Unformatted text preview: Jennifer is a community health nurse in a large metropolitan area. According to the American
Nurses Association's Code of Ethics (2001), community health nurses must align themselves
with public health programs that promote and preserve the health of populations by influencing:
After a suprapubic prostatectomy, a client's plan of care will include the prevention of
postoperative deep vein thrombosis. The nurse recalls that this can be achieved best by
Velocity of the venous return
For which clinical indicator should a nurse monitor a client with end-stage renal disease?
Mary is a nursing student doing her senior project in community health. Part of her assignment is
to conduct an activity that illustrates "social health" within a group in her community. The most
appropriate activity for Mary to organize would be a:
food bank in a local church.
It has been estimated that individual behaviors and environmental factors are responsible for
what percentage of all premature deaths in the United States?
Early public health nurse Lillian Wald and her associates were successful in addressing health
and disease in the immigrant community by:
supporting political activities to improve social and environmental conditions of immigrant
Disease prevention activities protect people from disease and the effects of disease. An example
of primary disease prevention is:
administering vaccines to children before kindergarten
Every 10 years, the U.S. Department of Health and Human Services publishes a national
prevention initiative titled Healthy People. One of the new objectives for Healthy People 2020 is
improve the nation's ability to prevent, prepare for, respond to, and recover from a major health
Which of the following is an example of "community health nursing" rather than "communitybased nursing"?
An RN reviewing school clinic records to determine which children are not up to date on their
Which of the following entities strives to improve the health of all the public by promoting
healthy lifestyles, preventing disease and injury, and protecting the health of communities?
Public health system
A variety of health indicators are used by health providers, policy makers, and community health
nurses to measure the health of the community. Indicators that illustrate the health status of a
community and may be useful in analyzing health patterns over time include: (Select all that
cancer incidence rates
Public health efforts focus on prevention and promotion of population health. The local level of
the health care system provides direct services to community members through community and
personal health services. An example of a health service that targets the larger community, rather
than individuals, is: (Select all that apply.)
a mobile immunization clinic.
condemning or repairing unsafe housing.
airing a weekly public service announcement to remind women to do breast self-examination.
Which of the following statements is NOT true about the "thinking upstream" model of
community health nursing practice?
It focuses the nurse on short-term, individual-based nursing interventions.
A microscopic approach to the community health problem of childhood obesity would focus on:
asking an obese child and his or her parent(s) to complete a 24-hour food diary.
Which of the following theories is based on the assumption that individual needs and related
activities are the focus of nursing care?
Orem's self-care deficit theory
A community health nurse explores a group of teenagers' beliefs about the seriousness of eating
disorders and their related susceptibility. The nurse is applying principles from which theory?
The health belief model
A major limitation of the health belief model is that the burden of action related to health
behaviors is exclusively on the aggregate.
The belief that health deficits result from an imbalance between the population's health needs and
its health-sustaining resources is the premise of which theory?
The community health nurse is teaching a prenatal class and includes the societal cost of fetal
alcohol syndrome in one of the educational sessions. The nurse is demonstrating an
critical theoretical perspective
Which of the following nurse leaders formulated the first theory-based conceptual model for
Using theory to guide community health nursing practice serves to: (Select all that apply.)
guide data collection and interpretation in a clear and organized manner
improve community health nursing practice
focus the student on factors that are critical to understanding the situation
The use of theory in population-focused community health nursing encourages which of the
following? (Select all that apply.)
A proactive approach to care
Development of population-focused programs Receiving immunizations, regular health screenings, and physical exams is an example of:
Which of the following "determinants of health" refers to factors that are experienced with the
senses-things that can be seen, touched, heard, and smelled?
Which of the following "determinants of health" would include predisposition to prostate cancer
and a history of depression?
According to the health belief model, the inconvenience of driving to a gym to exercise is an
example of a:
A man has been smoking for 20 of his 40 years. He smokes a pack of cigarettes daily and states,
"My dad smoked two packs a day and lived to be almost 90. Besides, I'm going to die from
something anyway, so why quit"? He is in which "stage of change" in the transtheoretical model?
