NR-442 Community Health Nursing - Set 5 - Part 2

Correct Answer: Direct arriving families to the registration line.

Moving people to the correct line is a nonclinical task that needs no assessment or judgment, and throughput is the operational problem at a dispensing site. The nurse keeps screening, teaching, and clinical decisions. Option a is incorrect because screening for allergies and contraindications is an assessment that determines whether a person may safely receive the medication. That judgment belongs to a licensed nurse and cannot be handed to a volunteer. Option c is incorrect because teaching is a nursing responsibility, and adherence to the full course is the main problem after a mass dispensing event. A volunteer cannot answer the questions that follow such teaching. Option d is incorrect because selecting an alternate antibiotic requires clinical evaluation of the person's history and current medications. Standing orders let the nurse dispense, yet any deviation from them goes back to the prescriber.

Correct Answer: Obtain the client's signed authorization before releasing any diagnoses.

A housing authority and a job training program are not treating providers, so the treatment exception does not reach them. Disclosure to a nonclinical partner needs the client's signed authorization naming what is released and to whom. Option a is incorrect because coordination alone does not make a partner a treating provider. The treatment exception covers clinicians delivering care, and stretching it to social service agencies would empty the authorization requirement of meaning. Option b is incorrect because trimming the amount disclosed does not create the permission to disclose. Minimum necessary limits how much travels once a disclosure is lawful. It does not authorize a release that requires the client's signature. Option d is incorrect because cutting off partners harms the client the nurse is trying to help. Housing and employment are powerful determinants of health, and the correct move is to obtain permission rather than to end the collaboration.

Correct Answer: Create a reason to interview the woman alone

Assessment for mistreatment is valid only when the older adult is alone. Creating a routine clinical reason to separate them lets the nurse screen privately without alerting the son or increasing risk to the woman. Option b is incorrect because questioning the accompanying person about an injury is confrontation, not assessment. It signals suspicion to the one adult who controls the woman's access to care and to the outside. Option c is incorrect because a report is required but must not be made where the suspected abuser can overhear it. Warning him first can bring retaliation before any protective service reaches the home. Option d is incorrect because documenting alone changes nothing about the woman's safety today, and postponing the private conversation gives up the one opportunity the nurse has while inside the home.

Correct Answer: Bruising over the buttocks and inner thighs

Accidental injury clusters over bony prominences such as knees, shins, and elbows. Bruising in areas protected by clothing and rarely struck in a fall points toward inflicted injury and requires a report. Option a is incorrect because scraped knees with ground debris fit exactly the event the child described. The finding matches the stated mechanism, which is the test that separates ordinary childhood injury from concern. Option c is incorrect because shins take the impact in almost every childhood tumble. Bruises there are so common in mobile children that they are the baseline against which suspicious patterns are judged. Option d is incorrect because a healing scab on an elbow reflects a minor injury from days earlier, a routine finding in a school-age child. One old superficial mark carries no pattern to interpret.

Correct Answer: Collect the containers clients brought and list them

Gathering the brown bag containers and writing down what the client brought is a standardized clerical task with a predictable outcome, so it falls within the scope of unlicensed assistive personnel. Option a is incorrect because matching a drug against the Beers Criteria requires pharmacologic knowledge and nursing judgment about the individual client, which is assessment and cannot be handed to unlicensed staff. Option b is incorrect because client teaching is a licensed nursing responsibility. Assistive personnel may reinforce information the nurse already gave, but they cannot originate instruction about how a regimen should be timed. Option c is incorrect because choosing what to raise with a prescriber is an evaluation step resting on clinical reasoning. Delegating that decision would place a judgment call outside the delegate's legal scope.

Correct Answer: Ask about the practice and assess further

Traditional healing practices can leave marks that mimic inflicted injury. The nurse asks about the origin of the marks and assesses the child's whole picture rather than assuming either maltreatment or innocence. Option a is incorrect because a report requires reasonable suspicion, and here the marks match an explanation the mother gave freely in a well, playful child. Reporting without that basis is not what the standard asks. Option b is incorrect because condemning a family practice ends the conversation and the relationship. Cultural humility means asking first, then teaching about safer alternatives if the practice actually poses harm to the child. Option d is incorrect because imaging is ordered when findings and history conflict or when a young child has unexplained injury. Skipping straight to a workup treats an explained finding as though no explanation existed.

Correct Answer: A yellow-tagged client whose respirations now exceed thirty

Triage tags are a snapshot, and casualties deteriorate. Respirations above thirty upgrade this client to immediate, and shock that responds to rapid intervention offers the greatest survival benefit for the resources spent. Option a is incorrect because bleeding from a wrist laceration is controlled with direct pressure in seconds and does not threaten life. Minor injuries wait, and green-tagged survivors are often recruited to assist responders. Option c is incorrect because agonal gasping with hypotension marks a casualty whose survival is unlikely with the resources at hand. Comfort measures are provided, and reclassification occurs only if the resource picture improves. Option d is incorrect because pain, however distressing, does not signal physiologic deterioration. Delayed casualties tolerate hours of waiting without significant harm, so this client stays behind anyone whose vital signs have actually worsened.

