NR-442 Community Health Nursing - Set 4 - Part 1

Correct Answer: Your daughter may finish the day and return tomorrow

No nit policies are not recommended, and lice do not warrant exclusion. The child finishes the school day, is treated that evening with a product used as labeled, and returns after treatment has started. Option a is incorrect because lice cannot survive long away from a human scalp. Routine cleaning, washing recently used bedding and clothing in hot water, and vacuuming are enough, so fumigation adds cost and chemical exposure without benefit. Option b is incorrect because nits remain cemented to the hair long after they are no longer viable. Requiring a nit free head keeps a child out of class for days without reducing spread in the school. Option d is incorrect because head lice are a human parasite that lives on the scalp. Transmission is mainly head to head contact between children, and blaming the family dog sends parents toward a useless intervention.

Correct Answer: Ask privately about school experiences and peer relationships

Repeated somatic complaints with a normal examination and avoidance of an unstructured setting like lunch are a recognized bullying presentation. The nurse asks directly and privately about peers, safety, and what happens during the school day. Option b is incorrect because rationing visits treats the pattern as a nuisance instead of a signal. The frequent visitor is telling the nurse something, and a quota removes the only place the child feels safe. Option c is incorrect because assessment precedes any decision to send a child back. Sending the student out without asking why the visits keep happening leaves an unexamined cause, whether that is anxiety, bullying, or trouble at home. Option d is incorrect because medical testing skips the psychosocial history that the pattern points toward. Referral remains available if symptoms change or findings appear, but nothing so far suggests a gastrointestinal disease process.

Correct Answer: The occupational therapist for adaptive bathing equipment

The occupational therapist addresses activities of daily living, adaptive equipment, and home modification, which is exactly what bathing and dressing difficulty in an unmodified bathroom requires. Grab bars and tub aids fall in that scope. Option a is incorrect because gait and balance are already adequate for walking with a device. Physical therapy targets mobility, strength, and transfers, and this client's barrier is self care rather than ambulation. Option b is incorrect because no financial, housing, or counseling problem has been described. Social work enters when insurance, placement, resources, or suspected neglect are at issue, none of which appears in this picture. Option d is incorrect because nothing suggests a nutrition problem such as weight loss, dysphagia, or a therapeutic diet the client cannot follow. A dietitian would add a visit without touching the stated barrier.

Correct Answer: A federally qualified health center with sliding fees

A federally qualified health center sits in a medically underserved area, uses a sliding fee scale, cares for people regardless of ability to pay, and answers to a patient majority governing board. Option b is incorrect because emergency departments treat episodes rather than manage health over time, and the bill that follows often exceeds what she was avoiding. Continuity, screening, and prevention are what she actually lacks. Option c is incorrect because a payment plan still assumes she can pay the full charge eventually. Specialty practices set no fee by income, so the barrier that kept her away remains firmly in place. Option d is incorrect because a home health referral requires homebound status, provider care, and a skilled need. This woman needs an accessible source of primary care, which is a different thing entirely.

Correct Answer: Leave the daily itinerary with the agency office

Leaving the itinerary with the agency means someone always knows where the nurse is and when she is due back. It allows the agency to act quickly if the nurse fails to check in. Option a is incorrect because a purse invites theft and occupies a hand the nurse needs free. Agency identification should be worn and visible, and keys belong in the hand while walking to the door. Option b is incorrect because poor lighting is exactly what field safety guidance warns against. The car belongs in a lit spot near the entrance, facing the direction of exit, with nothing of value visible. Option d is incorrect because higher risk areas are visited earlier, while daylight and foot traffic are on the nurse's side. Pushing those visits to the end of the day reverses the recommendation.

Correct Answer: Ergonomic hazard from repetitive manual lifting

Ergonomic hazards arise from a mismatch between the task and the worker's body. Repeated lifting from floor level with forceful exertion and awkward posture produces musculoskeletal disorders such as low back injury. Option b is incorrect because physical hazards involve energy coming from the environment, such as noise, vibration, heat, radiation, or a fall. Students misfile lifting here, but nothing external is delivering energy to the worker. Option c is incorrect because a chemical hazard requires a solid, liquid, gas, vapor, dust, fume, or mist that enters the body. Cardboard and tape in a warehouse carry no such exposure in this report. Option d is incorrect because production pressure would be psychosocial, and the reports describe the lift itself rather than the pace or the schedule. Quotas can worsen the ergonomic risk, but the named exposure is the load.

Correct Answer: A heart failure visit two weeks before admission

The encounter must occur no more than ninety days before the start of care or within thirty days after it, and must relate to the primary reason for home health. This visit meets both tests. Option a is incorrect because the look-back window closes at ninety days. An encounter four months old predates the allowed period, so it cannot support the certification even though the diagnosis matches. Option b is incorrect because only thirty days are allowed after the start of care. Students often reverse the two windows, since you may look back a long way but only a short way forward. Option c is incorrect because relatedness is a separate test from timing. An encounter falling inside the window still fails when it addresses something other than the condition driving the need for home health.

