Community HESI Practice exam 1

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1. Which presentation of an infectious disease is Malaria following exposure in a mosquito-infested area.

acquired through an indirect transmission? Malaria contracted from a biting mosquito is an example of a vector-related,
+Syphilis contracted from a sexual partner. indirect transmission of the disease (C). Indirect transmission of an infectious
+ Measles resulting from a daycare center disease involves the spread of infection through an intermediate source, such as
outbreak. vehicles, fomites, or vectors. (A, B, and D) are examples of direct transmission,
+Malaria following exposure in a mosquito- defined as the spread of an infection through person-to-person contact and is
infested area. characterized by portals of exit and entry.
+Nosocomial influenza spreading rapidly in a
long-term center
2. A home health nurse knows that a 70-year-old Thinning of the skin with loss of elasticity.
male client who is convalescing at home Thin, non-elastic skin (C) is an important factor in decubitus formation. Proportion
following a hip replacement, is at risk for of body fat to lean mass increases with age (A), and might help decrease ulcer
developing decubitus ulcers. Which physical tendency. (B) results in grey hair. (D) can contribute to broken bones, but it is
characteristic of aging contributes to such a probably not a factor in decubitus formation.
risk?
16% increase in overall body fat.
Reduced melanin production.
Thinning of the skin with loss of elasticity.
Calcium loss in the bones.
3. The nurse is developing a plan to provide Census data.
quality health care for a certain community. Risk management data.
Data obtained from which resources should be Budgeting process information.
helpful to the nurse in developing a Client-satisfaction surveys.
community healthcare plan for this Changes in the community's demographic data.
community? (Select all that apply.) Census data (A), risk management data (B), budgeting process information (C), data
Census data. obtained from client-satisfaction surveys (E), and changes in the community's
Risk management data. demographic data (F) provide pertinent data for planning for the current and future
Budgeting process information. healthcare needs of the community. Available workforce (D), although a concern, is
Available workforce in the community. not a factor in quality-assurance directives.
Client-satisfaction surveys.
Changes in the community's demographic
data.
4. The nursing education coordinator is Most of the clients are unemployed or disabled.
creating employee orientation Access to mass transit may be an issue.
materials for staff nurses who plan to Basic physiologic needs of this population are often unmet.
work at a clinic that serves a lower
socioeconomic neighborhood. What Correct choices are (A, B, and D). The unemployed or disabled will likely comprise a
information should the educator majority of this clinic's clients (A); the lack of access to mass transit may affect the
include regarding the clinic's client population's ability to keep health care appointments (B); and low-income clients are at risk
population? (Select all that apply.) for basic physiologic needs being left unmet (D). Most clients are not likely to have health
Most of the clients are unemployed or insurance (C) because they lack the funds to pay the insurance premiums. Homebound
disabled. status is not a defining qualification for public assistance, such as Medicaid (E). To state that
Access to mass transit may be an a low-income population is more likely to be non-compliant with healthcare
issue. recommendations is an example of stereotyping (F).
Clients will need reminders to bring
insurance cards.
Basic physiologic needs of this
population are often unmet.
Clients who are homebound will
qualify for Medicaid.
Nonadherence to healthcare
recommendations is likely.
5. While discussing the science of The person, the environment or situation, and health.
nursing, the nurse identifies the Nursing theories serve to describe, explain, predict, or prescribe nursing care measures.
domain of nursing theory. Which Any science has a domain, which is the view or perspective of the discipline. The elements
linkages should the nurse provide to of nursing's paradigm direct the activity of the nursing profession, including knowledge
describe nursing's paradigm? development, philosophy, theory, educational experience, research, practice, and literature
The person, the environment or identified with the profession. Nursing identified its domain in a paradigm that includes four
situation, and health. linkages: the person, health, environment/situation, and nursing (A). (B, C, and D) are not
Stress reduction, self-care, and a linkages of the domain.
systems model.
Curative care, restorative care, and
terminal care.
Self-actualization, fundamental needs,
and belonging.
