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Community and Public Health Nursing

June 9, 2024

Community and Public Health Nursing

PRACTICUM

Final Multiple Choice Examination

Questionnaire to Community and Public Health Nursing Final Exam

Multiple Choice

Identify the choice that best completes the statement or answers the question.

____ 1. A nurse is caring for an older adult with hypertension and heart disease who uses liberal amounts of table salt to season food, complaining that food does not taste good without it. What recommendations should the nurse make for this client?

Instruct the client that salt can be used as long as the blood pressure remains controlled.

Instruct the client to remove all salt from the diet to preserve kidney function.

Recommend table salt in small amounts in conjunction with diuretics.

Recommend that the client substitute herbs and spices to season food.

____ 2. An 85-year-old client with diabetes, heart disease, and renal insufficiency is admitted. What action should the nurse take to prevent falls by this particular client?

Provide assistance to the client in getting out of the bed or chair.

Place the client in restraints to prevent movement without assistance.

Maintain the client on complete bedrest with the siderails up at all times.

Request that a family member remain with the client at all times to assist in ambulation.

____ 3. An older adult client who has a history of falls has been placed in physical restraints after the failure of all other alternatives for fall prevention. What actions should the nurse take to ensure the safety of the client in restraints?

Check the client every hour, while keeping the restraints in place.

Check the client every 30 to 60 minutes, releasing the restraints every 2 hours.

Check the client once each shift, releasing the restraints for feeding only.

Check the client twice each shift, keeping the restraints in place.

____ 4. An older adult client has become agitated and combative toward the health care personnel on the unit. What is the first action that the nurse should take at this time?

Obtain an order for a sedative-hypnotic medication to reduce combative behavior.

Attempt to soothe the client’s fears and reorient the client to his or her surroundings.

Obtain an order to place the client’s arms in restraints to protect personnel.

Arrange for the client to be transferred to a mental health facility.

____ 5. An older adult client presents with signs and symptoms related to digoxin toxicity. Which age-related change can potentially result in toxic drug levels in this client?

Increased total body water

Decreased renal blood flow

Increased gastrointestinal motility

Decreased ratio of adipose tissue to lean body mass

____ 6. Which of the following statements made by an older adult client alerts the nurse to the possibility of medication errors?

“My husband is on the same medication, so we always take our medications together in the morning.”

“I prepare all my medication for the week and place the pills in a container labeled for each day.”

“When I don’t sleep well at night, I take two thyroid pills the next day instead of just one.”

“I take my Coumadin every day when the nooews comes on the television.”

____ 7. An 88-year-old client will be discharged from the hospital on a variety of medications. How can the nurse best ensure that the client is capable of taking the medication safely at home?

Have the client actively participate in drug administration during hospitalization.

Include the client’s children in discussions regarding proper medication administration.

Give the client a pamphlet outlining the actions, side effects, and doses of all prescribed drugs.

Make a chart for the client, showing exactly which drugs are to be taken at different times during the day.

____ 8. Which best represents four subgroups of late adulthood the nurse may encounter when caring for older clients?

Young old, middle old, older old, oldest old

Youthful old, mid-old, older old, oldest old

Young old, middle old, older old, elite old

Youthful old, mid-old, elite old, eldest old

____ 9. The family of an 85-year-old client expresses concern regarding the gradual decline in cognitive functioning of their family member. What mental health condition does this suggest?

Depression

Psychosis

Dementia

Delirium

____ 10. Which behavior exhibited by an older adult client should alert the nurse to the possibility that the client is experiencing delirium?

The client becomes confused within 24 hours after hospital admission.

The client displays a cheerful attitude despite a poor prognosis.

The client becomes depressed and sleeps most of the day.

The client begins to use slurred speech.

____ 11. A client with Alzheimer’s disease who has been hospitalized for dehydration. In making an assessment, the nurse notes the presence of a cluster of bruises on the client’s buttocks and suspects that the client may be the victim of elder neglect and abuse. What would be the best action for the nurse to take?

Call the local police.

Notify the client’s physician and social worker.

Confront the client’s family caregiver with the suspicions.

Alert hospital security to prevent visits by the client’s caregiver.

____ 12. A nurse is caring for an older client who has just been admitted to the hospital. Upon admission the client becomes increasingly confused, agitated, and combative. What action should the nurse take to minimize relocation stress syndrome in this client?

Reorient the client frequently to his or her location.

Obtain a certified sitter to remain with the client.

Speak to the client as little as possible to avoid overstimulation.

