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NUR426 Exam 1: Questions & Answers
Which statement regarding health disparities among LBGTQ population is incorrect? (Ans- Transgender youth are at the lowest risk for homelessness Discharging an agricultural migrant worker hospitalized for a burn injury, what disparity puts the client at highest risk for readmission? (Ans- Nature of work A pregnant incarcerated woman with type 1 diabetes experiencing hypoglycemia, what significant disparity does she face? (Ans- Access to care What is the important health outcome to improve the quality of life of residents in an assisted living setting? (Ans- Mental well being Assessing an older client's ability to return home after a fall due to alcohol consumption, what intervention should the nurse initiate? (Ans- Ask about current and prior alcohol use During a well visit, what vaccine is recommended for a 65-year-old client who is current on tetanus and influenza vaccines? (Ans- Pneumococcal Working with a family transitioning to palliative care, which statement is not part of palliative care treatment? (Ans- Palliative care means stopping all medical treatment Which client would be the best candidate for hospice care? (Ans- 42 - year-old with autoimmune disease no longer responding to treatment
Reviewing statistics on older adults in the community, what recommendation is not supported for wellness? (Ans- Recommend aerobic classes at nighttime A hospice nurse is admitting a client to the facility. During the admission the family asks the nurse what a hospice nurse does. Which of the following statements is the best response? (Ans- Educates, advises, provides emotional support, and helps prepare clients and families for the dying process An ambulatory clinic has noticed an increase in missed follow-up appointments in individuals in a rural community with limited access to primary care clinics. Which of the most effective approach to improve compliance? (Ans- Offer telehealth or communication through health applications for follow-up The nurse manager reviews the following nursing note concerns and comments made by the primary nurse. After reviewing the information provided what is the best step the nurse manager should take? (Ans- Notify Adult Protective Services (APS) Several families within a community are caregivers to loved ones suffering with dementia and are gathering at a support group session. What strategy are most helpful to review with families during this support group session regarding safety and supervision (Ans- Modify environments to limit potential harm, similar to childproofing A local ambulatory health care agency provides telehealth and in-person care to Native Americans community at an outreach clinic. What is the best strategy the agency can implement to improve compliance with well visits and follow-ups? (Ans- Collaborate with local community leaders to understand cultural health needs and improve appointment compliance
A nursing program is interested in integrating more opportunities for undergraduate and graduate students to address health equity and social determinants of health. Which of the following is NOT an example of a change in curriculum to support social determinants of health and health experiences (Ans- Clinical experiences primarily in acute care settings A nurse is about to interview a client which of the following is most important for the nurse to consider before beginning the interview. 64-year- old Hispanic female admitted per chart from the ED for dehydration. A&O x3, vitals stable, IV patent in the right AC, normal saline infusing 100ml/hour. Client has traditional beliefs about health and illness. (Ans- Ask the client if cultural healer should be contacted The school nurse works with a growing number of students and families from varying cultures. What is the best way to help the school nurse in providing culturally competent care for all students? (Ans- Increase knowledge and skills through web-based resources The public health team is focused on implementing initiatives to reduce inequities associated with access to behavioral health. Which is the best example of a population level behavioral health intervention (Ans- Flexibility in treatment policies and payments Results of a community health assessment indicate increasing obesity rates of residents a top priority. Using the ecological model (upstream) what is the least appropriate recommendation to focus on for the increasing obesity concern? (Ans- Avoid focusing on individual behavior change The nurse provides annual education to elementary aged children what is the most effective primary prevention intervention that the nurse can focus on to reduce the risk for disease? (Ans- Emphasize proper hand hygiene
