21 original SNLE questions on community nursing, each with an explanation for all four options. Part of Adult Nursing, worth 40% of the Saudi Nursing Licensure Examination.
Q01 / 10medium0 correct
Adult Nursingmediumq019
A community health nurse organizes a program that screens adults over 40 for hypertension and elevated blood glucose at a local mosque. This activity is best classified as which level of prevention?
All 21 questions
Every question below, with the reasoning for all four options. Try to answer before you open one.
Community nursing · medium
A community health nurse organizes a program that screens adults over 40 for hypertension and elevated blood glucose at a local mosque. This activity is best classified as which level of prevention?
ASecondary prevention
BTertiary prevention
CQuaternary prevention
DPrimary prevention
Show the answer and why the others fail
Answer: A. Secondary prevention
A — correct
Secondary prevention detects existing but asymptomatic disease early so treatment can begin before complications develop. Population screening for hypertension and diabetes is the classic example.
B
Tertiary prevention limits disability and rehabilitates people with established disease, such as a cardiac rehabilitation program.
C
Quaternary prevention aims to protect patients from over-medicalization and unnecessary intervention; it does not describe screening for undetected disease.
D
Primary prevention acts before disease occurs — for example health education, immunization, or dietary counselling to prevent onset.
TakeawayScreening asymptomatic populations for early disease is secondary prevention — primary prevents onset, tertiary limits disability.
Community nursing · hard
During an outbreak investigation of foodborne illness at a community event, the nurse calculates that 45 of 150 people who ate the rice dish became ill, while 5 of 100 who did not eat it became ill. Which epidemiological conclusion is best supported?
AThe data prove that the rice dish caused the illness in this outbreak
BBecause some unexposed people became ill, the rice can be excluded as a source
CThe attack rate among those who ate the rice dish is 45 percent
DThe exposed attack rate of 30 percent far exceeds the unexposed rate of 5 percent
Show the answer and why the others fail
Answer: D. The exposed attack rate of 30 percent far exceeds the unexposed rate of 5 percent
A
An epidemiological association identifies a likely vehicle but does not by itself establish causation; laboratory confirmation and other criteria are needed.
B
Background cases and secondary transmission are expected in the unexposed group and do not rule out a vehicle with a much higher attack rate.
C
This confuses the number of cases with a rate; 45 is the case count, and the denominator of 150 must be applied.
D — correct
Attack rate equals ill divided by total at risk in that group: 45/150 equals 30 percent exposed versus 5/100 equals 5 percent unexposed. A markedly higher attack rate in the exposed group identifies a probable vehicle warranting further investigation.
TakeawayAttack rate equals cases divided by the population at risk in that group; comparing exposed and unexposed attack rates points to the likely vehicle.
Community nursing · easy
A community nurse is conducting a home visit for an older adult living alone who has had two recent falls. Which intervention should the nurse prioritize?
AProvide a written fall-prevention leaflet and plan to review it at the next visit in three months
BRemove loose rugs and clutter, improve lighting, and install grab bars in the bathroom
CRecommend the patient limit walking within the home to reduce fall opportunities
DAdvise the patient to wear loose slippers indoors for comfort
Show the answer and why the others fail
Answer: B. Remove loose rugs and clutter, improve lighting, and install grab bars in the bathroom
A
Written education alone has little effect on fall rates and leaves every hazard in the home untouched for another three months. Education is a useful adjunct, but for someone who has already fallen twice it cannot substitute for acting on the hazards during this visit.
B — correct
Home hazard modification is a proven component of multifactorial fall prevention. Loose rugs, poor lighting, and unsupported bathroom transfers are among the most common modifiable causes of falls in older adults.
C
Restricting mobility causes deconditioning and muscle weakness, which increases rather than decreases future fall risk.
D
Loose, backless footwear is associated with increased fall risk; well-fitting non-slip shoes are recommended.
TakeawayFall prevention in older adults combines home hazard removal, strength and balance exercise, and review of fall-risk medications — never mobility restriction.
Community nursing · medium
A community health nurse is planning a program to reduce the incidence of type 2 diabetes in a neighborhood with high rates of obesity. The nurse decides to implement free community exercise classes and nutrition education workshops. Which level of prevention is the nurse primarily implementing?