Provide adequate sedation for all procedures to avoid fear-provoking situations.

____ 13. Which sign or symptom would lead a nurse to suspect that an older adult client is being neglected by a caregiver?

Injuries noted in the “bathing suit” zone of the body

Disorientation to time, place, and person

Excessive weight loss

Rapid heart rate

____ 14. An older client confides feeling a loss of control over life after having a mild stroke. What would be the best action the nurse could take to support this client?

Explain to the client that such feelings are normal, but that he or she must have realistic expectations for rehabilitation.

Encourage the client to perform as many tasks as possible and to participate in decision making.

Further assess the client’s mental status for other signs of denial.

Obtain an order for physical and occupational therapy.

____ 15. A nurse is caring for an older adult client who lives alone. Which economic situation presents the most serious problem for this client?

Stock market fluctuations

Increased provider benefits

Social Security as the basis of income

Costs associated with setting up a living will

____ 16. What government resource is available to assist older adults to meet the cost of health care?

Preferred provider organizations

Health maintenance organizations

Medicare

Medicaid

____ 17. Which definition of cultural competence is used by the U.S. Department of Health and Human Services?

The ability of health care providers and organizations to understand and respond effectively to the cultural and linguistic needs that clients bring to the health care setting

The commitment made by a health care organization to provide quality care to all clients regardless of race, religion, national origin, or economic status

The recognition of a body of learned beliefs, traditions, and guides for behavior that are shared among members of a particular group

The setting aside of a health care professional’s own cultural beliefs to embrace or adopt those of a different cultural group

____ 18. Which activity or situation helps meet the goals of Healthy People 2010 with regard to culture?

Ensuring accurate recording of a client’s race and/or ethnicity in the medical record

Hiring physicians and nurses from culturally diverse backgrounds

Providing magazines written in more than one language in waiting areas of clinics

Translating HIV prevention guidelines into multiple literacy and language forms

____ 19. What information obtained by observation or interview is considered part of cultural assessment?

The home is neat and clean.

The client is underweight for his or her height.

The skin tone of all family members is similar.

The wife corrects the husband’s response to the question of how old his parents are.

____ 20. Which subculture has often been neglected with regard to health care issues?

Clients from Middle Eastern countries

Gay and lesbian clients

Infants and children

Older adult clients

____ 21. The client, a Jehovah’s Witness scheduled for surgery, has expressed concern that she might receive blood products, an act condemned by her religion. What is the nurse’s best response?

“You should allow the health care professionals to do whatever is needed to save your life.”

“If you are worried about contamination, the blood supply in this country is the safest in the world.”

“I will have the hospital chaplain come and interpret the Bible for you to show you that there really is nothing unacceptable in a blood transfusion.”

“Transfusions are not routine and now there are good alternatives to transfusions if you should lose an excessive amount of blood.”

____ 22. Which of the following methods of cultural assessment is most helpful for understanding a particular culture?

Interview

Observation

Participation

Visitation

____ 23. Which statement regarding substance abuse is true?

Substance abuse should not be considered a public health problem because it only affects individuals rather than society as a whole.

Even when a person is not “addicted” to a substance, abuse can cause physical, psychological, and social problems.

Substance abuse is rarely seen among middle-class clients.

Cocaine is the most commonly abused substance.

____ 24. How are stress and substance abuse interrelated?

The neurotransmitters stimulated by many abused substances enhance the sense of well-being and cause the sensation of stress when the substance wears off.

Chronic substance abuse leads to destruction of brain cells in the limbic area, causing an increased intensity of the stress response.

Most abused substances are perceived by the body as physiologic stressors, which result in a heightened “fight-or-flight” response.

As tolerance or addiction develop, more of the abused substance is needed to achieve the same pleasurable responses.

____ 25. Why is it important to identify a substance abuser in the medical-surgical acute care setting?

To enable the staff to take appropriate actions to protect themselves and other clients

To anticipate additional care needs necessitated by withdrawal

To avoid being “taken in” by a manipulative client

To inform local authorities about illegal behavior

____ 26. Which characteristic response to stimulant drugs increases their potential for abuse?

They are not habit-forming.

They have sedating qualities.

They increase general metabolism

Their use is not controlled by the DEA.

____ 27. The client has narcolepsy. The nurse should be prepared to teach the client about which drug category that has potential for abuse?

Amphetamines

Benzodiazepines

Barbiturates

Phencyclidines

____ 28. Which characteristic, action, or behavior fails to meet the criteria for the nursing diagnosis of substance abuse?

