem, so Meals-on-Wheels (B) is a needed referral. (A) might be indicated, but does not have the priority that adequate nutrition does. Even though the client is “recently widowed,” (C and D) do not have the priority of (B) at this stage of her recovery.

**Delete**
African-American ethnicity.

The client’s previous history of a LBW infant and the non-modifiable risk factor of ethnicity are the most important risk factors for this pregnancy because the incidence of (LBW) infants is twice as high for African-American (B) births than Caucasian births. The modifiable risk factors of (A, C, and D) are related to infant morbidity, but (B) is most important because it is non-modifiable.

A young woman tells the public health nurse that a friend was recently diagnosed with Hepatitis B and she is concerned about getting the disease. During the assessment interview, which question is most important for the nurse to ask this woman?
Did you drink after or use any utensils that your friend used?
Have you noticed any yellowish tinge to the whites of your eyes?
Have you shared any needles or had sex with your friend?
How long ago was your friend diagnosed with Hepatitis B?
Have you shared any needles or had sex with your friend?

Hepatitis B virus is transmitted by sharing needles or unprotected sex, so (C) is the most important question for the nurse to ask this young woman. Hepatitis A is transmitted by (A). The incubation period for Hepatitis B is 75 days, so (B and D) are not priority questions at this time.

During a home health visit, a male client reports to the nurse that he felt a solid testicular mass during self-exam, but that it wasn’t painful. What instruction should the nurse provide the client?
Continue to monitor the mass until the next scheduled annual medical exam.
Notify the healthcare provider if the mass becomes soft, painful, or starts to drain.
Schedule an appointment with the healthcare provider for prompt evaluation.
Testicular nodules are of concern only if they feel matted or are not easily movable.
Schedule an appointment with the healthcare provider for prompt evaluation.

A painless testicular mass is an abnormal finding, and the nurse should instruct the client to obtain prompt medical evaluation (C). (A, B, and D) place the client at risk, since they do not emphasize prompt medical evaluation.

A 12-year-old female is seen by the school nurse after recently experiencing increasing difficulty sitting still and paying attention in class, and increasingly illegible handwriting. The nurse observes that the child has protruding eyeballs and a staring expression. What action should the nurse take next?
Refer the child for psychologic evaluation due to attention deficit disorder.
Call the child’s parents to schedule the child for an immediate medical exam.
Gather additional data by taking a health history and measuring vital signs.
Collaborate with the teacher to place the child on a behavior modification program.
Gather additional data by taking a health history and measuring vital signs.

Based on the available data, the child may have hyperthyroidism (Graves disease). The nurse should gather additional data (C) that may help confirm this suspicion. (A or D) are premature actions at this time. Once additional data are collected, a call to the parents is warranted (B).

Lillian Wald was a significant person in the history of American nursing. Which contributions can be attributed to her? (Select all that apply.)
Development of public health nursing practice.
First nursing service for occupational health.
Campaigned for laws to require registration for nurses.
Established committee that was the forerunner of the NLN.
Instituted a sliding scale fee for service.
Development of public health nursing practice.
First nursing service for occupational health.
Instituted a sliding scale fee for service.
Established committee that was the forerunner of the NLN.

(A, B, D, and E) are correct. Lillian Wald is known mostly for her work in public health (A) but she also developed the first nursing service for occupational health (B). She also established a committee — The Associated Alumnae of Training Schools for Nurses — which later developed into the ANA and the NLN (D). In her work for occupational health, she instituted a sliding scale fee for service (E). She advocated for Women’s Rights, but had no significant input into making nursing registration mandatory (C).

A male client is brought to the emergency department as the result of a motorcycle accident. He was not wearing a helmet at the time of the accident, and states that he has no intention of ever wearing one. Within the framework of the Transtheoretical Model (TTM), which response should the nurse provide?
Wearing a helmet or not is certainly an individual decision.
You should seriously consider wearing a helmet.
Riding a motorcycle with a helmet increases your safety.
I really think you don’t have the facts about helmet use
Wearing a helmet or not is certainly an individual decision.

