Epidemiology and Community Health PDF

Epidemiology and Community Health ‫مستر احمد السيد‬ 0503327640 ‫واتساب‬ community  group of people in defined geographical area with common goal and objective and interacting with one another. geographic community.  Example, a city,town or neighborhood common interest community  A collection...

Epidemiology and Community Health ‫مستر احمد السيد‬ 0503327640 ‫واتساب‬ community  group of people in defined geographical area with common goal and objective and interacting with one another. geographic community.  Example, a city,town or neighborhood common interest community  A collection of people, can have an interest or goal that binds the members together o It is part of the larger public health effort that is concerned With preserving and promoting the health of specific populations and communities. incorporates six basic elements: Promotion of health: o It includes all efforts that seek to move people closer to optimal wellbeing or higher level of wellness Prevention of health problems Treatment of disorders Rehabilitation o It involves efforts which seek to reduce disabilities, as much as possible, and restore functions e.g. stroke rehabilitation Evaluation It is the process by which the practice is analyzed,judged, and improved according to established goals Research Community health nursing: o It is a practice that is continuous and comprehensive directed towards all groups of community members Characteristics of Community health Nursing o Its practice combines public health with nursing o It is population focused. o It emphasizes on wellness and other than disease or illness o It promotes client‟s responsibility and self-care Factors affecting the health of any community include the following Except: a- welfare b- Physical environment c- Geography and climate d- Industrial condition Which of the following are considering perinatal cause of disability: a. The age of the mother b. Maternal health and nutrition c. Illness of the mother d. Sexually transmitted diseases CHN is a community-based practice. Which best explains this statement? A. The service is provided in the natural environment of people B. The nurse has to conduct community diagnosis to determine nursing needs and problems C. The service are based on the available resources within the community D. Priority setting is based on the magnitude of the health problems identified Which of the following is the most prominent feature of public health nursing? A. It involves providing home care to sick people who are not confined in the hospital B. Services are provided free of charge to people within the catchment area C. The public health nurse functions as part of a team providing a public health nursing service D. Public health nursing focuses on preventive, not curative services 36-year-old son is the primary caregiver to his 76-year-old has many chronic diseases and need full time assistance, discussed with the community nurse the idea of referring his of the elderly day care centers. The nurse explains the case to such services which of the following elderly groups this patient belongs to this service? A. With busy caregivers who need assistance. B. Who are bored staying at home and need socialization C. Who have been diagnosed with Alzheimer? D. Who want to engage in handcraft activities and art Community health nurse wants to develop a diabetic teaching program. In order to meet the clients’ needs, the nurse must first A. assess the clients’ functional abilities. B. ensures that insurance will pay for participation in the program. C. discusses the focus of the program with the multidisciplinary team. D. includes everyone who comes into the clinic in the teaching sessions What is the Main meaning for primary health care? A. Patient rather than population B. Individual rather than people C. Disease rather than health D. People rather than disease There is a family that was exposed to a fire in their house when they were sleep but nothing happens to them but there is elderly man can’t walk lives with them, and they ask the nurse how can they do to protect the older man from the fire if it occur again A Put someone sleep with him B. Put fire sensors on all the house C. Keep his room near the exit D. Keep the door and window opening A nursing student is assigned to administer immunizations to children in a clinic. The nursing instructor asks the student about related precautions and general contraindications to immunization. The student responds correctly by telling the instructor that the presence of which condition would be a reason to delay an immunization in a child? A. A cold B. Otitis media C. Mild diarrhea D. A severe febrile illness Types of fever Home visiting and Home Health Service o process of providing different nursing care activities to the clients where they live to assist and achieve the best level of wellness as possible. Importance of home visiting: o Health promotion and prevention of diseases. o Early case finding and referral. o Restoration and Rehabilitation. o Promoting support system and use of health