ATertiary prevention
BPrimary prevention
CQuaternary prevention
DSecondary prevention
Show the answer and why the others fail
Answer: B. Primary prevention
A
Tertiary prevention involves managing established disease to prevent complications and improve quality of life, such as diabetes self-management education for those already diagnosed.
B — correct
Primary prevention aims to prevent disease or injury before it occurs by reducing risk factors and promoting health. Exercise classes and nutrition education target the root causes of obesity to prevent the development of type 2 diabetes.
C
Quaternary prevention aims to protect patients from unnecessary or harmful medical interventions, which is not the focus of a health promotion program targeting the general at-risk population.
D
Secondary prevention focuses on screening and early detection of disease, such as blood glucose screening for diabetes, not on preventing the initial occurrence through lifestyle changes.
TakeawayPrimary prevention strategies, such as health education and lifestyle modification, aim to prevent disease before it occurs by reducing risk factors in the population.
Community nursing · medium
A community health nurse is investigating a suspected foodborne outbreak following a neighborhood potluck dinner. Of the 80 attendees, 50 ate the chicken salad and 30 did not. Among those who ate the chicken salad, 20 developed nausea and diarrhea. Among those who did not eat the chicken salad, 4 developed similar symptoms. What is the attack rate among those who ate the chicken salad?
A40%
B13%
C25%
D30%
Show the answer and why the others fail
Answer: A. 40%
A — correct
The attack rate among those who ate the chicken salad is (number ill among exposed / total exposed) × 100 = (20/50) × 100 = 40%.
B
This is the attack rate among those who did not eat the chicken salad (4/30 ≈ 13.3%), not the exposed group.
C
This is the proportion of all attendees who both ate the chicken salad and became ill (20/80 = 25%), not the attack rate among the exposed group.
D
This is the overall attack rate for all attendees (24/80 = 30%), not the rate specific to those who ate the chicken salad.
TakeawayThe attack rate in a foodborne outbreak investigation is the proportion of exposed individuals who become ill, calculated as (number ill among exposed / total exposed) × 100.
Community nursing · medium
A mother brings her 2-month-old infant to the community health center for a well-child visit. The infant is healthy and received the hepatitis B vaccine at birth. According to the Saudi National Immunization Schedule, which set of vaccines should the nurse administer at this visit?
ADTaP, Hib, IPV, rotavirus, HepB, and MMR
BDTaP, Hib, IPV, PCV, rotavirus, and MMR
CDTaP, Hib, IPV, PCV, rotavirus, and HepB
DDTaP, Hib, IPV, PCV, HepB, and varicella
Show the answer and why the others fail
Answer: C. DTaP, Hib, IPV, PCV, rotavirus, and HepB
A
MMR is not given until 12 months, and the pneumococcal conjugate vaccine (PCV) is recommended at 2 months to protect against invasive pneumococcal disease during a period of high susceptibility.
B
MMR is not indicated at 2 months; it is first given at 12 months. Additionally, the second dose of hepatitis B is due at this visit and is missing from this set.
C — correct
At 2 months, maternal antibodies are waning, leaving the infant susceptible to diphtheria, tetanus, pertussis, Haemophilus influenzae type b, polio, pneumococcal disease, rotavirus, and hepatitis B. This set provides the recommended primary doses for all these diseases.
D
Varicella vaccine is not given until 12 months of age. Additionally, rotavirus vaccine is recommended at 2 months to protect against severe diarrheal disease in infancy.
TakeawayAt the 2-month well-child visit, the Saudi National Immunization Schedule recommends DTaP, Hib, IPV, PCV, rotavirus, and the second dose of hepatitis B vaccine to protect against diseases during a period of increased susceptibility as maternal antibodies wane.
Community nursing · medium
A community health nurse is the first responder at the scene of a building collapse. Using the START triage system, which of the following victims should the nurse tag as immediate (red)?
AA victim who is unresponsive, not breathing after airway repositioning, and is not ambulatory.
BA victim who is alert, able to walk, and has a fractured forearm with capillary refill of 2 seconds.
