ATI PN Community Health Proctored Exam With NGN Version 7-12 With Answers-100 Solved Questions

ATI PN Community Health Proctored Exam with NGN: Version 7 -12
With complete Questions and Answers
VERSION 7
ATI COMMUNITY HEALTH PROCTORED PRACTICE ASSESSMENT
B1

1. A school nurse is discussing levels of prevention with a teacher. Which of the following
activities should the nurse identify as a primary prevention strategy?
A. provide nutritional counseling for students who have diabetes (3)
B. report suspected child neglect to the proper authorities (2)
C. conduct vision and hearing screening for kindergarten enrolment (2)
D. demonstrate proper handwashing techniques
Answer: D. demonstrate proper handwashing techniques

2. A school nurse is conducting hearing screening procedures in an elementary school. Which
of the following instructions should the nurse provide when performing the Rinne test?

A. "After I place the tuning fork on your scalp, tell me if you hear the sound better in one ear
or the same in both ears." (Weber)
B. "Use your finger to close one ear while I whisper some numbers into your other ear."
(Whisper voice test)
C. "After I place this tuning fork behind your ear, tell me when you no longer hear the
sound."
D. "You'll wear headphones and press the button when you hear a sound." (audiometry)
Answer: C. "After I place this tuning fork behind your ear, tell me when you no longer hear
the sound."

3. A palliative care nurse is teaching a client who has cancer about the services that are
available for the client. Which of the following statements should the nurse identify as an
indication that the client understands the teaching?
A. "If I begin palliative care, I will have to stop my chemotherapy."
B. "I can begin palliative care when I have less than 6 months to live."
C. "This type of care can help me with pain control."
D. "My family will not be involved with this type of care program."
Answer: C. "This type of care can help me with pain control."

4. A nurse is assessing a new client. Which of the following info should the nurse include in
the cultural portion of the assessment?
A. food preferences
B. employment status
C. hex of illness
D. sexual orientation
Answer: A. food preferences

5. A nurse collecting demographic data as a part of a community assessment. Which of the
following info should the nurse include?
A. racial distribution
B. family genograms
C. number of open water sources
D. presence of condemned buildings
Answer: A. racial distribution

6. A nurse is caring for a client who has AIDS and is experiencing rapid weight loss. Which
of the following actions should the nurse take first?
A. examine the client's oral mucous membranes
B. encourage the client to consume 1.2-2.0 g/kg of protein daily
C. recommend the client increase her daily calorie intake by 25%
D. teach the client about findings that should be reported to the provider
Answer: A. examine the client's oral mucous membranes

7. A home health nurse is caring for a client who has breast cancer. Which of the following
assessment findings should the nurse identify as an indication that the client is coping
effectively?
A. inability to concentrate
B. makes eye contact
C. excessive sleeping
D. lack of interest in food
Answer: B. makes eye contact

8. A home health nurse is scheduling client visits for the day. Which of the following clients
should the nurse plan to visit first?
A. a client who is 10 days postop following a mastectomy and needs to have surgical staples
removed
B. a client who has DM and reports new erythema to the left foot
C. a client who has COPD and needs a follow-up visit r/t home oxygen therapy
D. a client in a hip spica cast who reports pruritus under the cast
Answer: B. a client who has DM and reports new erythema to the left foot

9. A community health nurse is assessing a group of clients for risk factors of abusive
behaviours. Which of the following findings should the nurse identify as a risk factor for
developing violent behavior?
A. a client states he witnessed his mother physically mistreat his father
B. a client states that her mother-in-law provides childcare while she is working
C. a client participates in volunteer activities in the community
D. a client lives in the same neighborhood where he spent his childhood years

Answer: A. a client states he witnessed his mother physically mistreat his father

10. A school nurse is teaching health promotion to a group of staff members who sit at a desk
and use a comp for 8 hr at a time. Which of the following info is the priority for the nurse to
include?
A. "Take a walk after work."
B. "Point and flex your toes periodically."
C. "Have your visual acuity assessed regularly."
D. "Adjust your chair so that your elbows are at desk height."
Answer: B. "Point and flex your toes periodically."

11. A case manager is planning an educational program for a client who has DM. Which of
the following activities should the nurse include when using the psychomotor domain of
learning?
A. review a colour diagram of the food pyramid with the client
B. show the client a video about how to monitor blood glucose levels
C. observe the client's technique for drawing up insulin
D. give the client a pamphlet about foot care
Answer: C. observe the client's technique for drawing up insulin

12. A nurse manager at a community health clinic is presenting an in-service for nurses about
assessing client for abuse. Which of the following statements by a nurse indicates an
understanding of the teaching?
A. "Once I determine that a client is not at risk for abuse, I do not need to ask about it at
future visits."
B. "I should not document the name of the person the client accuses of the abuse in the
client's medical record."
C. "I should wait until I see signs of physical abuse before I help the client develop a safety
plan."
D. "I should refer a client for a rape kit examination if she reports sexual assault within the
previous 24 hours."
Answer: D. "I should refer a client for a rape kit examination if she reports sexual assault
within the previous 24 hours."

13. A nurse is teaching a client who has a new dx of hep A how to prevent the spread of the
virus. Which of the following instructions should the nurse include?
A. "Rinse your toothbrush with hydrogen peroxide after each use."
B. "Clean your bathroom fixtures with a chlorine bleach solution."
C. "Used shared hand towels to dry your hands after washing."
D. "Use condoms during sexual contact for 2 weeks."
Answer: B. "Clean your bathroom fixtures with a chlorine bleach solution."

14. A community health nurse is developing a plan of care for a client who is Hispanic.
Which of the following actions should the nurse include in the plan? a. avoid using hand
gestures when working with the client
B. use therapeutic touch during conversation
C. discourage the client from using a faith healer
D. maintain direct eye contact when speaking with the client
Answer: B. use therapeutic touch during conversation

15. A nurse is conducting an educational session at an assisted living facility for a group of
clients who have osteoporosis. Which of the following statements should the nurse include in
the teaching?
A. "It is important to avoid weight-bearing exercises."
B. "Decrease your dietary intake of folate."
C. "Increase your daily intake of leafy green vegetables."
D. "It is important to spend 30 mins each day exposed to sunlight."
Answer: C. "Increase your daily intake of leafy green vegetables."

16. A hospice nurse is teaching about expected grief reactions with the fam of a client who
has end-stage pancreatic cancer. Which of the following info should the nurse include?
A. "It is common to experience a persistent state of sadness while grieving."
B. "Disturbances in your self-esteem is an expected grief reaction."
C. "You will feel a sense of hopelessness throughout the grieving process."
D. "A component of healthy grieving is the ability to openly express your anger."
Answer: D. "A component of healthy grieving is the ability to openly express your anger."

17. A nurse is preparing an educational program about influenza for a group of community
health nurses. Which of the following activities should the nurse include as an example of
tertiary prevention?
A. offer classes to elementary school teachers about handwashing (2)
B. provide info to occupational nurses about the reasons for employees to not come to work
(2)
C. administer antiviral meds within 48 hours to clients who have manifestations of influenza
D. provide immunizations at long-term care facilities (1)
Answer: C. administer antiviral meds within 48 hours to clients who have manifestations of
influenza

18. An occupational health nurse is planning to use an interpreter during an educational
session with a group of migrant workers who do not speak the same language as the nurse.
Which of the following actions should the nurse take?
SATA
A. instruct the interpreter to guide the nurse in providing info in a culturally-sensitive manner
B. ask the interpreter to add info she feels may be necessary
C. choose an interpreter who speaks the workers' language and dialect
D. evaluate the interpreter's approach to clients prior to the educational session
E. encourage the interpreter to paraphrase the workers' questions and responses
Answer: A. instruct the interpreter to guide the nurse in providing info in a culturallysensitive manner
C. choose an interpreter who speaks the workers' language and dialect
D. evaluate the interpreter's approach to clients prior to the educational session

19. A nurse in a rural health clinic is caring for a client who has heart failure. The client
states, "I'm not going to take any more heart medicine." Which of the following responses
should the nurse make?
A. "Why did you decide to stop your heart medicine?"
B. "Can you tell me more about your decision to stop your medicine?"
C. "Don't you know what stopping your medicine will do to your heart?"
D. "Don't you think your doc knows what's best for your heart?"
Answer: B. "Can you tell me more about your decision to stop your medicine?"

20. A community health nurse is planning an educational program for farmers about
occupational health risks. Which of the following risks should the nurse include?
A. resp disorders
B. DM
C. sickle cell anaemia
D. HTN
Answer: A. resp disorders

21. A community health nurse is working to meet the health care needs of residents in a rural
community. Which of the following characteristics should the nurse identify as a barrier to
health care resources for this population?
A. less autonomy in providing client care
B. disinterest by members of the population in providing input for community health
programs
C. lack of cohesiveness among community members
D. unavailability of outreach services
Answer: D. unavailability of outreach services

22. A community health nurse is teaching a client who is overweight about steps to take to
begin an exercise program. The nurse should identify that which of the following statements
is an indication that the client understands the teaching?
A. "I will need to purchase exercise equipment before I can start."
B. "I should try to perform aerobic exercises for 1 hr/day, 5 days a week."
C. "I will see my doc before beginning an exercise program."
D. "I should avoid participating in weight-lighting exercises."
Answer: C. "I will see my doc before beginning an exercise program."

23. A public health nurse is participating in a community planning committee for disaster
preparedness for a local community that is at risk for hurricanes. Which of the following info
should the nurse contribute to the plan?
A. a list of residents who have experienced a hurricane in the past and will not need
evacuation
B. a list of areas within the community where residents speak English as a second language
C. how to activate the local medical facility's emergency-management plan

D. the name of the individual who is necessary to implement the plan
Answer: B. a list of areas within the community where residents speak English as a second
language

24. A nurse is providing BP screenings for older adult clients at a local community center.
Which of the following should the nurse identify as increasing a client's risk for developing
HTN?
A. BMI of less than 30
B. daily walking routine
C. African American race
D. HDL level greater than 70 mg/dL
Answer: C. African American race

25. A home health nurse is planning care for the day. Which of the following clients should
the nurse visit first?
A. an older adult client who was treated in the ED last night for a stage III pressure ulcer
B. a school-age child who was treated in the ED last night with status asthmaticus
C. an older adult client who has a newly prescribed antihypertensive med and needs a BP
check
D. a school-age child whose percutaneous endoscopic gastrostomy (PEG) tube needs
changing
Answer: B. a school-age child who was treated in the ED last night with status asthmaticus

26. A community health nurse is working in a mobile health care clinic. Which of the
following clients should the nurse assess first?
A. a client who requires removal of sutures from a laceration
B. a client who has a temp of 37.8 C (100.1 F)
C. a client who has COPD and an oxygen saturation of 92%
D. a client who has a new onset of confusion and slurred speech
Answer: D. a client who has a new onset of confusion and slurred speech

27. A nurse in a community center is preparing to administer a tuberculin skin test to multiple
clients to screen for TB. Which of the following actions should the nurse take?
A. prepare the outer aspect of the upper arm for the injection

B. insert the needle at a 45 degree angle
C. inject 0.1 mL of purified protein derivative
D. create a wheal that measures about 15 mm in diameter
Answer: C. inject 0.1 mL of purified protein derivative

28. A public health nurse is monitoring med compliance for a group of migrant workers who
are being treated for TB. The nurse should use info from which of the following resources to
assist with this process?
A. Agency for Healthcare Quality and Research (AHRQ)
B. Migrant Clinicians Network (MCN)
C. Centers for Disease Control and Prevention (CDC)
D. U.S. Preventive Services Task Force (USPSTF)
Answer: B. Migrant Clinicians Network (MCN)

29. A school nurse is conducting visual acuity testing for a school-age child. Which of the
following actions should the nurse take?
A. allow the child to keep her glasses on during the test
B. have the child stand 5 ft away from the Snellen letter chart
C. progress to the next line once the child reads 2 symbols correctly
D. begin the test by instructing the child to use both eyes to read the chart
Answer: A. allow the child to keep her glasses on during the test

30. A public health nurse is developing a visual health program by using a communityoriented approach. Which of the following interventions should the nurse include?
A. teach a client who has a vision loss about safety in the home environment
B. provide genetic counseling to the fam of a newborn who has congenital cataracts
C. consult with the local school nurse to schedule yearly vision screenings for students
D. develop a plan of care for a client who was newly dx with glaucoma
Answer: C. consult with the local school nurse to schedule yearly vision screenings for
students

31. A public health nurse is planning care for 4 clients. Which of the following interventions
should the nurse recognize as tertiary prevention?