resources. Phases of home visit: o o o o o o Referral phase Preparation phase for the visit. Introduction to the family, or social phase. Implementation phase: taking actions to meet the identified needs. Closing phase. Documentation phase Referral phase: o It is the first step in conducting the home visit techniques. Preparatory phase for the visit: o Collect data pertinent to the client and his family needs and problems. o Review the family file, records and nursing notes to understand the family's condition. o Communicate with other community agencies or leaders about the family to be visited. o Identify the client's needs (physical, emotional, medical,developmental, dietary, educational, and motivational). o Plan for nursing intervention according to the problems identified. o Prepare equipment and supplies needed to implement the planned interventions. Introductory/ Social Phase: o State her name clearly and that of the health facility. o Explain the reason for the visit and source of referral for the visit. Implementation phase: o Action phase and implement nursing care plan The pre-visit activities for home visiting are: a. Gathering information. b. Accepting the client. c. Explaining the reason for the visit. d.Observing the home environment. The community health nurse visit the patient to provide health education about colostomy care, she found the patient with his relatives will go outside. What should the nurse do? A. Write the patieng refuse the visit B. Don't go out, you will be late C. Arrange for another visit A Patient is recovering following surgery for placement of a colostomy. The nurse goes to the patient’s room to instruct the patient how to care for the colostomy. The patient’s roommate has visitors and the patient does not want to participate at this time. What should the nurse do? a. Document the patient’s refusal and add non-compliance to the care plan B. Tell the patient that this is vital information and may delay discharged c. Plan a time convenient to both the patient and the nurse Types of the Family Nuclear family:o include husband, wife, and their children all living together in the same household and it usually present in urban areas. Extended family (multigenerational family) o several generation or age-groups living together in the same household. o for example a household in which parents, grandparent , children ,aunt And uncle. Single-parent family: one parent (widowed or divorced(and his or her offspring children are living together in thesame household. Blended family: A married couple, one or both of whom is married previously and have children from the previous marriage. The couple may also have children of their own. cohabitating couple: o two adults (heterosexual, homosexual, or just friends) living together in the same household Nontraditional family includes: a- nuclear family b- a nuclear-dyad family c- single-parent family d- Ganges family There is single parents. One of both has one child. They will married. What is the type of family? A. Nuclear B. Extended C. Blended The importance of home visits is: a- Strengthening family function b- The nurse has unusual opportunities for case finding c- Focus on client out comes and cost effectiveness d- Requires a well-trained staff Clarifying the purpose for home visit occurs in a- Initiation phase. b- Pre-visit c- Actual visit d- Post visit Environment and Occupational Health Types of Environment: The Physical environment (natural environment) o nonliving like land, water, air ,atmosphere, soil Biotic environment( biological environment) o living part of the earth which includes the plants, trees, animals human beings Social or cultural environment o involves the culture and life style of the human beings which is created by the man through his different social and cultural activities and thinking. environmental hazard o any situation or state of events which poses a threat to the surrounding environment. Hazard: o “a factor or exposure that may adversely affect health” o a qualitative term expressing the potential of an environmental agent to harm the health of certain individuals if the exposure level is high enough Risk o quantitative probability that a health effect will occur after an individual has been exposed to a specified amount of a hazard. There are five types of environmental hazards: Chemical o Pesticides,Acids and Bases,Metal fumes, Solvents, Gases Physical o Noise and Vibration,Ionizing Radiation,Non-ionizing Radiation,Light, Laser Mechanical Biological o Insects Rodents Animals Bacteria Viruses Parasites Psychosocial Uncertainty Anxiety Lack of feeling of control over one own life Occupational Health Nursing: o It is application of nursing principles in conserving the health of workers at the workplace. Based on principles of recognition, prevention and treatment of illness, injuries. Occupational Hazard: It is source or situation with a potential for harm in terms of injury or ill damage to the workplace environment, or a combination of these. Occupational injuries: o It is a cut, fracture, sprain, amputation, etc, that may