The home health nurse enters the home of a client, and the client's spouse immediately reports that the client cannot be awakened and appears to have taken an overdose of some medications. After determining that the client is unresponsive but is breathing and has a pulse, which action should the nurse take?

Call 911 for emergency transport.

Determine what medications were ingested.

Contact the poison control center.

Attempt to induce vomiting using a tongue blade.

Answer and Explanation

The Correct Answer is A

A) Call 911 for emergency transport:
The client is unresponsive, which is a critical situation requiring immediate medical attention. Even though the client is breathing and has a pulse, the unresponsiveness suggests a potentially severe overdose that could rapidly deteriorate. Calling 911 ensures that emergency medical services are on their way to provide advanced care and transport to a facility where further treatment can be administered.

B) Determine what medications were ingested:
While knowing what medications were taken is important for treatment, the immediate priority is to address the client’s unresponsiveness. Identifying the medications can be done once the client is stabilized or while awaiting emergency services, but it does not replace the need for urgent medical intervention.

C) Contact the poison control center:
Contacting the poison control center is useful for guidance on managing an overdose, but it should be done in conjunction with calling 911 if the client is unresponsive. The poison control center can provide specific treatment advice, but immediate emergency medical assistance is crucial for the client’s safety.

D) Attempt to induce vomiting using a tongue blade:
Inducing vomiting can be dangerous, especially if the client is unresponsive or has an impaired airway. Attempting to induce vomiting without professional medical support could lead to aspiration or other complications. The priority is to ensure the client receives proper medical care through emergency services.

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Correct Answer is A

Explanation

A) Fasting blood glucose average readings were 20% lower at the end of the classes:
This outcome measure directly evaluates the effectiveness of the diabetes education classes. A significant reduction in fasting blood glucose levels indicates that the classes had a positive impact on the clients' diabetes management, reflecting the practical success of the educational interventions.

B) Discussion of food exchanges and calories was a well-attended class:
While class attendance is a positive indicator of interest, it does not measure the actual effectiveness of the classes in improving diabetes management. Attendance alone does not confirm that the information was effectively applied or that it led to improved health outcomes.

C) Demonstrating the use of a blood glucose meter was an effective teaching strategy:
Although demonstrating the use of a blood glucose meter is an important teaching strategy, evaluating its effectiveness does not provide a comprehensive measure of the overall impact of the classes. The ultimate goal is to see improvements in health outcomes, such as blood glucose control.

D) Parking convenience for attendees continued to be a major concern:
While logistical issues like parking convenience are important for class accessibility, they do not reflect the effectiveness of the educational content in improving health outcomes. The focus should be on measurable changes in clients' health status, such as blood glucose levels.

A. Low income families living in cramped quarters. B. Sexually active persons with multiple partners. C. IV drug users who share needles. D. Those who have recently received a blood transfusion.

Correct Answer is A

Explanation

A. Low income families living in cramped quarters: Hepatitis A is primarily spread through the fecal-oral route, often through contaminated food or water. Individuals living in overcrowded or unsanitary conditions are at a higher risk due to the increased likelihood of exposure to contaminated sources and poor hygiene practices. Thus, low-income families living in cramped quarters are particularly vulnerable to hepatitis A.

B. Sexually active persons with multiple partners: While hepatitis B and C are more commonly associated with sexual transmission, hepatitis A is less commonly spread through sexual activity. Hepatitis A transmission is more directly related to poor sanitation and hygiene rather than sexual behavior alone.

C. IV drug users who share needles: Intravenous drug users who share needles are at high risk for hepatitis B and C, not hepatitis A. Hepatitis A is not typically transmitted through blood but rather through contaminated food and water.

D. Those who have recently received a blood transfusion: Hepatitis A is not transmitted through blood transfusions. Hepatitis B and C are the types of hepatitis associated with blood transfusions. Hepatitis A is spread through ingestion of contaminated food or water.

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Naxlex Comprehensive Predictor Exams

A nurse designs a series of four weekly classes for clients with type 2 diabetes mellitus. Which information should the nurse use as an outcome evaluation for the classes?

Correct Answer is A

Explanation

Community health nurses are particularly concerned with the spread of communicable diseases such as hepatitis A. Which group of Individuals should the nurse identify as being at greatest risk for contracting this type of hepatitis?

Correct Answer is A

Explanation

A prescription for discharge is written for an elderly client who has asked to be discharged to home. The client lives alone and is able to walk 10 to 15 feet (3 to 4.5 meters) with assistance. Which action should the nurse implement first?

Tuberculosis (TB) screening at a federal prison reveals that two inmates have a positive skin test. Which action is most important for the nurse to take?

The nurse is caring for a client with gonorrhea. The client reports having sex with multiple partners. Which response should the nurse provide?

A newly hired school nurse conducts a "windshield" survey of the geographic area served by the school, Which method is best for the nurse to use to objectively validate the findings obtained?

A school nurse identifies 15 new students with positive tuberculin tests among the 500 at-risk students fested. Which is the rate per 1,000 with new positive tests?

One hundred families in a community refuse to have their children immunized because of religious beliefs. When one documented case of whooping cough occurs within this aggregate, which intervention should the nurse implement?

The city health department director asks the community health nurse to make a presentation describing the greatest health concern facing the city. How should the nurse begin to collect the data needed for this presentation?