ATI Community Health Nursing Proctored Focus Exam 2021 with complete solution

Care of specific populations: Migrants Migrant workers health problems include: Correct answer- 1. Dental disease 2. TB 3. Chronic conditions 4. Stress, anxiety, & other mental health conditions 5. Leukemia 6. Iron deficiency anemia 7. Stomach, uterine, & cervical cancers 8. Lack of prenatal care 9. Higher infant mortality rates Primary Prevention for Rural or Migrant Health care: Correct answer- -educate on measures to reduce exposure to pesticides -teach on accident prevention -prenatal care -mobilize preventative services (dental, immunizations) Secondary Prevention measures for Rural/Migrant Health care: Correct answer- SCREENING! screen for: -pesticide exposure -skin cancer -chronic preventable diseases -communicable diseases Tertiary Prevention measures for Rural/Migrant Health care: Correct answer- -treat for symptoms of pesticide exposure -mobilize primary care and emergency services Client's rights include... Correct answer- -right to info disclosure -privacy -informed consent -info confidentiality -participation in treatment decisions Autonomy Correct answer- respecting a client's right to choose (i.e. refusing chemo) Nonmaleficence Correct answer- doing no harm Beneficence Correct answer- maximize benefits and minimize possible harms Justice situation: Correct answer- determining eligibility for health care services based on income and fiscal resources HIPAA rules about information security: Correct answer- -only staff assigned to the patient may view/read client's health record (no other nurses or doctors) -client's have the right to read or obtain a copy of their health record -nurses may not photocopy any part of med record except for authorized exchange of docs between facilities & providers -staff must keep records/names of client in secured place -electronic records are password protected -no sharing info to family members w/out code in person, email, or phone call -talking about a client must be in a private setting so no one can overhear HIPAA info security protocols include: Correct answer- -log off computer before leaving workstation -never share ID or password -never leave med records where ppl can see it -shred any printed info about client after use -don't use or view social media in clinical settings -no posting about clinical stuff Caring for a client with gonorrhea: Correct answer- -nationally notifiable disease -women are frequently asymptomatic -CDC recommends yearly screening for all sexually active women 25 yrs or older or w/risk factors -at risk pregnant women must be screened at first prenatal visit -identify & treat all partners -admin erythromycin to all infants following delivery -ceftriaxone IM or azithromycin PO -it is the responsibility of the provider to report gonorrhea to local health dept -state notification to CDC is voluntary -if left untreated in women it can lead to PID which can cause infertility Referrals: Client barriers include: Correct answer- -lack of motivation -inadequate info about community resources -inadequate understanding of the need for referral -accessibility needs -priorites -finances -cultural factors Referrals: Resource barriers include: Correct answer- -attitudes of health care personnel -costs of services -physical accessibility of resources -time limitations -limited expertise working w/culturally diverse populations Just because someone is exposed to asbestos once doesn't mean they will develop health problems... Correct answer- long term exposure can lead to mesothelioma and lung conditions. Risk factors include workers (office buildings with it when they work there everyday). Priority action(s) in developing a disaster plan: Correct answer- -set up communication alternatives -highlight possible evac routes -identify local & distant meeting places -create disaster kit AS A NURSE: -identify at risk populations in community -identify community disaster warning system & how to access -identify 1st responders -make list of agencies for all levels of disaster -triage -gather equipment, check often Hyperthyroidism: Radioactive iodine therapy home safety: Correct answer- Client is radioactive! -no pregnant people -no breastfeeding -keep distance from others, limit visits to 30 min at a 6 ft distance -drink lots of fluid -maintain good hygiene to prevent infection Teaching safe disposal of insulin syringes: Correct answer- -put in strong plastic container i.e. old detergent container (no soda bottles) -DO NOT recycle old needles, throw container in trash -seal the container when 3/4 full with duct tape -facilities throw it in sharps red container Teaching about use of crutches: Correct answer- -don't alter crutches after fitting -follow prescribed crutch