Exam 3 Flashcards
To understand the causes of health and disease, epidemiology studies:
a. individuals.
b. families.
c. groups.
d. populations.
ANS: D
Epidemiology monitors health of populations, understands determinants of health and disease in communities, and investigates and evaluates interventions to prevent disease and maintain health. Epidemiology does not focus on individuals, families, and groups.
The factors, exposures, characteristics, and behaviors that determine patterns of disease are de-scribed using:
a. descriptive epidemiology.
b. analytic epidemiology.
c. distribution.
d. determinants.
ANS: D
Determinants are the factors, exposures, characteristics, and behaviors that determine patterns of disease, which may be individual, relational, social, communal, or environmental. Descriptive ep-idemiology seeks to describe the occurrence of a disease in terms of person, place, and time. An-alytic epidemiology focuses on the investigation of causes and associations. Distribution de-scribes who has the disease and where and when the disease occurs.
An epidemiologist wants to know what caused severe diarrhea and vomiting in several people at a local banquet. Which of the following principles is being applied in this situation?
a. Descriptive epidemiology
b. Analytic epidemiology
c. Distribution
d. Determinants
ANS: B
Analytic epidemiology is directed toward understanding the etiology of the disease. Descriptive epidemiology seeks to describe the occurrence of a disease in terms of person, place, and time. Distribution describes who has the disease and where and when the disease occurs. Determinants are the factors, exposures, characteristics, and behaviors that determine patterns of disease, which may be individual, relational, social, communal, or environmental.
A nurse states that she has been reading about an epidemic that has been occurring in the world. Which of the following is she most likely referring to?
a. “Bird” flu in China
b. Adult obesity in the United States
c. An isolated case of smallpox in Africa
d. The nursing shortage in the United States
ANS: B
It is estimated that 30% of the adults in the United States are obese. According to the Centers for Disease Control and Prevention, this is an epidemic. The other examples are not epidemics.
John Snow is called the “father of epidemiology” because of his work with:
a. cholera.
b. malaria.
c. polio.
d. germ theory.
ANS: A
John Snow investigated the spread of cholera in the mid-nineteenth century. John Snow did not investigate the other examples.
A nurse who is studying chronic disease considers the multifactorial etiology of illness. What does this imply?
a. Genetics and molecular structure of disease is paramount.
b. Single organisms that cause a disease, such as cholera, must be studied in more detail
c. Focus should be on the factors or combinations and levels of factors contributing to disease.
d. The recent rise in infectious disease is the main focus.
ANS: C
Multifactorial etiology implies a focus on combinations and levels of factors. There are many factors to consider other than only genetics or single organisms with multifactorial etiologies. The focus of studying multifactorial etiology is on chronic disease.
A nurse is investigating a serious epidemic of influenza. Which of the following best describes the amount of cases that are being examined?
a. 50 cases
b. 100 cases
c. 500 cases
d. Unable to determine
ANS: D
One cannot tell the degree of seriousness without a denominator, which represents the total pop-ulation.
The probability an event will occur within a specified period of time is called:
a. rate.
b. risk.
c. epidemiology.
d. epidemic.
ANS: B
Risk is the probability an event will occur within a specified period of time. Rate is a measure of the frequency of a health event in a defined population, usually in a specified period of time. Epidemiology is the study of the occurrence and distribution of health-related states or events in specified populations, including the study of the determinants influencing such states, and the application of this knowledge to control the health problems. Epidemic occurs when the rate of disease, injury, or other condition exceeds the usual level of that condition.
A screening for diabetes revealed 20 previously diagnosed diabetics and 10 probable new cases, which were later confirmed, for a total of 30 cases. Which of the following best describes what is being measured?
a. Prevalence
b. Incidence
c. Attack rate
d. Morbidity rate
ANS: A
Prevalence is the measure of existing disease in a population at a particular time. Incidence quan-tifies the rate of development of new cases in a population at risk, whereas an incidence propor-tion indicates the proportion of the population at risk who experience the event over some period of time. Attack rate is defined as the proportion of persons who are exposed to an agent and de-velop the disease. Morbidity rate is the incidence of disease.
Which statement is true about mortality rates? Mortality rates:
a. are informative only for fatal diseases.
b. provide information about existing disease in the population.
c. are calculated using a population estimate at year-end.
d. reveal the risk of getting a particular disease.