A. providing chemoprophylaxis for malaria to a client who is traveling to mosquito-infested
countries (1)
B. performing a serological screening for HIV for a client who is pregnant (2)
C. participating in partner notification for a client who has an STI (2)
D. administering antibiotics to a client who has AIDS and was diagnosed with Pneumocystis
jiroveci
Answer: D. administering antibiotics to a client who has AIDS and was diagnosed with
Pneumocystis jiroveci

32. A nurse in a county health dept is caring for a client who states, "I've been drinking too
much in the evenings since my mom died last year." Which of the following responses should
the nurse make?
A. "It sounds like you are probably an alcoholic."
B. "Don't you think your fam is being affected by your drinking?"
C. "Can I give you some info about AA?"
D. "I don't think your mom would have approved of your drinking."
Answer: C. "Can I give you some info about AA?"

33. A public health nurse is developing a presentation for local day care providers about
infectious childhood diseases. Which of the following statements should the nurse include?
A. "Resp syncytial virus is spread through contact with resp secretions from an infected
person."
B. "Rotavirus infections in children peak during the summer months."
C. "Children who have fifth disease will exhibit bloody diarrhoea."
D. "Antiviral meds shorten the duration of a shigella infection."
Answer: A. "Resp syncytial virus is spread through contact with resp secretions from an
infected person."

34. A community health nurse suspects an outbreak of scabies in the local area. Which of the
following actions should the nurse take first?
A. educate the community about disease transmission
B. determine the incidence rate
C. institute prophylactic tx
D. discuss tx plans with the clients' families

Answer: B. determine the incidence rate

35. A community health nurse is discussing the concept of epidemiology with a coworker.
Which of the following interventions should the nurse provide as an example of the use of the
principles of epidemiology?
A. conducting screenings for dental caries in the local school system
B. reviewing county health records for data on cases of chickenpox
C. providing a client with info about preventing STIs
D. documenting med compliance for clients who have TB
Answer: B. reviewing county health records for data on cases of chickenpox

36. A community health nurse is assigned to lead a county-level environmental task force.
Which of the following activities should the nurse direct the task force to complete first?
A. review community-specific epidemiological data
B. recommend updates to local environmental policies
C. create program goals that align with Healthy People 2020 objectives
D. distribute environmental health edu materials to community members
Answer: A. review community-specific epidemiological data

37. A community health nurse is teaching a client who was newly dx with active pulmonary
TB about disease transmission. Which of the following info should the nurse include?
A. household members should be placed in resp isolation
B. the client should use disposable utensils during meals
C. household members should take isoniazid for 6-12 months
D. the client should have a repeat purified protein derivative test in 3 months
Answer: C. household members should take isoniazid for 6-12 months

38. The daughter of a client who is terminally ill and at the end of life approaches a hospice
nurse and asks what she can do to help relieve her father's pain. Which of the following
interventions should the nurse suggest?
A. give the client brief hand massages
B. increase the illumination in the room
C. place a warm cloth on the client's forehead
D. administer citalopram when the client is agitated

Answer: A. give the client brief hand massages

39. A community health nurse has been contacted regarding a client dx of influenza type A in
an adult day care. Which of the following actions should the nurse take to assist in the
prevention of an outbreak?
A. administer antiviral med to clients at the facility -to provide immediate protection and to
help prevent an outbreak
B. schedule immunizations for clients at the facility
C. recommend that the day care center close for 2 weeks
D. give immune globulin to client at the facility who have early manifestations of influenza
Answer: A. administer antiviral med to clients at the facility -to provide immediate
protection and to help prevent an outbreak

40. A nurse in a rural community is planning edu for a young adult client who is a migrant
farm worker. Which of the following actions should the nurse include?
SATA
A. provide environmental health info
B. refer the client for a TB screening
C. provide skin cancer info
D. recommend a dental health screening
E. provide forms to apply for Medicare
Answer: A. provide environmental health info
B. refer the client for a TB screening
C. provide skin cancer info
D. recommend a dental health screening

41. A public health nurse is working in a community that has a population of 24, 096. There
are 2,096 existing cases of heart disease within the population. The nurse can determine
which of the following from this info?
A. mortality rate
B. attack rate
C. prevalence proportion
D. incidence proportion
Answer: C. prevalence proportion

42. A home health nurse is assessing an older adult client who is taking captopril to treat
heart failure. Which of the following findings should the nurse identify as an adverse effect of
this med?
A. weight gain
B. ataxia
C. photophobia
D. dry cough
Answer: D. dry cough

43. A nurse is developing an educational program about bioterrorism and smallpox. The
nurse should include in the teaching that the smallpox rash is expected to first appear in
which of the following locations?
A. face
B. posterior shoulders
C. abdomen
D. lower extremities
Answer: A. face

44. A nurse is assessing the risk and benefits of meal delivery services for an older adult
client who lives alone and has no transportation. Which of the following ethical principles is
the nurse demonstrating?
A. distributive justice
B. respect for autonomy
C. fidelity
D. beneficence - by determining if the client needs this service to maintain his health
Answer: D. beneficence - by determining if the client needs this service to maintain his
health

45. A nurse is conducting a home visit with a female client who reports a hx of intimate
partner abuse. The nurse should identify that which of the following findings places the client
at greatest risk for domestic violence?
A. the client is at 13 weeks of gestation
B. the client states she is leaving her partner

C. the client recently started a new job
D. the client visits friends without her partner's knowledge
Answer: B. the client states she is leaving her partner

46. A case manager is developing a discharge plan for a client who has a spinal cord injury
and is in a rehab facility. Which of the following actions should the nurse take first?
A. hold a care conference with the client and his fam to discuss tx options
B. contact service providers to determine the availability of services offered
C. determine the client's ability to perform self-care
D. evaluate the client's satisfaction with the case manager's services
Answer: C. determine the client's ability to perform self-care

47. A nurse at a county health clinic is caring for a client who has recently assumed the role
of primary caregiver for her mother. Which of the following statements by the client indicates
that she is experiencing role conflict?
A. "I feel overwhelmed with not having enough time for my mom as well as my children."
B. "I hope my siblings will be able to visit and help care for mom for a few days."
C. "I am glad that my job is flexible, so I can accommodate my mom's needs."
D. "I don't think my partner likes having to help more with the household chores."
Answer: A. "I feel overwhelmed with not having enough time for my mom as well as my
children."

48. A nurse is planning to teach a community group about the meningococcal vaccine. The
nurse should identify that which of the following clients should receive the vaccine?
A. a client who is traveling to northern Europe
B. an infant who has bronchiolitis
C. an infant who is 4 weeks old
D. a client who is moving into a college dormitory
Answer: D. a client who is moving into a college dormitory

49. A public health nurse is providing info to a client who has alcohol use disorder and is
asking about tx. Which of the following statements should the nurse identify as an indication
that the client understands the info?
A. "I will not have to completely stop drinking alcohol if I go into an inpatient tx program."

B. "Once I make it through detox, I will be free of my addiction."
C. "I am not eligible for an outpatient program until I have completed an inpatient program
first."
D. "I can expect to get help with other aspects of my life while in tx."
Answer: D. "I can expect to get help with other aspects of my life while in tx."

50. A nurse on the scene following a mass casualty explosion is triaging a client who has a
large, open occipital wound and the following findings: resp rate 6/min, agonal pattern; cap
refill time 4.5 secs; nonresponsive to painful stimuli. Which of the following actions should
the nurse take?
A. turn the client to left semi-Fowler's position and begin assessing the next client
B. place a firm pressure dressing to the occiput and open the airway
C. apply a cervical spine collar and perform a focused neurological exam
D. request that the client be assessed immediately by the next available provider
Answer: A. turn the client to left semi-Fowler's position and begin assessing the next client

VERSION 8
ATI COMMUNITY HEALTH PROCTORED PRACTICE ASSESSMENT
B2

1. A nurse who is facilitating a support group in a community center notices that one member
of the group expresses anger repeatedly. Which of the following strategies should the nurse
use to facilitate the group process with this member.
A. Remind the group that everyone should have a chance to participate.
B. Divide the group into pairs and give each pair a topic for discussion.
C. Give the member extra time to compose her thought before expressing them.
D. Focus more on the group members who have a positive outlook.
Answer: D. Focus more on the group members who have a positive outlook.
Explanation: This is a strategy that is often effective with group members who demonstrate
angry, hostel, or negative behavior. The nurse should also speak to the group member in
private to try to uncover the source of her ongoing anger.

2. Which of the following activities done by a nurse is considered public health nursing?

A. Reviewing morbidity and mortality data for the community.
B. Caring for new mothers and infants.
C. Reviewing the medications prescribed for an older adult couple.
Answer: A. Reviewing morbidity and mortality data for the community.
Explanation:
Reviewing morbidity and mortality data for the community is a key component of public
health nursing, which focuses on the health care of populations and communities.

3. A nurse working for a non-profit organization with limited resources is asked to develop an
education program that will benefit a supporting agency's employees. The nurse was planning
another program to benefit more people in the community. Which of the following is an
ethical tenet the nurse should follow in deciding which program to implement.
A. Allow members of the community to vice their shared ideas.
B. Develop public policy in concert with the interest and needs of the community.
C. Give precedence to community support provided by public servants over entrepreneurs.
D. Place the needs of the community above those of special interest groups.
Answer: D. Place the needs of the community above those of special interest groups.
Explanation:
This statement upholds the ethical tenet for policy development: to serve citizens, not
customers. While the nurse may feel pressure to comply with the agency's request due to its
financial or material support, the nurse must use available resources to meet the needs of the
greatest number of citizens first.

4. A community health nurse is providing care to a client who has stopped taking his
prescribed blood pressure medication. Which of the following actions should the nurse take
first to promote adherence to treatment.
A. Inform the provider of the client's decision.
B. Determine the client's reason for discontinuing the medication.
C. Discuss the consequences of discontinuing the medication with the client.
Answer: B. Determine the client's reason for discontinuing the medication.
Explanation:
Using the nursing process, the first step the nurse should take is to assess the client. By
determining the client's reason for discontinuing the medication, the nurse can promote
adherence to treatment.

5. A clinic nurse is caring for a client who reports taking ginkgo biloba for several weeks
since seeing a naturapathic healer. The nurse should instruct the client that ginkgo biloba may
alter the effects of which of the following medications?
A. Warfarin
B. Metoprolol
C. Digoxin
Answer: A. Warfarin
Explanation:
Ginkgo biloba can hinder coagulation; therefore, the nurse should instruct the client that
ginkgo biloba may alter the effects of warfarin.

6. A community health nurse is preparing a community presentation about the
epidemiological triangle. Which of the following elements is a host.?
A. Salmonella on a wood cutting board.
B. A raccoon with rabies
C. A farm containing pesticides.
D. a factory with high noise levels.
Answer: B. A raccoon with rabies
Explanation:
The epidemiological triangle is a model of the agent-host environment interaction that causes
disease. The host is a living species, either human or animal, that is capable of being infected
ore affected by an agent.

7. A community health nurse is providing anticipatory guidance to a group of adolescents. To
reduce premature deaths in this age group, which of the following topics would be most
important to discuss.
A. Underage smoking
B. Safe sex practices
C. Safety belt use.
Answer: C. Safety belt use.
Explanation:

Automobile crashes are currently the leading cause of death among adolescents; therefore,
this topic is important to discuss when providing anticipatory guidance to reduce premature
deaths in the age group.

8. A newly licensed nurse in a public health agency is assigned to assist with the task force
that is responsible for the core function of assessment. Which of the following is a task that
the nurse could be assigned that would be consistent with the focus of the task force?
A. Investigating local health hazards.
B. updating local policies to support community health efforts.
C. Collaborating with community agencies to improve availability of services.
Answer: A. Investigating local health hazards.
Explanation:
Investigating health hazards of the local community is a component of the public health core
function of assessment.

9. A community health nurse is visiting a family that has newborn twins and two school-age
children. The parents tell the nurse they are emotionally and financially overwhelmed. Which
of the following referrals are appropriate? (Select all that apply).
A. Postpartum support group
B. Women, Infant, and Children (WIC) program
C. Child Protective Service (CPS)
D. Medicare Part B
E. Free school lunch program.
Answer: A. Postpartum support group
B. Women, Infant, and Children (WIC) program
E. Free school lunch program.

10. A public health nurse is working in a community that has a population of 24.096. There
are 2.096 existing cases of heart disease within the population. The nurse can determine
which of the following from this information.
A. Mortality rate
B. Attack rate
C. Prevalence proportion
D. Incidence proportion.