CA victim who is not ambulatory, has a respiratory rate of 36/min, and capillary refill less than 2 seconds.
DA victim who follows commands, has a respiratory rate of 22/min, and capillary refill less than 2 seconds, but cannot walk.
Show the answer and why the others fail
Answer: C. A victim who is not ambulatory, has a respiratory rate of 36/min, and capillary refill less than 2 seconds.
A
In START triage, a victim who is not breathing after a simple airway maneuver is tagged black (deceased/expectant) without further assessment.
B
Ambulatory victims with minor injuries are tagged green (minor) and directed to a safe area, regardless of other findings.
C — correct
In START triage, a respiratory rate greater than 30/min is an immediate red tag; no further assessment of perfusion or mental status is required.
D
Victims who cannot walk but have normal mental status (follows commands), respiratory rate, and perfusion are tagged yellow (delayed).
TakeawayIn START triage, red (immediate) tags are for victims with life-threatening but reversible conditions: respiratory rate >30/min, capillary refill >2 seconds, or inability to follow commands. Black tags are for those not breathing after airway repositioning. Green tags are for ambulatory victims with minor injuries. Yellow tags are for non-ambulatory victims with normal respiratory rate, perfusion, and mental status.
Community nursing · medium
A community health nurse is teaching a 68-year-old patient with chronic venous insufficiency about measures to prevent venous leg ulcers. Which of the following instructions should the nurse include?
AWear compression stockings only during the night while sleeping.
BRestrict daily fluid intake to 1,000 mL to minimize swelling.
CApply a heating pad to the lower legs for 20 minutes twice daily.
DElevate the legs above the level of the heart when lying down.
Show the answer and why the others fail
Answer: D. Elevate the legs above the level of the heart when lying down.
A
Compression stockings should be worn during the day when the patient is upright to counteract gravity; wearing them only at night provides no benefit for venous stasis.
B
Fluid restriction is not indicated for venous insufficiency; edema is caused by venous stasis, not fluid overload, and adequate hydration supports tissue health.
C
Heat application causes vasodilation and can increase venous pooling and edema, worsening venous insufficiency rather than preventing ulcers.
D — correct
Leg elevation above heart level promotes venous return, reduces edema, and decreases the risk of skin breakdown and ulcer formation. This is best achieved by lying down and propping the legs on pillows.
TakeawayFor patients with chronic venous insufficiency, leg elevation above heart level when lying down and consistent daytime use of compression stockings are key strategies to prevent venous ulcers.
Community nursing · medium
A community health nurse is conducting a home visit for a patient with active pulmonary tuberculosis who started directly observed therapy 3 weeks ago. The patient is clinically improving but sputum smears remain positive. The patient lives with his wife and two young children. The nurse has already initiated contact investigation for the family. Which instruction should the nurse emphasize to the family to prevent further transmission of tuberculosis?
AAll household surfaces should be disinfected with a bleach solution daily.
BThe children should be tested for tuberculosis infection immediately.
CAll family members should wear N95 respirators when in the same room as the patient.
DEnsure the patient wears a surgical mask when in shared spaces with family members.
Show the answer and why the others fail
Answer: D. Ensure the patient wears a surgical mask when in shared spaces with family members.
A
TB is transmitted via airborne droplet nuclei, not through contaminated surfaces. Surface disinfection is not an effective measure to prevent TB transmission.
B
Testing identifies infection but does not prevent transmission. The nurse has already initiated contact investigation, which includes testing. The priority now is to implement measures to stop ongoing transmission.
C
N95 respirators are recommended for healthcare workers in high-risk settings, not for household members. Family members should be assessed for TB infection and may need preventive therapy, but routine use of N95 respirators at home is not standard.
D — correct
Placing a surgical mask on the patient reduces the release of infectious droplet nuclei into the air, which is the primary source control measure for preventing airborne TB transmission in the home. This is more effective than relying on cough etiquette alone, as TB can be transmitted through breathing and talking.
TakeawayFor patients with active pulmonary TB who remain sputum smear-positive, the most effective home source control measure is having the patient wear a surgical mask when in shared air spaces. This, along with ensuring adequate ventilation and completing directly observed therapy, helps prevent transmission to household contacts.