ANS: A
Mortality rates are informative only for fatal diseases and do not provide direct information about the level of existing disease or the risk of getting a particular disease. Because the popula-tion changes during the course of a year, typically an estimate of the population at midyear is taken as the denominator for annual rates, because the midyear population approximates the amount of person-time contributed by the population during a given year.
A public health nurse (PHN) reports an attack rate. Which of the following has most likely been reported?
a. Number of cases of cancer recorded at a medical center
b. Number of people who died of Ebola in a given year
c. Number of beef cattle inoculated against mad-cow disease on a farm
d. Proportion of people becoming ill after eating at a fast-food restaurant
ANS: D
Attack rates are often specific to exposures, such as food-specific attack rates. The number of cases of cancer, exposure to Ebola, and beef cattle are not significant without knowing the total number of people so that a proportion can be calculated.
The interaction between an agent, a host, and the environment is called:
a. natural history of disease.
b. risk.
c. web of causality.
d. the epidemiologic triangle.
ANS: D
The epidemiologic triangle consists of the interaction between an agent, a host, and the environ-ment. The natural history of disease is the course of the disease process from onset to resolution. Risk is the probability an event will occur within a specified period of time. The web of causality reflects the more complex interrelationship among the numerous factors interacting, sometimes in subtle ways, to increase (or decrease) risk of disease.
Public health professionals refer to three levels of prevention as tied to specific stages in the:
a. epidemiologic triangle.
b. web of causation.
c. natural history of disease.
d. surveillance process.
ANS: C
The natural history of disease is the course of the disease process from onset to resolution. The three levels of prevention provide a framework commonly used in public health practice to depict this process. The epidemiologic triangle consists of the interaction between an agent, a host, and the environment. The web of causality reflects the more complex interrelationship among the numerous factors interacting, sometimes in subtle ways, to increase (or decrease) risk of disease. The surveillance process involves the systematic collection, analysis, and interpretation of data related to the occurrence of disease and the health status of a given population.
A nurse is studying the characteristics of an agent as part of the epidemiologic triangle. Which of the following is the nurse most likely studying?
a. Human population distribution
b. Salmonella
c. Genetic susceptibility
d. Climate
ANS: B
An agent includes infectious organisms, such as Salmonella, chemical agents, and physical agents. Genetic susceptibility is considered to be a characteristic of a host. Human population distribution and climate are considered to be characteristics of the environment.
A PHN implements a primary prevention intervention in the community. Which of the following is most likely being implemented?
a. Pap smear
b. Blood pressure screening
c. Diet and exercise
d. Physical therapy
ANS: C
Primary prevention refers to those interventions aimed at preventing the occurrence of disease, injury, or disability. Blood pressure screening and pap smears are secondary prevention interven-tions. Physical therapy is a tertiary prevention intervention.
A PHN conducts an immunization clinic for measles. Which of the following is being imple-mented?
a. Primary prevention
b. Secondary prevention
c. Tertiary prevention
d. Health promotion
ANS: A
Primary prevention refers to those interventions aimed at preventing the occurrence of disease, injury, or disability. Immunizations are an example of primary prevention. Secondary prevention interventions are designed to increase the probability that a person with a disease will have that condition diagnosed at a stage when treatment is likely to result in cure. Tertiary prevention in-cludes interventions aimed at disability limitation and rehabilitation from disease, injury, or disa-bility. Health promotion is a specific primary prevention strategy.
As a result of an outbreak of influenza in a community, a nurse encourages members of the community to receive the influenza vaccine. Which of the following levels of prevention is being used?
a. Primary prevention
b. Secondary prevention
c. Tertiary prevention
d. Multifactorial prevention
ANS: A
Nurses are involved in epidemiologic surveillance by monitoring the potential for disease out-breaks. Primary prevention refers to interventions aimed at preventing the occurrence of disease, injury, or disability. Immunizations are an example of primary prevention. Secondary prevention interventions are designed to increase the probability that a person with a disease will have that condition diagnosed at a stage when treatment is likely to result in cure. Tertiary prevention in-cludes interventions aimed at disability limitation and rehabilitation from disease, injury, or disa-bility. Multifactorial prevention is not possible with a disease like influenza, which has one cause.
A nurse offers a screening for hearing defects at a local community center. Which of the follow-ing best describes the action of the nurse?
a. Primary prevention
b. Secondary prevention
c. Tertiary prevention
d. Health promotion
ANS: B
Secondary prevention focuses on early detection and prompt treatment of disease, injury, or dis-ability. Screenings are part of secondary prevention interventions. Primary prevention refers to interventions aimed at preventing the occurrence of disease, injury, or disability. Tertiary preven-tion includes interventions aimed at disability limitation and rehabilitation from disease, injury, or disability. Health promotion is a specific primary prevention strategy.
