Focused Review: NR441/442/444

June 2021

Presenter Tanya Spillman, MSN, RN

 Content Mastery Series
• This 60-item test offers an assessment of basic comprehension and mastery of community
health principles including:
• Foundations of community health (client advocacy, health promotion and disease
prevention, epidemiology, ethical decision-making, family and cultural care, environmental
health, national health care goals)
• Community assessment and diagnosis, and health program planning and evaluation
• Community health education
• Roles and settings for community health nursing
• Nursing care of aggregates in the community
• Special community needs
• Community protection and client safety (disaster preparedness, communicable disease)
• You have 60 minutes to complete the assessment.

©2021 Chamberlain University LLC. All rights reserved. 2

 Management of Care

©2021 Chamberlain University LLC. All rights reserved. 3

 End-of-Life Care
• Comfort needs near the end
of life:
• Physical Comfort
• Mental and Emotional
Needs
• Spiritual Issues
• Practical Tasks

Always talk to, not about, the person who is dying!

©2021 Chamberlain University LLC. All rights reserved. 4

 Hospice Care
• Focus on pain control and comfort
• Die with dignity
• Provide honest Information:
• Prognosis
• Disease progression
• Treatment options
• Effects of treatment

©2021 Chamberlain University LLC. All rights reserved. 5

 Grief and Loss
Factors Influencing Loss, Grief, and Coping Ability

• Developmental stage

• Social support networks

• Type and significance of the loss

• Culture and ethnicity

• Spiritual and religious beliefs and practices

• Prior experience with loss

• Socioeconomic status

©2021 Chamberlain University LLC. All rights reserved. 6

 Grief and Loss: The
Grief Process
• Five Stages of Grief

• Denial – The client has difficulty believing a terminal

diagnosis or loss.

• Anger – Anger is directed toward self, others, or

objects.

• Bargaining – The client negotiates for more time or a

cure.

• Depression – The client mourns and directly confronts

feelings related to the loss.

• Acceptance – The client accepts what is happening

and plans for the future.

©2021 Chamberlain University LLC. All rights reserved. 7

 Management of Care
‣ A home hospice nurse is caring for a client who is dying. A family member is talking
with the nurse, which statement requires clarification by the nurse?
A. “Although my father can’t get around very much, at least he is alert.”
B. “My siblings and I have a schedule of when we are available to provide care for
our father.”
C. “My biggest concern is that I don’t want my father to be in any pain.”
D. “I’m glad that professionals will be here in case my father stops breathing.”

©2021 Chamberlain University LLC. All rights reserved. 8

 Rationale
A. “Although my father can’t get around very much, at least he is alert.”

B. “My siblings and I have a schedule of when we are available to provide care for
our father.”
C. “My biggest concern is that I don’t want my father to be in any pain.”
D. “I’m glad that professionals will be here in case my father stops breathing.”

©2021 Chamberlain University LLC. All rights reserved. 9

 Mandatory Reporting
• Suspected Abuse
• Children, dependent adults and
Obligation to elderly
Report • Communicable Diseases
• CDC-60+ communicable diseases
are reportable

What are some examples?

©2021 Chamberlain University LLC. All rights reserved. 10

 Management of Care
‣ A nurse should prepare to notify public health officials about which of the following
client infections? (Select all that apply)
A. Gonorrhea
B. Hepatitis C
C. Clostridium difficile
D. Chlamydia trachomatis
E. Meningococcal disease

©2021 Chamberlain University LLC. All rights reserved. 11

 Rationale
A. Gonorrhea
B. Hepatitis C
C. Clostridium difficile
D. Chlamydia trachomatis
E. Meningococcal disease