Community nursing · easy
A home health nurse is visiting a 70-year-old client with type 2 diabetes mellitus and peripheral neuropathy. The client lives alone and has limited mobility. The nurse is providing education on foot care to prevent injury. Which instruction should the nurse emphasize as the most important?
AUse over-the-counter corn removers for calluses.
BInspect feet daily for cuts, blisters, and redness.
CSoak feet daily in warm water to improve circulation.
DApply a heating pad to feet at night to keep them warm.
Show the answer and why the others fail
Answer: B. Inspect feet daily for cuts, blisters, and redness.
A
Chemical corn removers contain acids that can break down healthy skin and lead to ulcers, especially in the presence of neuropathy and poor healing.
B — correct
Daily visual inspection is the cornerstone of foot care in diabetic neuropathy, allowing early detection of injuries before they progress to ulcers or infection.
C
Soaking can cause skin maceration and increase the risk of burns due to impaired sensation; it is not recommended for neuropathic feet.
D
Heating pads can cause severe burns because the client cannot feel excessive heat due to neuropathy.
TakeawayFor patients with diabetes and peripheral neuropathy, daily foot inspection is the most critical self-care behavior to prevent unrecognized injuries and subsequent complications.
Community nursing · medium
A community health nurse visits an 82-year-old client with type 2 diabetes and peripheral neuropathy. The nurse evaluates the client's foot care practices. Which client statement indicates a need for further teaching?
A"I wear cotton socks and well-fitting shoes even when I am at home."
B"I use a mirror to inspect the bottoms of my feet every day."
C"I soak my feet in warm water for 30 minutes every evening to keep the skin soft."
D"I check the inside of my shoes for pebbles before putting them on."
Show the answer and why the others fail
Answer: C. "I soak my feet in warm water for 30 minutes every evening to keep the skin soft."
A
Wearing socks and properly fitting shoes at all times protects the feet from trauma, which is essential for clients with neuropathy.
B
Daily foot inspection, using a mirror if necessary, is a recommended practice to detect early lesions, so this is correct.
C — correct
Prolonged soaking can macerate the skin and increase the risk of breakdown and infection, especially in a client with neuropathy who may not accurately gauge water temperature. This statement indicates a need for further teaching.
D
This is a correct practice to prevent injury to insensitive feet, so it does not indicate a need for further teaching.
TakeawayClients with diabetes and peripheral neuropathy should avoid prolonged foot soaking, use lukewarm water for brief washing, and dry thoroughly between toes to prevent skin breakdown and infection.
Community nursing · medium
A community health nurse is visiting a 68-year-old patient with moderate chronic obstructive pulmonary disease (COPD). The patient reports feeling increasingly short of breath after walking to the mailbox. Which instruction should the nurse provide to help manage dyspnea during daily activities?
AInhale quickly through the mouth and exhale slowly through the nose.
BLie down flat as soon as you feel breathless.
CUse pursed-lip breathing, especially during exhalation.
DAvoid all physical activity that causes shortness of breath.
Show the answer and why the others fail
Answer: C. Use pursed-lip breathing, especially during exhalation.
A
Inhalation should be through the nose to warm, filter, and humidify the air; exhalation should be through pursed lips, not the nose. Quick inhalation can increase air trapping and dyspnea.
B
Lying flat can worsen dyspnea by increasing pressure on the diaphragm. The recommended position is sitting upright and leaning forward (tripod position) to optimize chest expansion.
C — correct
Pursed-lip breathing creates slight back pressure that keeps airways open longer, prolongs exhalation, and reduces air trapping, thereby relieving dyspnea. It is a key self-management strategy for COPD patients in the community.
D
Complete avoidance of activity leads to deconditioning and worsening dyspnea. Instead, patients should pace activities, use energy conservation techniques, and gradually increase tolerance.
TakeawayPursed-lip breathing is a key self-management technique for COPD patients to control dyspnea by prolonging exhalation and reducing air trapping.