Answer: C. Prevalence proportion
Explanation:
The prevalence proportion can be calculated given how many people were affected at a given
time and the total population.

11. A newly licensed nurse is performing a community assessment. While collecting
secondary data at the library, the nurse is approached by a community member who is
concerned about air pollution. Which of the following statements by the nurse indicates a
need for further education regarding confidentiality?
A. "Records indicate that several pesticides have been entering the local streams causing
significant water pollution."
B. According to the latest research, there is an infant mortality ratio of 6.7 per 1,000 live
births in this community.
C. The circulation supervisor at the library is concerned about the amount of air pollution
coming from the town's industrial corridor.
D. Residents near Cherry Street Substation have a mortality rate of 29.6% from brain tumors
compared to the citywide rate of 9.2%.
Answer: C. The circulation supervisor at the library is concerned about the amount of air
pollution coming from the town's industrial corridor.
Explanation:
The nurse has a responsibility to protect community members who share concerns or provide
controversial information.

12. A nurse is planning to teach a community group about the meningococcal vaccine. For
which of the following individuals is this vaccination recommended.
A. An individual traveling to northern Europe.
B. An infant who has bronchitis.
C. An infant who is 4 weeks old.
D. An individual moving into a dormitory setting.
Answer: D. An individual moving into a dormitory setting.
Explanation:
Individuals living in crowded areas such as dormitories should receive the meningococcal
vaccine.

13. A community health nurse is caring for a client who has a new diagnosis of Lyme
disease. The requirements for a reporting Lyme disease are mandated by which of the
following?
A. Local county health departments
B. Individual state law
C. federal law
D. Center for disease control and prevention.
Answer: B. Individual state law
Explanation:
While Lyme disease is on the list of national diseases, the requirements and methods of
reporting individual diseases are determined by state laws.

14. A community health nurse is conducting an educational program for parents about the
effects of pollution on preschool-age children. Which of the following statements by a parent
indicates an understanding of the teaching?
A. Children drink fewer fluids for their body weight than adults, so they take in fewer toxins.
B. The kidneys filter toxins at a greater rate in children than in adults.
C. Children breathe more rapidly than adults, which increases their exposure to air pollutants.
D. Outdoor air pollutants are more likely to trigger asthma attacks than indoor pollutants.
Answer: C. Children breathe more rapidly than adults, which increases their exposure to air
pollutants.
Explanation:
Children breathe faster than adults, which increases their exposure to toxins in the air

15. A school nurse sees four students in 1 week who have a return-to-school release after
being diagnosed with methicillin-resistant Staphylococcus aureus(MRSA). Which of the
following actions should the nurse take
A. Coordinate an immunization clinic at the school.
B. Recommend prophylactic treatment for classmates.
C. Report the cases of MRSA to child protective services.
D. Provide education about MRSA throughout the school system.
Answer: D. Provide education about MRSA throughout the school system.
Explanation:
Hand hygiene will prevent the spread of MRSA.

16. A nurse in a rural community is planning education for a young-adult client who is a
migrant farm worker. Which of the following should the nurse include in the plan of care
(select all that apply).
A. Provide environmental health information.
B. Conduct tuberculosis screening
C. Provide skin cancer information
D. Conduct dental health screening.
E. Provide forms to apply for Medicare.
Answer: A. Provide environmental health information.
B. Conduct tuberculosis screening
C. Provide skin cancer information
D. Conduct dental health screening.

17. An occupational health nurse is assessing a client who reports taking ibuprofen daily for
several years. The nurse should counsel the client on the risk for which of the following
conditions?
A. Gastric ulceration
B. Orthostatic hypotension
C. Hyperglycaemia
D. Urinary retention.
Answer: A. Gastric ulceration
Explanation:
Long term use of NSAIDs such as ibuprofen increases the risk of gastric ulceration,
perforation and haemorrhage.

18. A school health nurse is caring for an adolescent newly diagnosed with type 1 diabetes
mellitus. Which of the following actions is appropriate to include in the client's plan of care?
A. Consult with a dietitian to determine an appropriate school lunch for the client.
B. Encourage the client to have a snack 3 hours prior to physical activities.
C. Provide weekly updates on the clients condition to the insurance provider.
D. Obtain specimen to test for ketonuria daily.
Answer: A. Consult with a dietitian to determine an appropriate school lunch for the client.
Explanation:

This action assists the client in obtaining appropriate nutrition for the disease process.

19. A school nurse is helping a student schedule speech therapy and physical therapy
appointments that do not interfere with the student's academic schedule. This is an example
of which of the following roles of the school nurse?
A. Health educator
B. Case manager
C. Counsellor
D. Consultant
Answer: B. Case manager
Explanation:
The nurse is coordinating the members of the interdisciplinary team to provide the health care
required by the student.

20. A nurse in a community health center is talking with the parent of an adolescent who is
concerned that her sons seems depressed and is giving away his favourite belongings. Which
of the following actions should the nurse take?
A. Tell the parent that it is common for adolescents to lose interest in their belongings.
B. Explain that what might seem like depression is probably typical teenage boredom.
C. Talk with the adolescent abut trying to be more cooperative and appreciative.
D. Determine if the adolescent has considered harming himself.
Answer: D. Determine if the adolescent has considered harming himself.
Explanation:
Clues that should alert the nurse to suicidal intent include giving away possessions.
Depression is another risk factor for suicide.

21. A nurse is collecting demographic data as a part of a community assessment. Which of
the following should be included?
A. Racial distribution
B. Family genograms
C. Number of open water sources
D. Presence of condemned buildings.
Answer: A. Racial distribution
Explanation:

Racial distribution is part of demographic data.

22. A nurse is a clinic is planning teaching for a client who is newly diagnosed with hepatitis
C. Which of the following instructions should the nurse include in the teaching?
A. Consume a low carbohydrate diet until symptoms resolve.
B. Schedule an appointment for an immunoglobulin injection.
C. Abstain from sexual intercourse until antibody tests are negative.
D. Wear a mask in public places while receiving treatment.
Answer: C. Abstain from sexual intercourse until antibody tests are negative.
Explanation:
Hepatitis C is transmitted through sexual intercourse; therefore, the nurse should instruct the
client to abstain from sexual intercourse until antibody tests are negative.

23. A home health nurse is caring for an older adult client who has diabetes mellitus
complicated by severe peripheral neuropathy. Which of the following instructions should the
nurse provide the client to avoid injury to the feet and lower legs? (select all that apply)
A. Test bath water with a thermometer before entering.
B. Wear shoes that extend 0.64 cm past the longest toe.
C. Use a dry heating pad to enhance circulation in feet.
D. Inspect feet for areas of redness daily.
E. Monitor temperature of feet and lower extremities for changes.
Answer: A. Test bath water with a thermometer before entering.
D. Inspect feet for areas of redness daily.
E. Monitor temperature of feet and lower extremities for changes.

24. A community health nurse is planning an in-service about sexually transmitted infections
to a group of adolescents. Which of the following clinical findings should the nurse include
as a manifestation of primary syphilis?
A. Malaise
B. Maculopapular rash on palms
C. Chancre
D. Lymphadenopathy.
Answer: C. Chancre
Explanation:

Chancre is a clinical manifestation of primary syphilis.

25. A hospice nurse is caring for a client who is at the end of life and has developed dyspnea
and noisy breathing. Which of the following actions should the nurse take?
A. Suction the client's oropharynx.
B. Encourage the client to take sips of water frequently.
C. Use a fan in the client's room.
D. Offer small portions of the clients favourite foods.
Answer: C. Use a fan in the client's room.
Explanation:
A fan moves the air, which stimulates the client's trigeminal nerve and can minimize the
sensation of dyspnea.

26. A nurse at a rehabilitation facility is providing discharge teaching for a client who is
recovering from a stroke. Which of the following statements should the nurse include.
A. Your family should provide the majority of your care to ensure that your needs are met.
B. You should contact outpatient therapy to schedule an admission assessment within two
weeks.
C. You should use a hand-held mirror to improve your ability to see objects around you.
D. You should focus on dressing and caring for the unaffected side of your body first.
Answer: C. You should use a hand-held mirror to improve your ability to see objects around
you.
Explanation:
Clients who experience a stroke may experience altered visual perception and decreased
visual fields; therefore, the nurse should recommend that clients use a hand-held mirror to
improve the ability see objects in the surrounding environment.

27. A nurse manger is providing orientation to a nurse who is new to hospice care. Which of
the following statements indicates that the new nurse needs additional orientation.
A. I will link clients with services that assist them to continue living at home.
B. I will modify client's treatment plan as needed to maximize his independence level.
C. I will provide care and education to clients in order to promote recovery.
D. I will work as team to alleviate symptoms and meet the client's special needs.
Answer: C. I will provide care and education to clients in order to promote recovery.

Explanation:
The goal of hospice is to deliver palliative care and emotional support to clients who are no
longer seeking curative treatment for an illness.

28. A nurse in a community health center is talking with a client who is receiving treatment
for an opioid addiction. Which of the following statements by the nurse is appropriate for
encouraging the client to attend his 12-step meeting?
A. You'll find the Narcotics Anonymous will help you regain power over your addictions.
B. Narcotics Anonymous will help you take responsibility for the symptoms of you disease.
C. At Narcotics Anonymous you willingness to change will be crucial for your sobriety.
D. At Narcotic Anonymous you'll learn to maintain control by never admitting to defeat.
Answer: C. At Narcotics Anonymous you willingness to change will be crucial for your
sobriety.
Explanation:
Basic tenets of all 12-step programs, including Narcotics Anonymous, have a willingness to
change and to make amends, as well as the incorporation of the 12-step process into daily
life.

29. A community health nurse is asked to give a health education program to a group of
African-American men age 40 to 75. Considering the health concerns of this group, which of
the following topics is most important to include in the program?
A. Prostate cancer screening.
B. Diabetes screening.
C. Depression screening.
D. Skin cancer screening.
Answer: A. Prostate cancer screening.
Explanation:
Cancer is the second leading cause of death for men and prostate cancer is the second leading
cause of cancer deaths in men. The incidence rate of prostate cancer is 51% higher among
African-American men than white men.

30. A clinical nurse manager is developing an education program on tuberculin skin testing.
The nurse should include that which of the following can cause a false negative result?
(Select all that apply).

A. Advanced HIV or AIDS.
B. Bacilli Calmette-Gue'rin (BCG) vaccination.
C. Time between exposure and screening.
D. Age of the client.
Answer: A. Advanced HIV or AIDS.
C. Time between exposure and screening.
D. Age of the client.
Explanation:
Recent abuse of IV-substance.

31. A nurse is planning health promotion activities for the local community. Which of the
following is an example of primary prevention.
A. Teaching foot care to adults who have diabetes mellitus.
B. Testing school-age children for lead exposure.
C. Providing tuberculosis screening for day care providers.
D. Teaching meal planning classes to older adults.
Answer: D. Teaching meal planning classes to older adults.
Explanation:
This is an example of primary prevention.

32. A nurse is caring for a client who has AIDS and is experiencing rapid weight loss. Which
of the following action should the nurse take first.
A. Examine the client's oral mucous membranes.
B. Encourage the client to consume 1.2 to 2.0 g/kg of protein daily.
C. Recommend the client increase daily calorie intake by 25%.
D. Teach the client about findings that should be reported to the provider.
Answer: A. Examine the client's oral mucous membranes.
Explanation:
The first action the nurse should take using the nursing process is to assess the client. The
nurse should examine the oral mucous membranes for painful lesions, such as candidiasis,
that result from HIV or HIV therapy.

33. A nurse is caring for a 50 year old client who has diabetes mellitus, recently lost his job,
and has no health insurance. The nurse should advise the client to do which of the following?

A. Contact Medicare to determine eligibility.
B. Contact Medicaid to determine eligibility.
C. Go to the emergency department when services are needed.
D. Go to the public health department when services are needed.
Answer: B. Contact Medicaid to determine eligibility.
Explanation:
Medicaid is available to individuals with low income and no insurance. Eligibility and
resources vary by state, so the client should contact the local office to determine his status.

34. A home health nurse is assessing a client who has a prescription for captopril to treat
heart failure. Which of the following findings is an adverse effect of this medication.
A. Weight gain
B. Ataxia
C. Photophobia
D. Dry cough
Answer: D. Dry cough
Explanation:
Captopril prevents the conversion of angiotensin 1 to angiotensin 2 which causes bradykinin
to accumulate. The client may experience cough as a result of bradykinin accumulation.

