Community Health Exam - Version A Your response has been submitted successfully.

Points Awarded Points Missed Percentage 9 36 20%

1. Which topic should the nurse include in planning a primary prevention class for adolescents? A. Risk factors for heart disease. B. Dietary management of obesity. C. Suicide risks and prevention. D. Coping with stressful situations. 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. Points Earned: 0/1 Correct Answer: C Your Response: B 2. 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.) A. Ricin. B. Pneumonic plague. C. Anthrax. D. Botulism. E. Smallpox. F. Brucellosis.

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. Points Earned: 0/2 Correct Answer: B, E Your Response: C, D, E 3. 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? A. Refer the child for psychologic evaluation due to attention deficit disorder. B. Call the child's parents to schedule the child for an immediate medical exam. C. Gather additional data by taking a health history and measuring vital signs. D. Collaborate with the teacher to place the child on a behavior modification program. 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). Points Earned: 0/1 Correct Answer: C Your Response: B 4. 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.) A. Census data. B. Risk management data. C. Budgeting process information. D. Available workforce in the community. E. Client-satisfaction surveys. F. 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. Points Earned: 1/5 Correct Answer: A, B, C, E, F Your Response: A, C, D 5. 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? A. The child's behavior was not acceptable. B. The purpose is to rid the body of disease. C. This method is commonly used for discipline. D. Temper tantrums are commonly managed using this method. 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. Points Earned: 0/1 Correct Answer: B Your Response: C

6. The nurse administers a booster dose of DTaP (diphtheria, tetanus, and pertussis) vaccine to an infant. Which level of prevention is the nurse implementing? A. Primary prevention. B. Tertiary prevention. C. Secondary prevention. D. Primary nursing. 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. Points Earned: 0/1 Correct Answer: A Your Response: B 7. A terrorist attack has occurred and several people have inhaled Ricin. Which intervention should the emergency department nurse implement when caring for these clients? A. Administer the antibiotic streptomycin, IV STAT. B. Provide all clients with the Ricin antidote. C. Implement strict respiratory isolation immediately. D. Provide supportive nursing care to the clients. There is no known cure or treatment for Ricin exposure and supportive care (D) is the only treatment. (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. Points Earned: 0/1 Correct Answer: D Your Response: B 8. When asked to help develop interventions to combat obesity among

children, the community health nurse should stress the importance of implementing which activity? A. Set goals that are focused on developing healthier lifestyles. B. Develop strict diet plans for school-aged children. C. Provide diet classes for the obese children during school hours. D. Require all children to participate in organized team sports. 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. Points Earned: 0/1 Correct Answer: A Your Response: B 9. 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? A. Ask the medical director to talk to the Board of Directors about obtaining funds to implement a computer system. B. Send a signed letter to the editor of the local newspaper describing the benefits to the community. C. Submit a written proposal to the Board of Directors about hardware and software improvement needs. D. Meet informally with some Board members to enlist their support for the idea of implementing a computer system. 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.

Points Earned: 0/1 Correct Answer: C Your Response: B 10. 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? A. Did you drink after or use any utensils that your friend used? B. Have you noticed any yellowish tinge to the whites of your eyes? C. Have you shared any needles or had sex with your friend? D. How long ago was your friend diagnosed with Hepatitis B? 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. Points Earned: 0/1 Correct Answer: C Your Response: D 11. Which topic should the nurse include in planning a secondary prevention project for the local retirement community? A. Safety measures in the home. B. Adult immunization program. C. Rehabilitation after surgery. D. 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. 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. Points Earned: 0/1 Correct Answer: D Your Response: B 12. 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? A. Pastoral care. B. Meals-on-Wheels. C. Grief support group. D. Physical therapy. 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. Points Earned: 1/1 Correct Answer: B Your Response: B 13. 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? A. Skin testing for tuberculosis. B. Glucose monitoring for diabetes. C. Blood work for cardiovascular disease. D. Height and weight for altered nutrition. 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. Points Earned: 0/1 Correct Answer: A Your Response: B 14. 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? A. Impaired physical mobility related to muscle rigidity and weakness. B. Ineffective coping related to depression and dysfunction due to disease progression. C. Ineffective breathing pattern related to respiratory muscle weakness. D. Fear related to constant possibility of experiencing seizures. 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). Points Earned: 0/1 Correct Answer: A Your Response: B 15. 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? A. Request a chaplain to counsel with the couple. B. Assign a home health care aide to provide care daily.