A smoking cessation class stresses increased lung function, money saved that is not spent on
cigarettes, and smelling clean and fresh as benefits to quitting smoking. These support which of
the following concepts?
A risk factor refers to a(n):
exposure that is associated with a disease
What is the most common chemical dependence in the United States?
A 22-year-old college student explains to the nurse at the health clinic that she drinks four to five
beers when she goes out with friends on Saturday nights. Otherwise, she rarely drinks during the
week because of her classes, studying, and part-time job. This would be considered:
Which of the following is an example of a modifiable risk factor? (Select all that apply.)
Diet Pregnancy, Labor, Childbirth,
Postpartum - Uncomplicated
A client at 11 weeks' gestation reports having to urinate more often. The nurse explains that urinary frequency often occurs because bladder capacity during pregnancy is diminished by: ► Compression by the enlarging uterus Immediately after the third stage of labor a nurse administers the prescribed oxytocin (Pitocin) infusion. Why is this medication administered? ►To help the uterus contract
Which position does the nurse teach the client to avoid when she experiences back pain during labor? ►Supine position
During a counseling discussion of nutrition, a nurse explains to a pregnant client that she will need additional calcium during pregnancy and that the best source is milk. The client states, "I never drink milk or eat milk products. They turn
my stomach." What is the nurse's best reply?
"Your practitioner can prescribe calcium supplements."
A nurse is preparing a pregnant client for an amniocentesis. What should nursing care include?
Encouraging her to void before the test
A nurse assesses the frequency of a client's contractions by timing them from the beginning of a contraction until the:
Beginning of the next contraction
A nurse is assessing a primigravida who was admitted in early labor after her membranes ruptured. She is at 41 weeks' gestation. Her contractions are irregular and her cervix is dilated 3 cm. The fetal head is at station 0 and the fetal heart rate tracing is reactive. How can the nurse help the client facilitate labor?
Take a walk around the unit with her.
A nurse plans to assess a postpartum client's uterine fundus. What should the nurse ask the client to do before this assessment?
Empty her bladder.
A 16yearold adolescent at 24 weeks' gestation visits the prenatal clinic for the first time. After the physical examination she tells the nurse, "I can't believe how big I am. Will I get much bigger?" What information about adolescent growth and development does the nurse need to know before responding?
Body image is very important to adolescents, so pregnant teenagers are concerned about body size.
A 29yearold gravida 3 para 3, was admitted to the recovery unit 2 hours after the birth of a 9lb baby girl. The nurse assesses the client an hour later and finds her fundus, which is slightly boggy, three fingerbreadths above the umbilicus and displaced to the right. The peripad, which was changed before the client's transfer, is now saturated. The nurse recognizes:
A distended bladder
A nurse is obtaining the health history of a woman who is visiting the prenatal clinic for the first time. She states that she is 5 months pregnant. For what positive sign of pregnancy should the nurse look in this patient?
Audible fetal heartbeat
A woman at 40 weeks' gestation is having contractions. Wondering whether she is in true labor, she asks, "How will you know if I'm really in labor?" What knowledge must the nurse have before responding? The cervix dilates and becomes effaced in true labor. A pregnant client is visiting her health care provider for a routine prenatal visit. The nurse measures the client's fundal
height at 37 cm. At her last routine visit the fundal height was 32 cm, which correlated directly with her gestation. What is the nurse's next action?
Asking the client whether she has emptied her bladder recently The nurse is caring for a gravida 2 para 2 client who gave birth the previous day. During the morning assessment the nurse notes that the lochia is rubra and moderately heavy. The picture indicates where the fundus is located. What should the nurse do next? Have the woman void and reassess.
The cervix of a client in labor is fully dilated and 100% effaced. The fetal head is at +3 station, the fetal heart rate ranges from 140 to 150 beats/min, and the contractions, lasting 60 seconds, are 2 minutes apart. What does the nurse expect to see when inspecting the perineum?