A skilled care facility has noticed an increase in the number of falls during the last quarter. Which of the following is not supportive of reducing falls (Ans- Providing fall education without personalized fall risk assessment The public health nurse puts together an informational handout for community members regarding vision and hearing screening. What important strategy can the nurse take when creating the informational handout to improve health literacy (Ans- Ensure the use of clear and simple language The nurse works on discharge plans for an individual who is homeless. What is the most difficult challenge for nurses with regards to treating vulnerable populations (Ans- Addressing social determinants of health Recent studies suggest that nearly 1 in 5 members of LGBTQ community avoid medical care because they have faced or fear facing discrimination. What is the most efficient way to identify if an individual identifies with an LGBTQ community to avoid discrimination? (Ans- Implement LGBTQ inclusive practices in intake procedures The nurse is completing the ages and stages screening tool on a 2-year-old child. The parent of the child asks the nurse 'what is the purpose of performing screenings'. Which is the best response by the nurse? (Ans- Screenings can detect developmental delays early A tornado has caused damage to homes in a large section of a rural city where many immigrant families reside. Many individuals are without running water, electricity, and food sources are virtually nonexistent. In this circumstance what is a positive approach to health equity circumstance (Ans- Prioritize resources for those with the greatest needs
The maternal child nurse who is fluent in Spanish is working at the public health department located in a sanctuary city. She is conducting a home visit with a young mother from Central America who arrived to the US in 2017 and is now staying with her brother who is a US citizen. Which of the following statuses is the mother eligible to apply for? (Ans- Asylee A nurse caring for a young man squatting in an abandoned factory a mile away from the clinic. What type of homelessness would the nurse document? (Ans- Primary Public health nurse found higher obesity rate in a neighborhood due to limited access to full service grocery stores and lack of exercise venues. What category of determinants of health do these issues fall into? (Ans- Upstream Increase in prevalence of noncommunicable and chronic diseases with aging. What is the most pressing issue from a public health perspective? (Ans- Increase demand for long term care International medical community involving WHO to contain worldwide pandemics. What is the goal of WHO? (Ans- a. The public health arm of the United Nations. b. Improve health and well-being globally c. Work with nurses for public health interventions d. All of the above PHNs in a county with measles increase using national history of disease framework for primary prevention program. What is the first step? (Ans- Conduct outreach to parents for children vaccination
Nurse developing educational program on diet reviews availability of fresh fruits and vegetables in the community. Which determinant of health best reflects this decision? (Ans- Social determinants of health In traditional public health framework, which prevention level includes early detection for treatment initiation? (Ans- Secondary Patient with DM educating himself on managing health. What method of adult learning is this? (Ans- Humanism Nurse wonders why patient with DMII struggles despite education. What should nurse check first before providing more information? (Ans- Health Literacy Level Nurse in home care agency providing hospice care. What is the primary role of the nurse in hospice care? (Ans- Assist patient and family through dying process towards a good death A patient's wife asks a clinic nurse about safe alcohol consumption for her 82 - year-old husband. What is the nurse's response based on age-related standards? (Ans- 3 standard drinks per day and no more than 7 per week A nurse is caring for a group of clients in a community. What should the nurse know about health disparities among the LGBTQ community? (Ans- Identifying correct information is essential A PHN found a high number of homeless people in the community using the local ED. What should the nurse do next? (Ans- Apply for a grant to fund the nurse-managed clinic
A nurse caring for a group of clients in a community should know that which of the following is not considered one of the six standards of practice for the public health? (Ans- Mitigation The PHN working in a small public local health department should know that licensing of local hospitals would be outside of their scope of practice. (Ans- Adjusted side 2 The PHN presenting information specific to healthy aging to members at a wellness fair should not incorporate traveling often in the teaching. (Ans- Adjusted side 2 A lesbian couple relocating to a rural community as part of a job relocation would not be influenced by overabundance to healthcare for LGBTQ in rural communities. (Ans- Adjusted side 2 The PHN working on recommendations for policymakers regarding health risks of locally incarcerated community members should prioritize limited access to care for this vulnerable population. (Ans- Adjusted side 2 A respiratory illness outbreak has occurred twice at an assisted living facility. The advanced public health nurse's primary goals include performing an assessment of the nursing home to identify why the outbreaks keep happening. (Ans- Adjusted side 2 A nurse working in a community health clinic should be aware that Healthy People 2030 includes fostering impact through public and private efforts to improve health and wellness in the community. Examples to meet this goal include promoting tobacco-free environments and increasing the number of bike trails and safe bike paths. (Ans- Adjusted side 2