gait -support body weight at the hand grips w/elbows flexed at 30 degrees -position crutches on unaffected side when sitting or rising from a chair Demographics of homeless population: Correct answer- -families w/children are the fastest growing segment -people with mental illness (large segment) -veterans -substance abuse disorders -youth and runaways -intimate partner abuse victims -people with HIV or AIDS -older adults Planning Primary Prevention Activities Correct answer- -determine solutions -establish goals -give responsibilities to individuals -determine resources -screening and education -determine funding, develop budget -plan for evaluation Parish nursing: Correct answer- promotes health and wellness within populations of faith communities -work with: pastoral care staff, professional health care members, and volunteers to provide holistic approach to healing Functions: -personal health counseling -health education -liaison between faith & community & local resources -facilitate support groups -spiritual support Windshield survey: Correct answer- -nurse and other driver drive through community assessing components -time consuming -provides descriptive overview of community -results limited because it is only based on visualization & doesn't include community member input nurse looks for: -pets and animals -evidence of drug abuse/substance abuse -origin/race/ethnicity of population -general appearance -natural/man made boundaries -housing details -social systems: clinics, hospitals, dentists, parks & rec, worship places, stores, public protection & transport Positive Mantoux skin test for TB includes: Correct answer- an induration-palpable, raised, hardened area of 10 mm or greater in diameter Positive Mantoux test indicates that... Correct answer- the client has developed an immune response to TB it does not confirm active TB Mantoux test: an induration of 5 mm may be considered Correct answer- positive mantoux test in immunocompromised clients Recognizing signs of abuse: Correct answer- Child: -unexplained injury -unusual fear of nurses or others -injuries/wounds not mentioned in hx -fractures, including other healed fractures -presence of wounds/fractures/injuries in various stages of healing -subdural hematomas -trauma to genitalia -malnourishment or dehydration -general poor hygiene or inappropriate dress for weather conditions -considered to be a "bad child" Adult: -unexplained or repeated physical injuries -physical neglect & unmet basic needs -rejection of assistance by caregiver -financial mismanagement -withdrawal & passivity -depression Manifestations of alcohol withdrawal: Correct answer- -abd cramping -vomiting -tremors -restlessness -irritability -increased HR -transient hallucinations or illusions -anxiety -increased BP and RR -increased temp -tonic-clonic seizures -alcohol withdrawal delirium (2-3 days after stopping) Provide culturally appropriate care by: Correct answer- -addressing clients by last name until told otherwise -introduce thyself and explain position -be authentic and honest about what you don't know about a culture -use culturally sensitive language -don't make assumptions about the client -encourage the client to ask questions -find out what the client knows about condition and treatments -respect beliefs, practices, and values -show respect for client's support systems Identifying hazards in occupational environments: Correct answer- -exposure to chemicals -worker inexperience/age/pregnancy -lifting heavy loads -constant sitting -stress and burnout and violence -temp extremes -noise extremes -not having proper protective equipment Diet teaching for adolescents: 1. Calories/day for 15 yr old male & female= 2. Adolescents have an increased need for... 3. Adolescents require at least ____/day of Calcium Teach them: Correct answer- 1. 2000 for female, 4000 for male 2. Iron (11-15 mg extra/day) 3. 1300 mg Teach: don't skip meals, eat more calcium, nutrient-dense snacks (fruit, pretzels, smoothies, cheese) identify agent factors in the epidemiological triangle: Correct answer- Chemical agents: drugs and toxins Physical agents: noise and temp Infectious agents: viruses and bacteria Agent is the animate/inanimate object that causes the disease Using web-based info: Correct answer- -must be credible, avoid .com (use .gov) -must use appropriate terminology (no layman terms) -EBSCO, CDC, NICBH are good sources Providing information on immunizations is a part of the... Correct answer- primary prevention Calculating prevalence proportion: Correct answer- # of existing cases in the population at a specific time divided by population total= _____per 1000 Caregiver burden responses: Correct answer- fatigue difficulty sleeping illness PTSD interventions Correct