Within the framework of the TTM, the client’s comment indicates that he is in the pre-contemplation stage where he is not even considering change. By responding with (A), the nurse allows the client to express feelings and diffuses the strength of the response. (B, C, and D) are likely to make the contemplator more hostile and resistant to change.

**Delete**
The person, the environment or situation, and health.

Nursing theories serve to describe, explain, predict, or prescribe nursing care measures. Any science has a domain, which is the view or perspective of the discipline. The elements of nursing’s paradigm direct the activity of the nursing profession, including knowledge development, philosophy, theory, educational experience, research, practice, and literature identified with the profession. Nursing identified its domain in a paradigm that includes four linkages: the person, health, environment/situation, and nursing (A). (B, C, and D) are not linkages of the domain.

A terrorist attack has occurred and several people have inhaled Ricin. Which intervention should the emergency department nurse implement when caring for these clients?
Administer the antibiotic streptomycin, IV STAT.
Provide all clients with the Ricin antidote.
Implement strict respiratory isolation immediately.
Provide supportive nursing care until antitoxin is available.
Provide supportive nursing care until antitoxin is available.

Production of the Ricin antitoxin involves immunizing sheep with inactive ricin, which results in the production of antibodies that are harvested to produce a freeze-dried product for reconstitution and injection for victims exposed to Ricin poisoning. Although the antitoxin is ready to be manufactured, full licensing is likely in 5 years (2014).There is no known cure or treatment for Ricin exposure so supportive care (D) should be provided until the antitoxin is available. (A) may be administered for secondary infections but is not a treatment for Ricin exposure. (B) does not exist at this time. Ricin does not have person-to-person transmission, so (C) is not necessary.

**Delete**
Conduct a windshield survey of the geographic areas served by the school

The windshield survey (the nurse drives through neighborhoods viewing homes, stores, churches, air quality, etc.) (D) gives the nurse the best initial overview of the children and a sense of their community. (A, B, and C) provide information about some of the children and parents, but are not as comprehensive as the windshield survey.

**Delete**
Census data.
Risk management data.
Budgeting process information.
Client-satisfaction surveys.
Changes in the community’s demographic data.

Census data (A), risk management data (B), budgeting process information (C), data obtained from client-satisfaction surveys (E), and changes in the community’s demographic data (F) provide pertinent data for planning for the current and future healthcare needs of the community. Available workforce (D), although a concern, is not a factor in quality-assurance directives.

The nurse is designing a bioterrorism plan for a community. Which agents are transmitted person to person via respiratory or inhalation exposure? (Select all that apply.)
Ricin.
Pneumonic plague.
Anthrax.
Botulism.
Smallpox.
Brucellosis.
Pneumonic plague.
Smallpox.

Correct selections are (B and E). The pneumonic plague (B) can be transmitted person to person via respiratory droplets. Smallpox (E) can produce aerosolized droplets of ruptured pock marks in the buccal cavity, thus aerosolizing the virus and causing respiratory transmission. (A) is a biological toxin that is not transmitted person to person. (C) can be spread by respiratory transmission from an exposure source, but is not transmitted person to person (communicable). (D) is a biological toxin commonly associated with food-borne or ingestion exposures, but is not communicable. (F) is found in livestock, but is not communicable.

Which example should the nurse identify as a significant outcome for the Leading Health Indicators of Healthy People 2020?
A community has adopted a no smoking policy.
A rural community has a public transportation system.
The high school drop out rate has decreased by 15%.
A county has decreased their divorce rate by 10%.
A community has adopted a no smoking policy.

Environmental quality and tobacco are two of the 12 leading indicators of Healthy People 2020 that are addressed by a community that adopts a no smoking policy (A), which reduces secondary smoke exposure of children as well as impacting Air Quality Index (AQI). Although (B and C) are indirectly related to other indicators of Healthy People 2020 , such as access to health services and social determinants (high school graduation), the most significantly related outcome is a community wide no smoking policy. (D) is unrelated to Healthy People 2020 .

**Delete**
Most of the clients are unemployed or disabled.
Access to mass transit may be an issue.
Basic physiologic needs of this population are often unmet.