A nurse refers a client with a neuromuscular disease to a vocational rehabilitation program. Which of the following best describes the action of the nurse?
a. Primary prevention
b. Secondary prevention
c. Tertiary prevention
d. Health promotion
ANS: C
Tertiary prevention includes those interventions aimed at disability limitation and rehabilitation from disease, injury, or disability. Referral of a client with a disease is an example of tertiary prevention. Primary prevention refers to interventions aimed at preventing the occurrence of dis-ease, injury, or disability. Secondary prevention focuses on early detection and prompt treatment of disease, injury, or disability. Health promotion is a specific primary prevention strategy.
A nurse implements a program that focuses on secondary prevention. Which of the following is most likely the topic of this program?
a. Rehabilitation
b. Avoidance of high-risk behaviors
c. Immunization
d. Mammogram
ANS: D
Secondary prevention focuses on early detection and prompt treatment of disease, injury, or dis-ability. Mammograms are a screening test. Avoidance of high-risk behaviors and immunizations are examples of primary prevention. Rehabilitation is an example of tertiary prevention.
An intervention that focuses on the tertiary level of prevention is implemented by the nurse? Which of the following did the nurse most likely complete?
a. Rehabilitative job training
b. Parenting education
c. Testicular self-examination
d. Family counseling
ANS: A
Tertiary prevention includes those interventions aimed at disability limitation and rehabilitation from disease, injury, or disability. Rehabilitative job training would be an example of tertiary prevention. Parenting education is an example of primary prevention. Testicular self-examination and family counseling are examples of secondary prevention.
A nurse is told that a screening test has high specificity. Which of the following is the best inter-pretation of this information?
a. The test provides precise and consistent readings.
b. The test accurately identifies those with the condition or trait.
c. The test accurately identifies those without the trait.
d. The test has a high level of false positives.
ANS: C
Specificity refers to the test accurately identifying those without the trait. High specificity is needed when rescreening is impractical and when reduction of false positives is important. The test would have a low level of false positives.
The proportion of persons with positive test results who actually have a disease, interpreted as the probability that an individual with a positive test result has the disease, is the:
a. sensitivity.
b. specificity.
c. positive predictive value.
d. negative predictive value.
ANS: C
Positive predictive value refers to the proportion of persons with positive test results who actually have the disease, interpreted as the probability that an individual with a positive test result has the disease. Sensitivity quantifies how accurately the test identifies those with the condition or trait. Specificity indicates how accurately the test identifies those without the condition or trait. Negative predictive value is the proportion of persons with a negative test who are actually dis-ease free.
A nurse examines birth and death certificates during an epidemiologic investigation. Which of the following data categories is being used?
a. Routinely collected data
b. Data collected for other purposes but useful for epidemiologic research
c. Original data collected for specific epidemiologic studies
d. Surveillance data
ANS: A
Birth and death certificates are considered to be vital records and are examples of data collected routinely. Data collected for other purposes would be hospital, physician, health department, la-boratory, and insurance records. Original data is that which is collected by the National Center for Health Statistics for specific health surveys. Surveillance data is used to assess and prioritize the health needs of populations, design public health and clinical services to address those needs, and evaluate the effectiveness of public health programs.
The most important predictor of overall mortality is:
a. race.
b. age.
c. gender.
d. income.
ANS: B
The mortality curve by age drops sharply during and after the first year of life to a low point in childhood, then begins to increase through adolescence and young adulthood and then increases sharply through middle and older ages. Race, gender, and income are not the most important predictor for overall mortality.
A nurse is investigating an outbreak of a gastrointestinal illness from a food-borne pathogen. Which of the following terms is being applied?
a. Attack rate
b. Point epidemic
c. Secular trend
d. Event-related cluster
ANS: B
One temporal and spatial pattern of disease distribution is the point epidemic. A point epidemic is most clearly seen when the frequency of cases is plotted against time. The sharp peak charac-teristic of such graphs indicates a concentration of cases in some short interval of time. Attack rate is defined as the proportion of persons who are exposed to an agent and develop the disease. Secular trends are long-term patterns of morbidity or mortality rates. Event-related clusters are patterns in which time is not measured from fixed dates on the calendar but from the point of some exposure or event, presumably experienced in common by affected persons, although not occurring at the same time.