The client uses the substance daily.

The client’s behavior when using the substance is not socially acceptable.

The client continues to use the substance even though she or he has expressed a desire to stop.

The client continues to use the substance even though it causes him or her to have chronic hypertension.

____ 29. An unconscious client who has just been involved in a motor vehicle accident is brought to the emergency department. Which presenting clinical manifestation makes the nurse suspicious of an opioid overdose rather than increased intracranial pressure as a cause of the unconsciousness?

Pinpoint pupils

Respiratory depression

Hyporeflexive deep tendon reflexes

Evidence that the client has vomited

____ 30. The client smokes three packs of cigarettes per day. The nurse should teach this client about his or her increased risk for which chronic health problem as a result of tobacco abuse?

Chronic pancreatitis

Rheumatoid arthritis

Cardiovascular disease

Type 2 diabetes mellitus

____ 31. The nurse suspects that the client is a substance abuser. Which clinical manifestation causes the nurse to suspect cocaine abuse rather barbiturates?

Shallow respirations

Pupillary constriction

Tachycardia

Flushing

____ 32. Which statement or information obtained from a client during assessment for alcohol abuse alerts the nurse to the possibility of alcohol addiction?

The client says he or she drinks alcohol to feel less stressed and have a good time.

The client has been arrested once for driving under the influence of alcohol.

The client uses alcohol to stop his or her hands from shaking.

The client drinks alcohol daily.

____ 33. Which nursing diagnosis is appropriate for a woman who abuses anabolic steroids?

Risk for Injury related to decreased muscle coordination

Hypothermia related to decreased metabolic rate

Chronic Confusion related to sodium and water retention

Disturbed Body Image related to presence of facial hair

____ 34. Which problem or manifestation in a 125-pound, 40-year-old woman, 1-day postoperative for a total abdominal hysterectomy, leads the nurse to suspect possible substance abuse?

She has vomited nine times during the first 24 hours after surgery.

Morphine 15 mg (subcutaneous) has failed to relieve her pain.

She has been unable to void after removal of the Foley.

Her wound drainage is greater than expected.

____ 35. The client has been transferred to the medical-surgical unit from the emergency department. His admitting diagnosis is “barbiturate overdose.” What is the nurse’s priority intervention?

Performing neurologic checks every 4 hours

Providing emotional support

Restricting visitors to immediate family

Taking vital signs every 4 hours

____ 36. Which intervention is compatible with the goals for end-of-life care?

Administering a flu shot

Preventing the client with COPD from smoking

Performing passive range-of-motion exercises to prevent contractures

Permitting the client with diabetes mellitus to have a serving of ice cream

____ 37. Which of the following represents a major philosophy of the hospice concept?

Improving the quality of life for a client with a terminal illness

Assisting the family of a terminally ill client to grieve more efficiently

Ensuring that a terminally ill client is never alone

Removing the stigma of death

____ 38. Which clinical manifestation alerts the nurse to the fact that the terminally ill client is approaching death?

The client calls one son by the other son’s name.

The client’s extremities are cold and mottled.

The client asks to see a minister.

The client’s pain is increasing.

____ 39. Which action constitutes active euthanasia?

Increasing opioid-based pain medication to achieve adequate pain relief

Discontinuing treatment of bacterial pneumonia with antibiotics

Allowing only oral fluids for a confused client

Limiting wound care to only once daily

____ 40. When should abnormal symptoms in a dying client be treated?

When they are serious and may lead to death

When they affect the client’s rest or comfort

When they do not interfere with religious beliefs

When they disturb the family

____ 41. The spouse of a person remaining at home during a terminal illness is concerned because the dying client does not want to eat. What is the nurse’s best response?

“If he says he is not hungry, let him know that food is available when he wants it but don’t insist that he eat.”

“A feeding tube can be placed in the nose to provide important nutrients.”

“Force him to eat even if he doesn’t feel hungry, or he will die sooner.”

“He is getting all the nutrients he needs from his IV.”

____ 42. Family members of a client with a terminal illness tell a nurse that the client keeps asking if she is dying. What is the nurse’s best response?

“Whenever the client asks about dying, change the subject.”

“Tell the client the truth in as gentle a way as possible.”

“Tell the client that she will get better eventually.”

“Ask the client if she is afraid to die.”

____ 43. In providing palliative care to a client with a terminal illness, under which condition should the nurse consider insertion of an indwelling urine catheter?

