Question

During a home health visit, a school-age child who has muscular dystrophy confides in the nurse that he was struck by his parents. Which of the following actions should the nurse take first?

Answer 1

Correct Answers:

Check the child for injuries

Rationale :

🌐 The nurse's immediate priority is to assess the child's physical condition for any signs of harm or injury. This ensures that urgent medical needs are identified and addressed without delay.

🌐 In cases of suspected abuse, client safety and well-being come first, especially for a vulnerable child with a chronic condition like muscular dystrophy who may be at higher risk for injury.

🌐 After assessing for injuries, the nurse can then follow through with mandatory reporting requirements and further protective actions as appropriate.

🌐 This approach aligns with the ABCs of prioritization—addressing physical concerns before psychosocial or legal actions, while still ensuring that reporting and protection follow promptly.

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Answer 2

Correct Answers:

Determine students' motivation to learn about healthy food choices.

Rationale :

🔶 Assessing the learners’ motivation is always the first step in designing an effective educational program—it informs the nurse about readiness, interest, and barriers to learning.

🔶 Without understanding what drives or limits the students’ engagement, teaching strategies might miss the mark or fail to produce behavioral change.

🔶 This step aligns with the nursing process (assessment first) and allows the nurse to tailor content and delivery methods to the students’ developmental level and interests.

🔶 It also helps in identifying whether students are influenced more by taste, peer pressure, habit, or lack of knowledge, thereby guiding targeted interventions.

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Answer 3

Correct Answers:

Investigate potential health and environmental issues.
Initiate support groups for parents of autistic children.
Participate in local health surveillance activities
Provide health-related education to community groups

Rationale :

🔸 Investigate potential health and environmental issues:

🎯This is a core responsibility of community-oriented nursing, which focuses on preventing disease and promoting population health.

🎯Nurses assess factors like water quality, pollution, and sanitation that can impact entire communities.

🎯Addressing environmental concerns helps identify upstream causes of illness.

🔸 Initiate support groups for parents of autistic children:

🎯Creating and leading support groups reflects community-oriented and population-based care, focusing on shared needs and fostering support systems.

🎯It addresses the emotional and educational needs of families, improving outcomes beyond direct medical care.

🔸 Participate in local health surveillance activities:

🎯Surveillance is vital for tracking disease trends, outbreaks, and emerging public health threats.

🎯This aligns with the preventive and proactive nature of community-oriented nursing.

🔸 Provide health-related education to community groups:

🎯Teaching groups about wellness, disease prevention, and healthy behaviors is central to community health promotion.

🎯Education empowers communities to manage risk factors and improve health outcomes.

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Answer 4

Correct Answers:

Clients will schedule bone density screening.

Rationale :

🎇 Bone density screening (DEXA scan) is an essential preventive measure for postmenopausal women due to decreased estrogen levels, which increase the risk of osteoporosis.

🎇 Estrogen has a protective effect on bone, and after menopause, the rate of bone loss accelerates, making early detection of osteopenia or osteoporosis crucial.

🎇 This outcome supports secondary prevention, aiming to identify bone loss early and reduce the risk of fractures through timely interventions.

🎇 Encouraging screening aligns with guidelines from the U.S. Preventive Services Task Force (USPSTF), which recommends routine bone density testing starting at age 65 or earlier if risk factors are present.

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Answer 5

Correct Answers:

The provider is paid a fixed sum for the client on a monthly or yearly basis.

Rationale :

📅 A Health Maintenance Organization (HMO) operates on a capitation payment model, where healthcare providers receive a fixed amount per client regardless of how many services the client uses.

📅 This structure encourages providers to focus on preventive care and cost-effective treatment, since their reimbursement does not increase with additional procedures.

📅 The goal of an HMO is to promote coordinated, comprehensive, and preventive care while controlling healthcare costs.

📅 This contrasts with fee-for-service models, which reimburse providers based on each specific service rendered.

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Answer 6

Correct Answers:

Observe the client during preparation of traditional foods.

Rationale :

🔎 The first step in culturally sensitive care is to assess the client’s current practices, which includes directly observing how traditional foods are selected, prepared, and consumed.

🔎 Observation allows the nurse to gather accurate, personalized, and context-specific data, including cooking methods (e.g., frying vs. steaming), ingredient choices, and portion sizes.

🔎 This approach shows respect for cultural values while enabling the nurse to make realistic, client-centered dietary recommendations that support diabetes management.

🔎 Once a thorough assessment is completed, the nurse can tailor educational strategies that preserve cultural integrity while promoting glycemic control.

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Answer 7

Correct Answers:

I am obese because it's in my genes

Rationale :

🍥 Rationalization is a defense mechanism where an individual justifies or explains away behaviors or outcomes to avoid facing the true underlying causes or taking responsibility.

🍥 By attributing obesity solely to genetics, the client is deflecting personal accountability and providing a socially acceptable reason for their condition.

🍥 This coping strategy is often unconscious and serves to protect self-esteem or reduce anxiety when facing uncomfortable truths.

🍥 While genetics may play a role, the client’s statement minimizes the influence of lifestyle choices, which is a hallmark of rationalization.

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Answer 8

Correct Answers:

Housing quality.

Rationale :

🧱 A windshield survey involves the nurse driving or walking through a community to observe firsthand environmental and social conditions.

🧱 Housing quality is a key observable factor—nurses assess whether homes are well-maintained, overcrowded, abandoned, or in disrepair.

🧱 Observing housing gives insight into socioeconomic conditions, safety concerns, and potential public health risks like poor sanitation or structural hazards.

🧱 This method provides qualitative data that complements statistical information and guides further investigation or intervention planning.