35. A community health nurse is providing education to a group of children who have
asthma. Which of the following statements indicates an understanding of the teaching.
A. I shouldn't play sports because it will make me too tired.
B. I will stay indoors during cold weather.
C. I will use my rescue medication every day.
D. I shouldn't get the flu shot because it might make me sick.
Answer: B. I will stay indoors during cold weather.
Explanation:
Cold air can be trigger for asthma. This response indicates the student recognizes the risk.

36. A client asks a home health infusion nurse the difference between a peripheral IV line and
Peripherally inserted central catheter (PICC) for long-term venous access. Which of the
following responses is appropriate?
A. Blockages do not form in central catheters like they do in peripheral catheters.

B. There won't be any infections in your arm from the central catheter.
C. The central catheter does not require flushing like the peripheral catheter.
D. The central catheter does not require replacement as often as a peripheral IV
Answer: D. The central catheter does not require replacement as often as a peripheral IV
Explanation:
Nurses must replace peripheral IV catheters every 72 to 96 hours, while a PICC may remain
in place for a year or more, as long as there are no complications with the insertion site or the
catheter.

37. The daughter of a client who is terminally ill and at the end of life approaches the hospice
nurse and asks what she can do to help relieve her father's anxiety. Which of the following
interventions should the nurse suggest?
A. Give the client brief hand massages.
B. Increase the illumination in the room.
C. Place a warm cloth on the clients forehead.
D. Administer citalopram when the client is agitated.
Answer: A. Give the client brief hand massages.
Explanation:
Soft massage and brief hand massage can reduce stress in palliative care settings.

38. A community health nurse is teaching a group of older adults about environmental health
hazards. A need for additional teaching is indicated when a group member lists which of the
following as a possible source of carbon monoxide exposure.
A. Motor vehicles
B. Gas ranges
C. Vented gas heaters
D. Electric space heaters.
Answer: D. Electric space heaters.
Explanation:
Electric space heaters are not a source of carbon monoxide poisoning.

39. A community health nurse is planning a presentation to aging adults who have a family
history of Alzheimer's disease. The nurse should include that which of the following
behaviours is an early manifestation of the disease.

A. Withdrawal form social activities
B. Difficulty learning new things
C. Loss of language skills
D. Neglecting personal hygiene.
Answer: B. Difficulty learning new things
Explanation:
Difficulty learning new things is generally an early indication of Alzheimer's disease. Other
early indicators include short-term memory loss and subtle changes in personality.

40. A home health nurse is planning care for the day. Which of the following clients should
the nurse visit first.?
A. An older adult client who was treated in the emergency department last night with a stage
3 pressure ulcer.
B. A school-age child who was treated in the emergency department last night with status
asthmaticus.
C. An older adult client on a newly prescribed antihypertensive who needs a blood pressure
check.
D. A school-age child whose percutaneous endoscopic gastrostomy (PEG) tube needs
changing.
Answer: B. A school-age child who was treated in the emergency department last night with
status asthmaticus.

41. A nurse is providing safety information to the parents of an infant. Which of the
following statement by a parent indicates the need for further teaching.
A. It important to keep our bathroom doors closed.
B. The slats on our child's crib are 2 inches apart.
C. I will make sure the water heater setting is no higher than 140 degrees F. D. I will clip a
pacifier onto my child's clothing during naps.
Answer: C. I will make sure the water heater setting is no higher than 140 degrees F.
Explanation:
The water heater should be at a setting no higher than 120 degrees F to prevent accidental
burns.

42. A school nurse is notified that an elementary school child is newly diagnosed with
pertussis. Which of the following actions should the school nurse take? (select all that apply).
A. Instruct the parent to keep the child home until the coughing stage has passed.
B. Encourage family members to obtain prophylactic treatment.
C. Quarantine the children in the child's class.
D. Recommend the child receive a pneumococcal vaccine in 28 days.
E. Check the immunization status of child's classmates.
Answer: A. Instruct the parent to keep the child home until the coughing stage has passed.
B. Encourage family members to obtain prophylactic treatment.
E. Check the immunization status of child's classmates.

43. Community leaders have requested a meeting with a community health nurse to discuss
creating a mobile meals program. Which of the following should the community health nurse
assess first?
A. The need for the program.
B. The accessibility of residences.
C. The availability of volunteers.
D. The leadership of the community.
Answer: A. The need for the program.
Explanation:
Using the urgent vs. non-urgent approach to client care, the nurse should first assess the need
for the mobile meals program. This action allows the nurse to collect data on the client, which
is the community, and meets the first step of program planning. The needs of the community
will determine all other steps of the planning process.

44. A public health nurse is providing an educational program about inhalation anthrax to a
group of first responders in the community. Which of the following statements by a member
of the group indicates an understanding of the teaching?
A. Inhalation anthrax is highly contagious.
B. A person exposed to inhalation anthrax may develop a dry cough.
C. The drug of choice to treat inhalation anthrax is ciprofloxacin.
D. The fatality rate for untreated inhalation anthrax is about 65%.
Answer: B. A person exposed to inhalation anthrax may develop a dry cough.
Explanation:

Early clinical manifestation of inhalation anthrax include fever, fatigue, mild chest pain, and
a dry cough.

45. A nurse is providing education regarding lead exposure to a group of clients who live in a
subsidized housing development built in 1968. Which of the following silent statements
indicates an understanding of the teaching?
A. I will use a dry sanding technique when preparing to repaint my front door.
B. I will vacuum our wood floors every week.
C. I will increase the amount of red meat and milk in my child's diet.
D. I will use hot tap water when preparing my baby's formula.
Answer: C. I will increase the amount of red meat and milk in my child's diet.
Explanation:
Children should get adequate amounts of iron and calcium in their diets in order to prevent
lead absorption from their environment.

46. A nurse is preparing a community education program about health care needs during
pregnancy. The nurse should include that which of the following vaccines is safe to
administer to a client who is pregnant?
A. Herpes zoster
B. Tetanus, diphtheria, pertussis.
C. Varicella
D. Measles, mumps, rebells
Answer: B. Tetanus, diphtheria, pertussis.
Explanation:
The center for disease control and prevention recommends this vaccine during pregnancy.

47. A nurse is developing a community education program about risk factors for family
violence. The nurse should include which of the following circumstances as a risk factor for
becoming a victim of intimate partner abuse.
A. Attempting to end the relationship with their partner.
B. Lacking supportive friends outside the relationship.
C. Having health issues that limit independence.
D. Taking anti-anxiety or sedative medication.
Answer: A. Attempting to end the relationship with their partner.

Explanation:
Those in a relationship with a potential or actual abuser heighten their risk for abuse when
they attempt to leave the relationship.

48. A community health nurse has conducted a teaching session about breast selfexamination. Which of the following best indicates whether or not the teaching was
effective?
A. Completion of a written quiz.
B. Verbalization of the steps in the process.
C. Demonstration on a breast model.
D. Self-evaluation of the teaching session.
Answer: C. Demonstration on a breast model.
Explanation:
Is the best indicator of teaching effectiveness when teaching a psychomotor skill.

49. A home health nurse is talking with a client whose partner died 3 months ago. The client
states " I still can't believe my partner is gone sometimes." Which of the following is an
appropriate nursing response.
A. Many people experience these feelings while grieving for a lost loved one.
B. Just give yourself some more time, and you'll feel better
C. Tell me more about how you're feeling.
D. I will schedule an appointment for you with the leader of your church.
Answer: C. Tell me more about how you're feeling.
Explanation:
The nurse should encourage the client to share her feelings about her life without her partner.

50. A home health nurse is orienting a newly licensed nurse who is drawing blood from a
client for laboratory testing and gets stuck by used needle. Which of the following statements
by the newly licensed nurse indicates a need for further teaching.
A. The client will be tested for HIV.
B. The client will be tested for hepatitis B virus.
C. The client will be tested for hepatitis C virus.
D. The client will be tested for hepatitis A virus.
Answer: D. The client will be tested for hepatitis A virus.

Explanation:
The client would not be tested for hepatitis A because it is primarily transmitted by the oralfecal route.

VERSION 9
ATI COMMUNITY NURSING PROCTORED
STUDY GUIDE
Community Health nursing Theories:
• Nightingale’s Theory of Environment Health Belief Model
o Focus on impact of a person’s environment on their health.
Focus is on preventative care (washing hands, clean
environment)
• Health Belief Model
o Assumes a person’s primary motivation in taking positive
health actions is to avoid getting a disease
• Likelihood of taking action is based on:
1. Modifying variables (age, gender, race, economy, education)
2. Perceived severity and susceptibility of getting the disease
3. Perceived benefits vs barriers of taking action
4. Cues to action (advice of doctor, media campaigns)
Community based nursing vs. community oriented nursing:
The community or population us the “client” in community health
nursing

• Community based nursing- is focused on illness care (acute or
chronic conditions) for individuals and families.
Examples: home health nurse doing would care,
school nurse administering epi-pen
• Community oriented nursing: is focused on improving collective
health of the community.
Examples: health education and promotion, disease
prevention activities. No illness care! Community oriented
nursing = public health nursing
Community Health nursing vs. public health nursing
• Community health nursing: delivers health care services to
individuals, families, and groups. Includes community based
nursing (illness care for individuals and families) AND community
oriented nursing (community focused care, with emphasis on
education and disease prevention)
• Public health nursing: disease prevention and health promotion of
communities and populations. They are not providing direct care
to individuals! Public health nursing = community oriented
nursing.
4 Ethical Principles in Community Health nursing
- Respect for autonomy: respect a patient’s right to self determination
- Nonmaleficence: do no harm
- Beneficence: do what is best (maximize benefits)
- Distributive justice: fail allocation of resources in community
Epidemiology
- Study of spread, transmission, and incidence of disease/ injury
Components:
- Agent: what is causing the disease (bacteria, toxin, noise)
- Host: human/ animal being affected by the disease
- Environment: physical environment (water/ food supply, geography),
social experiment (access to health care, work conditions, poverty)
Incidence vs prevalence
Incidence: number of NEW cases of disease/ injury iin a population during a
specified period of time

Prevalence: Number of ALL cases (new and pre existing) of disease/ injury in a
population during a specified period of time
Community Health Education:
• Obstacles: age, culture, illiteracy, language barriers lack of access, lack of
motivation
• Learning styles:
o Visual (videos, presentations)
o Auditory (verbal lectures, discussions)
o Tactile- kinesthetic (hands on, return demonstration)
• Healthy people 2020: Includes national health goals based on major risks
to health and wellness of U.S. population (ex. Diabetes, cancer, older
adults, LGBT health).
Primary vs. Secondary vs. Tertiary prevention:
• Primary: prevents initial occurrence of disease
o Ex. Education, immunizations, prenatal classes
• Secondary: focuses on early detection of disease, limiting severity of
disease
o Ex. Screenings, disease surveillance, control of outbreaks
• Tertiary: Maximize recovery after an injury/ illness
o Ex. Rehabilitation, PT/OT, support groups
Acculturation, Ethnocentrism, Cultural Assessment, Interpreter
• Acculturation: adopting the traits of a different culture
• Ethnocentrism: the belief that ones own culture is superior to all others.
View world from their own cultural viewpoint.
• Cultural Assessment: ask about patient’s ethnic background, religious
preference, family structure, food patterns and health practices.
Incorporate patient preferences into care whenever possible.
• Interpreter: use of family members is not recommended, interpreters need
to have knowledge of health terminology. Patient teaching materials
should be available in their primary language.
Environmental Risks/ Environmental Assessment:
• Environmental Risks:
o Toxins (ex. Lead, pesticides, asbestos, radon)
o Air pollution (ex. Carbon monoxide, tobacco smoke, lead)
o Water pollution (ex. Waste products, chemical runoff from soil)
• Environmental assessment questions:
o Condition of housing. Remodeling activities?

o
o
o
o

Water heater temperature less than 120 degrees F?
Occupation (including exposure to chemicals, toxins)?
Tobacco smoke present in home?
Quality of drinking water?