©2021 Chamberlain University LLC. All rights reserved. 12

©2021 Chamberlain University LLC. All rights reserved. 13
 Modes of Transmission

Airborne Foodborne Waterborne Vector-borne Direct contact

• Measles • Norovirus • Cholera • West Nile virus • STI

• Chickenpox • Salmonellosis • Typhoid fever • Lyme Disease • Infectious
• TB • Hepatitis A • Bacillary • Rocky mononucleosis
• Pertussis • Trichinosis dysentery Mountain • Enterobiasis
• Influenza • E. coli • Giardia lamblia spotted fever • Impetigo
• SARS • Malaria • Lice, scabies

©2021 Chamberlain University LLC. All rights reserved. 14

 Case Manager

• Collaborative process
• Decrease costs/improving client outcomes
• Advocates for client’s rights and health care needs
Continuity Referrals
of Care • Restoring, maintain, or promoting health
• Community resources
• Acute settings-based on medical diagnosis

*What are some barriers that might

impact the referral process?

©2021 Chamberlain University LLC. All rights reserved. 15

 Management of Care
‣ A case management nurse is preparing to initiate referrals for a client as part of
discharge planning. Which of the following actions should the nurse take first?
A. Monitor the client’s satisfaction with the referral.
B. Provide the client information to referral agencies
C. Review available resources with the client
D. Identify referrals that the client needs

©2021 Chamberlain University LLC. All rights reserved. 16

 Rationale
A. Monitor the client’s satisfaction with the referral.
B. Provide the client information to referral agencies
C. Review available resources with the client
D. Identify referrals that the client needs

©2021 Chamberlain University LLC. All rights reserved. 17

 Home Health
• Community Health Nurses
• Traditional Homes
• Assisted Living Facilities
• Nursing Homes

• Skilled Services
• Assessment
• Wound care
• Medication administration
• Parenteral nutrition
• IV fluids
• Central line care
• Urinary catheter care

©2021 Chamberlain University LLC. All rights reserved. 18

 Safety and Infection Control

©2021 Chamberlain University LLC. All rights reserved. 19

 Safety and Infection Control
‣ At the scene of a train crash, the nurse triages the victims. Which
clients should be coded for triage as most urgent or the first priority
(color red)? Select all that apply
1. Is dead
2. Has chest pain
3. Has a leg sprain
4. Has a chest wound
5. Has multiple fractures
6. Has full thickness burns over 30% of the body

©2021 Chamberlain University LLC. All rights reserved. 20

 Rationale

1. Is dead No, this client would be in the black category.

2. Has chest pain Yes, this client would be in the red category.
3. Has a leg sprain No, this client would be in the green category.
4. Has a chest wound Yes, this client would be in the red category.
5. Has multiple fractures No, this client would be in the yellow category.
6. Has full thickness burns over 30% of the body Yes, this client would be red since
they have less then 65% burns on their body.

©2021 Chamberlain University LLC. All rights reserved. 21

 Emergency Preparedness
©2021 Chamberlain University LLC. All rights reserved. 22
 Disaster Management Stages

Preparedness and
Prevention Stage Response Stage Recovery Stage
Planning Stage
• Assess areas at • Identify Specific • Triage • Heroic
risk Roles • Coordinate • Honeymoon
• Identify threats • Disaster Kits Evacuation • Disillusionment
and • Quarantine • Reconstruction
vulnerabilities • Open Shelters

©2021 Chamberlain University LLC. All rights reserved. 23

 Home Safety
• Grab bars
• Nonskid strips in tub
• Sturdy footstool
• Adequate railing on stairway
• De-clutter stairs / pathways
• Adequate lighting (e.g., stairs, thresholds)
• Furniture (e.g., soft, appropriate height, steady)
• Cords & electrical Hazards not exposed

©2021 Chamberlain University LLC. All rights reserved. 24

 Safety and Infection Control
‣ A home health nurse is performing an assessment of an older adult client’s home.
Which should the nurse identify as a potential hazard?
A. Hot water temperature at 46 degrees Celsius (115 degrees F)
B. A night light in each room of the house
C. A secured, large area rug in the living room
D. Wires for the television tunneled under the carpet

©2021 Chamberlain University LLC. All rights reserved. 25

 Rationale
A. Hot water heater temperature at 46 degrees C (115 degrees F)
B. A night light in each room of the house
C. A secured, large area rug in the living room
D. Wires for the television tunneled under the carpet

All others are appropriate measures in the home.