Enlarging area of caput with each contraction
A nurse is admitting a client in active labor. When the fetal monitor is applied to the client's abdomen, it records late decelerations. What should the nurse do first?
Reposition her on her left side.
A primigravida at 36 weeks' gestation is admitted to the birthing room with ruptured membranes and a cervix that is dilated 2 cm and 75% effaced. What is the priority question the nurse should ask?
"How frequent are your contractions?"
A nurse is assigned an adolescent who gave birth 12 hours ago. She continually talks on the phone to her friends and
does not respond when her new baby cries. What is the best immediate intervention?
Modeling appropriate behaviors that encourage infant bonding
A client who is at 12 weeks' gestation tells a nurse at the prenatal clinic that she is experiencing severe nausea and frequent vomiting. The nurse suspects that the client has hyperemesis gravidarum. What factor is frequently associated with this disorder?
High level of chorionic gonadotropin
A client in the 18th week of pregnancy is scheduled for ultrasonography. What instruction should the nurse give the client?
Don't urinate for at least 3 hours before the test."
Four hours after a vaginal birth, a client still has not voided. What is the next nursing action? Palpating the client's suprapubic area for distention
The nurse is preparing a client for epidural anesthesia. Which client statement would cause the nurse to stop the placement of the epidural catheter?
I'm not exactly sure how an epidural works."
Late decelerations are present on the monitor strip of a client who received epidural anesthesia 20 minutes ago. The nurse should immediately:
Reposition the client from supine to left lateral.
A client required an extensive episiotomy because her newborn was large. What is a priority nursing intervention that minimizes edema and lessens discomfort at the episiotomy site?
Applying ice packs to the perineum
A client at 10 weeks' gestation calls the clinic and tells a nurse that she has morning sickness and cannot control it. What should the nurse suggest to promote relief
Eat dry crackers before you get out of bed."
A client who is breastfeeding tells a nurse that her breasts are swollen and painful. What can the nurse teach her to do to limit engorgement?
Nurse at least every 3 hours for at least 10 minutes on each breast."
At 39 weeks' gestation a client asks the nurse about the difference between true and false labor. What information about true labor contractions should the nurse include in a response to the client's question?
Accompanied by progressive cervical dilation
The husband of a client who is in the transition phase of the first stage of labor becomes very tense and anxious and asks a nurse, "Would it be best for me to leave, seeing as how I don't seem to be doing my wife much good?" What is
the best response by the nurse?
I know that this is hard for you. Let me try to help you coach her during this difficult phase."
A client is admitted to the birthing unit in active labor. Amniotomy is performed by the health care provider. What physiologic change does the nurse expect to occur after the procedure?
Progressive dilation and effacement
A pregnant client uses a computer almost continuously during her working hours. This has implications for her plan of
care during pregnancy. What should the nurse recommend?
Try to walk around every few hours during the workday."
A nurse is caring for a client during an ultrasonogram. What parameters does the nurse expect to be used in the determination of pregnancy dates?
Crowntorump measurement until 11 weeks
A nurse helps a client to the bathroom to void several times during the first stage of labor. This is done because a full bladder:
May inhibit the progress of labor
A client at 32 weeks' gestation is admitted in active labor. Her cervix is effaced and dilated 4 cm. Intramuscular betamethasone (Celestone) 12 mg is prescribed. What should the nurse tell the client about why the medication is being given?
Fetal lung maturity is accelerated.
A pregnant client in the third trimester tells the nurse in the prenatal clinic that she has heartburn after every meal. What explanation should the nurse give about the cause of the heartburn?
The esophageal sphincter relaxes and allows acid to be regurgitated."
A nurse admits a client in active labor to the birthing center. She is 100% effaced, dilated 3 cm, and at +1 station. What stage of labor does the nurse identify?
First As the nurse inspects the perineum of a client who is in active labor, the client suddenly turns pale and says she feels
as if she is going to faint even though she is lying flat on her back. What should the nurse do?