Community nursing · medium
A community health nurse is visiting a 65-year-old patient who was discharged home 3 days ago after a sigmoid colostomy for colon cancer. The patient is independent in activities of daily living. Which instruction should the nurse emphasize to prevent complications?
AChange the pouching system every 24 hours to maintain skin integrity.
BIrrigate the colostomy daily to regulate bowel movements.
CAvoid foods that cause gas and odor to reduce pouch leakage.
DAssess the stoma color and report if it becomes dusky or black.
Show the answer and why the others fail
Answer: D. Assess the stoma color and report if it becomes dusky or black.
A
Pouching systems are typically changed every 3 to 7 days, not daily. Frequent changes can damage the peristomal skin and are not necessary for preventing complications.
B
Daily colostomy irrigation is not routinely required for all patients; it is an optional method for some to achieve bowel regulation, but it is not the priority for preventing early complications.
C
Dietary modifications help manage gas and odor, which can improve comfort and pouch seal, but they do not address the most serious immediate complication of stoma ischemia.
D — correct
A healthy stoma is pink to red and moist. A dusky or black color indicates compromised blood supply (ischemia/necrosis), which is a medical emergency requiring immediate intervention.
TakeawayA healthy colostomy stoma should be pink to red and moist; any color change to dusky or black indicates ischemia and requires immediate medical evaluation.
Community nursing · medium
A home health nurse is teaching a 72-year-old client with heart failure about self-monitoring. The client asks, "What should I do if I notice my weight has gone up by 3 pounds since yesterday?" Which response by the nurse is most appropriate?
A"Restrict your fluid intake to 500 mL for the next 24 hours."
B"Take an extra dose of your prescribed diuretic."
C"Reduce your dietary sodium intake for the next few days."
D"Notify your healthcare provider about the weight gain."
Show the answer and why the others fail
Answer: D. "Notify your healthcare provider about the weight gain."
A
While fluid restriction is part of heart failure management, acutely restricting fluids without provider guidance may not address the underlying cause and could delay necessary medical intervention. The immediate priority is to notify the healthcare provider.
B
Clients should not self-adjust diuretic doses unless specifically instructed by their healthcare provider as part of a flexible dosing plan. Taking an extra dose without such a plan could lead to electrolyte imbalances, dehydration, or hypotension.
C
While sodium reduction is important for long-term heart failure management, it is not the immediate action for a sudden weight gain. The client needs to report the weight change to the provider to determine if acute intervention is needed.
D — correct
A weight gain of 2 lb or more in one day or 5 lb in one week suggests fluid retention and possible worsening heart failure. The client should promptly report this to the healthcare provider for evaluation and possible medication adjustment.
TakeawayClients with heart failure should report a weight gain of 2 lb or more in one day or 5 lb in one week to their healthcare provider, as this may indicate fluid retention and worsening heart failure.
Community nursing · medium
A community health nurse is teaching a client with heart failure about self-management at home. Which of the following instructions should the nurse include?
AReport a weight gain of 2 pounds in a day or 5 pounds in a week after daily weighing.
BRestrict your fluid intake to 1.5 liters per day, even if you are not thirsty.
CTake your prescribed diuretic only when you notice swelling in your ankles or sudden weight gain.
DAvoid all physical activity, including walking, to prevent overworking your heart and worsening symptoms.
Show the answer and why the others fail
Answer: A. Report a weight gain of 2 pounds in a day or 5 pounds in a week after daily weighing.
A — correct
Daily weight monitoring is essential for early detection of fluid retention. A gain of 2 pounds in a day or 5 pounds in a week indicates worsening fluid retention and should be reported promptly.
B
Routine fluid restriction is not recommended for all heart failure patients; it is only indicated in specific cases such as hyponatremia or severe fluid retention, and should be guided by a healthcare provider.
C
Diuretics must be taken as prescribed, not on an as-needed basis. Waiting for symptoms like swelling or weight gain can lead to acute decompensation.
D
Complete inactivity leads to deconditioning. Clients with stable heart failure should engage in regular, moderate physical activity as tolerated to maintain function.