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Answer 9

Correct Answers:

Many people who acquire acute hepatitis B develop chronic hepatitis.

Rationale :

🏥 Acute hepatitis B can progress to chronic hepatitis, especially in infants and young children. In fact, up to 90% of infected infants and 25–50% of children aged 1–5 years can develop chronic hepatitis B.

🏥 Chronic infection increases the lifetime risk of liver cirrhosis, liver failure, and hepatocellular carcinoma, making prevention through immunization critically important.

🏥 Educating parents about this potential progression helps them understand why timely immunization is essential, even if the child is currently healthy or at low perceived risk.

🏥 The hepatitis B vaccine is highly effective when the full series (typically 3 doses) is completed and provides long-term protection in most individuals.

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Answer 10

Correct Answers:

A client who has a rigid abdomen with manifestations of shock

Rationale :

🚨 In mass casualty incidents, triage prioritizes clients who have life-threatening injuries but a high likelihood of survival if treated quickly—this is the principle behind “immediate” (red-tag) priority.

🚨 A rigid abdomen with signs of shock (e.g., hypotension, tachycardia, pallor) strongly indicates internal bleeding or organ damage, which is an immediate life threat.

🚨 Without rapid intervention, this client could deteriorate quickly, so they require urgent stabilization and surgical intervention.

🚨 This client falls into the highest triage category because prompt treatment could save their life, unlike minor injuries or stable trauma cases.

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QLexNursing

1 :
During a home health visit, a school-age child who has muscular dystrophy confides in the nurse that he was struck by his parents. Which of the following actions should the nurse take first?

2 :
A nurse is planning a program about healthy eating at an elementary school where most students select French fries and pizza at lunch every day. Which of the following actions should the nurse plan to take first?

3 :
A nurse manager in a local community health agency is creating a job description for a new nurse who will practice community-oriented nursing. Which of the following should the nurse include in the job description? (Select all that apply )

4 :
A community health nurse is planning an educational program for a group of women who are postmenopausal. Which of the following outcomes is appropriate for this program?

5 :
A nurse is working with a care manager for a client who participates in a health maintenance organization. The nurse should identify that a health maintenance organization provides which of the following payment structures?

6 :
A client who has diabetes mellitus asks a home health nurse to help her adapt some of her traditional cultural foods to fit her meal plan. Which of the following is the first action the nurse should take when assisting this client?

7 :
An occupational health nurse is discussing health promotion with a client who has a history of obesity. Which of the following comments indicates the client is using rationalization as a coping mechanism?

8 :
A nurse is conducting a community assessment. Which of the following information should the nurse include as part of the windshield survey?

9 :
A community health nurse is educating a parent about the importance of hepatitis B immunization. Which of the following explanations should the nurse give the parent about the disease?

10 :
A first response team is working at the location of a bombing incident. A nurse triaging a group of clients should give treatment priority to which of the following clients?

QLexNursing

1 : During a home health visit, a school-age child who has muscular dystrophy confides in the nurse that he was struck by his parents. Which of the following actions should the nurse take first?

2 : A nurse is planning a program about healthy eating at an elementary school where most students select French fries and pizza at lunch every day. Which of the following actions should the nurse plan to take first?

3 : A nurse manager in a local community health agency is creating a job description for a new nurse who will practice community-oriented nursing. Which of the following should the nurse include in the job description? (Select all that apply )

4 : A community health nurse is planning an educational program for a group of women who are postmenopausal. Which of the following outcomes is appropriate for this program?

5 : A nurse is working with a care manager for a client who participates in a health maintenance organization. The nurse should identify that a health maintenance organization provides which of the following payment structures?

6 : A client who has diabetes mellitus asks a home health nurse to help her adapt some of her traditional cultural foods to fit her meal plan. Which of the following is the first action the nurse should take when assisting this client?

7 : An occupational health nurse is discussing health promotion with a client who has a history of obesity. Which of the following comments indicates the client is using rationalization as a coping mechanism?

8 : A nurse is conducting a community assessment. Which of the following information should the nurse include as part of the windshield survey?

9 : A community health nurse is educating a parent about the importance of hepatitis B immunization. Which of the following explanations should the nurse give the parent about the disease?

10 : A first response team is working at the location of a bombing incident. A nurse triaging a group of clients should give treatment priority to which of the following clients?

1 :
During a home health visit, a school-age child who has muscular dystrophy confides in the nurse that he was struck by his parents. Which of the following actions should the nurse take first?

2 :
A nurse is planning a program about healthy eating at an elementary school where most students select French fries and pizza at lunch every day. Which of the following actions should the nurse plan to take first?

3 :
A nurse manager in a local community health agency is creating a job description for a new nurse who will practice community-oriented nursing. Which of the following should the nurse include in the job description? (Select all that apply )

4 :
A community health nurse is planning an educational program for a group of women who are postmenopausal. Which of the following outcomes is appropriate for this program?

5 :
A nurse is working with a care manager for a client who participates in a health maintenance organization. The nurse should identify that a health maintenance organization provides which of the following payment structures?

6 :
A client who has diabetes mellitus asks a home health nurse to help her adapt some of her traditional cultural foods to fit her meal plan. Which of the following is the first action the nurse should take when assisting this client?

7 :
An occupational health nurse is discussing health promotion with a client who has a history of obesity. Which of the following comments indicates the client is using rationalization as a coping mechanism?

8 :
A nurse is conducting a community assessment. Which of the following information should the nurse include as part of the windshield survey?

9 :
A community health nurse is educating a parent about the importance of hepatitis B immunization. Which of the following explanations should the nurse give the parent about the disease?

10 :
A first response team is working at the location of a bombing incident. A nurse triaging a group of clients should give treatment priority to which of the following clients?