Correct choices are (A, B, and D). The unemployed or disabled will likely comprise a majority of this clinic’s clients (A); the lack of access to mass transit may affect the population’s ability to keep health care appointments (B); and low-income clients are at risk for basic physiologic needs being left unmet (D). Most clients are not likely to have health insurance (C) because they lack the funds to pay the insurance premiums. Homebound status is not a defining qualification for public assistance, such as Medicaid (E). To state that a low-income population is more likely to be non-compliant with healthcare recommendations is an example of stereotyping (F).

Attendance at a community health clinic is rising and clients have long waits for service. The charge nurse believes that a computer system would be helpful in decreasing the time needed to conduct intake and exit processing. What is the best way for the nurse to introduce the idea of obtaining a computer system for the clinic?
Ask the medical director to talk to the Board of Directors about obtaining funds to implement a computer system.
Send a signed letter to the editor of the local newspaper describing the benefits to the community.
Submit a written proposal to the Board of Directors about hardware and software improvement needs.
Meet informally with some Board members to enlist their support for the idea of implementing a computer system.
Submit a written proposal to the Board of Directors about hardware and software improvement needs.

Submitting written information to the Board will give Board members the opportunity to review the proposal (C) and is the best method of introducing the idea. (A) is dismissing responsibility to the medical director. (B) is disrespectful to the Board, by not first presenting the idea to the Board. (D) is manipulative.

A nurse working in a community health setting is performing primary health screenings. Which individual is at highest risk for contracting an HIV infection?
A 17-year-old who is sexually active with numerous partners.
A 45-year-old lesbian who has been sexually active with two partners in the past year.
A 30-year-old cocaine user who inhales the drug and works in a topless bar.
A 34-year-old male homosexual who is in a monogamous relationship.
A 17-year-old who is sexually active with numerous partners.

(A) is at greatest risk for developing sexually transmitted diseases, including HIV, because the greater the number of sexual partners one has, the greater the risk for contracting STDs. (B) represents the group with the lowest number of infected persons because there is little transfer of body fluid during sexual acts. (C) would not be sharing needles, so contracting STDs is not necessarily a risk. A male homosexual in a monogamous relationship has a decreased risk of contracting HIV–as long as BOTH partners are monogamous and neither is infected (D).

**Delete**
Impaired physical mobility related to muscle rigidity and weakness.

Parkinson’s disease is a progressive neurologic disorder affecting the brain centers that are responsible for control and regulation of movement. The chief clinical manifestations are impaired movement, muscular rigidity, resting tremor, muscle weakness, and loss of postural reflexes (A). Depression and dysfunction are appropriate nursing diagnoses but are not the primary diagnosis (B). Client’s with Parkinson’s usually do not experience (C or D).

**Delete**
Thinning of the skin with loss of elasticity.

Thin, non-elastic skin (C) is an important factor in decubitus formation. Proportion of body fat to lean mass increases with age (A), and might help decrease ulcer tendency. (B) results in grey hair. (D) can contribute to broken bones, but it is probably not a factor in decubitus formation.

When asked to help develop interventions to combat obesity among children, the community health nurse should stress the importance of implementing which activity?
Set goals that are focused on developing healthier lifestyles.
Develop strict diet plans for school-aged children.
Provide diet classes for the obese children during school hours.
Require all children to participate in organized team sports.
Set goals that are focused on developing healthier lifestyles.

Setting goals focused on healthy lifestyles that include good nutrition, healthy food choices, and regular physical activity (A) is helpful in managing childhood obesity. (B) is not appropriate for school-aged children. The focus should be on increasing activity and making healthier food choices. (C) may make the children more self-conscious about their weight. Physical activities should be geared to things that will promote lifetime activities, not (D), which might not appeal to all children.

**DDelete**
Primary prevention.

Primary prevention (A) involves activities that focus on reducing the potential for illness before it occurs, such as immunizations. Tertiary prevention (B) minimizes the consequences of a disorder or illness through aggressive management or rehabilitation. Secondary prevention (C) includes early diagnosis and implementing interventions aimed at a cure or reducing the progress of a disease. Primary nursing (D) describes a method of nursing management and nursing care assignments, not a healthcare strategy.