TakeawayDaily weight monitoring is a cornerstone of heart failure self-management. A weight gain of 2 pounds or more in a day or 5 pounds in a week indicates fluid retention and should be reported immediately to prevent decompensation.
Community nursing · medium
A 70-year-old patient is being discharged home with a new suprapubic catheter after urinary retention. Which instruction should the community nurse emphasize to prevent catheter-associated infection?
AChange the suprapubic catheter every 2 weeks.
BKeep the drainage bag below the level of the bladder at all times.
CClean the insertion site daily with hydrogen peroxide.
DApply antibiotic ointment to the insertion site after each cleaning.
Show the answer and why the others fail
Answer: B. Keep the drainage bag below the level of the bladder at all times.
A
Suprapubic catheters are typically changed every 4 to 6 weeks, not every 2 weeks. Unnecessarily frequent changes increase infection risk and trauma.
B — correct
Maintaining the drainage bag below the bladder prevents backflow of urine, which is a key measure to reduce the risk of catheter-associated urinary tract infection.
C
Hydrogen peroxide is cytotoxic and can damage healthy tissue, delaying healing. The insertion site should be cleaned with mild soap and water or normal saline.
D
Routine use of topical antibiotics is not recommended as it can promote antimicrobial resistance and skin irritation; cleaning with soap and water is sufficient.
TakeawayTo prevent catheter-associated infection, always keep the drainage bag below the level of the bladder to avoid urine backflow.
Community nursing · medium
A community health nurse is teaching a 65-year-old patient with newly diagnosed hypertension how to monitor blood pressure at home. Which instruction should the nurse include?
AMeasure blood pressure in the standing position.
BUse the bathroom after taking the blood pressure.
CSupport the arm at heart level during measurement.
DTake the reading immediately after sitting down.
Show the answer and why the others fail
Answer: C. Support the arm at heart level during measurement.
A
Blood pressure should be measured with the patient seated, back supported, and feet flat on the floor. Standing measurements are not standard for routine home monitoring and may produce different values.
B
A full bladder can increase systolic pressure by 10–15 mmHg. The patient should empty the bladder before measurement, not after, to avoid a falsely elevated reading.
C — correct
Positioning the arm at heart level ensures the cuff is aligned with the right atrium, preventing hydrostatic pressure errors that can cause inaccurate readings. This is a critical step for reliable home monitoring.
D
The patient should rest quietly in a seated position for at least 5 minutes before taking a blood pressure reading to allow the body to stabilize; immediate measurement may yield a falsely elevated result.
TakeawayFor accurate home blood pressure monitoring, the patient should rest for 5 minutes, sit with back supported and feet flat, keep the arm supported at heart level, and avoid caffeine, exercise, and smoking for 30 minutes prior.
Community nursing · easy
A community nurse is providing dietary teaching to a client who has a new sigmoid colostomy. Which of the following foods should the nurse instruct the client to avoid?
AWhite rice
BBananas
CApplesauce
DPopcorn
Show the answer and why the others fail
Answer: D. Popcorn
A
White rice is a low-fiber, binding food that is easily digested and often recommended to reduce loose output; it does not increase the risk of stoma obstruction.
B
Bananas are a low-residue food that can help thicken stool and are generally safe for clients with a colostomy; they are not associated with stoma blockage.
C
Applesauce is a low-residue, easily digestible food that helps regulate bowel output and is safe for clients with a colostomy.
D — correct
Popcorn contains indigestible hulls that can form a mass and obstruct the stoma, so clients with a new colostomy should avoid it until individual tolerance is established.
TakeawayClients with a new colostomy should avoid foods that can cause stoma blockage, such as popcorn, nuts, seeds, and corn, until individual tolerance is established.
Community nursing · medium
A community health nurse is visiting a 55-year-old client who had an ileostomy created 1 week ago. The client asks, "What can I do to prevent my stoma from getting blocked?" Which of the following responses by the nurse is most appropriate?
AChew foods well and avoid high-fiber items for now; you can gradually add them back.
BChange the skin barrier every 3 to 5 days to maintain adhesion and protect skin.
CIncrease your fluid intake to at least 2 to 3 liters per day to keep output thin.
DEmpty the pouch when it is one-third full to prevent leakage and skin irritation.