When the client is taking medications affecting output

When the client’s output drops below 500 mL/day

When the client would be more comfortable

When the client is incontinent

____ 44. The dying client and family have been approached by their physician to consider a move to a hospice-like facility for palliative care. The family members tell the nurse they are afraid that their loved one will receive only custodial care because therapy for a cure is no longer being pursued. What is the nurse’s best response?

“The goal of palliative care is to provide the greatest degree of comfort possible and help the dying person enjoy whatever time is left.”

“Palliative care will release you from the burden of having to care for someone in the home; it does not mean that curative treatment will stop.”

“A palliative care facility is like a nursing home, which costs less than a hospital because less care is being provided.”

“Your loved one is unaware of his surroundings and will not notice the difference between home and a palliative care facility.”

____ 45. Which instruction should be given to the family regarding noise in the room when they are spending time with a dying family member?

“Remember that she can’t hear you.”

“Try to get her to talk or respond to you.”

“Avoid making any noise when you are with her.”

“Talk as softly to her as you would if you knew she could hear you.”

____ 46. The client who is near death is having severe dyspnea. What is the best management strategy for this problem?

Teach the family how to perform nasotracheal or oral-tracheal suctioning.

Request that the physician order administration of morphine sulfate.

Document the finding as the only action.

Initiate endotracheal intubation and ventilator.

____ 47. The client tells the nurse that even though it has been 4 months since her sister’s death from a ruptured aneurysm, the client finds herself crying uncontrollably several times a week. The client is afraid she is “losing her mind.” What is the nurse’s best response?

“Most people get on with their lives within a few months. You should see a grief counselor.”

“Whenever you start to cry, distract yourself from thoughts of your sister and try to sing.”

“You should try not to cry. I’m sure your sister is in a better place now.”

“Your feelings are completely normal and may continue for a long time.”

____ 48. The client is terminally ill and has signed an advance directive. In accordance with the client’s wishes, the physician has written a “do not resuscitate” (DNR) order. The family tells the nurse that they expect cardiopulmonary resuscitation (CPR) to be performed if their mother stops breathing. While they are talking, the client suddenly stops breathing. What should the nurse do?

Respect the wishes of the family

Have the family leave the room immediately

Notify the physician immediately.

Follow the DNR order.

____ 49. The nurse is caring for a client with Hodgkin’s disease who will be receiving radiation therapy. The nurse recognizes that, as a result of the radiation therapy, the client is MOST likely to experience:

High fever

Face and neck edema

Nausea

Night sweats

____ 50. When managing a client’s pain, which of the following statements BEST describes the ethical considerations of the nurse?

Nurses should not prejudge a client’s pain using their own values

Cultural sensitivity is fundamental to pain management

The client’s self-report is the most important consideration

Clients have the right to have their pain relieved

____ 51. Which intervention is compatible with the goals of end-of-life care?

Limiting visitors to reduce the risk for infection.

Removing a Foley catheter to promote client comfort.

Providing Ensure between meals to promote weight gain.

Encouraging the client with congestive heart failure to avoid foods high in sodium.

____ 52. Which of the following represents a major philosophy of the hospice concept?

Increasing the survival time for clients with a terminal illness.

Relieving families from the burden of custodial care.

Ensuring death with dignity for a terminally ill client.

Preventing the complications of prolonged bedrest.

____ 53. The family members of a dying client are distressed by the client talking to his brother, who died several years earlier, as if the brother were present in the room with the client. What is your best response?

“Ignore any references to the dead brother and redirect the conversation.”

“Reinforce that his brother died years ago and cannot possibly be present now.”

“Tell the client that he is hallucinating because of the medication.”

“Acknowledge that the client sees his brother.”

____ 54. Why is a pillow placed under the client’s head after death? To:

preserve the eyes for organ donation.

prevent facial discoloration.

make insertion of dentures easier.

make the family feel better.

____ 55. Which action constitutes active euthanasia?

Discontinuing cancer chemotherapy.

Removing a Foley catheter.

Discontinuing mechanical ventilation.

Requesting a DNR order.

____ 56. Read the communication dialogue and select the appropriate technique from the choices provided. Patient-“The head man expects some cash today.” Nurse-“I am not sure what you mean. Who is the head man?”

informing

clarification

theme identification

sharing perception

____ 57. Read the communication dialogue and select the appropriate technique from the choices provided. Patient-“My mother hates me.” Nurse-“Tell me about a time when you thought your mother hated you.”

focusing

reflection

broad opening

suggesting

____ 58. Read the communication dialogue and select the appropriate technique from the choices provided. Patient-“I need to change my appointment time again” (Said with an expression of dread). Nurse-“I am wondering from your expression if it is difficult for you to ask.”

clarification

theme identification

sharing perception

reflection

____ 59. Read the communication dialogue and select the appropriate technique from the choices provided.

Patient-“I don’t know what to do. My cat is home and no one is there to feed it.”