Correct Answer: Places a clean barrier under the bag first

The bag rests on a clean, hard, dry surface over a barrier the nurse brings, never on the floor, a bed, or upholstery. The barrier protects the bag's clean interior from a contaminated environment. Option a is incorrect because upholstery cannot be cleaned or disinfected and a cat has been lying on it. Soft furnishings, beds, and floors are all excluded surfaces for the nursing bag. Option b is incorrect because every entry into the bag is another chance to carry contamination inside. The nurse removes everything anticipated at once and performs hand hygiene before any later reach into it. Option d is incorrect because the inside of the bag is clean territory. Anything that touched the client or the environment stays out until it has been cleaned and disinfected, or it is discarded.

Correct Answer: The chaplain or spiritual care counselor

Existential distress about meaning is spiritual suffering, and the chaplain or spiritual care counselor is the team member prepared to explore it. The nurse still stays present and supports the client between those visits. Option a is incorrect because dietitians address therapeutic diets, malnutrition, and enteral nutrition. Food is not the source of this man's distress, and a nutrition consult would leave his actual question unanswered. Option b is incorrect because no medication treats a search for meaning. Reaching first for a drug review medicalizes spiritual pain and risks sedating a client who is asking to be heard. Option c is incorrect because bereavement counseling serves survivors, chiefly after the death, though anticipatory grief work may begin earlier. The person needing care right now is the client himself, not the family.

Correct Answer: The functional limits and the accommodation needed

The employer is entitled to fitness for duty information, work restrictions, and accommodation needs, and nothing more. Employee health records are kept separate from personnel files, and the diagnosis stays with the nurse and the worker. Option b is incorrect because a diagnosis is protected health information the supervisor has no need to know. Releasing it exposes the worker to judgment about a condition that has no bearing on scheduling the modified task. Option c is incorrect because laboratory results belong in the confidential health record rather than in a supervisor's hands. Raw findings also invite untrained interpretation, and a manager reading them could draw a conclusion the nurse never made. Option d is incorrect because prescribed treatment is clinical detail with no bearing on job placement. What the supervisor actually needs is how much the worker can lift and for how long, which the restriction already states.

Correct Answer: "You are protected by law from employer retaliation."

Workers have the right to request an OSHA inspection, speak to the compliance officer, and receive hazard information, and the Act protects them from retaliation for exercising those rights. Fear of firing should not silence a hazard report. Option a is incorrect because the right to request an inspection belongs to the employee directly. Routing every complaint through management would hand the employer a veto over the very reports OSHA depends on. Option c is incorrect because no waiting period stands between a worker and a complaint. An unguarded machine violates OSHA's specific machine guarding standard and is citable immediately, so months of documentation only leave the amputation risk in place. Option d is incorrect because nothing in the worker's rights requires his name be handed to the employer. Framing the report that way feeds the fear of reprisal that the Act's protection against retaliation exists to remove.

Correct Answer: Revoke the hospice benefit at any time

A hospice client may revoke the benefit at any time, resume curative treatment, and elect hospice again later. Revocation is the client's decision and requires no waiting period, court involvement, or intermediate enrollment step. Option a is incorrect because benefit periods govern recertification of the prognosis, not the client's freedom to leave. Nothing obliges a client to finish a ninety day or sixty day period before revoking. Option b is incorrect because hospice is elected voluntarily and left voluntarily. No legal process stands between the client and her decision; she signs a revocation statement and returns to standard Medicare coverage. Option d is incorrect because home health serves clients working toward recovery and independence and is not a required stepping stone. Enrollment there would delay the trial she wants without adding any benefit.

Correct Answer: Reinstruct the child and retest the same session

A failed screen is rechecked before it becomes a referral. Poor instruction, headphone position, and inattention explain many failures, so the nurse reinstructs, repositions the headphones, and retests in the same session before any referral. Option b is incorrect because referring on a single failure sends children with correctable technique problems into unnecessary evaluation. The rescreen comes first, and referral follows only when the child fails the repeat testing. Option c is incorrect because a pass requires a response at every test frequency in both ears. One missed frequency in either ear is a fail, and recording a normal result hides a possible hearing loss. Option d is incorrect because audiologic evaluation belongs later in the sequence. Middle ear fluid causes many school failures and often resolves, which is why a delayed rescreen precedes the appointment when a second attempt also fails.