6. Which topic should the nurse include in Vision and hearing screening.
planning a secondary prevention Health screenings (D) are the mainstay of secondary prevention, which focuses on health
project for the local retirement promotion, which includes screening, early detection and diagnosis of disease. (A and B)
community? are primary prevention topics which include health-promoting activities designed to reduce
Safety measures in the home. the likelihood of a specific illness occurring. Tertiary prevention includes interventions
Adult immunization program. aimed at disability limitation and rehabilitation (D) from disease, injury, or disability.
Rehabilitation after surgery.
Vision and hearing screening.
7. A nurse organizes a community action Low immunization rate of children.
group to help resolve health problems In the early phase of a community group, it is important for the group to experience
in a low income neighborhood with a success in resolving a problem so that they feel encouraged and empowered to continue
large population of recent immigrants working together. (B) is the problem easiest to tackle. While (A and C) are important, they
from Africa. What problem should the are complex problems to address, and it is crucial for the group to experience success on
nurse address first? a smaller scale issue so that they will be encouraged to attempt resolving more complex
High rate of unemployment. problems in the future. (D) is important, particularly with Hispanic immigrant populations,
Low immunization rate of children. but not as important as initial group success to this non-Hispanic majority.
Provision of substandard health care.
Access to bilingual care providers.
8. What action is best for the community Follow agency protocols to report suspected abuse.
health nurse to take if the nurse Nurses are mandated to report all suspected cases of child abuse and neglect, and it is
suspects that an infant is being best to follow agency protocols to protect the nurse and child's safety (A). (B) is available
physically abused? for the general public, but in this case it is best for the community health nurse to follow
Follow agency protocols to report the agency policy. While (C) can contribute to abuse and neglect, the situation warrants
suspected abuse. immediate action to protect the child and follow the law. (D) could jeopardize the safety of
Report suspicions to the local child the nurse, the child, or others in the home.
abuse reporting hotline.
Educate the child's caregivers about
growth and development issues.
Call the police department to have the
child removed from the home.
9. A nurse working in a community health A 17-year-old who is sexually active with numerous partners.
setting is performing primary health (A) is at greatest risk for developing sexually transmitted diseases, including HIV, because
screenings. Which individual is at the greater the number of sexual partners one has, the greater the risk for contracting
highest risk for contracting an HIV STDs. (B) represents the group with the lowest number of infected persons because there is
infection? little transfer of body fluid during sexual acts. (C) would not be sharing needles, so
A 17-year-old who is sexually active contracting STDs is not necessarily a risk. A male homosexual in a monogamous
with numerous partners. relationship has a decreased risk of contracting HIV--as long as BOTH partners are
A 45-year-old lesbian who has been monogamous and neither is infected (D).
sexually active with two partners in
the past year.
A 30-year-old cocaine user who
inhales the drug and works in a topless
bar.
A 34-year-old male homosexual who is
in a monogamous relationship.
10. During an initial clinic visit, the nurse is African-American ethnicity.
taking the history for a client who The client's previous history of a LBW infant and the non-modifiable risk factor of ethnicity
wants to confirm her pregnancy. The are the most important risk factors for this pregnancy because the incidence of (LBW)
client's last child has a history of low- infants is twice as high for African-American (B) births than Caucasian births. The
birth-weight (LBW). Which additional modifiable risk factors of (A, C, and D) are related to infant morbidity, but (B) is most
finding is most important for the nurse important because it is non-modifiable.
to consider?
Cigarette smoking.
African-American ethnicity.
Poor nutritional status.
Limited maternal education.
11. The nurse administers a booster dose Primary prevention.
of DTaP (diphtheria, tetanus, and
pertussis) vaccine to an infant. Which Primary prevention (A) involves activities that focus on reducing the potential for illness
level of prevention is the nurse before it occurs, such as immunizations. Tertiary prevention (B) minimizes the
implementing? consequences of a disorder or illness through aggressive management or rehabilitation.