Nurse-“Have you thought about asking a friend to feed your cat?”

restating

informing

suggesting

restating

____ 60. Read the communication dialogue and select the appropriate technique from the choices provided.

Patient-“I don’t know where to start.”

Nurse-“Tell me about what has been on your mind recently.”

broad opening

sharing perception

reflection

suggesting

____ 61. Read the communication dialogue and select the appropriate technique from the choices provided.

Patient-“Since my wife left me nothing matters.”

Nurse-“You have spoken so often of feeling deserted by your wife. It seems this change has left you feeling empty.”

clarification

informing

focusing

theme identification

____ 62. Read the communication dialogue and select the appropriate technique from the choices provided.

Patient-“I just want to scream when my husband spends all his time at the computer.” Nurse-“You are feeling very frustrated about your husband spending time at the computer.”

focusing

reflection

restating

broad opening

____ 63. Read the communication dialogue and select the appropriate technique from the choices provided.

Patient-“I am going to a restaurant on my pass.”

Nurse-“Let’s review the special diet required while you are taking this antidepressant.”

theme identification

clarification

informing

suggesting

____ 64. Read the communication dialogue and select the appropriate technique from the choices provided.

Patient-“After my son left home at fourteen, my life went downhill.”

Nurse-“You say your life is going downhill since your son left?”

restating

broad opening

sharing perception

focusing

____ 65. What is the most important priority in providing nursing care for a patient with a terminal illness?

Physical comfort.

Prevention of pressure sores.

Medications to reduce pain.

Encouraging unlimited visits from family members.

____ 66. A client in the terminal stages of AIDS is despondent upon hearing that a close friend, who also had AIDS, has just died. The client begins to cry and says to the nurse, “What’s the use of hanging on when there is no hope? I’ll die soon too.” What is the best response by the nurse?

“A cure for AIDS is bound to be discovered soon; don’t give up yet.”

“No one knows how long you’ll have to live. Make the most of the time you have left.”

“Let’s talk about pleasant memories.”

“Would you like to talk?”

____ 67. A woman’s refusal to see a physician about a lump in her breast can be interpreted by the nurse as:

Rationalization

Sublimation

Projection

Denial

____ 68. What is an essential component of a therapeutic nurse-client relationship?

Relabeling

Empathy

Confrontation

Sympathy

____ 69. The nurse working with clients from many different cultures recognizes that it is a PRIORITY to:

Refer to experts from those countries

Recognize personal attitudes and biases

Speak another language

Learn about all the cultures

____ 70. The nurse is instructing a client with moderate persistent asthma on the proper method for using MDI’s (multi-dose inhalers). Which medication should be administered FIRST?

Steroid

Anticholinergic

Beta agonist

Mast cell stabilizer

____ 71. A new nurse manager is responsible for interviewing applicants for a staff nurse position. Which of the following interview strategies is the BEST?

Ask personal information of each applicant to assure meeting of job demands

Develop an interview guide for consistency in interviewing each candidate

Vary the interview style for each candidate to learn different techniques

Use simple questions requiring “yes” and “no” answers to gain definitive information

____ 72. The nurse manager informs the nursing staff at morning report that the clinical nurse specialist will be conducting a research study on staff attitudes toward client care. All staff are invited to participate in the study if they wish. This affirms the ethical principle of:

Anonymity

Autonomy

Beneficence

Justice

____ 73. Which of the following BEST describes the goal of total quality management or continuous quality improvement in a health care setting?

Conducting chart audits to find common errors

Creating a flow chart to organize daily tasks

Observing reactive service and product problem solving

Improving processes in a proactive, preventive mode

____ 74. The nurse is planning care for an 8 year-old child. Which of the following should be included in the plan of care?

Provide frequent reassurance and cuddling

Talk with the child and allow him to express his opinions

Encourage child to engage in activities in the playroom

Promote independence in activities of daily living

____ 75. The nurse is teaching parents of a 7 month-old about adding table foods. Which of the following is an APPROPRIATE finger food?

Sliced bananas

Whole grapes

Popcorn

Hot dog pieces

____ 76. The client with a terminal illness is grimacing and giving other nonverbal indications of pain within an hour and a half of receiving 80 mg of morphine subcutaneously for pain. What is your best action as the home care nurse?