The type of epidemiologic study that is used to describe a group of persons enrolled in a study who share some characteristic of interest and who are followed over a period of time to observe some health outcome is a(n):
a. case-control study.
b. cross-sectional study.
c. cohort study.
d. experimental study.
ANS: C
A cohort study is the type of epidemiologic study that is used to describe a group of persons en-rolled in a study who share some characteristic of interest and who are followed over a period of time to observe some health outcome. A case-control study uses a sample from the cohort rather than following the entire cohort over time. A cross-sectional study provides a snapshot of a pop-ulation or group at one point in time. An experimental study is one in which the investigator ini-tiates some treatment or intervention that may influence the risk or course of the disease.
A study that uses information on current health status, personal characteristics, and potential risk factors or exposures all at once is called:
a. cross-sectional.
b. ecological.
c. case-control.
d. cohort.
ANS: A
A cross-sectional study collects information on current health status, personal characteristics, and potential risk factors or exposures all at once. A cohort study is the type of epidemiologic study that is used to describe a group of persons enrolled in a study who share some characteristic of interest and who are followed over a period of time to observe some health outcome. An ecolog-ical model considers the multiple factors that contribute to disease development.
Voters have recently decided to have fluoride added to the city water system. Epidemiologists now want to study the effect of fluoride on dental caries in this population. Which of the fol-lowing would be conducted by the epidemiologists?
a. Ecological study
b. Double-blind study
c. Community trial
d. Screening
ANS: C
A community trial is similar to a clinical trial, but the issue is often health promotion and disease prevention rather than treatment of existing disease. An ecological model considers the multiple factors that contribute to disease development. A double-blind study is one in which neither the subject nor the investigator knows who is receiving the treatment. A screening involves the test-ing of groups of individuals who are at risk for a certain condition but are not yet symptomatic.
A nurse is considering the potential for selection bias. Which of the following best describes the situation that is the nurse has encountered?
a. Determining the population to be studied
b. Considering how the participants will enter the study
c. Studying cause and effect relationships
d. Documenting results of the study
ANS: B
Selection bias is attributable to the way subjects enter a study. It has to do with selection proce-dures and the population from which subjects are drawn. Determining the population to be stud-ied relates to the design of the study. Studying cause and effect relationship has to do with eco-logical studies. Documenting the results of the study is completed at the end of the study after the participants have been selected.
During the twentieth century, a nurse participated in research that examined the epidemiology of various diseases. Which of the following best describes the factors that influenced these studies? (Select all that apply.)
a. Increasing rate of poverty
b. Declining child mortality rates
c. Overcrowding in major cities
d. Development of new vaccinations
e. Advancements in medical equipment
ANS: B, D
Factors contributing to the development and application of epidemiologic methods in the twenti-eth century were: improved nutrition, new vaccines, better sanitation, the advent of antibiotics and chemotherapies, and declining infant and child mortality and birth rates. A rise in the stand-ard of living occurred for many following the Great Depression and World War II. The ad-vancements in medical technology have not influenced the examination of the epidemiology of various diseases.
A nurse states that he has incorporated epidemiology into his practice and functions in epidemi-ologic roles. Which of the following best describes the actions taken by the nurse? (Select all that apply.)
a. Policy making
b. Collection, reporting, analysis, and interpretation of data
c. Environmental risk communication
d. Documentation on patient charts and records
e. Law enforcement
ANS: B, C, D
Collection, reporting, analysis, and interpretation of data, environmental risk communication, and documentation on patient charts and records are examples of the use of epidemiology in practice. Policy making and law enforcement do not apply to epidemiology.
A community health nurse is caring for a client with methicillin-resistant Staphylococcus aureus (MRSA). Which of the following should the nurse be aware of?
a. Persons with MRSA usually have a chronic illness.
b. MRSA is a hospital-acquired infection and not often seen in the community.
c. Vancomycin-resistant Staphylococcus aureus (VRE) follows MRSA.
d. MRSA is becoming more common in the community.
ANS: D
MRSA is being seen more and more in the community with outbreaks frequently associated with school athletic programs and prison populations. MRSA is still largely a health care-associated infection, but it is becoming more common. VRE was found before MRSA. MRSA is not asso-ciated with chronic illness.
The ability of an agent to produce a severe pathologic reaction is known as:
a. antigenicity.
b. invasiveness.
c. toxicity.
d. virulence.
ANS: D
The ability of an agent to produce a severe pathologic reaction is known as virulence. Antigenic-ity is the ability to stimulate an immunological response. Invasiveness is the ability to penetrate and spread throughout a tissue. Toxicity is the ability to produce a poisonous reaction.