Primary prevention. Secondary prevention (C) includes early diagnosis and implementing interventions aimed
Tertiary prevention. at a cure or reducing the progress of a disease. Primary nursing (D) describes a method of
Secondary prevention. nursing management and nursing care assignments, not a healthcare strategy.
Primary nursing.
12. The home health nurse is admitting a client Impaired physical mobility related to muscle rigidity and weakness.
with Parkinson's disease to the home healthcare Parkinson's disease is a progressive neurologic disorder affecting the brain centers
service. In planning care for this client, which that are responsible for control and regulation of movement. The chief clinical
nursing diagnosis has priority? manifestations are impaired movement, muscular rigidity, resting tremor, muscle
Impaired physical mobility related to muscle weakness, and loss of postural reflexes (A). Depression and dysfunction are
rigidity and weakness. appropriate nursing diagnoses but are not the primary diagnosis (B). Client's with
Ineffective coping related to depression and Parkinson's usually do not experience (C or D).
dysfunction due to disease progression.
Ineffective breathing pattern related to
respiratory muscle weakness.
Fear related to constant possibility of
experiencing seizures.
13. The nurse is assessing a Vietnamese child The purpose is to rid the body of disease.
during a home health visit and identifies round
swellings on the child's back. The child's mother Coining, a Vietnamese practice, may produce welt-like swellings from rubbing a
says she rubbed the edge of a coin on her coin lengthwise on oiled skin to rid the body of disease (B). Certain cultural
child's oiled skin. The nurse should recognize practices that address illness may be considered abusive by another culture and
that this behavior is prompted by which cultural misunderstood by uninformed professionals. (A, C, and D) are not correct
belief? interpretations.
The child's behavior was not acceptable.
The purpose is to rid the body of disease.
This method is commonly used for discipline.
Temper tantrums are commonly managed
using this method.
14. The nurse is working in a community clinic that Skin testing for tuberculosis.
serves a population comprised mainly of Secondary prevention focuses on health promotion, which includes screening,
migrant families. In planning the use of early detection and diagnosis of disease. Among migrant families, tuberculosis
resources for secondary prevention, which rates are unusually high and should be a priority focus for secondary prevention
activity should be the priority? (A). Although (B, C, and D) are important screenings, the incidence and the risk for
Skin testing for tuberculosis. spread of tuberculosis is a priority in this population.
Glucose monitoring for diabetes.
Blood work for cardiovascular disease.
Height and weight for altered nutrition
15. Which topic should the nurse include in Suicide risks and prevention.
planning a primary prevention class for Primary prevention focuses on health promotion and prevention of injury and
adolescents? illness. Since suicide is a leading cause of death in adolescents, including (C) is
Risk factors for heart disease. essential. Health screenings and interventions are designed to increase the
Dietary management of obesity. probability of early diagnosis and treatment, so (A, B, and D) are important
Suicide risks and prevention. secondary prevention topics for adolescents.
Coping with stressful situations.
16. What action is best for the community health Follow agency protocols to report suspected abuse.
nurse to take if the nurse suspects that an
infant is being physically abused? Nurses are mandated to report all suspected cases of child abuse and neglect,
Follow agency protocols to report suspected and it is best to follow agency protocols to protect the nurse and child's safety
abuse. Correct (A). (B) is available for the general public, but in this case it is best for the
Report suspicions to the local child abuse community health nurse to follow the agency policy. While (C) can contribute to
reporting hotline. abuse and neglect, the situation warrants immediate action to protect the child
Educate the child's caregivers about growth and follow the law. (D) could jeopardize the safety of the nurse, the child, or
and development issues. others in the home.
Call the police department to have the child
removed from the home.
17. An occupational health nurse is Asthma.
reviewing a 20-year-old trend in the Lung cancer.