C. Talk to the husband about placing his wife in a nursing home. D. Contact the client's children to discuss the situation. 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). Points Earned: 0/1 Correct Answer: B Your Response: D 16. What is an example of a positive outcome for one of the Leading Health Indicators of Healthy People 2010? A. A community has adopted a no smoking policy. B. A rural community has a public transportation system. C. The high school drop out rate has decreased by 15%. D. A county has decreased their divorce rate by 10%. Environmental quality, which includes reducing the proportion of nonsmokers exposed to environmental tobacco smoke (A) is one of the leading health indicators of Healthy People 2010. (B, C and D) are not included in the top ten leading indicators of Healthy People 2010. Points Earned: 1/1 Correct Answer: A Your Response: A 17. 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? A. Avoid creating barriers by wearing a name tag in the home. B. Schedule home visits that take place during the daylight hours. C. Ensure HIPAA laws are observed by avoiding visits with other home care providers. D. Use a duplicate copy of the client's record to provide concurrent services.

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. Points Earned: 0/1 Correct Answer: B Your Response: C 18. 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? A. Cigarette smoking. B. African-American ethnicity. C. Poor nutritional status. D. Limited maternal education. 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 AfricanAmerican (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. Points Earned: 1/1 Correct Answer: B Your Response: B 19. 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? A. High rate of unemployment. B. Low immunization rate of children. C. Provision of substandard health care.

D. Access to bilingual care providers. 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. Points Earned: 1/1 Correct Answer: B Your Response: B 20. 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? A. Increase in exercise will decrease obesity in children with a sedentary life style. B. Students with a body mass index above the 95 percentile will decrease. C. Within 2 years, students with a body mass index greater than 95% will be reduced by 50%. D. In the target population, 30% of students will be below the 95 percentile in weight. 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). Points Earned: 0/1 Correct Answer: C Your Response: D 21. 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? A. Continue to monitor the mass until the next scheduled annual medical exam. B. Notify the healthcare provider if the mass becomes soft, painful, or starts to drain. C. Schedule an appointment with the healthcare provider for prompt evaluation. D. Testicular nodules are of concern only if they feel matted or are not easily movable. 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. Points Earned: 0/1 Correct Answer: C Your Response: B 22. What action is best for the community health nurse to take if the nurse suspects that an infant is being physically abused? A. Follow agency protocols to report suspected abuse. B. Report suspicions to the local child abuse reporting hotline. C. Educate the child's caregivers about growth and development issues. D. Call the police department to have the child removed from the home. 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. Points Earned: 0/1 Correct Answer: A

Your Response: B 23. After accepting the position of school nurse in an public elementary school, what strategy is best for the nurse to use to obtain an overview understanding of the student body? A. Review all of the health records of the students presently registered for classes. B. Talk with the current officers of the parent-teacher association. C. Send home a survey form to parents of third grade students. D. 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. Points Earned: 0/1 Correct Answer: D Your Response: B 24. 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? A. 16% increase in overall body fat. B. Reduced melanin production. C. Thinning of the skin with loss of elasticity. D. Calcium loss in the bones. 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. Points Earned: 1/1 Correct Answer: C

Your Response: C 25. 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? A. The person, the environment or situation, and health. B. Stress reduction, self-care, and a systems model. C. Curative care, restorative care, and terminal care. D. Self-actualization, fundamental needs, and belonging. 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. Points Earned: 0/1 Correct Answer: A Your Response: C 26. 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)? A. Take the oral preparation 30 minutes before diving. B. Apply the skin patch behind the ear 12 hours before your trip. C. Use the medication at the first feeling of nausea on the boat. D. Apply a new skin patch every 6 hours to the chest or abdomen. 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).

Points Earned: 0/1 Correct Answer: B Your Response: A 27. Which presentation of an infectious disease is acquired through an indirect transmission? A. Syphilis contracted from a sexual partner. B. Measles resulting from a daycare center outbreak. C. Malaria following exposure in a mosquito-infested area. D. Nosocomial influenza spreading rapidly in a long-term center. 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 personto-person contact and is characterized by portals of exit and entry. Points Earned: 0/1 Correct Answer: C Your Response: B 28. 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. A male with a serum cholesterol level of 199 mg/dl. B. A female with a serum cholesterol level of 201 mg/dl. C. A male with a low-density lipoprotein (LDL) level of 200 mg/dl. D. A female with a low-density-lipoprotein (LDL) level of 160 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.

