Nursing Elites

1. A client presents at a community-based clinic with complaints of shortness of breath, headache, dizziness, and nausea. During the assessment, the nurse learns that the client is a migrant worker who often uses a gasoline-powered pressure washer to clean equipment and farm buildings. Which type of poisoning is the most likely etiology of this client's symptoms?

• A. asbestos
• B. silica dust
• C. histoplasmosis
• D. carbon monoxide

Correct answer: D

Rationale: The client's symptoms of shortness of breath, headache, dizziness, and nausea are indicative of carbon monoxide poisoning, which can result from exposure to gasoline-powered equipment like pressure washers. Asbestos (Choice A) exposure would typically present with respiratory issues and cancer but not the rapid onset of symptoms described. Silica dust (Choice B) exposure is associated with respiratory conditions like silicosis, not the multisystem symptoms in the scenario. Histoplasmosis (Choice C) is a fungal infection that primarily affects the lungs and is not related to the client's exposure to a gasoline-powered pressure washer.

2. The nurse at a health fair has taken a client's blood pressure twice, 10 minutes apart, in the same arm while the client is seated. The nurse records the two blood pressures of 172/104 mm Hg and 164/98 mm Hg. What is the appropriate nursing action in response to these readings?

• A. Refer the client to a nutritionist after providing health teaching about a low-sodium diet.
• B. Place the client in a recumbent position and call the paramedics for transport to the hospital.
• C. Talk with the client to assess whether there is stress in the client's life and refer to a counseling service.
• D. Take the client's blood pressure in the other arm and then schedule a healthcare practitioner's appointment for as soon as possible.

Correct answer: D

Rationale: The appropriate nursing action in response to significantly high blood pressure readings like 172/104 mm Hg and 164/98 mm Hg is to confirm the readings by taking the blood pressure in the other arm. This can help rule out any error or issue specific to that arm. The nurse should then schedule a healthcare practitioner's appointment for as soon as possible to further assess the client's condition and determine the appropriate intervention. Choice A is incorrect because solely referring the client to a nutritionist for a low-sodium diet without further assessment or confirmation of the blood pressure readings is premature. Choice B is incorrect as the client is already seated, and calling paramedics for immediate transport to the hospital is not warranted based solely on the blood pressure readings provided. Choice C is incorrect as stress may not be the sole reason for the high blood pressure readings, and further assessment is required before referring the client to counseling services.

3. The home health care agency can expect to obtain Medicare reimbursement for which home visit performed by a registered nurse or a practical nurse?

• A. assessment of the speech pattern of a mobile adult who had a mild stroke last year
• B. safety teaching for an older male client whose wife complains that he uses an unsafe ladder while painting
• C. wound care for a client who had postoperative infection following abdominal surgery two weeks ago
• D. evaluation of crutch use by a 65-year-old client who broke his tibia while snow skiing

Correct answer: C

Rationale: The correct answer is C because wound care for a postoperative infection qualifies for Medicare reimbursement. Medicare typically covers skilled nursing care, like wound care, required due to a postoperative infection. Choices A, B, and D involve assessments, teaching, and evaluation, which may not always be eligible for Medicare reimbursement unless they are directly related to skilled nursing care for a specific medical condition.

4. A community health action that focuses on reducing the frequency and severity of asthma in inner-city children by requiring a local incinerator to install particulate filters is an example of:

• A. downstream intervention
• B. risk management
• C. primary prevention
• D. upstream intervention

Correct answer: D

Rationale: The correct answer is D: upstream intervention. Upstream thinking addresses the root causes of health problems to create long-term solutions. In this scenario, requiring the incinerator to install particulate filters tackles the root cause of asthma triggers, which is pollution, rather than just managing the symptoms or risks associated with asthma. Choice A, downstream intervention, would focus more on treating asthma symptoms after they have already occurred rather than preventing them. Choice B, risk management, typically involves strategies to assess, control, or mitigate risks, which may not directly address the root cause. Choice C, primary prevention, usually refers to actions taken to prevent a disease or condition before it occurs, but in this case, the action is targeting the underlying cause rather than preventing asthma itself.

5. What role does a community health nurse play in disaster management?

• A. Providing direct patient care
• B. Conducting research on disaster impacts
• C. Coordinating emergency response efforts
• D. Developing new healthcare policies

Correct answer: C

Rationale: Community health nurses are primarily responsible for coordinating emergency response efforts during disasters. This involves organizing and implementing strategies to address the health needs of the community in crisis situations. Providing direct patient care (Choice A) is often carried out by other healthcare professionals such as doctors and paramedics during disasters. Conducting research on disaster impacts (Choice B) is important for understanding the effects of disasters but is not the primary role of a community health nurse. Developing new healthcare policies (Choice D) is typically the responsibility of policymakers and public health officials rather than community health nurses.

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