answer- -therapeutic relationship w/client -assess for suicide idealization & use precautions if necessary -use multiple strategies to reduce anxiety -allow time to express feelings rationalization Correct answer- coming up with reasons that avoid the true reason (i.e. I got cancer of the liver because its in my genes not because I drink to excess every day) Providing teaching to a patient who speaks a different language than the nurse: Correct answer- -interpreters should not be family members -interpreters should have knowledge of health care terminology -client preferences should be considered when choosing the age and sex of interpreters -interpreters should not be from the same community as the client -health teaching materials should be available in the client's primary language Exposure to anthrax: Correct answer- -IV cipro prophylactically -abx to stop disease progression s/s: -headache -fever -muscle aches -chest discomfort -severe dyspnea -shock Pertussis education: Correct answer- -droplet precautions -whooping cough -incubation 7-10 days -common cold s/s -antibiotics Women's health after menopause: Correct answer- -increase iron -vitamin B12 -lots of fluids -mammogram every year to 2 years -colon cancer screening -regular dr visits -skin assessment -immunizations -vision checks HIV/AIDs targets CD4+ T-lymphocytes, decreased count... Correct answer- determines stage of disease, lower the count the worse the disease. Tests for HIV/AIDS Correct answer- ELISA Western blot indirect immunofluorescence assay test Determining disease incidence rate: Correct answer- # of new cases in the population at a specific time divided by population total times 1000=______per 1000 Screening goals: Correct answer- provide accurate, reliable results, can be inexpensively and quickly administered to large groups and produce few/if any side effects priority finding in school health screenings: Correct answer- -abuse evidence -vision and hearing changes -height and weight changes -scoliosis -infestations first step in developing a community health plan Correct answer- identify population specifics nonpharm interventions to manage nausea: Correct answer- -eat cold or room temp foods -high carb, low fat -avoid fried foods -do not eat prior to chemo or radiation -sit up for 1 hr following meal -ginger Case manager nursing responsibilities: Correct answer- -promoting interprofessional services & increased client/family involvement -decreasing cost by improving client outcomes -providing education to optimize health participation -advocating for services & client rights Rheumatoid Arthritis: Teaching About Hydroxychloroquine Correct answer- -advise client to have a baseline eye exam & follow-up eye exams every 6 months w/ophthalmologist -stop med & notify provider if blurred vision occurs Manifestations of measles: Correct answer- -mild to moderate fever -conjunctivitis -fatigue -cough, runny nose, red eyes, sore throat -rash -*koplik spots* (tiny white spots) appear in mouth in 2 days before rash -red/reddish brown rash on face then spreading downward -spike in fever with rash Hepatitis and Cirrhosis: Client Education Correct answer- -contact precautions as needed -high carb, high cal, low-mod fat & protein diet -small frequent meals -no alcohol -limit physical activity -avoid sex until hep antibody test is neg -proper hand hygiene Communicable Diseases, Disasters, and Bioterrorism: Caring for a Client Who Has Ringworm Correct answer- clean all surfaces: furniture, counters, stuffed animals, etc. Infection Control: Caring for a Client Who Has MRSA Correct answer- -complete full course of antimicrobial therapy -avoid overuse of antimicrobials Endocrine Disorders: Teaching About Somatropin Correct answer- -monitor growth patterns -rotate injection sites -mix gently do not shake prior to admin -obtain baseline weight and height Cardiac Glycosides and Heart Failure: Indications of Digoxin Toxicity Correct answer- - hypokalemia -fatigue -weakness -vision changes -GI affects Fastest growing homeless population= Correct answer- families with kids Calculate disease Prevalence Correct answer- existing cases divided by population total X 1000 Calculate disease incidence Correct answer- new cases / population total X 1000 Reportable diseases to the CDC include: Correct answer- -gonnorhea -varicella -syphillis Windshield survey measures Correct answer- -population: ethnicity -housing -social: public resources/protection -natural environment -place secondary data Correct answer- use of existing data (statistics)-prevalence of disease reportable to the state health department: Correct answer- -suspected cases of child neglect/abuse -elder abuse/neglect -syphillis women health screening: Correct answer- Cholesterol 45-65 Fecal