The nurse recognizes the value of Healthy People 2030 guidelines and the importance of the functioning to the local departments. Challenges related to public health infrastructure include public health workforce, access to IT, and public health agencies capable of accessing and responding to public health needs. (Ans- Adjusted side 2 Healthy People 2030 has identified priorities with greater emphasis on social determinants of health and quality of life. Statistics from Healthy People 2020 indicate priorities over the next 10 years in the following order of highest priority to lowest: Access to health services, Preventative health services, Environmental quality, Mental health disorders, Obesity. (Ans- Adjusted side 2 A Public Health Nurse sets up a booth near a local homeless shelter focused on health prevention strategies. What are the healthcare priorities that would be pertinent to the homeless population? (SATA) (Ans- a. Free vaccination program b. Mobile screening c. Free health clinics d. Free distribution of condoms e. Free dental clinics The Public Health Nurse is providing care at a free clinic. The next client is a Mexican migrant worker with a history of DMII, HTN, and a pressure on the calcaneus. Which interventions performed by the nurse are tertiary prevention? (Ans- a. Provide free diabetic education and access to medication and testing b. Provide smoking cessation resources c. Assist with wound care d. Identify community resources for free socks and resources e. Review immunization records and provide immunizations if needed The Community Health Nurse reviews statistics about health disparities in the community. Which interventions would be considered upstream and
A Nurse is caring for a client with heart failure. What is a key aspect of managing fluid balance in this client population? (Ans- Monitor daily weights and symptoms of fluid retention Factor 8(Ans- - on demand or prophylactically 2 types
- Plasma-derived does not protect against prion-transmitted disease, but the risk is minimal Recombinant Factor 8: Adverse reaction(Ans- - allergic reaction, rash = diphenhydramine
- anaphylaxis = epi Factor 8: interactions(Ans- Avoid ASA and NSAIDS, Cerebrex is safe Desmopressin(Ans- stimulates release of stored factor 8 in those with MILD hemophilia Desmopressin: ADR(Ans- - fluid retention, HYPONATREMIA
- seizure, HA, nausea, GI upset Desmopressin: Interventions(Ans- - monitor Is and Os, diuretics for fluid retention
- client should weight daily, report increase in wt., avoid alc Disseminated Intravascular Coagulation (DIC)(Ans- - serious bleeding/thrombotic disorder
- abnormal activation of the proteins involved in blood coagulation, causing small blood clots to form in vessels and cutting off the supply of oxygen to distal tissues
- can lead to uncontrollable hemorrhage diffuse coagulation (microclots)(Ans- caused by an underlying condition triggering wide-spread coagulation
profuse bleeding(Ans- from the depletion of clotting factors and platelets patho of thrombus in DIC(Ans- injury/malignancy → causes release of tissue factor and enhances normal coagulation mechanisms → enhances platelet aggregation → causes widespread fibrin and platelet deposition in capillaries and arterioles → thrombus and multiorgan failure patho of hemorrhage in DIC(Ans- Excessive clotting → activates the fibrinolytic system (breaks down the newly formed clot) → clot breakdown creates fibrin split products (FSPs) → FSPs inhibit normal coagulation → FSPs accumulate and clotting factors are depleted → causes blood to lose its ability to clot → stable clot cannot be formed at injury sites → hemorrhage clinical manifestations related to bleeding in DIC: integumentary(Ans- oozing blood, venipuncture site bleeding, hematomas, petechiae, purpura, occult hemorrhage, pallor clinical manifestations related to bleeding in DIC: respiratory(Ans- tachypnea, hemoptysis, orthopnea clinical manifestations related to bleeding in DIC: CV(Ans- tachycardia and hypotension clinical manifestations related to bleeding in DIC: GI/GU(Ans- - upper and lower GI bleeding, abd distention, bloody stools
- hematuria clinical manifestations related to bleeding in DIC: neuro(Ans- vision changes, dizziness, headache, changes in mental status, and irritability clinical manifestations related to bleeding in DIC: musculoskeletal(Ans- bone and joint pain
+If pt is bleeding → blood products needed in addition to treating the cause collaborative care of DIC: bleeding (or at risk)(Ans- - Blood products → use cautiously
- Life threatening hemorrhage +Fresh Frozen Plasma (FFP): replaces all clotting factors (NOT platelets) and provides a source of antithrombin +Cryoprecipate: replaces factor VIII and fibrinogen (<100 mg/dL) +Platelets (PLTS): for plt count less than 20,000/ul or less than 50,000/ul with bleeding +RBCs: in the case of anemia collaborative care of DIC: thrombosis(Ans- - Heparin → used only when benefit (reduce clotting) outweighs the risk (further bleeding) +Chronic DIC does not respond to oral anticoagulants, but it can be controlled with long term use of heparin
- Antithrombin III (Atnativ) → used for Fulminant (severe/sudden) DIC, may increase risk for bleeding Warfarin (anticoagulant)(Ans- - Does nothing to factors already in the bloodstream but prevents the body from making future specific factors (works slowly)
- PE, VTE, A-fib, prosthetic heart valves, TIA, MI prevention Warfarin ADR(Ans- toxicity and hemorrhage Warfarin Reversal agent(Ans- vitamin K warfarin nursing interventions(Ans- Monitor INR (PT) (starts to work in 8- 12 hours, full effect may take 3-5 days) warfarin contraindications(Ans- Pregnancy, thrombocytopenia, alcoholism warfarin pt. education(Ans- - USE SOFT TOOTHBRUSH
- Know your dose, avoid NSAIDs, ASA, electric razor
- Keep vitamin K consumption consistent (leafy greens, broccoli, soybean oils, brussel sprouts) warfarin drug interactions(Ans- - LOTS!!