United States that has resulted in an
increase in certain medical conditions Asthma (A) and lung cancer (C) are triggered or worsened by airborne substances, such
due to the rapid expansion of an urban as tobacco smoke, ozone, and other particles and/or chemicals, so these conditions are
industrial workforce. Which medical specifically associated with the increase in urban industrial workforce growth.
conditions are specifically identified Alcoholism is a related condition (B), but it is not specifically associated with urban
with this trend? (Select all that apply.) industrialization. (D), while identified as a potential risk for workers in some urban
Asthma. industries, has not significantly increased in recent years, so it is not related to the
Alcoholism. expansion of urban industrial workplaces over the past 20 years. (E and F) are not
Lung cancer. related to the increase in the urban industrial workforce.
Lead poisoning.
West Nile virus infection.
Hepatitis B virus infection.
18. Which intervention should the public Design and implement a no smoking campaign at the local high school.
health nurse implement when The activity in (C) addresses reduced cigarette smoking by adolescents, which is the
attempting to address one of the focus of Tobacco use as a leading health indicator for Healthy People 2020. Regular
leading health indicators of Healthy exercise (A) is a leading indicator but it recommends daily exercise for 30 minutes a day,
People 2020? not weekly. (B and D) are not leading indicators of Healthy People 2020.
Lead a weekly water aerobics class for
the elderly at a community center.
Teach a class on cultural awareness to
nursing students at the university.
Design and implement a no smoking
campaign at the local high school.
Write a grant to help provide
glucometers to individuals who cannot
afford one.
19. A college student asks the nurse in the Apply the skin patch behind the ear 12 hours before your trip.
Campus Student Health Center about Medications used to control motion sickness must be taken prior to the onset of nausea
obtaining medication for motion and vomiting. They are most effective if taken 12 hours before (B) expected travel or
sickness before a scuba diving trip. What activity. (A, C, and D) do not describe correct administration procedures for prescription-
instruction should the nurse give the strength scopolamine (Transderm-V).
student regarding the use of
prescription-strength scopolamine
(Transderm-V)?
Take the oral preparation 30 minutes
before diving.
Apply the skin patch behind the ear 12
hours before your trip.
Use the medication at the first feeling of
nausea on the boat.
Apply a new skin patch every 6 hours to
the chest or abdomen.
20. *Delete* Malaria following exposure in a mosquito-infested area.
Malaria contracted from a biting mosquito is an example of a vector-related, indirect
transmission of the disease (C). Indirect transmission of an infectious disease involves the
spread of infection through an intermediate source, such as vehicles, fomites, or vectors.
(A, B, and D) are examples of direct transmission, defined as the spread of an infection
through person-to-person contact and is characterized by portals of exit and entry.
21. The multidisciplinary home health care team is Assign a home health care aide to provide care daily.
discussing a female client diagnosed with Parkinson's The nurse should first ensure the client's safety by providing assistance
disease. The home health care nurse reports the client is in the home (B), which will help both the client and her husband until
getting worse and her husband is no longer able to care other arrangements can be made. A chaplain (A) provides spiritual
for her in the home. Which action should the home guidance. social After assigning home health care, the nurse should
health nurse implement first? discuss possible options for care, such (C or D).
Request a chaplain to counsel with the couple.
Assign a home health care aide to provide care daily.
Talk to the husband about placing his wife in a nursing
home.
Contact the client's children to discuss the situation.
22. The nurse is preparing to discharge an elderly, recently Meals-on-Wheels.
widowed female client following a mild stroke. At this
time she is able to walk with the aid of a walker. As part Since this client lives alone and uses a walker, food preparation is a
of the discharge planning, what referral is most potential problem, so Meals-on-Wheels (B) is a needed referral. (A)
important for the nurse to make? might be indicated, but does not have the priority that adequate
Pastoral care. nutrition does. Even though the client is "recently widowed," (C and D)
Meals-on-Wheels. do not have the priority of (B) at this stage of her recovery.
Grief support group.
Physical therapy.
23. *Delete* African-American ethnicity.

The client's previous history of a LBW infant and the non-modifiable risk
factor of ethnicity are the most important risk factors for this pregnancy
because the incidence of (LBW) infants is twice as high for African-
American (B) births than Caucasian births. The modifiable risk factors of
(A, C, and D) are related to infant morbidity, but (B) is most important
because it is non-modifiable.