Correct Answer: Refer the member for skilled home health services

The faith community nurse does not provide hands on clinical care. The role is health promotion, education, counseling, referral, advocacy, and spiritual support, so linking the member to skilled services is the correct use of it. Option a is incorrect because dressing changes, injections, and medication administration sit outside this role no matter who pays. Working without compensation does not widen a scope that the specialty deliberately drew narrow. Option b is incorrect because a nurse who trains lay volunteers does so for nonclinical support such as visiting and transportation. Delegating sterile wound care to an untrained congregant would endanger the member. Option c is incorrect because the liaison function exists for exactly this situation. Saying nothing can be done abandons a member when the nurse could connect the family to agencies, charity care, and community resources.

Correct Answer: "Required protective equipment must be provided at no cost."

Under OSHA the employer must provide the personal protective equipment required for the hazard at no cost to the worker, ensure it fits, train on its use, and maintain and replace it. Option a is incorrect because gloves matched to the chemical are required equipment, not an optional accessory. Charging for them shifts a legal duty onto the worker and predictably reduces how often the gloves get used. Option c is incorrect because a receipt process still starts with the worker paying. It also lets the worker choose a glove material that may not resist this particular chemical, which is the selection decision the employer owes. Option d is incorrect because praising the workaround leaves the violation in place. The worker's initiative is real, yet the nurse's job here is to correct a company practice that is putting the whole crew at risk.

Correct Answer: Analyze the essential functions of available jobs

Matching restrictions to work requires an essential job function analysis. The nurse compares what the worker can safely do against the tasks each job demands, which is what makes a transitional or modified duty assignment possible. Option b is incorrect because prolonged time away worsens outcomes. Deconditioning, lost income, and a shrinking chance of ever returning follow long absences, which is why early safe return on modified duty is the goal. Option c is incorrect because the supervisor receives functional limitations and accommodation needs, never the medical diagnosis. Employee health records stay separate from personnel files, and disclosing the condition would breach confidentiality the nurse owes the worker. Option d is incorrect because sending someone back to unrestricted lifting ignores the written limits and invites reinjury. Return to work is meant to be graduated, with the assignment adjusted until full duty is safe.

Correct Answer: Offer the vaccine series now at no cost

The bloodborne pathogens standard requires hepatitis B vaccination to be offered free within ten working days of initial assignment to employees with occupational exposure. The offer is overdue, so the nurse makes it now. Option a is incorrect because a declination form documents a refusal the technician never made. Recording a decline she was never given the chance to consider would paper over the employer's failure to make the offer. Option b is incorrect because the vaccine is an employer obligation, provided at no charge to the worker. Sending her elsewhere shifts the cost to her and adds a delay while she works around blood every shift. Option c is incorrect because annual training and the vaccination offer are separate requirements on separate clocks. Holding the series for a training date extends an exposure window that has already run past its deadline.

Correct Answer: Assess for urinary retention and fecal impaction

Terminal restlessness demands a search for a reversible cause first, and this man has two obvious candidates in retention and impaction. Treating the cause relieves the agitation without adding a sedating medication. Option a is incorrect because benzodiazepines treat anxiety but can worsen delirium in older adults. Reaching for one before the bladder and bowel are checked risks sedating a man whose distress has a fixable source. Option b is incorrect because restraint is the opposite of what terminal agitation calls for. Removing restraints and unnecessary tubes is part of the nursing response, and physical restriction usually escalates the struggling. Option d is incorrect because familiar voices and a calm presence settle a restless client rather than agitate him. Clearing the room strips away the reassurance he needs and still leaves the cause unexamined.

Correct Answer: "Label the spray bottle with the product and hazards."

The hazard communication standard requires each workplace container to carry the product identifier and hazard information. Its only exemption covers a portable container for the immediate use of the worker who fills it, which this bottle is not. Option a is incorrect because a label posted on a wall travels nowhere with the bottle. The custodian carries that container through the building, and anyone who picks it up has no way to identify the contents. Option c is incorrect because the immediate use exemption is narrower than a whole shift. A bottle mixed for daily use and carried through the building fails that test, and its contents stay unknown to anyone who finds it. Option d is incorrect because separate storage addresses incompatibility between chemicals, a different problem entirely. Segregating the bottle solves nothing about identification, which is the gap the standard was written to close.

Correct Answer: The quota that rewards working faster

Environment covers everything surrounding the host and agent interaction, including the organizational climate. A production quota that rewards speed is part of that climate, shaping how workers perform the task and how willing they are to report. Option b is incorrect because the overhead reach is the agent, the hazardous element that delivers harm. Naming it as environment blurs the distinction the triad exists to make between the hazard and its surroundings. Option c is incorrect because the host is always the worker. Inexperience, age, fitness, prior injury, and fatigue are host characteristics, and a new hire without training sits squarely in that category. Option d is incorrect because tendinitis is the outcome the investigation is trying to explain, not one of the three elements. Placing the injury inside the triad leaves the nurse with nothing left to change.