- Phenobarbital, oral contraceptives, Phenytoin, vitamin K ↓ effects
- Aspirin, acetaminophen, glucocorticoids, sulfonamides, cephalosporins ↑ effects Heparin (anticoagulant)(Ans- - Deactivate factors that are already in the bloodstream (works quickly)
- AMI, CVA, PE, DVT, DIC; adjunct for open heart, hemodialysis, blood transfusion; prophylaxis: VTE/PE heparin ADR(Ans- Bleeding, thrombocytopenia (HIT), hypersensitivity heparin nursing interventions(Ans- Monitor aPTT (should be 1.5x baseline value) - only given in hospital heparin reversal agent(Ans- Protamine lovenox (anitcoagulant)(Ans- - AMI, CVA, PE, DVT, DIC; adjunct for open heart, hemodialysis, blood transfusion; prophylaxis: VTE/PE
- Does not break up existing clots → prevents new ones lovenox ADR(Ans- Bleeding, thrombocytopenia (HIT), hypersensitivity lovenox nursing interventions(Ans- No need to monitor PTT - pt can inject himself at home lovenox reversal agent(Ans- protamine Clopidogrel (antiplatelet, ADP inhibitor)(Ans- - MI, ischemic CVA, stents +Given with ASA for ACS
- P2Y12 ADP receptor antagonist (prevents platelet aggregation)
- Irreversible (lasts 7-10 days)
iron dextran(Ans- - Give iron preparations for iron deficiency anemia only (eg. NOT hemolytic anemia)
- Injectable
- ADRs: seizures, anaphylaxis (have epi available) Pernicious anemia treatment(Ans- Vitamin B12 injections Vitamin B12 ADRs(Ans- - Erythema, HTN, hypokalemia
- Check K levels, watch for signs of hypokalemia (EKG changes, muscle weakness) vitamin B12 interventions(Ans- - Give with food to enhance absorption
- Get baseline labs (H/H, RBC, B12 levels)
- Expect lifelong treatment for irreversible B12 deficiency foods high in B12(Ans- egg yolks, dairy, seafood, enriched cereal vitamin B12 contraindications(Ans- sensitivity, renal dysfunction Ateplase (thrombolytic)(Ans- - AMI, PE, ischemic CVA, establishing patency for central lines
- BREAKS down existing clots alteplase ADR(Ans- - Bleeding (intracranial, GI, GU, integumentary etc.)
- Limit venipuncture, monitor for signs of bleeding alteplase admin(Ans- - Give through dedicated line (need another line for emergency drugs)
- AMI = within 2 hrs
- CVA = within 3-4.5 hrs alteplase contraindications(Ans- - Past intracranial hemorrhage/hemorrhagic CVA, AVM, aneurysm, other internal bleeding
- Severe HTN, recent ischemic CVA< major recent surgery, PUD
alteplase interactions(Ans- - don't give with any other drug that enhances bleeding
- NSAIDs, anticoagulants, antiplatelets sickle cell anemia(Ans- a genetic disorder that causes abnormal hemoglobin, resulting in some red blood cells assuming an abnormal sickle shape patho of sickle cell anemia(Ans- - Autosomal recessive; Inherit one sickle cell gene "S' and one normal hemoglobin gene, can pass to children
- As sickling begins, blood flow slows which promotes hypoxemia and perpetuates sickling
- Decrease in pH decreases the hemoglobin's affinity for oxygen so less oxygen is transported
- As less oxygen is taken up by the hemoglobin in the lung→ PO2 drops promoting sickling further
- Once sickling begins, it continues until the PO2 returns to normal and then it cease spontaneously stressors that can cause sickling(Ans- - Infection - most common
- Decreased PO2 in the blood, decreased pH
- Increased plasma osmolality - dehydration
- Decreased blood volume
- Low temp - vasoconstriction
- Blood loss
- Emotional stress what can cause a sickle cell crisis(Ans- S - significant blood loss e.g. surgery trauma I - illness C - climbing to high altitudes K - keeping continued stress L - low fluid intake E - elevated temp