©2021 Chamberlain University LLC. All rights reserved. 26

 Fire Safety

©2021 Chamberlain University LLC. All rights reserved. 27

 Health Promotion and Maintenance

©2021 Chamberlain University LLC. All rights reserved. 28

 Health Promotion and Maintenance
‣ The nurse is performing an assessment on an older adult client. Which
signs/symptoms are normal age-related changes in the eye?
Select all that apply.
1. Clear Lens
2. Blurred vision
3. Protruding cornea
4. Increased tear production
5. Diminished pupillary adaptation to darkness
6. Increased ability to discriminate among colors

©2021 Chamberlain University LLC. All rights reserved. 29

 Rationale

1. Clear lens No, the lens becomes cloudy.

2. Blurred vision Yes, vision becomes blurry with age progression.
3. Protruding cornea No, this is not a normal age related change.
4. Increased tear production No, they have a decreased tear production.
5. Diminished pupillary adaptation to darkness Yes, this is a normal age related
change.
6. Increased ability to discriminate among colors No, they have a decreased ability to
discriminate among colors.

©2021 Chamberlain University LLC. All rights reserved. 30

 Normal Aging Process

©2021 Chamberlain University LLC. All rights reserved. 31

 Health Promotion & Maintenance

©2021 Chamberlain University LLC. All rights reserved. 32

 Health Promotion and Maintenance
‣ A community health nurse is caring for a community of migrant workers. What is
an example of each level of prevention for this population?

– Primary: ________________________________________________
– Secondary: ______________________________________________
– Tertiary: ________________________________________________

©2021 Chamberlain University LLC. All rights reserved. 33

 Rationale

Primary:
• Educate regarding measures to reduce exposure to pesticides (Hand hygiene and change clothes after
working)
• Accident prevention education
• Provide prenatal care
• Mobile preventative services (dental, immunizations)

Secondary:
• Testing and screening programs
• TB, Prenatal, pesticide exposure, skin and other cancers, communicable diseases, anemia (children)
Tertiary:
• Treat manifestations from pesticide exposure
• Mobilize primary and emergency care services
• Promote rehabilitation (therapy) for injuries
• Educate those who have diseases (DM, anemia) regarding appropriate nutrition

©2021 Chamberlain University LLC. All rights reserved. 34

 Psychosocial Integrity

©2021 Chamberlain University LLC. All rights reserved. 35

 Psychosocial Integrity

‣ The client is admitted to the hospital for alcohol detoxification. Which

of the following interventions should the nurse use? Select all that
apply.
1. Taking vital signs
2. Monitoring intake and output
3. Placing the client in restraints as a safety measure
4. Reinforcing reality if the client is disoriented or hallucinating
5. Explaining to the client that the symptoms of withdrawal are temporary

©2021 Chamberlain University LLC. All rights reserved. 36

 Rationale

1.Taking vital signs Yes vitals are important to help monitor the client.
2.Monitoring intake and output Yes, I&O is important to help monitor this client.
3.Placing the client in restraints as a safety measure No, this is not necessary. Restraints should always
be a last resort.
4.Reinforcing reality if the client is disoriented or hallucinating Yes, this is important during alcohol
withdrawal.
5.Explaining to the client that the symptoms of withdrawal are temporary Yes, it is important to
educate clients about their illness.

©2021 Chamberlain University LLC. All rights reserved. 37

 Psychosocial Integrity
‣ Which of the following foods should the nurse eliminate from the diet of a client in
alcohol withdrawal?

1.Milk
2.Regular coffee
3.Orange juice
4.Eggs

©2021 Chamberlain University LLC. All rights reserved. 38

 Rationale

1.Milk No, milk is an appropriate choice.

