HESI RN TEST BANK
HESI Community Health
While assessing a client receiving a blood transfusion, which finding requires immediate intervention?
A. Temperature of 100.4°F (38°C).
B. Blood pressure of 110/70 mm Hg.
C. Heart rate of 90 beats per minute.
D. Complaints of feeling cold.
Correct Answer:
Rationale: A heart rate of 90 beats per minute requires immediate intervention when assessing a client receiving a blood transfusion. This finding can indicate a potential transfusion reaction, such as a hemolytic reaction or fluid overload, which requires prompt evaluation and management to prevent serious complications. While a temperature of 100.4°F (38°C) may indicate a mild fever, it is not typically an immediate concern during a blood transfusion. A blood pressure of 110/70 mm Hg is within the normal range, and complaints of feeling cold can be addressed but do not indicate an urgent need for intervention compared to the critical nature of a potential transfusion reaction indicated by an elevated heart rate.
After assessing the health care needs of an elementary school, the nurse determines that an increased prevalence of pediculosis capitis is a priority problem. The nurse develops a 2-month program with the goal to eradicate the condition in the school. The program includes educational pamphlets sent home to parents and regular assessment of children by the school nurse. What action should the nurse implement to evaluate the effectiveness of the program?
- A. evaluate the teachers' ability to identify pediculosis capitis 2 months after initiation of the program
- B. conduct an initial examination of each child in the school to obtain baseline data
- C. survey parents 3 weeks after pamphlets are sent home to assess their understanding of the condition
- D. measure the prevalence of pediculosis capitis among the children after four months
Correct Answer: D
Rationale: Measuring the prevalence after four months provides data on the program's long-term effectiveness.
Which intervention by the community health nurse is an example of a secondary level of prevention?
- A. providing a needle exchange program at a community mental health clinic
- B. developing an educational program for clients with diabetes mellitus
- C. administering influenza vaccines to residents of a nursing home
- D. initiating contact notifications for sexual partners of an HIV client
Correct Answer: C
Rationale: Administering influenza vaccines is a secondary prevention method aimed at early detection and intervention.
A 56-year-old female client is receiving intracavitary radiation via a radium implant. Which nurse should be assigned to care for this client?
- A. A nurse who is pregnant.
- B. A nurse with Marfan syndrome who is postmenopausal.
- C. A nurse with a cold.
- D. A nurse who is lactating.
Correct Answer: B
Rationale: A nurse with Marfan syndrome who is postmenopausal can safely care for the client because Marfan syndrome does not affect the ability to care for this client, and postmenopausal status minimizes the risk of radiation exposure affecting reproductive health. Choice A is incorrect because pregnancy increases the risk of radiation exposure to the fetus. Choice C is incorrect because a nurse with a cold may have a compromised immune system and should not be exposed to radiation therapy. Choice D is incorrect because lactation can increase the risk of radiation exposure to breast tissue.
A nurse is planning a community event to raise awareness about mental health. Which activity should be included to best engage participants?
- A. lectures by mental health professionals
- B. interactive workshops on stress management
- C. distribution of mental health resources
- D. screenings for depression and anxiety
Correct Answer: B
Rationale: Interactive workshops on stress management actively involve participants and provide practical skills they can use to manage their mental health.