A home health nurse is scheduled for a first-time visit to a client. Which of the following should the nurse perform first?
- A. Blood pressure screening
- B. Mental status examination
- C. Review of the neighborhood
- D. Family history
Correct Answer: C
Rationale: The correct answer is C: Review of the neighborhood. This should be performed first to assess the safety and environment of the client's home, ensuring the nurse's safety and the ability to provide care effectively. It helps identify potential hazards or resources in the community. Blood pressure screening (A) can wait until after ensuring a safe environment. Mental status examination (B) is important but can be conducted after assessing the neighborhood. Family history (D) is not a priority for the first visit.
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A newly hired occupational health nurse is assessing hazards in the work environment. Which of the following actions will help the nurse detect potential physical hazards?
- A. Survey workers about job-related emotional stress.
- B. Measure the noise levels at various locations in the facility.
- C. Identify industrial toxins that are present in the environment.
Correct Answer: B
Rationale: The correct answer is B: Measure the noise levels at various locations in the facility. This action will help the nurse detect potential physical hazards because excessive noise can lead to hearing damage and other health issues. By measuring noise levels, the nurse can identify areas where noise levels exceed safe limits and implement control measures.
Surveying workers about emotional stress (Choice A) is important for psychological well-being but does not directly address physical hazards. Identifying industrial toxins (Choice C) is important for chemical hazards, not physical hazards related to noise. The other choices are not provided, but measuring noise levels is the most relevant action for detecting physical hazards in this scenario.
A community health nurse is planning an educational program for a group of women who are postmenopausal. Which of the following outcomes is appropriate for this program?
- A. Clients will schedule bone density screening
- B. Clients will arrange for mammograms every 3 years
- C. Clients will start hormone replacement therapy
- D. Clients will significantly decrease caloric intake
Correct Answer: A
Rationale: The correct answer is A: Clients will schedule bone density screening. This outcome is appropriate because postmenopausal women are at increased risk for osteoporosis, making bone density screening crucial for early detection and prevention. It is a proactive measure to assess bone health and reduce the risk of fractures.
Explanation for why other choices are incorrect:
B: Clients will arrange for mammograms every 3 years - While mammograms are important for breast cancer screening, the focus of this program is on postmenopausal women's specific health needs related to bone health.
C: Clients will start hormone replacement therapy - Hormone replacement therapy has risks and benefits and should be individualized based on a woman's specific health history and needs. It is not a universal recommendation for all postmenopausal women.
D: Clients will significantly decrease caloric intake - Caloric intake is important for overall health, but the specific focus of this program is on bone health and screening, not weight management.
A community health nurse is providing screening for lipid disorders. Which of the following is the primary goal of this activity?
- A. Early detection of disease
- B. Client enrollment in prevention programs
- C. Promotion of appropriate lifestyle changes
- D. Identification of family history of medical problems
Correct Answer: A
Rationale: The correct answer is A: Early detection of disease. The primary goal of screening for lipid disorders is to identify individuals at risk for developing lipid disorders such as high cholesterol levels. Early detection allows for timely intervention and treatment to prevent complications like heart disease. Choice B is incorrect because enrollment in prevention programs is a secondary outcome of screening, not the primary goal. Choice C is also incorrect as promoting lifestyle changes is a part of the intervention phase, not the primary goal of screening. Choice D is incorrect as identifying family history is important but not the primary goal of screening for lipid disorders.
A community health nurse is providing teaching to a group of clients who have alcohol use disorder. Which of the following findings should the nurse include in the teaching as a manifestation of alcohol withdrawal?
- A. Bradycardia
- B. Hypothermia
- C. Increased appetite
- D. Insomnia
Correct Answer: D
Rationale: The correct answer is D: Insomnia. Alcohol withdrawal commonly presents with symptoms such as difficulty sleeping, restlessness, and anxiety due to the disruption of the central nervous system. Insomnia is a hallmark manifestation of alcohol withdrawal syndrome. Bradycardia (A) is not typically associated with alcohol withdrawal; instead, tachycardia is more common. Hypothermia (B) is rare in alcohol withdrawal, as alcohol tends to cause vasodilation and can lead to increased body temperature. Increased appetite (C) is not a typical symptom of alcohol withdrawal; in fact, decreased appetite or nausea is more common. Therefore, the correct choice is D based on the typical manifestations of alcohol withdrawal.
A community health nurse is working with a group of clients. The nurse practices the ethical principle of distributive justice by performing which of the following tasks?
- A. Keeping a promise to visit a client who is housebound after the delivery of care.
- B. Ensuring that a client who is homeless receives preventive medical care.
- C. Being honest with the parents of a child about the need to report suspected abuse.
- D. Accepting the decision of an older adult client to live alone in her home.
Correct Answer: B
Rationale: The correct answer is B. Distributive justice refers to fair distribution of resources and services to all individuals, with priority given to those in need. By ensuring that a homeless client receives preventive medical care, the nurse is upholding this principle. This action promotes equity and fairness by addressing the health needs of a vulnerable population.
A: Keeping a promise to visit a housebound client is important for maintaining trust and continuity of care, but it does not directly relate to distributive justice.
C: Being honest about reporting suspected abuse is related to ethical duty and integrity, not distributive justice.
D: Accepting an older adult's decision to live alone respects autonomy and independence, but it is not directly tied to distributive justice.
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