Points Earned: 0/1 Correct Answer: C Your Response: B 29. 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. A 17-year-old who is sexually active with numerous partners. B. A 45-year-old lesbian who has been sexually active with two partners in the past year. C. A 30-year-old cocaine user who inhales the drug and works in a topless bar. D. A 34-year-old male homosexual who is in a monogamous relationship. (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). Points Earned: 0/1 Correct Answer: A Your Response: B 30. 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? A. Wearing a helmet or not is certainly an individual decision. B. You should seriously consider wearing a helmet. C. Riding a motorcycle with a helmet increases your safety. D. I really think you don't have the facts about helmet use.

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. Points Earned: 0/1 Correct Answer: A Your Response: C 31. 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.) A. Asthma. B. Alcoholism. C. Lung cancer. D. Lead poisoning. E. West Nile virus infection. F. Hepatitis B virus infection. 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. Points Earned: 0/2 Correct Answer: A, C Your Response: B, D 32. Which intervention should the public health nurse implement when attempting to address one of the leading health indicators of Healthy People 2010?

A. Lead a weekly water aerobics class for the elderly at a community center. B. Teach a class on cultural awareness to nursing students at the university. C. Design and implement a no smoking campaign at the local high school. D. Write a grant to help provide glucometers to individuals who cannot afford one. The activity in (C), which addresses reduced cigarette smoking by adolescents is a leading indicator for Healthy People 2010. 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 2010. Points Earned: 0/1 Correct Answer: C Your Response: B 33. 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.) A. Most of the clients are unemployed or disabled. B. Access to mass transit may be an issue. C. Clients will need reminders to bring insurance cards. D. Basic physiologic needs of this population are often unmet. E. Clients who are homebound will qualify for Medicaid. F. Nonadherence to healthcare recommendations is likely. 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).

Points Earned: 2/3 Correct Answer: A, B, D Your Response: A, B 34. Lillian Wald was a significant person in the history of American nursing. Which contributions can be attributed to her? (Select all that apply.) A. Development of public health nursing practice. B. First nursing service for occupational health. C. Campaigned for laws to require registration for nurses. D. Established committee that was the forerunner of the NLN. E. Instituted a sliding scale fee for service. (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). Points Earned: 1/4 Correct Answer: A, B, D, E Your Response: B, C, D Community Health Exam - Version B Your response has been submitted successfully. Points Awarded Points Missed Percentage 6 31 16%

1. Which factors influence an occupational health nurse's role in the workplace? (Select all that apply.) A. Skill level.

B. Punctuality. C. Role perception. D. Organizational politics. E. Graduate school program attended. F. Commitment to the company occupational health and safety program. Correct selections are (A, C, and F). An occupation health nurse's role in the workplace is influenced by the individual's skill level (A), perception of the role (C), and commitment to the company's programs (F). Punctuality (B) is not an important factor in determining the nurse's role, but it can influence the nurse's ability to lead others by example. While organizational politics (D) are a concern in environmental health nursing role development, they are not considered a major factor. Although graduate education (E) is desirable, it is not necessarily relevant or required in the role development of an environmental health nurse. Points Earned: 0/3 Correct Answer: A, C, F Your Response: B, C, E 2. What title should be given to this occupational health nurse job description? A registered nurse with expertise in health promotion, illness and injury prevention, risk reduction, and adult learning principles. A. Case manager. B. Health educator. C. Nurse consultant. D. Health promotion specialist. This description is referencing the role of a health promotion specialist (D) who is an occupational health nurse with activities that include developing and monitoring goals and strategies, as well as developing primary, secondary, and tertiary prevention programs within the work site. (A) coordinates quality health services to meet an individual-specific healthcare need in a cost-effective manner. (B) teach staff within the workplace. (C) serve as resource persons to other occupational and environmental health nurses, management, members of the occupational health team, and related organizations and agencies. Points Earned: 0/1