results from exposure or incident in the work department or during the course of work. Occupational illness: o It is any abnormal condition or disorder, other than one resulting from an occupational injury caused by exposure to environmental factors associated with employment. Occupational (Workplace) Hazards: Chemical Hazards Routes of excretion: o Feces exhalation urine Routes of entry into the body: o Inhalation Health Effects Ingestion sweat Skin Contact o Renal Diseases Respiratory Diseases Diseases Carcinogenic Skin Diseases Hematologic What key procedure for Occupational health nursing to protect health and security for working population? A.Health promotion and prevention B.Health hazard identification C.Cost containment , job productivity D.Eliminate complaints Blanching fingers resulted from exposure to one of the following hazards: a- Mechanical hazards b- Chemical hazards c- Physical hazards d- Biological hazards Accident can be prevented by the following : a-Emergency care b-Home care c-Vision care d-Physical disabilities Which of the following is an appropriate goal of nursing care for a client at risk for nutritional problems ? a-Provide oxygen. b-Promote healthy nutritional practices. c-Treat complications of malnutrition. d-Increase weight Disease Prevention and Control Two main patterns of health care Preventive o Primary Prevention o Secondary Prevention o Tertiary Prevention Curative o Emergency care o Episodic care o Continuous care o Terminal care Primary prevention Targeted at healthy people for:  actions taken to prevent the development of a disease in a person who is well and does not have the disease include:  Vaccination  Provision of information on behavioral and medical health risks,  disease prevention programs at primary and specialized health care levels,  Nutritional and food supplementation Secondary prevention o Targeted at sick individuals to: Detecting disease at an early stage during the preclinical phase of an illness by screening after the disease has developed, but before clinical signs and symptoms have appeared. Secondary prevention includes activities such as: • screening programs for early detection of diseases • Provision of maternal and child health programs, including screening and prevention of congenital malformations • Provision of medicines to control risk factors, such as hypertension Tertiary prevention clinical phase Targeted at people with chronic diseases and disabilities that can‟t be cured Rehabilitation  Assisting the handicapped person who was not completely cured improves their quality of life. Which the rehabilitation types that making strengthen of the weak muscles and maintain proper body alignment? a. Vocational rehabilitation b. Social rehabilitation. c. Medical rehabilitation d. Psychological rehabilitation Preventive school health services include the following: a - Treatment of any discovered disease. b- Follow-up and counseling for normal child. c- Referral for specialist care. d- Dental care A community health nurse is working with disaster relief in a local community after a hurricane that destroyed many homes in the community. The nurse is working to find housing for the survivors and is organizing counseling services. The nurse actions represent which type of level of prevention? A. Primary B. Secondary C. Tertiary D. Fourth Immunization is considering an example of: A. Primary prevention B. Secondary prevention C. Tertiary prevention D. All the above Occupational therapy for CVA patient is consider an example of A. Primary prevention B. Secondary prevention C. Tertiary prevention D. All the above Primary health care centers hold cancer awareness campaign including on-site mammograms to detect breast cancer. This campaign is an example of A. primary prevention. B. secondary prevention. C. tertiary prevention. D. passive prevention. Stroke is a cerebrovascular medical emergency considered as the fifth killer in the United States. Stroke patients need long-term rehabilitation programs. What is the prevention level for stroke rehabilitation programs? A. Primary prevention B. Secondary prevention C. Tertiary prevention D. Passive prevention Mrs. Ahmed attends a local screening for hypertension offered by the MOH. The community health nurse determines that Mrs. Ahmed has high blood pressure. Discovering hypertension at such a screening is considered A. primary prevention B. secondary prevention C. tertiary prevention D. assessment not prevention Teaching children about health lifestyles is which type of prevention? A. primary prevention B. secondary prevention C. tertiary prevention D. all of the above Sporadic  disease that occurs infrequently and irregularly. Endemic  constant presence of a disease or infectious agent in a population within a geographic area. Epidemic  increase, often sudden, in the number of cases of a disease above what is normally expected in that population in that area. Pandemic  an epidemic that has spread over several countries or continents, usually affecting a large number of people. Emerging disease that occurs for the first time in