Turn her onto her left side
A client is admitted to the birthing room in active labor. The nurse determines that the fetus is in the left occiput posterior (LOP) position. At what point can the fetal heart be heard?
A pregnant client asks the clinic nurse how smoking will affect her baby. What information about cigarette smoking will influence the nurse's response?
The resulting vasoconstriction affects both fetal and maternal blood vessels.
A 36yearold primigravida, accompanied by her husband, is admitted to the birthing unit at 39 weeks' gestation. External fetal monitoring is instituted. What should the nurse consider when a fetus is being monitored?
The machinery may be frightening to a laboring couple.
After a client gives birth, what physiologic occurrence indicates to the nurse that the placenta is beginning to separate
from the uterus and is ready to be expelled?
Appearance of a sudden gush of blood
During a prenatal examination a nurse draws blood from an Rhnegative client. The nurse explains that an indirect Coombs test will be performed to predict whether the fetus is at risk for:
Acute hemolytic anemia
A pregnant client is scheduled for ultrasonography at the end of her first trimester. What should the nurse instruct her to do in preparation for the sonogram?
Increase fluid intake for 1 hour before the procedure.
A nurse concludes that a client's placenta has separated during the third stage of labor. What assessment supports the nurse's conclusion?
A gush of blood
A 42yearold client at 39 weeks' gestation has a reactive nonstress test (NST). What should the nurse explain to the client about the positive result?
This is the desired response at this stage of gestation.
A primigravida in her 10th week of gestation is concerned because she has read that nutrition during pregnancy is important for the growth and development of the fetus. She wants to know something about the foods she should eat.
How should the nurse respond initially?
By asking her what she has eaten over the last 3 days
A man calls the prenatal clinic to ask the nurse when he should bring his wife to the hospital. He says, "The baby is due in 2 weeks, but she thinks it could be earlier. This is our first baby, and we're nervous." The nurse knows that as a nullipara, it would be important for the client to be seen if the contractions:
Come every 5 minutes for an hour
A nurse is caring for a client during the transition phase of labor. The nurse determines that the client has entered the second stage of labor when:
The client reports that she feels the urge to move her bowels.
The nurse is caring for a client in her third trimester who is to undergo amniocentesis. What should the nurse do to prepare the client for this test?
Instruct her to void immediately before the test.
A client arrives in the birthing room with the fetal head crowning. Birth is imminent. What should the nurse tell the client to do?
Use the pantbreathing pattern.
During a prenatal visit, a client at 37 weeks' gestation tells a nurse that she has painful, irregular contractions. What should the nurse recommend?
Walking around until they subside The fetus of a woman in labor is at +1 station. At what place in the pelvic area does the nurse conclude that the presenting part is located?
Below the ischial spines
A 23yearold primigravida is at her first prenatal appointment today. Ultrasound indicates that she is at 9 weeks' gestation. She asks when she can first expect to feel her baby move. The best response by the nurse is:
Many women are able to first feel light movement between 18 and 20 weeks."
A laboring client experiences a spontaneous rupture of membranes. The nurse's priority is:
Assessing the fetal heart rate
A nurse notes that a client is voiding frequently in small amounts 8 hours after giving birth. What should the nurse conclude about this small output of urine during the early postpartum period?
It may indicate retention of urine with overflow.
A nurse at the prenatal clinic examines a client and determines that her uterus has risen out of the pelvis and is now an abdominal organ. At what week of gestation would the nurse expect this assessment finding to occur?
12th week of pregnancy
While a client is being interviewed on her first prenatal visit she states that she has a 4yearold son who was born at 41 weeks' gestation and a 3yearold daughter who was born at 35 weeks' gestation and lost one pregnancy at 9 weeks and another at 18 weeks. Using the GTPAL system, how would you record this information?
G5 T1 P1 A2 L2
While waiting for his 39yearold wife to change clothes after an amniocentesis, the husband says to the nurse, "I sure hope that they...
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