Correct Answer: D Your Response: B 3. What title should be given to this occupational health nurse job description? An advanced practice nurse who provides workers with primary care services with an emphasis on the diagnosis and management of common acute illnesses/injuries and stable chronic diseases. A. Case manager. B. Nurse consultant. C. Clinician nurse practitioner. D. Health promotion specialist. This description is referencing the role of an occupational and environmental health nurse clinician/practitioner (C) who directs care for clients with occupational and non-occupational injuries and illnesses. (A) coordinate quality health services to meet an individual-specific health care need in a cost-effective manner. (B) serve as a resource persons to other occupational and environmental health nurses, management, members of the occupational health team, and related organizations and agencies. (D) is an occupational health nurse who develops and monitors goals and strategies. Points Earned: 0/1 Correct Answer: C Your Response: A 4. What title should be given to this occupational health nurse job description? A registered nurse who establishes a provider network, recommends treatment plans that assure quality and efficacy while controlling costs, monitors outcomes, and maintains communication among all involved. A. Manager. B. Researcher. C. Case manager. D. Nurse consultant. This description is referencing the role of a case manager (C), which in the occupational health nurse setting includes timely coordination of quality health services to meet an individual-specific health care need in a cost-

effective manner. (A) provides structure and direction for the development, implementation, and evaluation of an effective, high quality nursing unit. (B) supports and expands the body of nursing knowledge based on evidencebased practice to bridge the gap between development and implementation and application to practice. (D) serves as a resource person to other occupational and environmental health nurses, management, and members of the occupational health team. Points Earned: 0/1 Correct Answer: C Your Response: A 5. What title should be given to this occupational health nurse job description? A registered nurse who functions in a comprehensive executive role to set goals, formulate policy, and direct and evaluate the health service. A. Manager. B. Researcher. C. Health educator. D. Health promotion specialist. This description is referencing the role of a nurse manager (A) who provides structure and direction for the development, implementation, and evaluation of an effective, high quality nursing program, and communicates and interprets the occupational health program to management and other members of the occupational health team, sets goals, formulates policy, and manages health service. Researcher nurses (B) support and expand the knowledge base that provides a foundation for practice. Health educator nurses (C) teach and prepare nursing students to function in the healthcare arena. A health promotion specialist (D) develops primary, secondary, and tertiary prevention programs within the worksite. Points Earned: 0/1 Correct Answer: A Your Response: D 6. What title should be given to this occupational health nurse job description? A registered nurse who teaches and prepares nursing students to function as expert clinicians/practitioners, administrators,

educators, researchers, or consultants to the work site. A. Researcher. B. Case manager. C. Health educator. D. Health promotion specialist. This description is referencing the role of a nurse health educator (D) who is responsible for preparing occupational and environmental health nurses to assume leadership positions to improve, maintain, and account for quality health outcomes for workers. (A) supports and expands the knowledge base using evidence-based practice. (B) coordinates the quality of health services to meet an individual-specific healthcare need in a cost-effective manner. (D) develops primary, secondary, and tertiary prevention programs within the work site and provides health education to increase awareness of certain health issues. Points Earned: 0/1 Correct Answer: C Your Response: A 7. What title should be given to this occupational health nurse job description? A registered nurse who develops researchable questions, conducts research, and communicates the findings to occupational and environmental health nurses, other peers, and the public. A. Manager. B. Researcher. C. Clinician/practitioner. D. Health promotion specialist. This description is referencing the role of a nurse researcher (B) support and expand the knowledge base using evidence-based practice to bridge the gap between development and implementation and application to practice, develop research questions, conduct research, and communicate findings to the workforce. (A) provides structure and direction for the development, implementation, and evaluation of an effective, high quality nursing program. (C) provide primary care services with an emphasis on the diagnosis and management of common acute injuries/illnesses and stable chronic disease.

(D) develops primary, secondary, and tertiary prevention programs within the work site. Points Earned: 1/1 Correct Answer: B Your Response: B 8. What title should be given to this occupational health nurse job description? A registered professional nurse who has knowledge and experience in occupational and environmental health nursing and is able to communicate effectively, both orally and in writing, and possesses good administrative, consultative, and listening skills. A. Manager. B. Case manager. C. Health educator. D. Nurse consultant. This description is referencing the role of a nurse consultant (D) who serves as a resource person to other occupational and environmental health nurses, management, members of the occupational health team and related organizations and agencies and provides structure and direction for the development, implementation, and evaluation of an effective, high quality nursing program, and also communicates and interprets the occupational health program to management and other members of the occupational health team. (A) sets goals, formulates policy, and manages health service. (B) coordinates quality health services to meet an individual-specific health care need in a cost-effective manner. (C) teaches in the healthcare arena. Points Earned: 0/1 Correct Answer: D Your Response: B 9. Which client has the greatest risk for developing community-acquired pneumonia? A. A 40-year-old first-grade teacher who works with underprivileged children. B. A 75-year-old retired secretary with exercise-induced wheezing. C. A 60-year-old homeless person who is an alcoholic and smokes.