a certain country. Re-emerging  disease that was eliminated in a certain country and then reappears. The rates that measure disease Mortality rates o describes patterns of death in relation to age, gender and cause of death. o Information usually from death certificates o It is a reflection of illness and not health. Morbidity rates o This is information on types of illness and disability, o their incidence and prevalence. o It can be taken from a wide range of sources including hospital records, infectious Disease notifications and disability registers, sickness records, It is a reflection of illness and not health incidence rate:  Number of new cases notified for a given year and specific location Incidence rate = Number of new cases notified\ Midyear population at risk ×1,000 When the incidence rate is high it indicates one of the following: • Seasonal increase • Epidemic when the incidence rate increases more than usual (expected) for the time and place • Failure of primary prevention of the condition When this incidence rate is low, it indicates that primary prevention had an effect. prevalence rate:  The estimated rate of all diseased cases (newly diagnosed and those under treatment) for a given year and specific location Prevalence rate =  Number of all present cases\ Midyear population at risk ×1,000 When this rate is high, it means one of the following:  New cases are increasing in number (incidence rate is high).  The disease lasts a long time before recovery (number of old cases is high). When the prevalence rate is low, it may indicate one or more of the following:  The number of new cases decreased (low incidence rate).  The illness is of short duration (few old cases).  Some of the affected persons (hosts) died because the disease may be highly fatal. The crude death rate =  Number of all deaths\ Midyear population at risk ×1,000 cause-specific death rate  show the disease’s behavior, time, place, and the people at risk:  Number of Cause-specific death rate\Midyear population at risk ×1,000 Age-specific death rates  draw the attention to certain age groups Number of deaths recorded for individuals in a certain age group \Midyear population of the same age at risk× 1000 infant mortality rate  The most useable health care indicator  Number of deaths recorded for children in the first year of life\Number of registered live births ×1,000 Epidemiology  study of health in populations to understand the causes and patterns of health and illness health “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” • Physical wellbeing  good structure (anatomy) and function (physiology) Mental wellbeing  psychological balance and good mood Social wellbeing  well-adapted to the traditions of a community and able to interact well with other people within it  Determinants of any disease or health problem is dependent on studying the characteristics of the host, environment, and cause The process of health problem occurrence is as follows: 1. Exposure to the cause.  Examples: Influenza virus (communicable disease)  Susceptible – A lack of immunity leads to infection.  Resistant – Immunity prevents infection 2. symptoms and signs may appear (disease occurs) or they may not (subclinical infection or pathology). 3. Proper health management, good diagnosis, and specific treatment 4. the last stage of a health problem is recovery or death. Three factors determine the disease process agent  infectious microorganism or pathogen, such as a virus, bacterium, or parasite. host  the human who can get the disease Environment  extrinsic factors that affect the agent and the opportunity for exposure. such as crowding, sanitation, and the availability of health Services Which of the following factors is necessary for disease to occur? A. Agents B. Host C. Environment D. Time One of the following considers characteristic for chronic disease: a- Un-residual disability b- Caused by reversible pathogenic alterations c- Caused by non-pathogenic alterations d- Need average time of supervision and care In assessment of chronic disease the community health nurse collect data about: a- Morbidity and mortality b- Nutritional status c- Lifestyle d- Psycho-social condition Which among the following is a modifiable risk factor? A. Age B. Race C. Gender D. Lifestyle Which among the following is a non-modifiable risk factor? A. Tobacco use B. Hereditary C. Unhealthy diet D. Physical inactivity The main problem with mortality data is A. definition of death. B. causes of death. C. lack of death certificate. D. incomplete data. Advantages of face to face methods include: a- There is no involvement and participation of the recipient. b- It is one way of communication. c- It provides immediate and personal rewards. d- It is fixed and rigid. Mother should visit antenatal clinic during pregnancy at least: a- 10-12 visits in normal cases b- 15-17 visits in normal cases c- 15-20 visits in normal cases d- 12-15 visits in normal cases Body mass index is used to: a-Reduce risk of chronic disease b-Build a base for healthy c-Evaluate weight in adult d-Recommendation dietary