24. A young woman tells the public health nurse that a Have you shared any needles or had sex with your friend?
friend was recently diagnosed with Hepatitis B and she
is concerned about getting the disease. During the Hepatitis B virus is transmitted by sharing needles or unprotected sex,
assessment interview, which question is most important so (C) is the most important question for the nurse to ask this young
for the nurse to ask this woman? woman. Hepatitis A is transmitted by (A). The incubation period for
Did you drink after or use any utensils that your friend Hepatitis B is 75 days, so (B and D) are not priority questions at this
used? time.
Have you noticed any yellowish tinge to the whites of
your eyes?
Have you shared any needles or had sex with your
friend?
How long ago was your friend diagnosed with Hepatitis
B?
25. During a home health visit, a male client reports Schedule an appointment with the healthcare provider for prompt evaluation.
to the nurse that he felt a solid testicular mass
during self-exam, but that it wasn't painful. What A painless testicular mass is an abnormal finding, and the nurse should instruct
instruction should the nurse provide the client? the client to obtain prompt medical evaluation (C). (A, B, and D) place the client
Continue to monitor the mass until the next at risk, since they do not emphasize prompt medical evaluation.
scheduled annual medical exam.
Notify the healthcare provider if the mass
becomes soft, painful, or starts to drain.
Schedule an appointment with the healthcare
provider for prompt evaluation.
Testicular nodules are of concern only if they
feel matted or are not easily movable.
26. A 12-year-old female is seen by the school Gather additional data by taking a health history and measuring vital signs.
nurse after recently experiencing increasing
difficulty sitting still and paying attention in Based on the available data, the child may have hyperthyroidism (Graves
class, and increasingly illegible handwriting. The disease). The nurse should gather additional data (C) that may help confirm this
nurse observes that the child has protruding suspicion. (A or D) are premature actions at this time. Once additional data are
eyeballs and a staring expression. What action collected, a call to the parents is warranted (B).
should the nurse take next?
Refer the child for psychologic evaluation due
to attention deficit disorder.
Call the child's parents to schedule the child for
an immediate medical exam.
Gather additional data by taking a health history
and measuring vital signs.
Collaborate with the teacher to place the child
on a behavior modification program.
27. Lillian Wald was a significant person in the Development of public health nursing practice.
history of American nursing. Which First nursing service for occupational health.
contributions can be attributed to her? (Select Instituted a sliding scale fee for service.
all that apply.) Established committee that was the forerunner of the NLN.
Development of public health nursing practice.
First nursing service for occupational health.
Campaigned for laws to require registration for (A, B, D, and E) are correct. Lillian Wald is known mostly for her work in public
nurses. health (A) but she also developed the first nursing service for occupational
Established committee that was the forerunner health (B). She also established a committee -- The Associated Alumnae of
of the NLN. Training Schools for Nurses -- which later developed into the ANA and the NLN
Instituted a sliding scale fee for service. (D). In her work for occupational health, she instituted a sliding scale fee for
service (E). She advocated for Women's Rights, but had no significant input into
making nursing registration mandatory (C).
28. A male client is brought to the Wearing a helmet or not is certainly an individual decision.
emergency department as the result of a
motorcycle accident. He was not
wearing a helmet at the time of the Within the framework of the TTM, the client's comment indicates that he is in the pre-
accident, and states that he has no contemplation stage where he is not even considering change. By responding with (A),
intention of ever wearing one. Within the the nurse allows the client to express feelings and diffuses the strength of the response.
framework of the Transtheoretical Model (B, C, and D) are likely to make the contemplator more hostile and resistant to change.
(TTM), which response should the nurse
provide?
Wearing a helmet or not is certainly an
individual decision.
You should seriously consider wearing a
helmet.
Riding a motorcycle with a helmet
increases your safety.
I really think you don't have the facts
about helmet use
29. *Delete* The person, the environment or situation, and health.

Nursing theories serve to describe, explain, predict, or prescribe nursing care measures.