D. A 35-year-old aerobics instructor who skips meals and eats only vegetables. Although age is a factor in the development of community-acquired pneumonia, other lifestyle behaviors, such as smoking, alcoholism, and exposure factors related to homelessness (C) increase one's risk due to impaired nutrition and immune function. (A, B, and D) have fewer risk factors. Points Earned: 0/1 Correct Answer: C Your Response: B 10. A 17-year-old unmarried, pregnant client with drug addiction is a high school dropout, homeless, and has a history of past abuse arrives at the clinic for her first prenatal visit. Which findings should the nurse document as health risk factors for the client? (Select all that apply.) A. Age. B. School dropout. C. Drug addiction. D. History of abuse. E. Pregnancy. F. Homelessness. G. Unmarried. Health risk factors for this client include (A, C, D, E and F). Each factor should be considered individually. The client, as an adolescent mother, is at high risk for nutritional deficits, anemia, gestational diabetes, and hypertension, which also impact the fetus risk for small for gestational age, fetal anomalies, and fetal demise. (B and G) may impact the client's social adaptation, but do not direct constitute health risk factors. Points Earned: 3/5 Correct Answer: A, C, D, E, F Your Response: C, D, E 11. The nurse is designing a community health project based on a report provided by the World Health Organization that describes healthcare problems in the United States. Which healthcare issue

should the nurse give the highest priority when planning the project? A. Overuse of diagnostic technology. B. Government-based health insurance. C. The neonatal and infant mortality rates. D. Number of people without access to health care. The most important concern of the World Health Organization is the number of people in the United States who are not receiving health care services (D), either through public- or private-sector funding. France, Japan, and the United States do overuse diagnostic technology (A) but this is not the priority issue. All developed countries except the United States have national healthcare systems (B) dedicated to universal healthcare services to their populations, which is not the priority. Hungary, Korea, Mexico, Poland, and Turkey all have higher infant mortality rates than the United States (C). Points Earned: 0/1 Correct Answer: D Your Response: A 12. The nurse working in a community health clinic that serves recent Somali immigrants notes that most mothers refuse to give permission for routine immunizations of their preschoolers. Which individual is likely to have the most influence on these women's perceptions about their children's health care needs? A. Husbands. B. Clinic healthcare provider. C. Older females. D. Tribal chief. Consulting with the tribal chief, who is the primary authority figure for Somalis as a cultural group, is the best strategy for changing mothers' opinions about the importance of immunizations for their children (D). While (A) have significant influence on their wives, they cannot influence the opinion of the whole group as effectively as the tribal chief. To enlist the assistance of the healthcare provider interrupts the development of a therapeutic nurse-client relationship (B), and the mothers are more likely to

follow the advice of the tribal chief. While the elderly (C) are respected in this community, the chief has greater authority and consequently a wider impact on this group's decision-making. Points Earned: 0/1 Correct Answer: D Your Response: A 13. The community health nurse is planning a series of educational courses about the healthcare system and meeting healthcare needs for the community center. Which adjunct issue should the nurse address for a group of older adults? A. Peer concerns. B. Adult daycare. C. Retirement issues. D. Vocational concerns. Older adults should consider plans for ways that they will be able to retire (C) and still be able to meet their healthcare needs. Peers (A) are a priority concern in adolescence. The advantages of an adult daycare center (B) are typically considered as an option of retirement, which is often the first plan as an older adult retires from the workforce. Although the selection of a profession or vocation (D) is a concern throughout adulthood, the older client usually focuses on retirement, then chooses a second career for additional income or diversion. Points Earned: 0/1 Correct Answer: C Your Response: A 14. A female adult walks into a local community health clinic and tells the nurse that she is homeless and cannot seem to find help. Which statement indicates to the nurse that a client is feeling separated from society and hopeless? A. I'm feeling really isolated from everyone and scared. B. I feel like I cannot get enough food to live any longer. C. I know that I will always be poor so what's the use of trying? D. People like me are never respected, no matter how well we do.