allowance What is the pathogen that causes typhoid fever? a- Shigella dysentery b- Salmonella typhi c- Escherichia coli d-Vibrio cholera Tertiary prevention is needed in which stage of the natural history of disease? a- Pre-pathogenesis b- Pathogenesis c- Prodromal d- Terminal The school health committee is recommended comprehensive medical examination a. Every year b. Every new grade c. Every four years d. Every two years Nurse is supervising a group of elderly clients in a residential home setting. Which of the following reason is at greater risk of developing sensory deprivation for elderly client? a. Increased sensitivity to the side effects of medications. b. Decreased visual, auditory, and gustatory abilities. c. Isolation from their families and familiar surroundings. d. Decrease musculoskeletal function and mobility Community Health Nurse concerned with establishing a trustful relation with the family. This is most likely done by any of the following actions. a. Implementing nursing process b. Initiating referrals. c. Making brief socialization. d. Controlling interruptions Which type of the following examination required for food handlers? a. Complete blood count b. chest X ray c. urine analysis d. Anthropometric measurement Community Heath services in Saudi Arabia should be developed. What is the best way for better outcomes? A. Improve the health program B. Using Education technology Community health nurse visit diabetic patient. One of family member complaining for her that patient unmoved. What should the nurse do? A. Forced the patient to move B. Walk with the patient and take round C. Ask patient express feeling and the cause Which goal is an aim of public surveillance? A. To rapidly detect the introduction and early cases of a pandemic disease B. To serve as an early warning system to detect increases in illness in the community C. To monitor a pandemic's impact on health D. To track trends in community disease activity and identify populations that are severely affected Why would a hospital use surveillance? a. To protect the public against isolated patients b. To eliminate pathogens from the environment c. To improve quality of care and outcomes d. To decrease the incidence of ventilator-acquired pneumonia The nurse research ER need data for study. She called to another nurse in the ward to ask about Information for DM patient. What should the nurse response ? A. Give her information B. This my patient not give you information C. No problem to give you information but not on the phone D. Ask patient to get informed consent to use this information Which type of study design provides the strongest evidence? A. Qualitative study B. Randomized control trial C. Systematic review of descriptive studies D. Systematic review of correlational studies The nurse is providing Session about (disease process, coping, dietary management) for patient. Which is the initial important long term goal? A. Increase understanding of disease process B. Have a healthy life style C. Increase coping D. Dietary management Which step in community organizing involves training of potential leaders in the community? A. Integration B. Community organization C. Community study D. Core group formation Which of the following ethical principle define that the nurse should not allowing personal beliefs or feelings or pressure from others or patients to affect decisions that are made? A. Subjectivity B. Objectivity C. Reliability D. Validity The community health centers want to improve condition for people with disabilities. What is Primary prevention for disabilities patients? A. Contact with families and supporting organization B. Provide extra educational programs During home visits nurse suspects that mother and child are being abused by husband. Which question should the nurse ask? A. “Is there anything else bothering you you want to tell me about?” B. “Are you being abused by husband?” C. “Does your husband argue with you beat you and your son?” D. “Is your husband abusive? d. Pull the curtain around be bed and speak, ensuring privacy What is The term that use to describe people communicate their own belief same culture, goals, values and ethical? A.Interpersonal communication B.Intrapersonal communication C.Intergroup communication Community health nurse visited Alzheimer’s disease patient. The patient complained from bruises and many injuries. The caregiver denied any fallness caused for patient. What is the nurse response? A.Restrain the patient B.Blame to patient that he is the reason C.The cause is a cognitive impairement D.Arrange room and provide lightnight in room Community health nurse visited Alzheimer’s disease patient. The patient complained from bruises and many injuries. The caregiver denied any fallness caused for patient. What is the Nursing diagnosis for this patient? A. Impaired memory related to disease process B. Risk of injury related to lack of judgment, impaired cognitive, neglecting of caregiver C. Impaired physical mobility related to immobilization Patient told nurse researcher he wants to stop the research what will the