Correct Answer: Possible trafficking of this client

A companion who keeps the client's documents, speaks for her, and will not step away is a recognized trafficking indicator. Control of identification and of the encounter itself is the signal the nurse notes. Option a is incorrect because a language need is met by a professional interpreter, never by the accompanying person. Holding a client's documents is a control behavior, not a communication problem. Option b is incorrect because family members do commonly attend visits in many cultures, yet keeping a person's papers and blocking a private conversation falls outside ordinary accompaniment in any culture. Option c is incorrect because a client with anxiety chooses her own support person and can still speak for herself. Here another adult is controlling the documents and the answers, which points somewhere different.

Correct Answer: They fall only when several parts of the system work.

A woman survives childbirth only if antenatal care, a skilled attendant, transport, a stocked facility, and a working referral chain all hold. Because failure at any link raises deaths, these rates act as sentinel indicators of system function. Option a is incorrect because ease of counting is not why these measures are used. Vital registration is incomplete in many of the places where these deaths concentrate, and the figures are estimates built on uneven reporting. Option b is incorrect because these rates track mothers and young children rather than adult inpatient care. Much of the mortality happens outside hospitals altogether, in homes and on the way to a facility that could not be reached. Option d is incorrect because the leading causes are largely preventable or treatable. Hemorrhage, infection, hypertensive disorders, preterm complications, and pneumonia respond to available care, which is why access rather than inheritance drives these deaths.

Correct Answer: High mortality with major public health impact

Category A agents threaten national security, spread easily or move person to person, carry high mortality with major public health impact, and can cause panic, so they demand special preparedness action. Option b is incorrect because moderate morbidity paired with low mortality defines Category B. Those agents need enhanced laboratory diagnostic capacity and surveillance, but they lack the lethality that drives the highest priority designation. Option c is incorrect because emerging pathogens with future potential belong in Category C. The concern there is what an organism could become, not the immediate national security threat that Category A already represents. Option d is incorrect because limited spread is the opposite of what earns Category A status. Ready transmission between people, together with high mortality, is exactly what places an organism in this group.

Correct Answer: An unlit hallway cluttered with boxes

Poor lighting and clutter on the path between the bed and the bathroom are the classic setup for a nighttime fall, and both are correctable with a night light and a cleared walkway. Option a is incorrect because a raised toilet seat lowers the effort of standing from a low surface. It is a fall prevention device rather than a hazard contributing to the falls described. Option c is incorrect because keeping a phone within reach at the bedside is recommended so help can be summoned after a fall. Nothing about that placement puts the man on the floor. Option d is incorrect because a stair handrail is a protective modification, and the basement is not on the route this man describes. The hazard has to sit along the path he actually walks.

Correct Answer: "I will call my case manager before I run out."

Continuity is the fragile part of community psychiatric care, and a lapse in supply is the common route back to relapse. Contacting the case manager before the supply runs out keeps treatment unbroken through a move. Option a is incorrect because feeling well is usually evidence the medication is working rather than a signal to stop it. Self-discontinuation is among the most frequent precipitants of rehospitalization for clients with serious mental illness. Option b is incorrect because metabolic monitoring is the safeguard against the cardiovascular deaths that shorten life in this population. Weight, blood pressure, glucose, and lipid checks let the prescriber adjust treatment before diabetes develops. Option c is incorrect because waiting passively leaves the client without medication whenever the clinic call is late or the phone number has changed. Community treatment depends on the client holding an active part in the plan.

Correct Answer: "Poverty produces illness, and illness then deepens the poverty."

The relationship runs in both directions. Low income delays care and forces harmful trade-offs, and the resulting illness costs work, wages, and savings, which lowers income further and closes the loop. Option b is incorrect because clinical treatment repairs the health half and leaves the income half untouched. A family with a treated illness still owes the bills, the missed wages, and the rent that accumulated during it. Option c is incorrect because income support is among the strongest health interventions available. Tax credits, food assistance, and housing subsidies improve birth outcomes and chronic disease control, so dismissing them discards the most effective tool. Option d is incorrect because the federal poverty measure ignores geography, taxes, child care, and medical costs. Families just above the line are often ineligible for programs while remaining one broken car or one hospital bill from crisis.