Any science has a domain, which is the view or perspective of the discipline. The
elements of nursing's paradigm direct the activity of the nursing profession, including
knowledge development, philosophy, theory, educational experience, research, practice,
and literature identified with the profession. Nursing identified its domain in a paradigm
that includes four linkages: the person, health, environment/situation, and nursing (A). (B,
C, and D) are not linkages of the domain.
30. A terrorist attack has occurred and Provide supportive nursing care until antitoxin is available.
several people have inhaled Ricin. Which
intervention should the emergency Production of the Ricin antitoxin involves immunizing sheep with inactive ricin, which
department nurse implement when results in the production of antibodies that are harvested to produce a freeze-dried
caring for these clients? product for reconstitution and injection for victims exposed to Ricin poisoning. Although
Administer the antibiotic streptomycin, the antitoxin is ready to be manufactured, full licensing is likely in 5 years (2014).There is
IV STAT. no known cure or treatment for Ricin exposure so supportive care (D) should be
Provide all clients with the Ricin antidote. provided until the antitoxin is available. (A) may be administered for secondary
Implement strict respiratory isolation infections but is not a treatment for Ricin exposure. (B) does not exist at this time. Ricin
immediately. does not have person-to-person transmission, so (C) is not necessary.
Provide supportive nursing care until
antitoxin is available.
31. *Delete* Conduct a windshield survey of the geographic areas served by the school

The windshield survey (the nurse drives through neighborhoods viewing homes, stores,
churches, air quality, etc.) (D) gives the nurse the best initial overview of the children
and a sense of their community. (A, B, and C) provide information about some of the
children and parents, but are not as comprehensive as the windshield survey.
32. *Delete* Census data.
Risk management data.
Budgeting process information.
Client-satisfaction surveys.
Changes in the community's demographic data.

Census data (A), risk management data (B), budgeting process information (C), data obtained from
client-satisfaction surveys (E), and changes in the community's demographic data (F) provide pertinent
data for planning for the current and future healthcare needs of the community. Available workforce (D),
although a concern, is not a factor in quality-assurance directives.
33. The nurse is designing a Pneumonic plague.
bioterrorism plan for a Smallpox.
community. Which agents
are transmitted person to Correct selections are (B and E). The pneumonic plague (B) can be transmitted person to person via
person via respiratory or respiratory droplets. Smallpox (E) can produce aerosolized droplets of ruptured pock marks in the
inhalation exposure? buccal cavity, thus aerosolizing the virus and causing respiratory transmission. (A) is a biological toxin
(Select all that apply.) that is not transmitted person to person. (C) can be spread by respiratory transmission from an exposure
Ricin. source, but is not transmitted person to person (communicable). (D) is a biological toxin commonly
Pneumonic plague. associated with food-borne or ingestion exposures, but is not communicable. (F) is found in livestock,
Anthrax. but is not communicable.
Botulism.
Smallpox.
Brucellosis.
34. Which example should the A community has adopted a no smoking policy.
nurse identify as a
significant outcome for Environmental quality and tobacco are two of the 12 leading indicators of Healthy People 2020 that are
the Leading Health addressed by a community that adopts a no smoking policy (A), which reduces secondary smoke
Indicators of Healthy exposure of children as well as impacting Air Quality Index (AQI). Although (B and C) are indirectly
People 2020? related to other indicators of Healthy People 2020 , such as access to health services and social
A community has adopted determinants (high school graduation), the most significantly related outcome is a community wide no
a no smoking policy. smoking policy. (D) is unrelated to Healthy People 2020 .
A rural community has a
public transportation
system.
The high school drop out
rate has decreased by
15%.
A county has decreased
their divorce rate by 10%.
35. *Delete* Most of the clients are unemployed or disabled.
Access to mass transit may be an issue.
Basic physiologic needs of this population are often unmet.