Disenfranchisement refers to a feeling of separation from society (A). (B) is indicative of anxiety with possibly suicidal ideations. (C) indicates a "giving up-giving in" attitude. (D) might be indicative of depression, and additional assessment is needed to determine the client's feelings and degree of risk for self-harm or harm to others. Points Earned: 0/1 Correct Answer: A Your Response: D 15. A community health nurse is planning to implement an outreach program for a community group. Which criteria should the nurse clarify about the program when examining sources for funding? A. Focuses on multiple health problems or concerns. B. Identifies populations and individuals in need of healthcare services. C. Evaluates variations in health services and health status among populations. D. Offers healthcare services to community members in local factories, schools, and churches. An outreach program provides a wide variety of services at various community sites (D) to community members in need of healthcare services. (A) is an aspect of comprehensive services. (B) describes case finding. (C) is a method of identifying health disparities. Points Earned: 0/1 Correct Answer: D Your Response: B 16. The home health nursing director is conducting an educational program for registered nurses and practical nurses about Medicare reimbursement. To obtain payment for Medicare services, what must be included in the client's record? A. A prescription from the healthcare provider for each visit made. B. Documentation of a skilled care service provided during the visit. C. A copy of the client's health history and social security card. D. A record of the preventative healthcare services provided

during the visit. All home health visits must include documentation of a skilled service (B) to qualify for Medicare reimbursement, and these services must be reasonable and necessary. (A) does not mean that the service prescribed is a skilled service for a homebound client or that it is reasonable and necessary. (C) is not necessary for Medicare reimbursement, but all client records should contain a health history. Medicare does not reimburse for preventative (D) or maintenance health services, such as annual physical examinations or mammograms. Points Earned: 0/1 Correct Answer: B Your Response: A 17. The home health care agency can expect to obtain Medicare reimbursement for which home visit performed by a registered nurse (RN) or a practical nurse (PN)? A. Assessment of the speech pattern of a mobile adult who had a mild stroke last year. B. Safety teaching for an older male client whose wife complains that he uses an unsafe ladder while painting. C. Wound care for a client who had postoperative infection following abdominal surgery two weeks ago. D. Evaluation of crutch use by a 65-year-old male client who broke his tibia while snow skiing. An older adult client must be homebound and a skilled nursing service must be performed during the home visit to qualify for Medicare reimbursement. Clients are considered homebound for a limited period of time for postoperative complications, and wound care qualifies as a skilled nursing activity (C). Assessment of speech patterns may be a skilled activity, but (A) is not homebound. (B) is a preventative measure, which is not eligible for Medicare reimbursement, but a client who can snow ski at age 65 (D), is not likely to be homebound. Points Earned: 0/1 Correct Answer: C Your Response: B

18. The nurse is administering the measles, mumps, rubella (MMR) vaccine to a 12-month old child during the well-baby visit. Which age range should the nurse advise the parents to plan for their child to receive the MMR booster based on the current recommendations and guidelines by the Center for Disease Control (CDC)? A. 13 to 18 years of age. B. 11 to 12 years of age. C. 18 to 24 months of age. D. 4 to 6 years of age. The second booster of the measles, mumps, rubella (MMR) vaccine is recommended by the CDC for routine immunization at 4 to 6 years of age (D), which is commonly required prior to entrance into elementary school. Those who have not previously received the second dose should complete the schedule by 11 to 12 years of age (A and B). The MMR may be administered during any visit, provided at least 4 weeks have elapsed since the first dose and both doses are administered beginning at or after 12 months of age (C). Points Earned: 0/1 Correct Answer: D Your Response: A 19. The occupational health nurse is completing a yearly self-evaluation. Which activity should the nurse document as an example of proficient performance criteria in professionalism? A. Contributes money to a professional society or organization. B. Maintains chairmanship of the hospital nursing council. C. Documents the nursing process in care management. D. Develops policy initiatives that impact occupational health and safety. Leadership roles (B) in advancing the profession is an example of proficient performance criteria in professionalism under occupational and environmental health nursing. Supporting a professional society (A) is an example of competent performance criteria in professionalism. Using and documenting the nursing process in care management (C) is an example of competent performance criteria in clinical and primary care. Participating in or guiding the development of policy initiatives that impact occupational