Lead exposure key points
• Pre 1978 housing at risk for lead based paint!
• Screen child 6 months- 5 years for blood lead levels
• Avoid playing in soil right outside home
• Wet mop floors (vs. vacuuming floors)
• Use wet sanding technique (vs. dry sanding)
• Make sure children get enough iron and calcium diet, as this decreases
absorption of lead in the body
• Use cold water (vs. hot water) because lead dissolves more quickly in hot
water
Medicare and Medicaid
• Medicare eligibility:
o Older than 65
o Receiving disability for at least 2 years
o Diagnosed with amyotrophic lateral sclerosis (ALS) or end stage
renal disease (ESRD) and receiving dialysis
• Part A: inpatient hospital, limited SNF, home health care
• Part B: outpatient care, diagnostic services, PT/OT
• Part C: combines Part A and Part B provided through private insurance
• Part D: prescription drug coverage (D is for Drug)
• Medicaid Eligibility: those with low socioeconomic status and no other
insurance, based on household size and income
State Department of Health, stage board of nursing, local health department
• State department of health: manages WIC program, CHIP, Medicaid
program. Reports notifiable communicable diseases to CDC (voluntary)
• State board of nursing: license LPNs and RNs, oversees state schools of
nursing, develops state’s nurse practice act
• Local health department: meets health needs of community. Reports
notifiable communicable diseases to state department of health
Community Assessment
• People:
o Demographics
o Biological factors (race, age, gender, health/ disease status)

o Social factors (education, income, crime rate)
o Cultural factors (history, religion, customs)
• Environment:
o Physical factors (geography, housing, location of health care
services)
o Environmental factors (climate, pollutants, topography)
Types of Data collection in community nursing
• Informants interviews: direct conversations with member of community
• Community forum: public meeting (participation challenges)
• Secondary data: review existing data available (statistics, health records)
• Participant observation: observe community activities
• Windshield survey: literally drive through community and make
observations
• Focus groups: meet with representative sample of community
• Surveys: written format (expensive, low response rate)
Windshield Survey
• People: general appearance, ethnicity/race of community members. Signs
of violence? Mental illness? Drug abuse?
• Place: quality of housing, access to health care facilities, types and
availability of grocery stores, public transportation, presence of schools,
parks, and churches
Steps in developing and managing a community health plan
• Pre planning: brainstorm ideas
• Assessment: data collection
• Diagnosis: analyze collected data to determine health needs of the
community. Set priorities.
• Planning: Plan interventions. Establish goals, identify responsibilities,
develop budget.
• Implementation: execute plan
• Evaluation: determine effectiveness of intervention
Home Health Nurse
• Provides health care in patient’s homes and assisted living facilities
(including nursing homes)
• Provides patient education, direct nursing care, and care coordination
(including referrals)
• Assesses home for safety. Key items to look for: NO scatter rugs (carpet
ok), no clutter, adequate lighting on stairs (use of colored tape on step

edges is helpful). For Alzheimer’s patients, locks/ alarms on exit doors
are appropriate.

Hospice nurses, parish nurses
• Hospice nurse: provides palliative care (focus on symptom
management, not curing disease), supports patient and family with dying
process.
• Parish nurse: works w/ pastoral stall to improve the health and wellness
of the faith community Provides health education and facilitates support
groups. Does NOT do bedside nursing tasks.
Occupational Health Nurse
• Promotes health and wellness of employees, prevents workplace illness
and injury
• Through surveillance, identifies risks within work environment. Identifies
ways to decrease or eliminate workplace hazards.
• Keeps informed about OSHA standards.
• Primary prevention: provides safety education
• Secondary prevention: performs screenings
• Tertiary Prevention: sets up limited duty programs
School Nurse
• Provides direct nursing care to children at school
• Provides health education
• Case manager for children w/ health needs (makes referrals, schedules
appointments, coordinates services)
• Primary prevention: assesses immunization status of children
• Secondary prevention: provides vison and hearing screening, screens for
oral health, scoliosis, infestations. Assesses for child abuse/neglect.
• Tertiary prevention: Administers medications, provides nursing care for
children with chronic diseases, assesses children with disabilities.
Key Health Concerns for:
Infants/Children: SIDS (sleep on back), injuries (wear helmets and seat belts),
communicable diseases (get immunizations)
Adolescents: motor vehicle accidents (wear seatbelts), substance abuse
(including smoking), safe sex, mental health
Women: menopause, osteoporosis, (encourage weight bearing exercise), heart
disease, diabetes, cancer prevention (get mammograms, pap smears)

Men: heart disease, cancer prevention, (get prostate cancer screening, testicular
self exams), lung disease, liver disease
Older Adults: heart disease, CVAs, COPD, pneumonia, polypharmacy, cancer,
injury prevention (including falls)

Transitions, genograms, ecomaps
• Transitions: includes birth or adoption of child, death in family, major
illness, divorce, loss of income, etc.
o Transitions = time of risk for family
• Genograms: graphical representation of relationships within the family,
patterns of illness (i.e. “enhanced” family tree)
• Ecomaps: graphical representation of family interaction with outside
groups/ organizations which provides information about the family’s
support network
Types of violence
• Homicide: often related to drug abuse, usually victim is someone know
to perpetrator. Males at higher risk.
• Rape: Intimate partner violence very common; often unreported.
• Suicide: Highest in men, and those over 65 year old.
• Abuse: physical abuse, sexual abuse, emotional abuse (humiliation,
intimidation), neglect (failure to provide food, shelter, emotional care,
medical care, education), economic abuse (misuse of money, failure to
provide for needs of victim despite adequate funds, theft).
Violence, Child abuse
• Community factors that increase risk of violence: Unemployment,
poverty, social isolation. Child abuse is more common when spousal
abuse is present.
• Signs of child abuse: presence of wounds or injuries in various states of
healing, unexplained bruises/ injuries, unusual fear of others. Small round
burns that could be caused by cigarettes, forearm spiral fractures
• Signs of child neglect: poor hygiene, inappropriate dress (for weather),
signs of malnourishment, withdrawal, school absences
Alcohol Abuse
• Factors that affect alcohol metabolism: size/ weight of drinker, time
elapsed while drinking, gender, presence of food in stomach
• Alcohol withdrawal: manifestations appear within 4-12 hours. Symptoms
include: tachycardia, hypertension, n/v, headache, anxiety/ irritability,

diaphoresis, tremors, seizures. It is important to ask patient when their
last drink was!
• Primary prevention: public education campaigns, school education
• Secondary prevention: screen individuals for signs of abuse
• Tertiary prevention: refer patients to AA or NA, promote coping and
lifestyle changes
Homelessness, Veterans
• Homelessness:
o Fast growing segment: families with children
o Risk factors: unemployment, migrant workers, veterans, mental
illness, substance abuse, HIV/AIDS, at risk youth
o Key health issues: tuberculosis, infestations (scabies/ lice),
substance abuse, HIV/AIDS, mental illness
• Key health issues of veterans: mental health issues (PTSD, depression),
substance abuse, suicide, traumatic brain injury, spinal cord injury,
amputations
Migrant workers
• Key health risks: tuberculosis, dental disease, skin cancer, diabetes,
obesity, high risk suicide, increased work related injuries (exposure to
pesticides, injuries from machinery)
• Primary prevention: education on reducing exposure to pesticides,
accident prevention. Preventative care (immunizations, dental care)
• Secondary prevention: screen for skin cancer, pesticide exposure,
communicable diseases
• Tertiary prevention: provide ER or primary care services, including
treatment of symptoms of pesticide exposure
Communicable Diseases: Modes of Transmission
• Airborne: chickenpox, measles, tuberculosis, pertussis, influenza
• Foodborne: salmonella, hepatitis A (fecal oral route), E-Coli, botulism
• Waterborne: cholera, typhoid fever
• Vector- borne: (ex. Mosquito or tick) lyme disease, malaria, rocky
mountain spotted fever
• Sexually transmitted: HIV, Hep B/C/D, syphilis, HPV, gonorrhea
• Direct contact: lice, scabies, impetigo
• Saliva: mononucleosis
Types of Immunity

• Herd immunity: most community members have immunity, protecting
those who cant (or choose not to get) immunized. Makes exposure
unlikely.
• Active natural immunity: body produces antibodies in response to
exposure to live pathogen
• Active artificial immunity: body produces antibodies in response to
vaccine
• Passive natural immunity: antibodies are passed form the mom to her
baby thought the placenta or breast milk
• Passive artificial immunity: Immunoglobulins are administered to an
individual after they have been exposed to a pathogen
Communicable Diseases: reporting, prevention
• Communicable disease reporting is mandated by state and local
regulations. State notification to CDC is voluntary.
• Primary prevention: provide education re: immunization, hand hygiene,
proper food handling, risk of infectious diseases when traveling to other
countries (including Hepatitis A)
• Secondary Prevention: provide screening, quarantine patients when
needed, refer suspected cases for definitive diagnosis
• Tertiary prevention: monitor treatment compliance (may require direct
observation therapy)
Nationally Notifiable Diseases
• Lyme disease: key symptom is red bullseye ring around the area of the
tick bite
• Meningococcal disease: individuals should get vaccinate prior to living in
a crowded housing environment (college dorms, prisons, military
housing)
• Pertussis: Children w/ pertussis should stay home from school until
coughing is gone. Family members and those exposed should be treated
with antimicrobials. Check immunization status of other children in
school.
• TB: Treated with up to 4 antibiotics (to prevent drug resistance) for 6-12
months. Family members need to be tested for TB. Sputum samples will
be needed ever 2-4 weeks – patients are no longer infectious after three
negative sputum cultures. Patients with active TB need to wear N95
masks in public.
Disaster Management: Four levels

• Disaster prevention: surveillance, inspections, immunizations, education,
risk assessment
• Disaster preparedness: create disaster action plan, identify evacuation
routes, create disaster kit, identify meeting place and communication
plan, perform disaster drills
• Disaster response: assess extent of disaster. Perform triage, and direct
those affected. Coordinate evacuations, quarantines.
• Disaster recovery: begins when danger no longer exists. Coordinate care
in shelters, homes.
Bioterrorism, Inhaled anthrax, Small pox
• Category A: small pox, botulism, anthrax, plague
• Category B: typhus cholera
• Category C: hantavirus
• Inhaled Anthrax: symptoms: severe dyspnea, fever, shock, muscle aches.
Intervention: IV ciprofloxacin for those exposed (or have high risk of
exposure)
• Small pox: symptoms: rash (begins on face and spreads down), high
fever, headache, vomiting. Prevention: vaccination
Consultations vs. Referrals
• Consultation: Request from provider to another physician or resource
who can provide expert advice and/or services for the patient
• Referral: Provider requests or recommends management of one or more
of the patient’s concerns/ issues to another provider or for support
services (ex: support groups, churches, transportation services, meal
delivery services)
Case management: Responsibilities
• Help the patient transition from acute to community based care
• Evaluate patient’s medical needs, psychosocial issues, financial
constraints
• Collaborate with patient, family, insurance, companies, health care
providers, medical services/ equipment providers to meet the health care
needs of the patient
• Facilitate discussion of patient’s needs with an interprofessional team
• Provide referrals as needed
Informatics, Telehealth, Nursing roles in Health Policy

• Informatics: incorporates nursing, information technology, and
communication technology to develop and to support nursing practice
and improve patient outcomes
• Telehealth: Delivery of health care through technology (vs. in person).
This is particularly helpful in rural areas, where there is a lack of
specialty care services
• Nursing roles in health policy: Nurses can act as an advocate for changes
in health policy, lobby legislators, serve in public office, or help form
coalitions (collaboration of groups to achieve a goal)
VERSION 10
ATI RN COMMUNITY HEALH PROCTORED: FOCUS STUDY GUIDE

Care of specific populations
• Planning care for a pt who has antisocial personality disorder
o Antisocial personality disorder, borderline, histrionic, and
narcissistic are part of cluster B
o and is characterized by disregard of others with exploitations,
repeat unlawful actions, deceit, and failure to accept personality
responsibility. They have impulsive behavior, lack of remorse and
fail to empathize, they get easily agitated and aggressive or
controlling
o Nurse needs to set limits with clients who have maladaptive
behavior
o Behavioral therapy through Operant conditioning would change the
client behavior to refrain from manipulating others to earn dining
room privileges
• Prior Action for a client who is homeless
o Refer those who have underlying mental health disorders to
therapy and counseling
o Enhance parenting skills that can prevent young people from
feeling the need to run away
o Alleviate the existing homeless by making referrals for financial
assistance, food supplements, and health services
o Assist homeless clients in locating temporary shelte, and finding
ways to meet long-term shelter

o If homeless shelters are not provided in the community work with
government officials to develop shelter programs
o To prevent reoccurrence of poverty, homeless and health problems
advocate and provide effort toward political activity to provide
needed services for people who have mental health disorders and
are homeless
o Make referrals for employee assistance and educational programs
to allow clients who are homeless to eliminate the factors
contributing to their homelessness
o Families with children are the fasting-growing segment of the
homeless population
• Identifying risk factors for child abuse
o
o
o
o
o
o
o
o
o

Unexplained injury
Unusual fear of the nurse and others
Injuries or wound not mentioned in history
Fractures, including older healed fractures
Presence of injuries in various stages of healing
Subdural hematomas, trauma to genitalia
Malnourishment or dehydration
General poor hygiene or inappropriate dress for weather conditions
Parents consider the child a bad kid.