Show the answer and why the others fail
Answer: A. Chew foods well and avoid high-fiber items for now; you can gradually add them back.
A — correct
Thorough chewing and temporary avoidance of obstructive foods (e.g., raw vegetables, nuts) are the primary strategies to prevent stoma blockage; gradual reintroduction aligns with current postoperative guidelines.
B
Routine barrier changes are essential for skin integrity, but this practice is unrelated to preventing mechanical blockage of the ileostomy.
C
Adequate hydration helps maintain liquid effluent, reducing the risk of obstruction from thickened output, but it is not the most direct measure to prevent food bolus blockage.
D
Regular pouch emptying maintains a secure seal and protects peristomal skin, but it does not address the risk of stoma obstruction from food particles.
TakeawayTo prevent stoma obstruction, clients with a new ileostomy should chew foods thoroughly and temporarily avoid high-fiber items such as raw vegetables and nuts; these can be gradually reintroduced as tolerated.
Community nursing · medium
A community health nurse is providing education to a family after one member was diagnosed with hepatitis A. The other household members are unvaccinated and have not previously received hepatitis A vaccine or immune globulin. Which instruction should the nurse emphasize as the priority to prevent transmission?
ARefrain from sharing eating utensils, cups, and toothbrushes.
BReceive hepatitis A vaccine or immune globulin as soon as possible.
CDisinfect bathroom surfaces with a bleach solution after each use.
DWash hands thoroughly with soap and water after using the bathroom.
Show the answer and why the others fail
Answer: B. Receive hepatitis A vaccine or immune globulin as soon as possible.
A
Avoiding shared items reduces fecal-oral transmission risk, but it is a secondary measure; post-exposure prophylaxis is the priority for susceptible contacts.
B — correct
CDC guidelines recommend that unvaccinated household contacts receive post-exposure prophylaxis (vaccine or immune globulin) within 14 days as the primary measure to prevent hepatitis A infection.
C
Environmental disinfection is supportive but does not provide direct protection; post-exposure prophylaxis is the most critical intervention for unvaccinated household members.
D
Hand hygiene is essential to reduce fecal-oral spread, but it is not the priority intervention for susceptible contacts; post-exposure prophylaxis is more effective in preventing infection.
TakeawayFor unvaccinated household contacts of a person with hepatitis A, the priority intervention is post-exposure prophylaxis with hepatitis A vaccine or immune globulin within 14 days, as it provides direct protection; hand hygiene and other measures are adjunctive.
Community nursing · medium
A community health nurse visits a 68-year-old patient who was discharged home yesterday after insertion of a permanent pacemaker. The patient asks, "What activities should I avoid while my incision heals?" Which response by the nurse is most appropriate?
AAvoid using a microwave oven because it can interfere with the pacemaker.
BAvoid lifting the arm on the pacemaker side above shoulder level for 1 to 2 weeks.
CAvoid showering until the pacemaker generator is replaced.
DAvoid taking your own pulse for the first month after surgery.
Show the answer and why the others fail
Answer: B. Avoid lifting the arm on the pacemaker side above shoulder level for 1 to 2 weeks.
A
Modern pacemakers are shielded against microwave interference; using a microwave oven is safe and does not require avoidance.
B — correct
Limiting overhead arm movement reduces the risk of lead dislodgement while still allowing gentle range-of-motion exercises below shoulder level to prevent adhesive capsulitis. This is a common precaution, though modern active-fixation leads are more secure; the exact duration may vary per provider.
C
Showering is typically permitted once the incision is dry and healed, usually within 5-7 days, not delayed until generator replacement.
D
Patients are encouraged to take their pulse daily to monitor for arrhythmias or pacemaker malfunction; avoiding pulse checks would delay detection of problems.
TakeawayAfter pacemaker insertion, patients are often instructed to avoid lifting the affected arm above shoulder level for 1-2 weeks to protect the incision and leads, while heavy lifting (>10 lbs) is restricted for 4-6 weeks. These precautions are provider-specific and may vary with modern lead technology; gentle range-of-motion exercises below shoulder level are encouraged to prevent stiffness.