occult blood test 50 yrs and older Disposal of insulin syringes Correct answer- metal container/heavy plastic container Leading cause of death in adolescents Correct answer- MVAs Dehydration effects: Correct answer- impaired motor control alcohol withdrawal symptoms Correct answer- -appear within 4-12 hrs -abd cramping -vomiting -tremors -restlessness -inability to sleep -TACHYCARDIA -HTN -transient hallucinations or illusions -anxiety -increased RR, temp -tonic clonic seizures -diaphoresis meds for alcohol withdrawal Correct answer- -diazepam -carbamazepine -clonidine -chloridiazepoxide -phenobarbital -*naltrexone* alcohol withdrawal delirium symtoms Correct answer- -appear 2-3 days after stopping -hallucinations -severe HTN -cardiac dysrhythmias -delirium -can progress to death alcohol abstinence meds: Correct answer- -disulfuram -naltrexone -acamprostate immunizations to not give preggos Correct answer- -MMR -rubella b/c infection can develop -herpes zoster -varicella immunization to give preggo Correct answer- TDaP Epidemiological triangle Agents: Correct answer- 1. Chemical: drugs, toxins 2. Physical: noise, temp 3. Infections: viruses, bacteria Epidemiological triangle Hosts: Correct answer- -age -gender -genetics -ethnicity -immunological status -physiological state -occupation Epidemiological triangle Environment: Correct answer- 1. Physical: geography, water/food supply, presence of reservoirs/vectors 2. Social: access to health care, increase work environment, poverty If you see education or immunizations think: Correct answer- PRIMARY PREVENTION If you see screenings (lice, TB, HTN, cancer) or safety checks (home safety, outbreak control) think: Correct answer- SECONDARY PREVENTION If you see rehab, support groups, counseling, therapy, disease management, etc, think: Correct answer- TERTIARY PREVENTION Web-based information, use... Correct answer- EBP that is validated by peer-review no bias (quality), number of studies, participants, strength of it (quantity), repeatable results (consistency) Domains of learning Cognitive: Correct answer- involves knowledge of development of intellectual skills i.e. discusses how sodium intake affects BP Domains of learning Affective: Correct answer- Involves change of attitude & development of values i.e. acceptance of having a colostomy & maintains self-esteem Domains of learning: Psychomotor: Correct answer- involves performance of a skill i.e. community nurse teaches a client how to self-admin insulin Prioritizing client care Systemic before local: Correct answer- *Life before Limb* interventions for a patient with shock comes before interventions for a patient with localized limb injury Prioritizing client care Acute (new injury or illness) before Chronic: Correct answer- care of a pt w/a new injury/illness or acute exacerbation of previous comes before care of a pt w/long term illness Prioritizing client care Actual problems before potential future problems: Correct answer- admin of meds to a pt experiencing acute pain comes before ambulation of a pt at risk for thrombophlebitis eastern chinese/asian medicine beliefs Correct answer- an imbalance in nature is believed to cause disease mexican culture medicine beliefs Correct answer- hot-cold theory of balance in relation to health and illness that accompanies belief in framework christian religions medicine/health beliefs Correct answer- believe in faith healing Caribbean nations health/medicine beliefs: Correct answer- voodoo and witchcraft Native American health/medicine beliefs Correct answer- -use of religion -avoiding eye contact -use of spiritual practices -use of healing practices Hispanic health/medicine beliefs: Correct answer- -avoid direct eye contact -use therapeutic touch -use face, hand, and body gestures -respect them wanting to use traditional therapies Cold or other illnesses are not contraindicated for getting... Correct answer- immunizations infants get what vaccine at 12 months? first year of life? Correct answer- MMR Rotavirus vaccines 6 weeks to 6 years Correct answer- 5 vaccines of DTaP vaccines 11-12 years Correct answer- meningococcal conjugate vaccines at 60 yrs Correct answer- herpes zoster case manager role Correct answer- -provide referral info -facilitates movement of pt through health care system -negotiation -collaboration What is HMO? Correct answer- insurance group that provides health services for a fixed annual fee there is an agreed upon payment level anthrax exposure, need access to... it is used as... Correct answer- ciprofloxacin, used as prophylactic tx what are administered if manifestations of anthrax infection are present? Correct answer- antitoxins and IV abx early manifestations of anthrax Correct answer- -dry cough -mild chest pain -fever -fatigue