• Teaching about alcohol withdrawal
o Irritability
o Tremors
o Nausea and vomit
o Headache
o Diaphoresis(sweating)
o Anxiety
o Sleep disturbances
o Tachycardia
o Elevated BP
o Medication for alcohol withdrawal: benzodiazepines
o Is important to asses last drink to accurately asses for signs of
withdrawal

communicable diseases, disasters and bioterrorism

• Priority action for infectious diarrhea
• Reporting infectious prenatal conditions
o HIV; is transmitted from mother to neonate prenatally through the
placenta and postnatal through breast milk
o HIV: laboratory testing recommended in the 3rd trimester for
patients who are at increased risk, ask for informed consent, test
begins with antibody screening test such as enzyme immunoassay,
confirmation of positive results if confirmed by western blot test or
immunofluorescence assay.
o HIV: procedures such as amniocentesis and episiotomy, use of
internal fetal monitors, vacuum extraction, and forceps during
labor should be avoided due to risk of maternal blood exposure
o Baby should be first bath before giving him injections or blood
testing
o Nursing care; provide conseling prior and after testing, use standar
precautions, encourage vaccination against hepatitis b,
pneumococcal infection, haemophilus influenza type b and viral
influenza.
o HIV med: Retrovir should be administer at 14 weeks of gestations,
throughout the pregnancy and before the onset of labor or cesarean
birth and is administer to bab at delivery and for 6 weeks following
birth
o TORCH- acronym for group of infections that can negatively affect
a woman who is pregnant, they can cross placenta and have
teratogenic affects on the fetus
o TORCH risk factors: toxoplasmosis- is caused by consumption of
raw or undercooked meat or handling cat feces, symtoms similar to
influenza or lymphadenopathy. Other infections can include; hep a
and b, syphilis, mumps, parvovirus b19 and varicella-zoster
o Torch- measles, rubella, cytomegalovirushepers simplex virus
continuity of care
• Role of the Case Manager
o Coordinating care, facilitating continuity of care, improving the
efficiency of care and utilization of resources
o Enhancing quality of care provided, limiting unnecessary costs and
lengthy stays, advocating for client and family

o The goal of case management is to avoid fragmentation of care and
control cost
o Case manager can be a nurse, social worker or the designated
health care pro. They are required to advance practice degrees or
advance training in this area.
o Case manager nurses do not usually provide direct client care, they
oversee a caseload of clients who have similar disorders or
treatment regimens
o Case managers in community coordinate resources and services for
clients who care is based in a residential setting
o A critical or clinical pathway or care map can be used to support
the implementation of clinical guidelines and protocol, these tools
are usually based on cost and length of stay parameters mandated
by prospective payment systems such as medicare and insurance
companies
• Continuity of care: consultations and referrals, transfers and discharge
planning
o Continuity of care is desired as clients move from one level of care
to another such as from ICU to a medical unit, or from acute care
facility to skill care facility, PACU to post surgical unit
o Nurses are responsible for facilitating continuity of care and
coordinating care through documentation, reporting and
collaboration.
o A formal written plan of care enhances coordination of care
between nurses, interpro team members and providers.
o Nurse role in continuity of care:
▪ Facilitates continuity of care provided by members of the
health care team
▪ Acts as a representative of the client and as a liaison when
collaborating with the provider and other health care team.
When acting as a liaison the nurses serves in the role of
client advocate by protecting the rights of clients and
ensuring that the client needs are met
▪ Nurse is responsible for admission, transfer, discharge and
postdischarge prescriptions.
▪ Initiation, revision and evaluation of the plan of care
▪ Reporting the clients status to other nurses and provider
▪ Coordinating the discharge plan and facilitating referrals and
the use of community resources

• Assement for a client following a traumatic amputation
o Nurse needs to monitor capillary refill and compare extremities
o Observe for edema, necrosis, hair distribuition of extremity due to
inadequate peripheral circulation
o Manifestations of decrease tissue perfusion: clients may or may not
report pain, altered peripheral pulses (Doppler), differences in temp
of extremities, altered color of extremities, presence of infection
and lack of sensation in affected area

Chapter 30 skin infections and infestations NCC
• Recommended natural treatment for lice
o Shampoos containing 1% permethrin
o Remove nits with a nit comb repeat in 7 days after shampoo
treatment
o Wash cloths in hot water with detergent

Chapter 31 anger management MH
• Priority action for violent behavior
o Provide safe environment for client and others
o Asses for triggers or preconditions that escalate the client emotions
o Steps to handle aggressive behavior:
▪ Respond quick in a calm and in control manner
▪ Encourage client to express feelings verbally using
therapeutic communication techniques, allowing the client as
much personal space as possible
▪ Maintaining eye contact and sitting or standing at the same
level as the client
▪ Be honest, sincerity and nonagrressive stance
▪ Avoid accusatory or threating statements
▪ Describing options clearly and offering choices
▪ Reassuring the client that staff memners are present to help
preven loss of control
▪ Set limits for client
▪ Tell him calmly and directly what he must do in a particular
situation such as “I need you to stop yelling and walk with
me to the day room where we can talk,”
▪ Use physical activity, such as walking, to deescalate anger
and behaviors inform the client of the consequences of his
behavior such as loss of privileges

▪ Use pharmacological interventions if the client does not
respond to a limit-setting
▪ Plan for four to six staff members to be available and in sight
of the client as a “show of force” if appropriate

Chapter 18 substance use and addictive disorders MH
• Interventions for gambling
o Encourage the client in a 12-step program such as gamblers
anonymouse
▪ Teaching abstinence is necessary for recovery
▪ Higher power is needed to assist in recovery
▪ They are not responsible for their disease but they are
responsible recovery
▪ Others cannot be blamed for their addictions and they must
acknowledge their feelings and problems

Chapter 12 acute neurological disorders
• Priority action for client who has bacterial meningitis
o Isolate the pt as soon as meningitis is suspected
o Droplet precautions which require private room or room w cohorts,
wearing of a surgical mask when with in 3 ft of the pt, appropriate
hand hygiene and use of designated equipment such as a BP cuff
and thermometer
o Implement fever reduction measures (cooling blanket)
o Report meningococcal infections to public health dept.
o Decrease environment stimuli, minimize exposure to bright light
o Bed rest with HOB – head of the bed ELEVATED 30 Degrees
o Seizure precautions
o Replace fluid and electro. Balance
o Older adults clients are at an increased risk for secondary
complications such as pneumonia
o Monitor for ICP increase, pupillary changes, widening pulse
pressue, decrease level of consciousness
o To decrease ICP provide positioning and avoidance of cought and
straining, and mannitol can be administered IV
o Expected findings: photophobia, nausea, irritable and headache
o Brudzinki’s sign: severe neck stiffness cause ships and knees to
flex when neck is flexed, 2 years and throught adolescence

o Medications: only for bacterial meningitis, for viral only suuportive
care
▪ Ceftriaxone (rocephin) or cefotaxime (claforan)
▪ Antibiotics given until culture and sensitivity results are
available
▪ Phenytoind(dilantin)- for antivonvulsants given if ICP
increases or pt experiences seizure
▪ Ciprofloxacin( cipro) and rifampin (rifadin) are giving
prophylactic antibiotics to individuals in close contact with
pt.

Chapter 11 infection control
• Caring for a client who has c. difficle
o Withdrawal of causative antibiotic
o Good skin care
o Well balanced ite and increase fluid intake
o Rest periods during acute phase
o Meds: IV FLUIDS, probiotics, metronidazole oral or IV,
Vancomycing as fist line agent for severe disease
o Teach family to wear a gown and gloves
o Wash hands with soap and water, because alcohol base does not
remove the bacteria

Chapter 1 overview of community health nursing
• Planning primary prevention programs
o Prevention of initial occurrence of disease or injury
o Nutrition education
o Family planning
o Sex ed, smoking cessation education
o Communicable diseases education
o Safety education, prenatal classes, providing immunizations
o Advocating for access to health care and healthy environments

Chapter 2 factors influencing community health
• Counseling and adolescent who is pregnant
o Refer her to prenatal provider

Chapter 3 health promo. Of infants 2 days to 1 year
• Evaluating parent understanding of infant care
o Asses family readiness of home care for newborn
o Asses if they have previous experience or knowledge,
o Social support received, education needs indicated
o Sibling rivalry issues,
o Newborn infants should be placed in car seat at 45 degree angle to
prevent slumping and airway obstruction. Palced rear facing in the
rear seat of the vehicle and secure using the safety belt. Shoulder
harness are placed in the slots at or below the level of the infants
shoulder. The harness should be snug and the retainer clip placed at
the level of the infants armpits.
o Newborns require a checkup by provider within 72hours of
discharge, important for breastfed newborns to evaluate weight and
hydration status.

Chapter 4 Practice settings and aggregates
• Teaching about disposal of insulin syringes
o Place the needle and syring into the shaprs container
o Do not try to recap the needle after it has been used, do not try to
separate the needle and syringe before disposal
ATI Community Health
Version 11
*Will also include questions from Med-Surge, Fundamentals, Pharmacology, Pediatrics,
etc.).
*Take practice exams!
Chapter 1
Community Health Nursing Theories
1. Nightingale’s Theory of the Environment
a. Impact of a person’s environment on their health
b. PREVENTATIVE CARE
i. Washing hands
ii. Maintain a clean environment
2. Health Belief Model
a. Assumes a person’s primary motivation in taking positive health actions is to
AVOID getting a disease
b. Likelihood that they are going to take these positive health actions is based
on
i. Modifying variables (age, gender, race, economy, education)

1. Depending on where they fall, they may or may not be inclined
to take positive health actions
ii. Perceived severity and susceptibility of getting a disease
1. They perceive that the disease is very serious and that they
can get it, they’re going to be more motivated to take action
iii. Perceived benefits vs. barriers of taking action
1. If they see more benefits than barriers, they’re more likely to
take action
2. If they see more barriers than benefits, they’re more likely to
take action
iv. Cues to action
1. Getting advice from Dr.?
2. Are they seeing media campaigns (i.e. smoking cessation)?
3. If they see these cues, there is an increased likelihood that
they will take a positive action to improve their health
Community Health Nursing (contains both community-based nursing and communityoriented nursing)
Difference between community-based nursing vs. community-oriented nursing
Community Health Nursing
-The client is community/population as opposed to an individual
Community-Based Nursing
-Providing illness care
-Helping to take care of patients with acute/chronic conditions
-Treating individuals and families
-Hands-on specific nursing care for individuals and families
Examples:
1. Home health nurse providing wound care
2. School nurse providing an EpiPen injection for a patient
Community-Oriented Nursing
-NOT focused on illness care
-They are focused on disease prevention, education, and trying to improve the collective
health of the community
Focus on:
1. Health education
2. Health promotion
3. Disease prevention
Public health nurses are community-oriented nurses
-Not providing illness care
-Not treating individuals and families
-They are focused on the population and the community as a whole
-Focused on disease prevention, health promotion, and education
Four ethical principles
1. Respect for autonomy
a. Respecting patient’s right to self-determination

2. Non-Maleficence
a. Not doing harm to the patient
3. Beneficence
a. Doing what is best for the patient
b. Maximize benefits
4. Distributive Justice
a. Fair allocation of resources in the community
Epidemiology – The study of the spread, transmission, and incidence of disease and injury
Epidemiology Triangle – they interact to either increase/decrease someone’s chance of
getting a disease
1. Agent
a. Thing that is causing the disease
i. (bacteria, toxin, noise, pollution)
2. Host (human or animal) that is being affected by the disease
3. Environment
i. Physical – water, food supply, geography
ii. Social – Access to healthcare, work conditions, poverty)
Incidence
-# of new cases of a disease/injury in a population during a specified time period
Prevalence
-# of all cases (new and pre-existing) in a population during a specified time period
Community-Health Education
Obstacles:
1. Age
2. Culture
3. Illiteracy
4. Language Barriers
5. Lack of access
6. Lack of motivation
Education
-Understand that people have different learning styles
1. Visual – videos, presentations
2. Auditory – verbal lecture or discussion
3. Tactile – Hands-on demonstration and a return-demonstration to demonstrate
understanding
Healthy People 2020
Examples of Goals:
1. Care of people with diabetes
2. Cancer
3. Older Adult Health
4. LGBT Health
Primary Prevention
1. Actions that help prevent initial occurrence of a disease
2. Immunizations/Vaccines