Correct choices are (A, B, and D). The unemployed or disabled will likely comprise a majority of this
clinic's clients (A); the lack of access to mass transit may affect the population's ability to keep health
care appointments (B); and low-income clients are at risk for basic physiologic needs being left unmet
(D). Most clients are not likely to have health insurance (C) because they lack the funds to pay the
insurance premiums. Homebound status is not a defining qualification for public assistance, such as
Medicaid (E). To state that a low-income population is more likely to be non-compliant with healthcare
recommendations is an example of stereotyping (F).
36. Attendance at a community health clinic is rising Submit a written proposal to the Board of Directors about hardware and
and clients have long waits for service. The software improvement needs.
charge nurse believes that a computer system
would be helpful in decreasing the time needed Submitting written information to the Board will give Board members the
to conduct intake and exit processing. What is opportunity to review the proposal (C) and is the best method of introducing the
the best way for the nurse to introduce the idea idea. (A) is dismissing responsibility to the medical director. (B) is disrespectful to
of obtaining a computer system for the clinic? the Board, by not first presenting the idea to the Board. (D) is manipulative.
Ask the medical director to talk to the Board of
Directors about obtaining funds to implement a
computer system.
Send a signed letter to the editor of the local
newspaper describing the benefits to the
community.
Submit a written proposal to the Board of
Directors about hardware and software
improvement needs.
Meet informally with some Board members to
enlist their support for the idea of implementing
a computer system.
37. A nurse working in a community health setting A 17-year-old who is sexually active with numerous partners.
is performing primary health screenings. Which
individual is at highest risk for contracting an (A) is at greatest risk for developing sexually transmitted diseases, including HIV,
HIV infection? because the greater the number of sexual partners one has, the greater the risk
A 17-year-old who is sexually active with for contracting STDs. (B) represents the group with the lowest number of infected
numerous partners. persons because there is little transfer of body fluid during sexual acts. (C)
A 45-year-old lesbian who has been sexually would not be sharing needles, so contracting STDs is not necessarily a risk. A
active with two partners in the past year. male homosexual in a monogamous relationship has a decreased risk of
A 30-year-old cocaine user who inhales the contracting HIV--as long as BOTH partners are monogamous and neither is
drug and works in a topless bar. infected (D).
A 34-year-old male homosexual who is in a
monogamous relationship.
38. *Delete* Impaired physical mobility related to muscle rigidity and weakness.

Parkinson's disease is a progressive neurologic disorder affecting the brain

centers that are responsible for control and regulation of movement. The chief
clinical manifestations are impaired movement, muscular rigidity, resting tremor,
muscle weakness, and loss of postural reflexes (A). Depression and dysfunction
are appropriate nursing diagnoses but are not the primary diagnosis (B). Client's
with Parkinson's usually do not experience (C or D).
39. *Delete* Thinning of the skin with loss of elasticity.

Thin, non-elastic skin (C) is an important factor in decubitus formation.

Proportion of body fat to lean mass increases with age (A), and might help
decrease ulcer tendency. (B) results in grey hair. (D) can contribute to broken
bones, but it is probably not a factor in decubitus formation.
40. When asked to help develop Set goals that are focused on developing healthier lifestyles.
interventions to combat obesity among
children, the community health nurse Setting goals focused on healthy lifestyles that include good nutrition, healthy food
should stress the importance of choices, and regular physical activity (A) is helpful in managing childhood obesity. (B) is
implementing which activity? not appropriate for school-aged children. The focus should be on increasing activity and
Set goals that are focused on making healthier food choices. (C) may make the children more self-conscious about their
developing healthier lifestyles. weight. Physical activities should be geared to things that will promote lifetime activities,
Develop strict diet plans for school- not (D), which might not appeal to all children.
aged children.
Provide diet classes for the obese
children during school hours.
Require all children to participate in
organized team sports.
41. *DDelete* Primary prevention.

Primary prevention (A) involves activities that focus on reducing the potential for illness
before it occurs, such as immunizations. Tertiary prevention (B) minimizes the
consequences of a disorder or illness through aggressive management or rehabilitation.
Secondary prevention (C) includes early diagnosis and implementing interventions aimed
at a cure or reducing the progress of a disease. Primary nursing (D) describes a method
of nursing management and nursing care assignments, not a healthcare strategy.