Contact the physician immediately about increasing the dose and frequency of pain medication.

Hold the next dose of medication to reduce the chances the client will become addicted.

Avoid administering the next dose of pain medication early to reduce the risk for respiratory depression.

Document the observation and reassess the client’s need for pain control if the problem persists.

____ 77. Which of the following best describes the purposes of ambulatory health care delivery?

Long-term skilled care, emergency care, health promotion

Health promotion, managed care, selected surgery

Health protection, short-term treatment, health promotion

Short-term treatment, long-term treatment, health protection

____ 78. What factor has influenced the growth and acceptance of home care in the United States?

The lower cost of home care as compared to institutional care

A cultural shift away from traditional nursing home care

The increasing numbers of terminally ill individuals

The recent nursing staff shortages

____ 79. Which of the following activities demonstrates a major role of the nurse in an ambulatory care setting?

Drawing blood for preoperative testing

Teaching the client how to change the dressing on an incisional biopsy site

Obtaining the client’s signature on the surgical consent form before surgery

Performing a physical examination and taking the health history of a new client

____ 80. In what way does a nursing community center differ from a physician’s office practice setting?

Clients at nursing community centers are not eligible to receive care elsewhere.

Physicians’ offices are usually associated with large university medical centers.

The care provided is limited to interventions for nursing diagnoses.

The primary health care providers are advanced practice nurses.

____ 81. Which of the following activities is outside of the scope or role of the home care nurse?

Providing direct nursing care to an ill client in the home

Assessing the community for environmental hazards and health risks

Teaching family members how to monitor the intravenous infusion pump

Consulting with a dietician regarding the nutritional needs of a client with a large wound

____ 82. Which of the interventions performed by licensed nurses in the home would be reimbursed by Medicare for an eligible home care client?

Administration of intravenous medication

Bathing and positioning a paraplegic client

Preparing a meal for a client requiring a special diet

Evaluating the client’s home setting before discharge

____ 83. In which of the following settings would the nurse be expected to minimally implement the supervisor role of the nurse?

Subacute care setting

Home care setting

Skilled nursing facility

Assisted living facility

____ 84. Which of the following nursing home facilities offers the residents a range of services from independent living to skilled nursing care?

Skilled nursing facilities

Chronic care facilities

Residential facilities

Nursing facilities

____ 85. Which client is likely to require transitional subacute care before being discharged home?

The client with stable human immunodeficiency virus infection

The client with a progressive neurologic disease

The client requiring deep wound management

The client who is ventilator dependent

____ 86. Which statement best summarizes the purpose of managed health care?

To provide high-tech care in the home setting

To standardize and control health care costs

To provide health care on a fee-for-service basis

To promote the use of nurse practitioners as primary health care providers

____ 87. Which statement best describes a fee-for-service means of health care reimbursement?

Health care providers and hospitals are reimbursed based upon their fees.

Health care providers and hospitals receive a uniform amount of money.

Health care providers and hospitals are reimbursed though client payments only.

Health care providers and hospitals are reimbursed by insurance companies based upon client outcomes.

____ 88. Other than educational preparation, what is the main difference between health care provided by a nurse practitioner and that provided by a physician?

Federal law permits only physicians to prescribe medications.

Nurse practitioners are limited to providing interventions centered on nursing diagnoses.

Nurse practitioners provide care from a wellness model, and physicians more often focus on illness care.

There is no difference in scope, interventions, responsibility, and liability in the health care provided by nurse practitioners and physicians.

____ 89. Which statement best describes the process of case management?

The coordination of care services to at-risk populations

A collaborative process to promote quality and cost-effective care

The implementation of care to acutely ill, underserved populations

A cost-effective model of care delivery that meets the needs of specially defined groups

____ 90. Which of the following clients would be best served by a case manager?

70-year-old woman with chronic cystitis

55-year-old man with moderate hypertension

65-year-old woman with chronic congestive heart failure and diabetes mellitus

28-year-old man with a fractured ankle from a sports injury and seasonal allergies to molds and pollens

____ 91. Which of the following statements made by a health care professional regarding clinical pathways indicates a lack of understanding about their purpose?

“The clinical pathways are useful in determining how effective specific treatment plans are.”

“Although clinical pathways map out a specific plan of care, they can be modified for variances in client outcomes.”

“Without the implementation of clinical pathways, our agency could not be accredited by the Joint Commission on Accreditation of Health Care Organizations.”