2.Regular coffee Yes, coffee contains caffeine that increases tremors and agitation.
3.Orange juice No, orange juice is an appropriate choice.
4.Eggs No, eggs are an appropriate choice.

©2021 Chamberlain University LLC. All rights reserved. 39

 Alcohol Withdrawal Syndrome
4-6 hours
• Anxiety
• Restlessness
• Tremors
• Insomnia
12-36 hours
• Marked tremens(DTS)
• Paranoia
• Hallucinations
• Diaphoresis 2-3 days
• Medical Emergency!
• Death from MI, electrolyte
imbalance, vascular
collapse, or suicide
• What medications

‣What medications are given to treat alcohol withdrawal?

©2021 Chamberlain University LLC. All rights reserved. 40
 Opioid Abuse
‣ Drug
– Heroin
– Meperidine
– Fentanyl
– Hydromorphone

‣ What happens when these patients are intoxicated?

‣ Withdrawal
– Yawning
– Insomnia
– Panic
– Diaphoresis
– Cramps
– N/V
– Chills
– Fever
– Diarrhea
©2021
©2020 Chamberlain University LLC. All rights reserved. 41
 Psychosocial Integrity

‣ Which of the following clients are the highest risk for suicide completion?

1. 85 year old Caucasian male who lives alone after his wife's death
2. 34 year old single Hispanic female who recently was diagnosed with cancer
3. 15 year old African American women whose boyfriend broke up with her
4. 52 year old Asian male who was terminated from his job because of downsizing

©2021 Chamberlain University LLC. All rights reserved. 42

 Rationale

1. 85 year old Caucasian male who lives alone after his wife's death Yes, over age 65, male and
Caucasian are associated with high suicidal rates.
2. 34 year old single Hispanic female who recently was diagnosed with cancer. No, client is female
and Hispanic. Both are associated with low suicidal rates.
3. 15 year old African American women whose boyfriend broke up with her No, client is female and
African American. Both are associated with low suicidal rates.
4. 52 year old Asian male who was terminated from his job because of downsizing No, although
client is male the Asian culture does not have a high suicidal rate.

©2021 Chamberlain University LLC. All rights reserved. 43

 Suicide
Does the client have a plan?

Client Centered Care: • How lethal is the plan?

• Does the client have access to the
intended method?
• Suicide precautions
• What are they?
Therapeutic Communication:
• “Are you thinking of suicide?”
Potential Warning Signs
• Avoid being overly cheerful • Sudden cheerfulness
• Verbalize relief
• Sit with them in silence • Give away personal
• Allow them to cry belongings

©2021 Chamberlain University LLC. All rights reserved. 44

 Psychosocial Integrity
‣ A nurse is caring for a client who is from a different culture than the nurse. When
beginning the cultural assessment, which of the following actions should the nurse
take first?
A. Determine the client’s perception of their current health status.
B. Gather data about the client’s cultural belief.
C. Determine how the client’s culture can affect the effectiveness of nursing
actions.
D. Gather information about previous client interactions with the health care
system.

©2021 Chamberlain University LLC. All rights reserved. 45

 Rationale
A. Determine the client’s perception of their current health status.
B. Gather data about the client’s cultural belief.
C. Determine how the client’s culture can affect the effectiveness of nursing
actions.
D. Gather information about previous client interactions with the health care
system.

©2021 Chamberlain University LLC. All rights reserved. 46

 Cultural Awareness
Cultural Assessment Convey Cultural Sensitivity Health Beliefs and Practices

• Collection of self- • Authentic and honest • Biomedical beliefs

identifying data • Incorporate preferences • Naturalistic beliefs
• Pose questions that and practices • Magico-religious beliefs
address client’s • Do not make assumptions
perceptions of their • Respect values, beliefs,
health needs and practices
• Identify how cultural
factors can affect the
effectiveness of nursing
interventions

©2021 Chamberlain University LLC. All rights reserved. 47

 Questions

©2021 Chamberlain University LLC. All rights reserved. 48