health and safety (D) at all levels is an example of expert performance criteria. Points Earned: 0/1 Correct Answer: B Your Response: D 20. The nurse-manager is planning to transform safety ideas into prevention and protection strategies in the work place. What committee should review and plan policies and education about safety in the work place? A. Policy and procedures committee. B. Quality assurance committee. C. Education committee. D. Ethics committee. The quality assurance or safety committee (C) can study and analyze unusual occurrences, incidents, and errors related to health care and recommend policies and programs for improved safety strategies for the entire organization. (A and C) implement adopted strategies for change. (D) focus on professional and client legal and ethical issues addressing quality health care. Points Earned: 1/1 Correct Answer: B Your Response: B 21. The nurse is screening children at a local community health clinic for infectious diseases. Which child is at highest risk for hepatitis B virus (HBV)? A. A newborn. B. A 3-year-old. C. A 7-year-old. D. An 11-year-old. The highest incidence of HBV in children occurs in newborns (A) who acquire the infection perinatally from mothers who are HBV positive. (B, C, and D) are also at risk for contracting HBV if they are in contact with infected

blood or blood products, but the newborn whose mother is HBV positive is at greatest risk because of recent contact with maternal blood during delivery. Points Earned: 0/1 Correct Answer: A Your Response: B 22. The nurse is planning an immunization campaign targeting the children of migrant farm workers in the community. Which data should the nurse review before exploring solution options when developing this program plan? A. Uncertain risks. B. Potential outcomes. C. Priority of solutions. D. Target population data. A decision tree is a useful graphic aids that builds on previously collected and validated target population data (D) to develop a program plan that lays out potential outcomes (A), uncertain risks (B), and prioritization of potential solutions (C) for the population needs. Points Earned: 0/1 Correct Answer: D Your Response: B 23. The nurse plans to implement a community health program targeting teenage smoking. Prior to initiating this program, which information is most important for the nurse to obtain? A. The incidence of smoking among the teenage population in this community. B. The amount of available funding for tobacco prevention education programs. C. The target objectives for teenage smoking described by Healthy People 2010. D. Satisfaction data from programs that targeted the teenage population in this community. Prior to implementing the program, the nurse must know the prevalence of teenage smoking in this community (A) so that the program's effectiveness

can be measured by the prevalence of teenage smoking after implementation of the program. (B) does not directly affect the impact of the program. (C) provides national benchmarks, but does not relate to specific initiatives. (D) is not relevant for this program. Points Earned: 1/1 Correct Answer: A Your Response: A 24. The nurse is designing a home health care program for disabled children. Which factor should be considered when assessing reimbursement for services from private insurance companies? A. Greater access to any healthcare provider. B. Allowance for early discharge. C. Concern for the quality of care. D. Approval by the network healthcare provider. Managed care is a direct result of escalating healthcare costs. Managed care maintains a gatekeeper effect which is controlled by an approval system within the insurance company's network (D). The gatekeeper effect may limit the access to healthcare providers (A) because many specialists must be approved by the network. Although early discharge (B) is part of the managed care plan to reduce hospital expenditures, it creates a need for additional care in the home. Although quality control is important (C), it does not influence reimbursement. Points Earned: 0/1 Correct Answer: D Your Response: C 25. A community health nurse is conducting a neighborhood discussion group about disaster planning. What information regarding the transmission of anthrax should the nurse provide to the group? A. Infection is acquired when anthrax spores enter a host. B. Mature anthrax bacteria live dormant on inanimate objects. C. Spores cannot survive for extended periods outside of a living host. D. Anthrax is transmitted by respiratory droplets from person to

person. Anthrax is an acute disease caused by the spore-forming bacterium Bacillus anthracis. Products made from infected animal materials, such as animal hair, wool, animal bone meal, or products made from these materials, such as rugs and drums, may transmit this disease by spore entrance via cutaneous, gastrointestinal, and respiratory or inhalational (A). Anthrax spores can remain viable in the environment for many years, but the mature bacteria, Bacillus anthracis, cannot survive long outside a host (B and C). Although anthrax spore aerosolization, spore resistance to environmental degradation, and a high fatality rate implicate it as a potential biological warfare threat, person-to-person (D) transmission is rare. Points Earned: 0/1 Correct Answer: A Your Response: B 26. A client is suspected of being poisoned and presents with symmetric, descending flaccid paralysis, blurred vision, double vision, and dry mouth. The nurse should consider these findings consistent with which potential bioterrorism agent? A. Ricin. B. Botulism toxin. C. Sulfur mustard. D. Yersinia pestis. Botulism toxin (B) poisoning is characterized by neurological symptoms including symmetric, descending flaccid paralysis, double vision, blurred vision, drooping eyelids, slurred speech, difficulty swallowing, and muscle weakness that descends through the body starting with the shoulders. Ricin (A) poisoning causes system-specific reactions when poisoning occurs by inhalation, ingestion, or injection (resulting in death). Yersinia pestis (D) (pneumonic plague) begins with high fever, dyspnea, hemoptysis, nausea, vomiting, diarrhea, and abdominal pain. Sulfur mustard (mustard gas) (C) causes ophthalmic and cutaneous reactions, respiratory and gastrointestinal symptoms, and bone marrow depression. Points Earned: 0/1 Correct Answer: B Your Response: A