“Involvement of multiple disciplines in the development of clinical pathways allows for a comprehensive plan to achieve the best outcomes for an individual client.”

____ 92. Which of the following certifications are used as designations for case managers?

CCM, CIS, CCRN

CNM, A-CCC, CLCP

CCM, A-CCC, CAM

CCM, CDMS, MAC

____ 93. Which activity, if performed on a regular basis among relatives or friends in a household, has the greatest potential to spread HIV?

Sharing a safety razor with an HIV-positive person

Using the same toilet as an HIV-positive person

Sharing eating utensils with an HIV-positive person

Kissing an HIV-positive person on the mouth

____ 94. The client who is HIV positive has a bout of Pneumocystis pneumonia and is prescribed to take a combination of sulfamethoxazole and trimethoprim (Bactrim). Which precaution is most important for the nurse to stress to this client?

“If you miss one dose, take two tablets at the next scheduled dose.”

“Drink at least 4 liters of fluid/day while taking this medication.”

“Do not take this medication within 4 hours of taking any other medication.”

“Avoid direct sunlight or use a sunscreen with a minimum SPF of 45 during and for 2 weeks following drug therapy.”

____ 95. Which precaution is most important for the nurse to teach the client with HIV disease who is prescribed to start taking enfuvirtide (Fuzeon)?

“Rotate the injection site.”

“Take your temperature twice daily.”

“Do not rub or massage the injection site.”

“Report any change in urine color to your health care provider.”

____ 96. The client with AIDS has chronic diarrhea. Which dietary change should the nurse suggest for this client?

“Avoid fatty foods.”

“Increase your intake of fiber.”

“Take an antacid 30 minutes before each meal.”

“Restrict your intake of fluids to 1 liter per day.”

____ 97. Which statement made by a client who has HIV disease and is taking a “cocktail” consisting of protease inhibitors, nucleoside reverse transcriptase inhibitors, and non-nucleoside analogue reverse transcriptase inhibitors indicates the need for clarification regarding the management of this condition?

“Using three drugs at the same time enhances suppression of viral replication.”

“There is no problem using complementary therapies along with the protease inhibitors.”

“Because the protease inhibitors kill the virus, I do not need to worry about transmitting the virus.”

“If the virus becomes resistant to this cocktail, another combination of drugs may be required to reduce my viral load.”

____ 98. The client who has just been diagnosed as HIV-positive asks if he poses a health hazard to his co-workers in the secretarial pool. What is the nurse’s best response?

“The only time you could make someone else sick is when you have Pneumocystis pneumonia.”

“As long as you are taking your antiviral medications, you cannot transmit the virus to your co-workers.”

“Unless your blood or other body fluids comes into contact with your co-workers, you are not a health risk to them.”

“You should inform your co-workers of your HIV status so that they can take proper precautions to reduce their risk.”

____ 99. With which sexually transmitted disease should the nurse teach the client about an increased risk for development of cancer in the genital region?

Syphilis

Chancroid

Cytomegalovirus

Human papillomavirus

____ 100. The client has just been diagnosed with a recurrence of genital herpes simplex. She asks how this is possible, because she has not had sex since she was diagnosed and treated 1 year ago. What is the nurse’s best response?

“Sometimes one course of therapy is not enough to eradicate the disease.”

“The disease can be controlled but is never cured, and outbreaks are common.”

“Did you take the medication exactly the way it was prescribed for you?”

“If you had more than one sex partner in your life, you may have had more than one strain of the disease.”

____ 101. Which statement made by the client about condom use indicates a need for clarification?

“I will use a new condom each time I have intercourse.”

“I will use an oil-based lubricant whenever I have intercourse.”

“I will always use a latex condom rather than a natural membrane condom.”

“When intercourse is over, I will keep the condom on my penis until it is out of the vagina.”

____ 102. The client diagnosed with chancroid is prescribed to take erythromycin orally. Which statement made by the client indicates correct understanding of the antibiotic regimen?

“If my temperature is normal for 3 days in a row, the infection is gone, and I can stop taking my medicine.”

“One dose of this medication is enough to stop the infection and make me noninfectious.”

“Even if I feel completely well, I should take the medication until it is gone.”

“When my sores have healed, I will no longer need to take the antibiotics.”

____ 103. The client is a 24-year-old woman who has just been diagnosed with a human papillomavirus infection. She is very angry at her ex-boyfriend, who has been her only sexual contact. She is crying and says she isn’t going to tell him that he is infected. What is the nurse’s best response?

“You do not have to tell him because this is not a reportable disease in this state.”