The nurse is teaching a community group about risks of cardiovascular disease. Several clients ask the nurse to determine their risk. Which client should the nurse identify as having the greatest risk for cardiovascular disease?
A male with a serum cholesterol level of 199 mg/dl.
A female with a serum cholesterol level of 201 mg/dl.
A male with a low-density lipoprotein (LDL) level of 200 mg/dl.
A female with a low-density-lipoprotein (LDL) level of 160 mg/dl.
A male with a low-density lipoprotein (LDL) level of 200 mg/dl.

The risk factors for cardiovascular disease include nonmodifiable variables, such as gender, family history, and race, and modifiable variables, such as underlying diseases (hypertension, diabetes mellitus, hyperlipidemia, and obesity, smoking, sedentary lifestyle, and stress). Laboratory results that support these risk factors include elevated LDL and serum cholesterol levels, so (C), being male, has a higher risk than (D). (A and B) have borderline results.

**Delete**
Suicide risks and prevention.

Primary prevention focuses on health promotion and prevention of injury and illness. Since suicide is a leading cause of death in adolescents, including (C) is essential. Health screenings and interventions are designed to increase the probability of early diagnosis and treatment, so (A, B, and D) are important secondary prevention topics for adolescents.

The nurse is planning a community-based project to reduce obesity in a school-aged population. Which outcome statement best supports the goal for this population?
Increase in exercise will decrease obesity in children with a sedentary life style.
Students with a body mass index above the 95 percentile will decrease.
Within 2 years, students with a body mass index greater than 95% will be reduced by 50%.
In the target population, 30% of students will be below the 95 percentile in weight
Within 2 years, students with a body mass index greater than 95% will be reduced by 50%.

Goals are intended to be expressed in specific outcomes that provide direction toward interventions and determine change in measurable terms. Outcome statements include past or present events with specific quantitative expectations with a time frame, so (C) supports these specific terms. (A, B, and D) are not as specific as (C).

The home health nurse is planning a visit with a client who has been discharged home after a hospitalization. Which action should the nurse implement?
Avoid creating barriers by wearing a name tag in the home.
Schedule home visits that take place during the daylight hours.
Ensure HIPAA laws are observed by avoiding visits with other home care providers.
Use a duplicate copy of the client’s record to provide concurrent services.
Schedule home visits that take place during the daylight hours.

To ensure safety of the client and the nurse, home visits should be scheduled during daylight hours (B). The nurse practice act requires the nurse to wear an identification name tag during client care which also provides clear role expectations (A) for the client. Making visits with another home care provider (B) provides an opportunity for the nurse to evaluation and coordinate care (C). (D) is not necessary.

**D**
Skin testing for tuberculosis.
Secondary prevention focuses on health promotion, which includes screening, early detection and diagnosis of disease. Among migrant families, tuberculosis rates are unusually high and should be a priority focus for secondary prevention (A). Although (B, C, and D) are important screenings, the incidence and the risk for spread of tuberculosis is a priority in this population.
**Delete**
The purpose is to rid the body of disease.

Coining, a Vietnamese practice, may produce welt-like swellings from rubbing a coin lengthwise on oiled skin to rid the body of disease (B). Certain cultural practices that address illness may be considered abusive by another culture and misunderstood by uninformed professionals. (A, C, and D) are not correct interpretations.

Which topic should the nurse include in planning a secondary prevention project for the local retirement community?
Safety measures in the home.
Adult immunization program.
Rehabilitation after surgery.
Vision and hearing screening
Vision and hearing screening

Health screenings (D) are the mainstay of secondary prevention, which focuses on health promotion, which includes screening, early detection and diagnosis of disease. (A and B) are primary prevention topics which include health-promoting activities designed to reduce the likelihood of a specific illness occurring. Tertiary prevention includes interventions aimed at disability limitation and rehabilitation (D) from disease, injury, or disability.

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