42. The nurse is teaching a community A male with a low-density lipoprotein (LDL) level of 200 mg/dl.
group about risks of cardiovascular
disease. Several clients ask the nurse The risk factors for cardiovascular disease include nonmodifiable variables, such as
to determine their risk. Which client gender, family history, and race, and modifiable variables, such as underlying diseases
should the nurse identify as having the (hypertension, diabetes mellitus, hyperlipidemia, and obesity, smoking, sedentary lifestyle,
greatest risk for cardiovascular and stress). Laboratory results that support these risk factors include elevated LDL and
disease? serum cholesterol levels, so (C), being male, has a higher risk than (D). (A and B) have
A male with a serum cholesterol level borderline results.
of 199 mg/dl.
A female with a serum cholesterol
level of 201 mg/dl.
A male with a low-density lipoprotein
(LDL) level of 200 mg/dl.
A female with a low-density-
lipoprotein (LDL) level of 160 mg/dl.
43. *Delete* Suicide risks and prevention.

Primary prevention focuses on health promotion and prevention of injury and illness.
Since suicide is a leading cause of death in adolescents, including (C) is essential. Health
screenings and interventions are designed to increase the probability of early diagnosis
and treatment, so (A, B, and D) are important secondary prevention topics for
adolescents.
44. The nurse is planning a community- Within 2 years, students with a body mass index greater than 95% will be reduced by 50%.
based project to reduce obesity in
a school-aged population. Which Goals are intended to be expressed in specific outcomes that provide direction toward
outcome statement best supports interventions and determine change in measurable terms. Outcome statements include past or
the goal for this population? present events with specific quantitative expectations with a time frame, so (C) supports these
Increase in exercise will decrease specific terms. (A, B, and D) are not as specific as (C).
obesity in children with a
sedentary life style.
Students with a body mass index
above the 95 percentile will
decrease.
Within 2 years, students with a
body mass index greater than 95%
will be reduced by 50%.
In the target population, 30% of
students will be below the 95
percentile in weight
45. The home health nurse is planning Schedule home visits that take place during the daylight hours.
a visit with a client who has been
discharged home after a To ensure safety of the client and the nurse, home visits should be scheduled during daylight
hospitalization. Which action should hours (B). The nurse practice act requires the nurse to wear an identification name tag during
the nurse implement? client care which also provides clear role expectations (A) for the client. Making visits with
Avoid creating barriers by wearing another home care provider (B) provides an opportunity for the nurse to evaluation and
a name tag in the home. coordinate care (C). (D) is not necessary.
Schedule home visits that take
place during the daylight hours.
Ensure HIPAA laws are observed
by avoiding visits with other home
care providers.
Use a duplicate copy of the client's
record to provide concurrent
services.
46. *D* Skin testing for tuberculosis.
Secondary prevention focuses on health promotion, which includes screening, early detection
and diagnosis of disease. Among migrant families, tuberculosis rates are unusually high and
should be a priority focus for secondary prevention (A). Although (B, C, and D) are important
screenings, the incidence and the risk for spread of tuberculosis is a priority in this population.
47. *Delete* The purpose is to rid the body of disease.

Coining, a Vietnamese practice, may produce welt-like swellings from rubbing a coin
lengthwise on oiled skin to rid the body of disease (B). Certain cultural practices that address
illness may be considered abusive by another culture and misunderstood by uninformed
professionals. (A, C, and D) are not correct interpretations.
48. Which topic should the nurse Vision and hearing screening
include in planning a secondary
prevention project for the local Health screenings (D) are the mainstay of secondary prevention, which focuses on health
retirement community? promotion, which includes screening, early detection and diagnosis of disease. (A and B) are
Safety measures in the home. primary prevention topics which include health-promoting activities designed to reduce the
Adult immunization program. likelihood of a specific illness occurring. Tertiary prevention includes interventions aimed at
Rehabilitation after surgery. disability limitation and rehabilitation (D) from disease, injury, or disability.
Vision and hearing screening