A male client who has been taking propranolol (Inderal) for 18 months tells the nurse the healthcare provider discontinued the medication because his blood pressure has been normal for the past three months. Which instruction should the nurse provide?

Correct Answer: C

Rationale: The correct answer is C) Ask the healthcare provider about tapering the drug dose over the next week. This instruction is appropriate because propranolol should not be abruptly stopped due to the risk of rebound hypertension and other potential adverse effects. Tapering the dose under the guidance of a healthcare provider helps the body adjust gradually and minimizes these risks. Option A) Abruptly stopping the medication is incorrect because it can lead to adverse effects like rebound hypertension, angina, or arrhythmias. Option B) Continuing the medication at the same dose is not the best choice as the client's blood pressure has been normal for the past three months, indicating a potential for dose adjustment or discontinuation. Option D) Increasing the dose of the medication is unnecessary and potentially harmful since the client's blood pressure has been normal, indicating that a dose reduction or discontinuation may be more suitable. In a community health nursing context, it is essential to educate clients on the importance of proper medication management and the potential risks associated with abruptly stopping certain medications. Collaborating with healthcare providers and following their guidance is crucial to ensuring the safe and effective management of medications in community settings.

Correct Answer: D

Rationale: In this scenario, the correct answer is D) Rhinorrhea or otorrhea with a halo sign. This finding is consistent with a basilar skull fracture, which is a serious injury that can occur due to significant head trauma. Rhinorrhea (nasal discharge) or otorrhea (ear discharge) with a halo sign (a ring of blood surrounding the fluid) indicates a cerebrospinal fluid leak, which is a concerning sign of a basilar skull fracture. Option A) Blurred vision is not typically associated with a basilar skull fracture but can occur with other head injuries or conditions affecting the eyes. Option B) Shoulder pain is not specifically linked to a basilar skull fracture. It is more commonly seen in musculoskeletal injuries or conditions involving the shoulder. Option C) Abdominal pain is not a typical manifestation of a basilar skull fracture. Abdominal pain may indicate issues within the abdomen, such as gastrointestinal problems or referred pain from other areas. Understanding the signs and symptoms of basilar skull fractures is crucial for healthcare providers, especially in cases of suspected child abuse where prompt identification and intervention are essential. This educational context underscores the importance of thorough assessment skills and knowledge of potential red flags for serious injuries in pediatric patients.

Correct Answer: A

Rationale: The correct answer is A) designated clinics conveniently located in target neighborhoods. This intervention is likely to be most useful in increasing immunization rates in underserved community groups because it addresses key barriers to accessing healthcare services, such as transportation and proximity. By providing designated clinics in target neighborhoods, individuals in underserved communities can easily access the influenza vaccine without having to travel long distances or incur additional costs. This strategy improves convenience and increases the likelihood that individuals will receive the immunization. Option B) reports decreasing influenza rates during times of greatest prevalence does not directly address the issue of access to immunization services in underserved communities. While providing information about decreasing rates may raise awareness, it may not necessarily lead to increased vaccination rates, especially in populations facing barriers to access. Option C) legislative proposals that mandate influenza vaccinations for all may be met with resistance and may not effectively address the underlying reasons for low immunization rates in underserved communities. Mandates can be controversial and may not necessarily address the root causes of disparities in healthcare access. Option D) radio announcements about the availability of the influenza vaccine may increase awareness but may not overcome the practical barriers that individuals in underserved communities face in accessing healthcare services. Simply knowing about the availability of the vaccine may not be sufficient to increase immunization rates in these populations. In an educational context, understanding the importance of addressing barriers to healthcare access and tailoring interventions to meet the specific needs of underserved communities is crucial in community health nursing. By implementing strategies that improve access and convenience, nurses can effectively increase immunization rates and promote better health outcomes in these vulnerable populations.

Correct Answer: B

Rationale: In the context of community health nursing, understanding the risk factors associated with communicable diseases such as hepatitis A is crucial for effective prevention and intervention strategies. In this scenario, option B) low-income families living in cramped quarters have a higher risk of contracting hepatitis A. Low-income families living in cramped quarters are more susceptible to poor sanitation and hygiene practices due to overcrowding, limited access to clean water, and inadequate bathroom facilities. These conditions create an environment conducive to the spread of hepatitis A, which is primarily transmitted through the fecal-oral route. Option A) IV drug users who share needles are at higher risk for bloodborne diseases like hepatitis B and C, but not specifically hepatitis A, which is mainly transmitted through contaminated food or water. Option C) those who have recently received a blood transfusion are at risk for bloodborne pathogens but not necessarily hepatitis A, which is not commonly transmitted through blood products. Option D) sexually active persons with multiple partners are more at risk for sexually transmitted infections like HIV or hepatitis B and C, but again, not hepatitis A which is not primarily transmitted through sexual contact. Educationally, this question highlights the importance of understanding the social determinants of health and how they influence the risk of communicable diseases in different populations. It emphasizes the need for community health nurses to identify vulnerable groups and tailor interventions to address specific risk factors for effective disease prevention and control.

Correct Answer: B

Rationale: In this scenario, the correct answer is option B: demonstrate foot care to a group of clients who have diabetes. This option aligns with tertiary prevention, which focuses on managing and reducing the impact of disease or injury. For individuals with diabetes, foot care is crucial to prevent complications like ulcers and amputations, making it an essential aspect of tertiary prevention. Option A, teaching clients about immunizations, pertains more to primary prevention by preventing the onset of disease. Option C, taking blood pressures, falls under secondary prevention as it aims to detect and treat conditions early. Option D, educating teens on STD prevention, also relates to primary prevention by aiming to prevent the initial occurrence of sexually transmitted diseases. In an educational context, understanding the levels of prevention in community health nursing is essential for students to effectively plan and implement programs that address the specific needs of diverse populations. By analyzing the different prevention levels and their applications in real-world scenarios, students can develop comprehensive and targeted intervention strategies to promote community health effectively.