“Because there is no cure for this disease, telling him would be of no benefit to him or to you.”

“Even though you are angry, he should be told so that he can take precautions to prevent the spread of infection.”

“You should tell him so that he can feel as guilty and miserable as you do now, knowing that you have this disease.”

____ 104. Why are women more likely to have “silent” infections of sexually transmitted disease than men?

Women are less susceptible to sexually transmitted diseases.

Many of the places where lesions would appear in women are not readily visible.

The longer urethra of a man provides more opportunity for microorganisms to multiply.

The clinical manifestations of infection in women are more likely to be systemic and vague rather than local.

____ 105. Which client is at greater risk for development of an ectopic pregnancy as a result of a sexually transmitted disease?

The client with chlamydia

The client with genital herpes

The client with the human papillomavirus

The client with pelvic inflammatory disease

____ 106. Which statement made by the client who has had a sexually transmitted disease indicates a need for clarification regarding risk factors and prevention strategies?

“I always urinate immediately after intercourse.”

“I douche daily, even when I have not had intercourse.”

“I use a condom for casual sex, even though I am on the pill.”

“When I have sex twice in the same evening, I add more spermicidal jelly rather than removing my diaphragm.”

____ 107. A nurse in an ambulatory care clinic is performing an admission assessment for an African-American client scheduled for a cataract removal with an intraocular lens implant. Which of the following questions would be inappropriate for the nurse to ask on an initial assessment?

“Do you have any difficulty breathing?”

“Do you have a close family relationship?”

“Do you ever experience chest pain?”

“Do you frequently have episodes of headache?”

____ 108. A community health nurse has volunteered to assist in providing health care instruction to an American Indian community group. The nurse plans instruction based on the common practices and rituals of this group, knowing that which of the following is not a common characteristics associated with ethnic group?

Corn is an important component of the diet.

Alcohol use is minimal.

Fried bread and mutton are prepared in lard.

Vitamin D deficiency is a concern.

____ 109. A home health nurse is visiting a client who does not speak English. The nurse attempts to obtain a translator to assist in communication but it unsuccessful in doing so. Which communication technique will not overcome the language barrier during the visit with the client?

Communicating by writing medical terms

Using simple words and avoiding medical terms

Using simple words with simple actions while verbalizing them

Discussing one topic at a time

Completion

Complete each statement.

110. _________________________ is an area of study and practice that focuses on the care, health, and illness patterns of individuals with similarities and differences in their cultural beliefs, values, and practice.

111. Typically, a client who has a life expectancy of less than ____________________ months should be referred to hospice.

Other

112. Clients with which of the following factors are more likely to experience acute confusion or delirium? (Select all that apply.)

A. Alcoholism

B. Chronic pain

C. Acute infection

D. Major loss

E. Multi-infarct cerebrovascular disease

F. Change in drug regimen

113. Mrs. Jones, 85, has just been admitted to a skilled nursing facility following surgery for a fractured hip. Select the interventions most likely to help her adjust to her new surroundings. (Select all that apply.)

A. Make sure that she has her hearing aid and glasses.

B. Offer her the anxiolytic that her physician has prescribed.

C. Encourage her family to bring in her favorite pictures.

D. Ask her where she wants the room furnishings placed.

E. Encourage her to eat meals in her room.

F. Invite her to group activities.

114. Which assessment data gathered during the admission of an older client should alert the nurse to an increased risk for falls? (Select all that apply.)

A. Visual impairment

B. Use of a cane while walking

C. Hypertension

D. Obesity

E. Difficulty arising from a sitting position

F. Being male

115. Which of the following are not indicators of alcohol abuse? (Select all that apply.)

A. Craves alcohol

B. Drinks one 12-oz beer each day

C. Fails to fix meals at home

D. Frequent sick days at work

E. Grades at school drop

F. Loss of control

G. Physical dependence

116. An older woman has just had surgery to repair a fractured hip. Identify the care settings, ordering from least to most client autonomy, that the woman may encounter.

A. Transitional care unit (TCU)

B. Skilled nursing facility (SNF)

C. Inpatient orthopedic unit

D. Independent living in her own home

E. Assisted-living facility (ALF)

117. A client requiring intermittent infusion therapy for cancer is usually treated in which of the following care settings? (Select all that apply.)

A. Home

B. Skilled nursing facility (SNF)

C. Inpatient unit

D. Outpatient clinic

E. Infusion center

118. Which characteristics distinguish nursing care in the home from nursing care in an inpatient setting? (Select all that apply.)