nurse response? A.you can stop at any time B.You can’t stop C.You must have good reason to stop In the scope of community nursing, epidemiology and vital statistics are very essential in controlling disease spreading, disease impact on the given population and effectiveness of the preventive measures done. An outbreak of measles has been reported in the community. Which of the following epidemiological actions should the nurse perform initially? A. Identify the disease that was reported B. Classify the outbreak if sporadic or pandemic C. Determine the date when the disease first occurred D. Report the incident to the nearest primary hospital All the following from elements or function of primary health care Centers EXCEPT: A. Immunization B. Promotion of food supply C. Health education D. Epidemic diseases control An industrial nurse is providing instructions to a group of employees regarding care to a client in the event of a chemical burn injury. The nurse instructs the employees that the first consideration in immediate care is A. leaving all clothing in place until the client is brought to the emergency department. B. removing all clothing including gloves and shoes. C. lavaging the skin with water and avoiding brushing powdered chemicals off the clothing to prevent further spread of the injury. D. determining the antidote for the chemical and placing the antidote on the burn site. A nurse employed in a preschool agency is planning a staff education program to prevent the spread of an outbreak of an intestinal parasitic disease. The nurse includes which priority prevention measure in the educational session? A. All food will be cooked before eating B. Only bottled water will be used for drinking C. All toileting areas will be cleansed daily with soap and water D. Staff will practice standard precautions when changing diapers and toileting A home care nurse visits a 3-year-old child with chickenpox. The child’s mother tells the nurse that the child keeps scratching the skin at night and asks the nurse what to do. The nurse tells the mother to A. place soft cotton gloves on the child’s hands at night. B. apply generous amounts of a cortisone cream to prevent itching. C. give the child a glass of warm milk at bedtime to help the child to sleep. D. keep the child in a warm room at night and cover the child with blankets. An older adult client has been identified as a victim of physical abuse. In planning care, the nurse places highest priority on A. obtaining treatment for the abusing family member. B. adhering to federal mandatory abuse reporting laws. C. notifying the case worker to intervene in the family situation. D. removing the client from any situation that presents immediate danger. . The nurse is outside of a client’s room and hears the provider tell the client that the nurse “doesn’t know anything” in a der manner. Which legal tort has the provider violated? A. Libel B. Battery C. Assault D. Slander The nurse provides home care instructions to the parent of a child with acquired immunodeficiency syndrome (AIDS). Which statement by the parent indicates the need for further teaching? A. “I will wash my hands frequently”. B. “I will keep my child immunizations up to date”. C. “I will avoid direct unprotected contact with my child body fluids”. D. “I can send my child to day care if he has a fever, as long as it is a low-grade fever”. A home care nurse provides instructions regarding basic infection control to the mother of an infant with human immunodeficiency virus (HIV) infection. Which statement, if made by the mother, indicates the need for further instructions? A. “I will wash baby bottles, nipples, and pacifiers in the dishwasher”. B. “I will clean up any spills from the diaper with full-strength alcohol”. C. “I will be sure to prepare foods that are high in calories and high in protein”. D. “I will be sure to wash my hands carefully before and after caring for my infant”. A nurse provides home care instructions to the parents of a child hospitalized with pertussis. The child is in the convalescent stage and is being prepared for discharge. Which statement by a parent indicates a need for further instructions? A. "We need to encourage our child to drink fluids." B. "Coughing spells may be triggered by dust or smoke." C. "Vomiting may occur when our child has coughing episodes." D. "We need to maintain droplet precautions and a quiet environment for at least 2 weeks." A 6-month-old infant receives a diphtheria, tetanus, and acellular pertussis (DTaP) immunization at a well-baby clinic. The mother returns home and calls the clinic to report that the infant has developed swelling and redness at the site of injection. A nurse tells the mother to A. monitor the infant for a fever. B. bring the infant back to the clinic. C. apply a hot pack to the injection site. D. apply an ice pack to the injection site. A community nurse has instructed a group of parents of preschoolers about home safety measures for children. The nurse would identify the need for reinforcement of the instructions if one of the parents A. says he or