a hospitalized child suddenly has a seizure while his family is visiting the nurse notes whole body rigidity followed by general jerking movements the
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Nursing Elites

HESI LPN

Community Health HESI Exam

1. A hospitalized child suddenly has a seizure while his family is visiting. The nurse notes whole body rigidity followed by general jerking movements. The child vomits immediately after the seizure. A priority nursing diagnosis for the child is

Correct answer: D

Rationale: Risk for aspiration is a priority concern following a seizure, especially when the child vomits, as there is a danger of aspirating the vomit into the lungs, leading to respiratory complications. The other options are not the priority in this situation. While infection risk and fluid volume deficit are important, ensuring the child's airway is clear and there is no risk of aspiration takes precedence. Altered family processes may be a concern but addressing the immediate physiological risk is the priority.

2. Which of the following patients should the home care nurse assess first?

Correct answer: A

Rationale: The correct answer is A. A patient with known COPD and difficulty breathing after physical exertion like climbing stairs requires immediate assessment by the nurse. This could indicate a potential exacerbation of COPD, which needs prompt intervention to prevent respiratory distress. Choices B, C, and D describe important patient situations that also require attention, but the urgency is higher with a COPD patient experiencing difficulty breathing.

3. A male client is brought to the emergency department as the result of a motorcycle accident. He was not wearing a helmet at the time of the accident and states that he has no intention of ever wearing one. Within the framework of the Transtheoretical Model (TTM), which response should the nurse provide?

Correct answer: C

Rationale: Providing information on safety aligns with the TTM framework.

4. In terms of CHN practice, how is the nurse in the community trained?

Correct answer: C

Rationale: In community health nursing practice, nurses are trained as generalists in nursing. They receive education that equips them to address a wide range of health concerns in the community. Choice A, nurse-midwife, is incorrect as it refers to a specific role focusing on childbirth and maternal health. Choice B, practice nursing, is vague and does not specifically describe the training of community health nurses. Choice D, midwife, is also incorrect as it refers to a specialized role in maternal and newborn care, different from the generalist training of community health nurses.

5. A community health nurse is conducting a neighborhood discussion group about disaster planning. What information regarding transmission of anthrax should the nurse provide to the group?

Correct answer: A

Rationale: The correct information the nurse should provide is that anthrax infection occurs when spores enter a host. Choice B is incorrect as mature anthrax bacteria do not live dormant on inanimate objects. Choice C is incorrect as anthrax spores can survive for extended periods outside a living host. Choice D is incorrect as anthrax is not transmitted by respiratory droplets from person to person.

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