3. Providing education (Prenatal classes)
a. Make sure it is written at an eighth-grade level or lower to accommodate a
variety of education backgrounds
4. Nobody has the disease YET
Secondary Prevention
1. Focused on the early detection of the disease and limiting the severity of the
disease,
2. SCREENING or Disease Surveillance
3. Helping to control the outbreaks
4. Checking people for the disease at this point
Tertiary Prevention
1. They have the disease already
2. Maximizing the recovery after an injury/illness
3. Rehabilitation, Physical Therapy, Occupational therapy, support groups
Chapter 2
Factors that influence Community Health
Acculturation – someone adopts the traits of a different culture
Ethnocentrism – The belief that one’s own culture is superior to all others
-They view the world from their own cultural viewpoint
Culture assessment
1. Patient’s ethnic background
2. Religious preferences
3. Family Structure
4. Food patterns
5. Health practices
Incorporate patient preferences into care plan whenever possible
When we need to use an interpreter, do NOT use a family member
-Interpreters need to have knowledge of medical terminology
-Certified medical interpreter
Patient teaching:
-available in patient’s primary language

Environmental Risks
1. Toxins (lead, pesticides, asbestos, and radon)
2. Air pollution (Carbon monoxide, tobacco smoke, airborne lead contamination
3. Water pollution (waste products and chemical runoff from the soil)
Assessments on environmental risks ASK:
1. What the condition of their housing
2. Are they doing any remodeling activities
3. Water heater temperature set up?
a. Want less than 120 degrees
4. Occupation
a. Exposure to chemicals/toxins
i. Hairdresser?

ii. Coal mine worker (Risk for black lung)
5. Is tobacco smoke present in the home?
6. Quality of their drinking water
Lead Exposure
Ask a patient and their family when their house was built
-pre-1978 housing is at high risk for lead-based paint
-If lead issue is suspected, screen children ages 6 months-5 years for their blood lead
levels
Provide teaching points
-Have children AVOID playing right outside their home because paint/residue might
be in the soil
-Instruct them to wet mop their floors rather than vacuuming
-Make sure families are using wet sanding technique rather to dry sanding technique
-Make sure their children are getting enough iron and calcium in their diet
-helps to decrease absorption of lead in the body
-Encourage them to use cold water
-lead dissolves more quickly in hot water
-If a mom is preparing a bottle formula for the baby, use cold water because
it’s
safer
Medicare eligibility
1. People over 65 years old
2. Receiving disability for at least 2 years
3. Diagnosed with ALS or ESRD and receiving dialysis
Medicare Part A: Covers inpatient hospital expenses limited skilled nursing facility services
and home health care
Medicare Part B: outpatient care including diagnostic services, PT, & OT
Medicare Part C: combines A and B and offered through private insurance companies
Medicare Part D: Prescription drug coverage
Medicaid
1. Low socioeconomic status
2. No other insurance
3. Based on household size and income level
Agencies
State Department of Health
-manages WIC (Woman, Infants, and Children) program
-Oversee the CHIP (Children’s Health Insurance Program) program
-Manage Medicaid program for the state
-Report notifiable communicable diseases to the CDC (all those is voluntary for them)
State Board of Nursing
-Licenses LPNS and RNs
-oversee state schools of Nursing
-Develop state nursing practice acts
Local Health Department

-Helps meet the health needs of the community
-they report notifiable communicable diseases to the State Department of Health
Chapter 3
Community Health Program planning
Community Assessment – assessing the people and the environment
When assessing the people, you want to look at the:
1. Demographic (density and distribution of people)
2. Biological factors (race, age, gender, and health and disease status)
3. Social factors (occupations, education, income, and crime rates)
4. Cultural factors (history, customs, religion)
When assessing the environment, you want to look at the:
1. Physical factors (geography, locations of health services, housing)
2. Environmental factors (climate, topography, Pollutants/toxins)
Data collection
1. Informant interviews
a. Direct conversations with people in the community to gather data
2. Community forums
a. Public meetings
i. It may be difficult to get participation
3. Secondary data
a. Getting existing data
i. Birth certificates, morbidity data, health records that have already
been created
4. Participant observation
5. Windshield survey
a. Drive through community and check things out
b. Assessing
c. Noticing general appearance
d. Signs of violence and mental illness
e. Are there drug abuse?
f. Look at the quality of the housing
g. Good access to health care facilities?
h. What are they types of availability of grocery store?
i. Public transportation?
6. Focus groups
a. Meet with a representative sample of the community
7. Surveys
a. Written
b. Expensive
c. Low-response rate
After gathering data into a database, making sure it’s complete, synthesizing the data, and
identifying themes and community needs, and setting priorities. Develop community health
plan!
-Pre-planning stage (brainstorm)
-Assessment
-Diagnosis (analyze data and determine health needs and set priorities

-Planning (establish goals, identify responsibilities, and set budget)
-Implementation (execute plan)
-Evaluation (determine effectiveness of intervention)
Chapter 4
Practice settings and aggregates
1. Home health nurses
a. Provide direct health care in the patient’s home or in assisted living facilities
or nurses home
b. Provide patient education, direct nursing care, care coordination (case
manager)
i. Provide referrals and help coordinate care like a case manager
c. Assess the home for safety
i. No scatter rugs
ii. House is free of clutter
iii. Adequate lighting on the stairs
iv. Colored tape on step edges
v. Alzheimer’s – keep locks or alarms on exit door
1. Do not lock bathroom
2. Hospice Nurses
a. Provide palliative care to dying patients
b. Focus on symptom management only
i. Helping them to manage symptoms and supporting patient and family
through dying process
3. Parish Nurses
a. Work with pastoral staff to improve health and wellness of faith community
b. Provide health education
c. Facilitate support groups
d. They DO NOT provide bedside nursing care
i. Not hands-on
4. Occupational health nurse
a. Promote health and wellness of employees and help prevent workplace
illness and injury
b. Through surveillance, they help identify risk within the work environment
c. Identify ways to decrease or eliminate workplace hazards
i. Primary prevention – provide safety education to the employees
ii. Secondary prevention – screenings
iii. Tertiary prevention – help provide limited duty programs to
employees who have been hurt
d. Need to keep closely informed about OSHA standards so that workplace is
meeting standards
5. School Nurses
a. Direct nursing care to children at the school
b. Provide health education
c. Case manager for children who have health needs
i. Make referrals
ii. Schedule appointments

iii. Coordinate services for these children
d. Primary Prevention – assessing immunization status of all the children
e. Secondary Prevention – Providing a number of screenings
i. Vision and hearing
ii. Screen for oral health
iii. Scoliosis
iv. Lice/scabies infestations
v. Assess for neglect and abuse
f. Tertiary prevention – help administer medications, provide nursing care with
chronic diseases, and help assess children who have disabilities
Key health concerns for certain populations
Infants
SIDS – put children to sleep on their back
Children
-Make sure they’re getting their immunizations
-make sure they’re free from injuries
-encourage use of helmets
-use seatbelt in care
Adolescents
-MVA = big risk
-seatbelts
-assess risk of substance abuse (includes smoking)
-risks associated with sex
-safe sex
-mental health (depression, anxiety, suicide risk)
Women
-osteoporosis (after menopause)
-engage in weight-bearing exercises
-adequate consumption of calcium and vitamin D
-Heart disease
-diabetes
-cancer prevention
-mammograms and pap smears
Men
-heart disease
-cancer prevention
-prostate cancer screening
-testicular self-exams
-lung disease due to smoking
-liver disease r/t excess alcohol intake
-* 45-64 years old = highest risk of suicide
Older adults

-heart disease
-CVAs
-COPD
-PNA
-Polypharmacy
-using different medications that may interact with each other
-Metabolism is impaired – higher risk of toxicity
-cancer
-injury preventions
-falls
Families
-Times of transition
-birth/adoption of a child
-death
-major illness
-divorce
-loss of income
Times of transition create high risk for family
Assessment:
1. Genogram- graphical representation of the relationship within the family and
patterns of illness
2. Eco-map – graphical representation of family interactions with outside groups and
organizations
a. Provides information about the family support network
Chapter 5
Care of special populations
Violence
-Homicide r/t substance abuse
-victim is known to perpetrator
-males are at higher risk than females
-Rape
-Intimate Partner Violence
-underreported
-Counseling – tell victim not the bathe following the assault as this can destroy
medical evidence
-receive medical care to collect evidence
-Suicide
-Highest in men (45-64 years old) and those over 65 years old
-Abuse
1. Physical
2. Sexual
3. Emotional
humiliation, intimidation
4.neglect – failure to provide food, shelter, emotional care, medical care, or education to
someone that you’re responsible for
5. Economic abuse – misuse of money, failure to provide for the needs of the victim despite
adequate funds or theft of the money

Community factors that increase the risk of violence
1. Unemployment
2. Poverty
3. Social isolation
4. Child abuse is more common when spousal abuse is present
a. S/S of child abuse: presence of wounds or injuries in various states of healing,
unexplained bruises/injuries, unusual fear of others from the child, small
round burns that could be cause be cigarettes, forearm spiral fractures
b. S/S of child neglect: poor hygiene, inappropriate dress for the weather, signs
of malnourishment, withdrawal, and school absences
Substance abuse
Alcohol abuse
-There are many things that affect a body’s metabolism of alcohol
-size and weight of drinker
-time elapsed while drinking
-gender
-presence of food in their stomach
Manifestations of alcohol withdrawal typically appear within 4-12 hours after last drink
S/S: Tachycardia, hypertension, n/v, headache, anxiety and irritability, diaphoresis, tremors,
and seizures
*find out when they had their last drink
Primary: public education campaigns and school education
Secondary: screening individuals for signs of abuse
Tertiary: referral to AA/NA; also help to promote better coping skills and lifestyle changes
Homelessness
-families with children
-risk: those who are unemployed, migrant workers, veterans, those suffering from mental
illness/substance abuse, HIV/AIDS patients (highest risk), and at risk-youth
Key Health issues: TB, infestations (scabies/lice), substance abuse, HIVAIDs, and mental
illness
Key health issues of veterans: mental health issues (PTSD, depression), substance abuse,
suicide, traumatic brain injury, SCI, and amputations
Migrant workers
-at risk for TB, dental disease, skin cancer, DM, obesity, suicide, increase work-related
injuries d/t exposure to pesticides and injuries from machinery
Primary: provide with education on reducing exposure to pesticides and accident prevent &
provide with preventative care such as immunizations and dental care
Secondary: screen for skin cancer, pesticide exposure, and communicable diseases (TB)
Tertiary: provide ER, or primary care services including treatment of symptoms of pesticide
exposure
Chapter 6

Communicable diseases
Mode of transmission:
1. Airborne: Chicken pox, measles, TB, pertussis, and influenza
2. Food borne: Salmonella, Hepatitis A (which is spread through the fecal-oral route), E.
coli, and botulism
3. Waterborne- Cholera and typhoid fever
4. Vector borne – spreads through a mosquito/tick – Lyme disease, malaria, and Rocky
Mountain spotted fever
5. STDs: HIV, hepatitis B, C,D, syphilis, HPV, and gonorrhea
6. Direct contact: lice, scabies, impetigo, mononucleosis (spread through saliva)
Immunity
Herd immunity – most community members have immunity against a disease and helps
protect the individuals in the community that can’t be vaccinated (if they’re getting
chemotherapy or immunocompromised or too young)
-concept is being threatened because more people are not getting vaccinated
-vulnerable people are a higher risk of getting those diseases
-makes exposure unlikely because most community members are immune and vaccinated
1. Active natural immunity – body produces antibodies in response to exposure to a
live pathogen
a. Next time you’re exposed, body is ready to fight off pathogen more
effectively
2. Active artificial immunity – get a vaccine with a dead/weakened pathogen that
causes body to produce antibodies
3. Passive natural immunity –antibodies are passed from the mom to the baby through
breast milk/placenta
4. Passive artificial immunity – immunoglobulins are administered to an individual after
they have been exposed to the pathogen
Reporting requirements for communicable diseases
-mandates by state and local regulations. Not a nationally regulated thing
-State notification to the CDC is voluntary
primary: providing education on immunizations, encouraging hand hygiene, teaching proper
food handling, and advising patients of risks of infectious diseases when traveling to other
countries (Hepatitis A)
Secondary: screening for communicable diseases, quarantine patients when needed, and need
to refer suspected cases for definitive diagnoses
Tertiary: monitor treatment compliance and may require direct observation therapy
If patient is non-compliant and not taking their medications, they pose a risk to
society if they spread their diseases
Nationally notifiable diseases
1. Anthrax
a. Peron who has been exposed is recommended to get IV ciprofloxacin after
exposure
2. Lyme disease
a. S/S white center where tick was and get a bullseye red ring around

