A community health nurse is providing teaching to a client who speaks a different language. Which of the following findings should the nurse document as an indication that the client understands the teaching?

The client nods their head and smiles during the teaching.

The client demonstrates what they learned during the teaching.

The client wears their glasses and hearing aids during the teaching.

The client makes frequent eye contact during the teaching.

Answer and Explanation

The Correct Answer is B

Choice A reason: Nodding and smiling are positive reactions, but they do not necessarily indicate understanding, as they can be polite responses or reflexive actions.

Choice B reason: Demonstration of learned content is a clear indication of understanding. When a client can replicate the teaching, it shows they have comprehended the information and are able to apply it.

Choice C reason: While wearing glasses and hearing aids can help a client see and hear the teaching better, it does not confirm that the client has understood the material presented.

Choice D reason: Frequent eye contact might suggest attentiveness, but like nodding and smiling, it is not a reliable indicator of comprehension.

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Correct Answer is B

Explanation

Choice A reason: This statement is not the first action, as it does not address the immediate needs of the students. Contacting the local health department may be necessary to report a potential outbreak or environmental hazard, but it is not a priority.

Choice B reason: This statement is the first action, as it addresses the immediate needs of the students. Establishing a triage area can help the nurse assess the severity of the symptoms, identify the possible cause, and provide appropriate interventions.

Choice C reason: This statement is not the first action, as it may not be appropriate for all students. Administering oxygen therapy may be necessary for some students who have severe respiratory distress, but it is not a universal intervention.

Choice D reason: This statement is not the first action, as it does not address the immediate needs of the students. Notifying the parents of the students may be necessary to inform them of the situation and obtain consent for treatment, but it is not a priority.

A. Clostridium difficile B. Influenza C. Disseminated herpes zoster D. Respiratory syncytial virus (RSV)

Correct Answer is C

Explanation

Choice A reason: This is incorrect. Clostridium difficile is a bacterium that causes an infection of the colon, which can result in diarrhea, abdominal pain, and fever¹. Clostridium difficile is transmitted by contact with fecal matter or contaminated surfaces². Therefore, it requires contact precautions, not airborne precautions³.

Choice B reason: This is incorrect. Influenza is a viral infection that affects the respiratory tract, causing symptoms such as fever, cough, sore throat, and muscle aches⁴. Influenza is transmitted by respiratory droplets that are generated by coughing, sneezing, or talking⁵. Therefore, it requires droplet precautions, not airborne precautions³.

Choice C reason: This is correct. Disseminated herpes zoster is a widespread form of shingles that affects multiple areas of the skin and can involve the internal organs⁶. Shingles is caused by the reactivation of the varicella-zoster virus, the same virus that causes chickenpox⁷. Disseminated herpes zoster is transmitted by airborne particles that contain the virus, or by direct contact with the lesions⁶. Therefore, it requires airborne precautions, as well as contact precautions³.

Choice D reason: This is incorrect. Respiratory syncytial virus (RSV) is a common respiratory virus that causes mild to severe infections of the lungs and airways, especially in infants and young children⁸. RSV is transmitted by respiratory droplets, or by contact with contaminated surfaces or secretions⁹. Therefore, it requires contact precautions, and sometimes droplet precautions, but not airborne precautions³.

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A community health nurse is providing teaching to a client who speaks a different language. Which of the following findings should the nurse document as an indication that the client understands the teaching?

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