Correct Answer: A flood whose demands exceed all local response resources

A disaster is defined by a mismatch between demand and available resources. When the event overwhelms local capacity and outside assistance becomes necessary, the community is experiencing a disaster rather than a manageable emergency. Option a is incorrect because a single displaced family is absorbed easily by routine fire and social services. Severity for that family is real, yet local capacity is never exceeded, which keeps the event an emergency. Option b is incorrect because the trauma center absorbed those casualties using its usual staffing and supplies. Events that a system handles through its normal plan remain emergencies, no matter how dramatic they appear. Option d is incorrect because backup generators are a mitigation measure that worked exactly as designed. Describing a hazard the facility already planned for and controlled identifies preserved capacity, not the overwhelmed capacity a disaster requires.

Correct Answer: Deep lesions all in the same stage

Smallpox lesions on any one body area progress together, so they all sit in the same stage, and they are deep and firm. Varicella produces successive crops in several stages at once. Option a is incorrect because collapsing superficial vesicles describe the dewdrop lesions of chickenpox. Smallpox lesions are firmly seated in the dermis, feel like a pea under the skin, and resist puncture. Option c is incorrect because rapid crusting within a day reflects the quick tempo of varicella. Smallpox moves slowly, taking days between stages and one to two weeks before scabs form. Option d is incorrect because a trunk-predominant rash sparing palms and soles is the centripetal pattern of chickenpox. Smallpox is centrifugal, concentrating on the face and distal extremities including palms and soles.

Correct Answer: Refer the client to home-delivered meals

Home-delivered meals under the Older Americans Act provide nutrition to homebound older adults, and the delivery itself functions as a wellness check because the driver notices when the client does not answer the door. Option a is incorrect because assisted living moves the client out of her own home, and nothing in the scenario shows she needs help with bathing, dressing, or other personal care tasks. Option b is incorrect because skilled nursing placement serves people requiring around-the-clock nursing care after hospitalization. This widow is managing at home; the least restrictive safe option is the correct choice here. Option d is incorrect because an exercise class addresses strength and balance rather than intake, and a woman who rarely leaves the house is unlikely to attend, so neither problem gets solved.

Correct Answer: Offer warmth, water, and contact with family

Psychological first aid begins with safety and comfort, then practical help the person actually names. Meeting basic needs and reconnecting survivors with family strengthens the social support that best protects against later problems. Option b is incorrect because psychological first aid never presses anyone to recount the event. Survivors may speak if they choose, and probing for details can deepen distress rather than relieve it. Option c is incorrect because most people exposed to disaster recover without any treatment. Predicting a disorder pathologizes a normal acute stress response and undercuts the resilience this intervention is built to support. Option d is incorrect because required single session debriefing does not prevent later stress disorders and has produced worse outcomes in some studies. Voluntary support, rest, and access to counseling are recommended instead.

Correct Answer: I believe you. This is not your fault.

Validation is the first thing a survivor needs, and it keeps the relationship open for safety planning and referral. Pressuring someone to leave repeats the control she is living with and raises her risk. Option a is incorrect because separation is the point at which risk of serious harm rises sharply. Directing her out the door without a plan can put her in more danger than she is in now. Option b is incorrect because conditioning care on a decision the client is not ready to make ends the one professional contact she has. Support cannot be a reward for complying with the nurse. Option c is incorrect because using the children to push her adds guilt to a woman who already blames herself. Concern for children in the home is addressed through assessment and reporting, not through pressure.

Correct Answer: Rapid diagnostic tests that need no laboratory or power.

Appropriate technology means fit for the setting: scientifically sound, affordable, maintainable with local skills, and culturally acceptable. Rapid tests work without a laboratory or electricity, so the clinic can use and sustain them after the team leaves. Option a is incorrect because vaccine that must stay cold cannot be stored where power fails. The donation would spoil, and the clinic would absorb the loss along with the cost of disposing of it. Option b is incorrect because equipment without a maintenance pathway becomes scrap. Donated machines need consumables, spare parts, a manual in the local language, and training, or they sit unused while the clinic looks well equipped. Option d is incorrect because a label nobody at the clinic can read makes a drug unsafe to dispense. Donation guidance calls for generic names in the language the recipients actually use in practice.

Correct Answer: A designated triage team applies published criteria

Crisis standards require a declaration and published criteria applied by a designated triage team, keeping allocation separate from the bedside clinician so that nurse remains the client's advocate and is protected from moral injury. Option b is incorrect because placing the decision at the bedside destroys the advocacy relationship and exposes the nurse to severe moral distress. Allocation is deliberately assigned to clinicians who are not caring for these clients. Option c is incorrect because first come first served rewards proximity, transportation, and privilege rather than likelihood of benefit. Crisis frameworks reject it precisely because it produces unequal outcomes that cannot be justified publicly. Option d is incorrect because comfort and symptom management are owed to everyone, always. A client who does not receive a scarce resource still receives palliative care, presence, and honest communication with the family.