27. Which bioterrorism agent is at high risk for use as a potential biological weapon that is readily transmitted by several portals of entry? A. Anthrax. B. Smallpox. C. Botulism. D. Tularemia. Anthrax is caused by the bacillus bacterium, Bacillus anthracis, which sporulates in the environment or from infected animal products, and is transmitted by spore entrance via cutaneous, gastrointestinal, and respiratory or inhalational, which implicates it as high risk for potential biological warfare threat because of the ability for spore aerosolization, spore resistance to environmental degradation, and its high fatality rate. Other potential bioterrorism agents include smallpox (B) (which has been eradiated and transmitted by direct contact), botulism (food poisoning transmitted by ingestion), and tularemia (transmitted by direct contact or anthropod bite). Points Earned: 0/1 Correct Answer: A Your Response: B 28. A 16-year-old female client returns to the clinic because she is pregnant for the third time by a new boyfriend. Which vaccine should the nurse plan to administer? A. Measles-mumps-rubella. B. Hepatitis B. C. Human papillomavirus. D. Pneumococcal. Multiple sexual contacts are associated with the risk for hepatitis B, so (B) has the highest priority for this client. The MMR vaccine (A), which contains attenuated live viruses that are teratogenic, is not recommended during pregnancy. The safety of the human papillomavirus (C) during pregnancy has not been determined and should not be given or completed during pregnancy. The pneumococcal vaccine (D) is not indicated at this time. Points Earned: 0/1

Correct Answer: B Your Response: C 29. The nurse is preparing an orientation class for new employees at an inner city clinic that serves a low-income population. Which information should the nurse include in the presentation to these new employees? A. A lack of transportation is the major impediment for the clinic's clients. B. Basic physiologic needs are likely to be unmet in this clinic's client population. C. Printed material is less effective for this population that has limited reading skills. D. A group education class is often poorly attended by noncompliant clients. Low-income clients are at risk for basic physiologic needs being unmet (B) because they do not have the funds to pay for healthcare services, whether preventive or acute. Transportation issues (A) are a lesser priority than (B). (C) is stereotypical of a low-income population. (D) is a generalization about this population and does not consider multiple factors related to client noncompliance. Points Earned: 0/1 Correct Answer: B Your Response: A 30. A client presents at a community-based clinic with complaints of shortness of breath, headache, dizziness, and nausea. During the assessment, the nurse learns that the client is a migrant worker who often uses a gasoline-powered pressure washer to clean equipment and farm buildings. Which type of poisoning is the most likely etiology of this client's symptoms? A. Asbestos. B. Silica dust. C. Histoplasmosis. D. Carbon monoxide.

Carbon monoxide poisoning (D) is a common and serious health issue in industrial workers, particularly migrant workers. (A, B, and C) do not present with the same type of acute symptoms as those that are associated with carbon monoxide poisoning. (A) results in asbestosis, from the inhalation of dust particles containing it. Inhaling (B) results in silicosis. It is created in grinding and manufacturing industries. (C) is a fungal disease that occurs when spores within the soil are inhaled. Points Earned: 0/1 Correct Answer: D Your Response: A 31. The nurse is conducting a process evaluation of a prevention education program for older adults who are at risk for substance abuse. Which data source provides the information the nurse needs to conduct this process evaluation? A. Client's score on an alcohol screening instrument. B. Results of a urine drug and alcohol screen. C. Most recent community census data. D. Documentation of client education in the nursing record. Process evaluation examines whether or not interventions were implemented, and a nursing record audit (D) should indicate if prevention education had been conducted. (A and B) indicate assessment, but not intervention. (C) describes the demographics of the population, but does not collect information about educational programs. Points Earned: 0/1 Correct Answer: D Your Response: B