she will store medications in child-proof containers. B. refers to medication as candy for when you are sick. C. states the intention to label all toxic substances and place them in a locked area. D. keeps the Poison Control Center telephone number readily available. A 7-year-old child is diagnosed with viral conjunctivitis. Antibiotic eye drops are prescribed for the child. The mother asks the nurse when the child can return to school. The appropriate response is A. “The child can return to school immediately.” B. “The child should be kept home until the antibiotic eye drops have been administered for 24 hours.” C. “The child should be kept home until the antibiotic eye drops have been administered for 72 hours.” D. “The child cannot return to school until seen by the physician in 1 week.” A child is scheduled to receive inactivated polio vaccine (IPV), and a nurse preparing to administer the vaccine reviews the child record. The nurse questions the administration of IPV if which of the following is documented in the child record? A. Recent recovery from a cold B. A history of frequent respiratory infections C. A history of an anaphylactic reaction to neomycin D. A local reaction at the site of injection of a previous IPV A 12-year-old child is scheduled to receive a series of the hepatitis B vaccine. The child arrives at a clinic for the second dose. Before administering the vaccine, a nurse performs an assessment on the child and asks the child and parent about a history of a severe allergy to A. eggs. B. penicillin. C. sulfonamides. D. a previous dose of hepatitis B vaccine or component. When communicating with a client who speaks a different language, the best practice for a nurse is to A. speak loudly and slowly. B. stand close to the client and speak loudly. C. arrange for an interpreter when communicating with the client. D. speak to the client and family together to increase the chances that the topic will be understood. In the work setting, what is your primary responsibility in preparing for disaster management that includes natural disasters or bioterrorism incidents? A. Knowledge of the agency’s emergency response plan B. Awareness of the signs and symptoms for potential agents of bioterrorism C. Knowledge of how and what to report to the CDC D. Ethical decision-making about exposing self to potentially lethal substances You are giving discharge instructions to a woman who has been treated for contusions and bruises sustained during an episode of domestic violence .‫عنف اسري‬ What is your priority intervention for this patient? A. Transportation arrangements to a safe house B. Referral to a counselor C. Advise about contacting the police D. Follow-up appointment for injuries The community health nurse is instructing a group of female clients about breast self-examination. The nurse instructs the clients to perform the examination A. at the onset of menstruation. B. every month during ovulation. C. weekly at the same time of day. D. 1 week after menstruation begins. A nurse is making an initial home visit to a client who was recently discharged from the hospital after treatment for a myocardial infarction. The nurse uses which type of database to obtain information from the client? A. An episodic database (assessment) B. A follow-up database C. An emergency database D. A complete health database A nurse is testing a client for astereognosis ‫عدم التعرف علي االشياء باللمس‬. The nurse should ask the client to close the eyes and do which of the following? A. Identify three numbers or letters traced in the client's palm B. Identify three objects placed in the hand one at a time C. State whether one or two pinpricks are felt when the skin is pricked bilaterally in the same place D. Identify the smallest distance between two detectable pinpricks, made with two pins held at various distances A school nurse has conducted a class on testicular self-examination (TSE) at the local high school. The nurse determines that the information was correctly interpreted if one of the student’s states that one should A. perform the exam after a cold shower. B. expect the exam to be slightly painful. C. roll the testicle between the thumb and forefinger. D. perform the self-examination every other month. A nurse is teaching a postpartum client about breast-feeding. Which of the following instructions should the nurse include? A. The diet should include additional fluids B. Prenatal vitamins should be discontinued C. Soap should be used to cleanse the breasts D. Birth control measures are unnecessary while breast-feeding A 4-day-old newborn is receiving phototherapy at home for a bilirubin level of 14 mg/dL. The nurse should plan to include which of the following in the teaching plan of care during the home visit to the mother of the newborn? A. Applying lotions to exposed newborn skin B. Assessing skin integrity and fluid status of the newborn C. Having minimal contact with the newborn to prevent stimulation D. Advising the mother to limit the newborn's oral intake during phototherapy A home care nurse is assessing a client functional abilities