3. Meningitis
a. As you send kids to college, it’s recommended to get the meningitis vaccine
b. Recommended to other individuals are who going to a crowded environment
such as dorm, barracks, jail cell
4. Pertussis
a. S/S violent whooping cough
b. If child is diagnosed, they need to stay home until their cough is gone
c. May need erythromycin for 7 days for those exposed and family members
need to be treated prophylactically
d. Check immunization status of other children in school
5. Small pox
a. Starts as a rash on the face and moves down the body
6. Syphilis
a. Early sign is sore on genitals (canker)
Disaster Management
1. Disaster prevention
a. Surveillance, inspections, immunizations, education, and risk assessment
2. Disaster preparedness
a. Creating a disaster action plan, identifying evacuation routes, creating a
disaster kit, identifying a meeting place and a communication plan, and
performing disaster drills!!
3. Disaster response
a. Disaster has occurred
b. Assess the extent of disaster, perform triage, and direct those affected,
coordinate evacuations, and help coordinate quarantines (depending on
disaster)
4. Disaster recovery
a. Begins when there is no longer danger present
b. Coordinate care in shelters and homes and start the process of recovery
Bioterrorism
1. Category A
a. Smallpox, botulism, anthrax, and play
2. Category B
a. Typhus and cholera
3. Category C
a. Hantavirus
Inhaled anthrax S/s: severe dyspnea, fever, shock, and muscles aches
-administer IV Ciprofloxacin for those exposed or those who have a high risk of
exposure
Smallpox: starts with rash on the face that moves down the body
S/S: high fever, headache, and vomiting
Prevention is through vaccination
Chapter 7
Consultations

-provider puts out a request to another provider or another resource who can provide expert
advice and/or services for the patient
-hospital setting: Dr. sends out consultations to wound nurse
Referrals
-provider request or recommends management of one or more of the patient’s concerns or
issues to another provider or they can recommend support services (support groups, churches,
transportation services, and meal delivery services)
-case management will provide referrals
Case managements/Care Coordinators
-instrumental in helping the patient move from acute care to home/skilled nursing facility,
making sure they have everything they need (Equipment), making sure they have their
follow-up appointments identified
Responsibilites
1. Evaluate the patient’s medical needs, psychosocial issues, and financial constraints
a. Work with patient’s insurance to see what’s covered and what’s going to
work best
2. Collaborate with the patient, family, insurance companies, health care providers,
medical service, and equipment providers to meet the healthcare needs of the
patient
3. They help facilitate discussion of the patient’s needs with an interprofessional team
a. Working with Drs, bedside nurses, wound care nurses,
b. Provide referrals as needed for support services
Informatics – incorporates nursing and IT and communication technology to develop and
support nursing practice and improve patient outcomes
Telehealth – delivary of healthcare through technology vs in person.
Helpful in rural areas where they lack specialists
-connect with specialists through telehealth
Nursing roles in health policy
-act as advocate for changes in health policy
-help lobby legislators
-serve in public office
and help form coalitions (collaborations of group to achieve a goal)
in the hopes to improve community’s health and wellness

ATI Community Health Focus Review
VERSION 12
❖ Nightingale’s Environment Theory:
➢ Emphasized prevention care.
▪ Washing hands
▪ Sterilizing instruments

❖ Health Belief Model
➢ Assumes that preventive health behaviors are taken primarily for the purpose of avoiding
disease.
➢ Describes the likelihood of taking an action to avoid disease based on:
▪ Susceptibility, seriousness, and threat of disease
▪ Modifying factors
• Demographics
• Knowledge level
• Age
• Race
▪ Cues to action
• Media
• Disease effect on ppl
• Recommendations from health care professionals
▪ Perceived benefits minus perceived barriers to taking action
❖ Goals of community health nursing:
➢ Promote, preserve, and maintain health of populations by delivery of services to
individuals, families, and groups to influence community health
➢ Who is the client in community health nursing?
▪ The community or population
➢ BOTH COMMUNITY ORIENTED NURSING AND COMMUNITY BASED NURSING
❖ Public Health Nursing
➢ Also known as Community-Oriented Nursing
➢ Population focused
➢ Goal:
▪ Promoting health
▪ Preventing disease
➢ No illness cares
➢ Key Principles:
▪ Emphasize primary prevention
▪ Greatest good for largest number of individuals
▪ Client is partner in health
▪ Use resources wisely to promote best outcomes
❖ Community-oriented Nursing:

➢ Focus of Care:
▪ Aggregates
▪ Communities
▪ Populations (public health)
▪ At-risk or unserved individuals and families
➢ Primary Goal:
▪ Health promotion and disease prevention
▪ Education
➢ Nursing Activities:
▪ Indirect (programmed management)
▪ Can include direct care of at-risk individuals and populations
❖ Community-based Nursing
➢ Focus of care:
▪ Individuals and families
▪ Management of acute or chronic conditions
▪ Direct (one-on-one)
▪ Illness care:
• School nurse
• Camp nurse
• Prison nurse
❖ Ethical principles to community health nursing
➢ Autonomy
➢ Nonmaleficence
➢ Beneficence
➢ Justice
❖ Community Health Education
➢ Obstacles:
▪ Age
▪ Cultural barriers
▪ Poor read comprehension
▪ Language
▪ Lack of motivation
➢ Effective health education requires planning
❖ Learning Styles
➢ Visual

➢ Auditory
➢ Tactile-kinesthetic
❖ Epidemiological triangle
➢ Agent
▪ Causes disease
• Drugs
• Toxins
• Noise
• Temperature
• Viruses
• bacteria
➢ Host
▪ Being affected
• Age
• Gender
• Genetics
• Ethnicity
• Immunological status
• Physiological state
• Occupation
➢ Environment
▪ Physical Environment
• Geography
• Water/food supply
• Presence of reservoirs/vectors
▪ Social Environment
• Access to health care
• High-risk working conditions
• Poverty
❖ Incidence
➢ Number of NEW cases in specific time frame
❖ Prevalence
➢ Number of NEW AND EXISTING cases in specific time frame

❖ Health People 2020
➢ Goals:
▪ Based on issues that are considered major risks to health and wellness
▪ Educate on DM, cancer, older adult health, and LGBT health
❖ Primary Prevention
➢ Prevent initial occurrence of disease or injury
▪ Education
▪ Immunizations
▪ Advocation for access to health care
❖ Secondary Prevention
➢ Early detection
➢ Limiting severity
▪ Screenings
▪ Disease surveillance
▪ Control of outbreaks
❖ Tertiary Prevention
➢ Maximize recovery after an injury or illness
▪ Rehabilitation
▪ Case management
▪ Support groups
▪ Nutrition counseling for management of Crohn’s disease.
❖ When to assess cultural beliefs and practices?
➢ When developing plan of care
❖ Acculturation
➢ Process of merging with or adopting the traits of a different culture
❖ Ethnocentrism
➢ Belief that your current beliefs or cultural is superior and better
❖ Cultural Assessment Parameters
➢ Ethnic background
➢ Religious preferences
➢ Language and literacy needs
➢ Communication needs
➢ Education
➢ Cultural values
➢ Food patterns

❖

❖

❖

❖

➢ Health practices
➢ Always include pt preferences in assessment/plan of care
Using an interpreter
➢ They should have knowledge of health-related terms
➢ NEVER use family members
➢ Consider preferences of age and gender
➢ Should NOT be from same community as pt
Environmental Risks
➢ Toxins
▪ Lead
▪ Pesticides
▪ Asbestos
▪ Radon
➢ Air pollution
▪ Carbon monoxide
▪ Tobacco smoke
▪ Lead
▪ Sulfur dioxide
➢ Water pollution
▪ Wastes
▪ Erosion after mining
▪ Run-off from chemicals added to soil
➢ Contamination
▪ Food and food products with bacteria, pesticides, radiation, and meds
Key questions for health history
➢ What is the condition of the residence?
▪ Age and location
➢ What is the pt’s occupation?
➢ Do you smoke in the home?
➢ Are you exposed to second-hand smoke?
➢ What is the source/quality of drinking water?
➢ Is there any presence of mold or fungi?
➢ What temperature is the water heater set on?
▪ Should be 65 y.o and receiving Social Security/disability for 2 yrs
➢ Part A
▪ Hospital care
▪ Home care
▪ Hospice
▪ Limited skilled nursing care for 100 days/yr
➢ Part B
▪ Health care provider
▪ Outpatient care
▪ Home health
▪ Diagnostic services
▪ Physiotherapy
▪ Durable medical equipment
▪ Ambulance service
▪ Mental health
▪ Preventive services
➢ Part C
▪ Known as Medicare Advantage Plan
• Combination of A & B
• Provided through private insurance
➢ Part D
▪ Prescriptions
▪ THINK D FOR DRUGS
❖ Medicaid
➢ Provides health care to pt’s of low socioeconomic status and children through the combined
efforts of federal and state governments
➢ Eligibility based on:
▪ Household size
▪ Income
▪ Priority given to children
▪ Pregnant
▪ Disability
❖ State Health Agencies
➢ State department of health
▪ Manages WIC

▪ Oversees CHIP
• Provides health coverage to uninsured children
▪ Responsible for administration of Medicaid program
▪ Reports communicable diseases within state to CDC
➢ State boards of nursing
▪ Development and oversight of state’s nurse practice act
▪ Licensure of RN and LPN
▪ Oversight of state’s schools of nursing
❖ Community assessment components
➢ People
▪ Demographic
• Distribution
• Mobility
• Density
• Census data
▪ Biological factors
• Health and disease status
• Genetics
• Race
• Age
• Gender
• Cause of death
▪ Social factors
• Occupation
• Activities
• Marital status
• Education
• Income
• Crime rates
• Recreation
• Industry
▪ Cultural Factors
• Ethnohistory

• Hierarchy
• Language
• Religion
• Values
• Customs
• Norms
➢ Place or environment
▪ Physical factors
• Geography
• Terrain
• Community
• Location of health services
• Housing
• Animal control
▪ Environmental factors
• Geography
• Climate
• Flora
• Fauna
• Topography
• Toxic substances
• Vectors
• Pollutants
❖ Data Collection
➢ Informant interviews
▪ Direct discussion
➢ Community forum
▪ Open public meeting
➢ Secondary data
▪ Existing data
• Death stats
• Birth stats
• Census data

• Mortality
• Morbidity
• Health records
➢
➢
➢
➢

• Prior health surveys
Participant observation
▪ Observation of formal or informal community activities
Focus groups
▪ Directed talk with a representative sample
Surveys
▪ Specific questions asked in a written format
Windshield surveys
▪ Descriptive approach that assess several community components by driving through a
community
▪ Survey Components
• What is their general appearance?
 Age
 Dress
 Well-nourished
 Obese
 Frail
 Unkept
• What is the origin, ethnicity, or race of people?
• Is there any evidence of substance use, violence, disease, mental illness?
• Is there easy access to health care?
• Are there grocery stores which provide fresh produce, or is this a “food desert”?
• Is the housing of acceptable quality?
• Is the housing in good repair or not?
• Is there vacant housing?
• Is there public transportation?

• What grocery stores or other stores within community?
❖ Preplanning
➢ Brainstorming
❖ Assessment

❖

❖

❖
❖

❖

➢ Collect data
Diagnosis
➢ Prioritize health needs of the community
▪ Analyze data to determine health needs
Planning
➢ Develop interventions to meet identified outcomes
➢ Establish goals and objectives for the selected solution
➢ Identify who will assume responsibility for each intervention
➢ Determine funding opportunities for needed intervention and develop budgets
Implementation
➢ Carry out the plan
Evaluation
➢ Examine the success of the interventions
▪ Determine achievement of desired outcomes
Lead Poisoning
➢ Important to ask a pt when house was built?
▪ <1978 house may have lead-based paint.
➢ If suspected
▪ Screen children 6 mos -5 y.o blood levels
➢ Teaching points
▪ Avoid playing right outside home

• d/t some paint in the soil
▪ Wet mop floor
▪ Wet sanding technique
▪ Educate on children getting enough iron and calcium in diet
▪ Encourage parents to use cold water when making bottles instead of hot
❖ Home Health
➢ Provides care where the pt resides
▪ Homes
▪ Assisted living
▪ Nursing homes
➢ Working as part of an interprofessional team is essential to providing holistic care
➢ Functions
▪ Education
▪ Provider

▪ Coordinator of care
▪ Assess home for safety
• No scatter rugs
• Free of clutter
• Adequate lighting
• Color tape on step edges
▪ For Alzheimer Patient Safety
• Keep locks/alarms on exit doors
• NO locks on bathroom doors