Chapter 08: EPIDEMIOLOGICAL APPLICATIONS Flashcards
Epidemiology is a primary tool used by the nurse scientist for researching which of the following topics?
a.
Locations where family violence is increasing
b.
Contributing factors to childhood obesity
c.
Morbidity statistics
d.
Population characteristics for healthy older adults
B
Epidemiology refers not only to epidemics of infections but also to other health-related events. Analytical epidemiology looks at the etiology (origins or causes) of a disease.
When doing which of the following activities does the community health nurse (CHN) act in the role of a nurse epidemiologist?
a.
Eliciting the health history of a client presenting with an illness
b.
Performing a physical assessment of an ill client
c.
Providing treatment and health education to a client with a disease
d.
Evaluating the number of clients presenting with similar diseases
D
Epidemiology differs from clinical medicine, which focuses on the diagnosis and treatment of disease in individuals. Epidemiology investigates the distribution, or the patterns, of health events in populations and the determinants or the factors that influence those patterns.
During the years 2005 to 2010, in a particular district, 1,000 of 10,000 girls aged 16 to 18 years tested positive for a sexually transmitted infection (STI). Of the 1,000 diagnosed STIs, 300 were gonorrhea and 500 were Chlamydia. Which one of the following statements would the CHN recognize as being true?
a.
The proportion of cases of gonorrhea to all STIs was 300:1300.
b.
The proportion of cases of gonorrhea to Chlamydia was 300:500.
c.
The proportion of STIs to the total population was 10 per 1,000.
d.
The proportion of cases of gonorrhea to all STIs was 50%.
C
In epidemiology, a proportion is a ratio in which the denominator includes the numerator. In public health statistics, if the proportion is small, we can express the number per 1,000.
Which model best explains the reasons why homeless individuals are at increased risk of disease as a result of multiple agent, host, and environmental factors? a. The web of causality b. The epidemiological triangle c. The levels of prevention d. The Health Promotion Model
A
The web of causality refers to the interrelationship of multiple factors that interact to influence health. The epidemiological triangle, by contrast, categorizes factors as agent, host, or environment but does not address the interactions of these factors. Levels of prevention are actions taken to improve health outcomes whereas health promotion addresses health improvement, not risk of disease.
Through which of the following actions would the CHN who wishes to decrease the incidence of obesity in elementary school children provide secondary prevention?
a.
Giving a presentation on the importance of exercise and physical fitness
b.
Designing a game in which students need to make healthy food choices
c.
Weighing students to identify those who are overweight
d.
Putting students on a diet if they weigh more than 20% of their ideal weight
C
Secondary prevention refers to interventions that increase the probability of early diagnosis of a condition. Health screenings are the mainstay of secondary prevention. Weighing students and identifying higher-than-recommended weight will enable early intervention to prevent obesity.
Which of the following is a CHN implementing when advising a client with osteoporosis to have three servings of milk or dairy products daily? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Treatment, but not prevention
C
Interventions that prevent the worsening of a condition are tertiary prevention activities. In this instance, the client already has a health problem (osteoporosis). By advising adequate dairy intake, the CHN aims to ensure that the client gets enough calcium to prevent worsening of the osteoporosis.
Which one of the following would be the best choice for the nurse researcher who wishes to identify the long-term benefits and risks of a treatment for hyperlipidemia? a. A cross-sectional study b. An ecological study c. A clinical trial d. A retrospective analysis
C
The goal of a clinical trial is to evaluate the effectiveness of an intervention. Clinical trials are generally the best way to show causality.
Of the following actions proposed by a CHN to prevent problems related to coronary artery disease (CAD) in a region with a high prevalence, which one is most likely to have positive outcomes?
a.
Introducing heart health information in the curriculum as early as grade 1, presentations on diet and exercise for the community at large, and special education sessions for high-risk populations
b.
Providing online activities related to the prevention of cardiac disease, smoking cessation programs, and blood pressure screenings
c.
Distributing handouts about age-appropriate games, self-assessments, and educational materials on heart-healthy lifestyles, availability of community screenings for hyperlipidemia in persons age 35 years and older, and walking programs for those affected by CAD
d.
Enrolling clients with CAD into cardiac rehabilitation programs, routinely evaluating the effectiveness of CAD treatment regimens, and participating in clinical trials that evaluate interventions for those diagnosed with CAD
C
Early introduction of health information focuses only on primary prevention activities. Provision of online activities focuses only on primary and secondary prevention. Enrollment of clients with CAD into cardiac rehabilitation programs focuses only on those already affected by CAD. The correct answer includes all three levels of prevention to target all members of the population. Targeting all members of the population and implementing all levels of prevention increases the likelihood of positive outcomes for the community as a whole.
People with immune deficiencies may have a negative tuberculosis (TB) skin test (Mantoux), even though they are infected. Which of the following measurements will the CHN conclude to be low when the TB skin test is given to persons with acquired immune deficiency syndrome (AIDS)? a. Positive predictive value b. Reliability c. Sensitivity d. Specificity
C
Sensitivity is the extent to which a test identifies those individuals who have the condition. AIDS being an acquired immune deficiency, clients with the disease may have a false-negative response to TB skin tests; that is, they may have the disease but the test is not sensitive enough to detect infection in these individuals.
To find out about substance abuse among students in a local high school, a teacher recommends to the CHN that questionnaires be given to students during various school programs, but the CHN rejects this method. Which situation does the CHN think the teacher’s recommendation would create? a. Classification bias b. Confounding bias c. Personal bias d. Selection bias
D
Classification bias refers to how information is collected and classified. Confounding bias results when a third factor is not considered in the relationship between an outcome and a study factor. A personal bias may occur when the investigator allows personal opinion to influence interpretation of findings. Selection bias is the correct answer. Selection bias occurs when selection procedures are not representative of the population as a whole. In this instance, the goal is to find out about substance abuse among all the students at the school. If only those students who join school programs are selected, those who do not join will not be represented in the results.
The CHN can enhance the sensitivity and specificity of a test by using its predictive value. Which one of the following best defines positive predictive value?
a.
The proportion of persons with a negative test who are actually disease-free
b.
The variation inherent in the trait being measured
c.
Any inconsistency in the testing instrument
d.
The proportion of persons with a positive test who actually have the disease
D
Positive predictive value (also called predictive value positive) is the proportion of persons with a positive test who actually have the disease, interpreted as the probability that an individual with a positive test has the disease.
A CHN determines that out of 8,000 women screened for breast cancer, 35 have previously been diagnosed with a cancer event and 20 are newly diagnosed with a cancer event. What is the prevalence rate in this group? a. 55 b. 0.7 c. 70% d. 55/8,000
D
The prevalence rate identifies the number of persons in a population that have a disease or have experienced an event at a specific period (old and new cases included). The formula for calculating prevalence rate is number of population with the disease divided by the number of individuals at risk.
The CHN knows that a regular-sized blood pressure (BP) cuff will provide readings that are falsely high if used to measure BP in an obese person and will provide readings that are falsely low if used to measure BP in a small or very thin person. Which of the following does a regular-sized BP cuff lack when used to measure BP in all individuals? a. Reliability b. Sensitivity c. Specificity d. Validity
D
Validity is the accuracy of a test or measurement or how closely it measures what it claims to measure.