and ability to perform activities of daily living (ADLs). The nurse focuses the assessment on: A. self-care needs such as toileting, feeding, and ambulating. B. the normal everyday routine in the home. C. ability to do light or heavy housework, and to pay the bills. D. ability to drive a car. The home care nurse visits a client at home who has been experiencing increased weakness. The client tells the nurse that he is using a cane that was purchased at a local pharmacy. The home care nurse assesses the client's use of the cane and determines that the cane is sized correctly if A. the handle of the cane is even with the client's waist. B. the client's elbow is flexed at a 15- to 30-degree angle when ambulating with the cane. C. the client's elbow is flexed at a 50- to 75-degree angle when ambulating with the cane. D. the client's elbow is straight when ambulating with the cane. A nurse provides instructions to the mother of a child with mumps regarding respiratory precautions, and the mother asks the nurse about the length of time required for the respiratory precautions. The nurse should make which statement to the mother? A. "Droplet precautions are not necessary once the swelling appears." B. "Droplet precautions are not necessary before the swelling begins." C. "Droplet precautions are indicated during the communicability." period of D. "Droplet precautions are indicated for 18 days following the onset of parotid swelling." In the work setting, what is your primary responsibility in preparing for disaster management that includes natural disasters or bioterrorism incidents? A. Knowledge of the agency’s emergency response plan B. Awareness of the signs and symptoms for potential agents of bioterrorism C. Knowledge of how and what to report to the CDC D. Ethical decision-making about exposing self to potentially lethal substances You are giving discharge instructions to a woman who has been treated for contusions and bruises sustained during an episode of domestic violence. What is your priority intervention for this patient? A. Transportation arrangements to a safe house B. Referral to a counselor C. Advise about contacting the police D. Follow-up appointment for injuries A school nurse has conducted a class on testicular self-examination (TSE) at the local high school. The nurse determines that the information was correctly interpreted if one of the student’s states that one should A. perform the exam after a cold shower. B. expect the exam to be slightly painful. C. roll the testicle between the thumb and forefinger. D. perform the self-examination every other month. A nurse is teaching a postpartum client about breast-feeding. Which of the following instructions should the nurse include? A. The diet should include additional fluids B. Prenatal vitamins should be discontinued C. Soap should be used to cleanse the breasts D. Birth control measures are unnecessary while breast-feeding The home care nurse is visiting a mother 1 week after she gave birth to an infant who is at risk for developing neonatal congenital syphilis. After teaching the mother about the signs and symptoms of this disorder, the nurse instructs the mother to monitor the infant for which of the following? A. Loose stools B. A copper-colored skin rash C. High-pitched cry D. Vigorous feeding habits The home care nurse's assignment is to visit a new mother at home 24 to 48 hours after discharge. What of the following would the nurse expect to note in a healthy mother who is breast-feeding her newborn infant? A. The mother is breast-feeding with the infant in a tummy-to-tummy position without signs of cracked nipples; the baby demonstrates bursts of sucking, followed by a pause and swallow B. The mother is breast-feeding the infant with the infant's head turned toward her breast and the body flat in her arms; the mother has sore nipples, and the infant has a suck blister C. The mother complains of breast engorgement, and the infant demonstrates difficulty in latching onto the breast D. The mother has cracked nipples and feeds the infant with a supplemental bottle The home care nurse is performing an environmental assessment in the home of an older client. Which of the following, if observed by the nurse, requires immediate attention? A. Unsecured scatter rugs ‫سجاد مبعث‬ B. Clear exit passageways C. An operable smoke detector D. A prefilled medication cassette A community health nurse is providing a teaching session about terrorism to members of the community and is discussing information regarding anthrax. The nurse tells those attending that anthrax can be transmitted by which route? A. Bites from ticks or deer flies B. Inhalation of bacterial spores C. Direct contact with an infected individual D. Sexual contact with an infected individual The definition of Epidemiology is best described as A. the study of how disease is distributed in populations and the factors that influence or determine this distribution. B. the study of how people react to infectious diseases. C. the study of diseases affects minorities in populations. D. the study of biostatistics.