Immunity is a characteristic of the:
a. agent factor.
b. host factor.
c. environmental factor.
d. epidemiologic triad.
ANS: B
Immunity refers to species-determined resistance to an infectious agent and is determined by the characteristics of the host. The agent is the infection that is causing the infection/disease. Envi-ronmental factors may influence the susceptibility of the host. The epidemiologic triad involves the interaction of the host, agent, and environment.
A nurse is investigating the role of the agent in the cause of an illness. Which of the following best describes what the nurse is examining?
a. Host resilience
b. Virus
c. Infectiousness
d. Bug bite
ANS: B
An agent is described by its ability to cause disease and the nature and the severity of the dis-ease. The four major categories of agents are: (1) bacteria, (2) parasites, (3) fungi, and (4) viruses. Host resilience is a host factor. Infectiousness is the measure of the potential ability of an infect-ed host to transmit the infection to other hosts. Environmental factors facilitate the transmission of an infectious agent from an infected host to other susceptible hosts, such as a bug bite.
A nurse is providing education to a mother about the importance of having her infant immunized for measles, mumps, and rubella. Which of the following best describes the type of immunity that will be provided?
a. Active
b. Passive
c. Natural
d. Acquired
ANS: A
Active immunity refers to the immunization of an individual by administration of an antigen (in-fectious agent or vaccine) and is usually characterized by the presence of an antibody produced by the individual host. Passive immunity refers to immunization through the transfer of a specific antibody from an immunized individual to a non-immunized individual. Natural immunity refers to species-determined, innate resistance to an infectious agent. Acquired immunity is the re-sistance acquired by a host as a result of previous natural exposure to an infectious agent.
The nurse teaches food handlers to wash utensils after contact with raw meat. Which of the fol-lowing best describes the focus of this education?
a. Agent
b. Host
c. Environment
d. Food handler
ANS: C
Environmental factors facilitate the transmission of an infectious agent from an infected host to other susceptible hosts. Teaching food handlers to wash utensils after contact with raw meat is a prevention that focuses on the environment. An agent is described by its ability to cause disease and the nature and the severity of the disease. The four major categories of agents are: (1) bacte-ria, (2) parasites, (3) fungi, and (4) viruses. A food handler is an example of a host, which is a human or animal that can harbor an infectious agent.
The time interval between invasion by an infectious agent and the first appearance of signs and symptoms of the disease is called:
a. communicable period.
b. incubation period.
c. infectiousness.
d. endemic.
ANS: B
The incubation period is the time interval between invasion by an infectious agent and the first appearance of signs and symptoms. The communicable period is the interval during which an in-fectious agent may be transferred directly or indirectly from an infected person to another per-son. Infectiousness is the measure of the potential ability of an infected host to transmit the in-fection to other hosts. Endemic refers to the constant presence of a disease within a geographic area or a population.
A nurse is teaching members of the community about vertical transmission of a disease. Which of the following would the nurse most likely discuss?
a. Transmission through breast milk
b. Transmission through sexual contact
c. Transmission from mosquito bites
d. Transmission through contaminated food
ANS: A
Vertical transmission is the passing of infection from parent to offspring via sperm, placenta, milk, or contact in the vaginal canal at birth. Transmission through sexual contact is horizontal transmission. Transmission from mosquito bites is vector transmission. Transmission from con-taminated food is common vehicle transmission.
A nurse is discussing the role of a vector in the spread of disease. Which of the following is the nurse most likely referring to?
a. Contaminated water
b. A tick
c. A dirty needle
d. An infected person
ANS: B
Vectors are arthropods such as ticks and mosquitoes that transmit the infectious agent by biting or depositing the infective material near the host. Contaminated water, a dirty needle, and an in-fected person would be common vehicles.
One case of smallpox occurs in a population in which it was considered to be previously elimi-nated. Which of the following best describes what has occurred?
a. Endemic
b. Epidemic
c. Pandemic
d. Infectivity
ANS: B
The occurrence of one case of smallpox in a population in which it was considered to be previ-ously eliminated is an epidemic. Endemic refers to the constant presence of a disease within a geographic area or population. Pandemic refers to an epidemic occurring worldwide and affect-ing large populations. Infectivity is the ability to enter and multiply in the host.
Requirements for disease reporting in the United States are mandated by:
a. the Centers for Disease Control and Prevention (CDC).
b. federal laws.
c. state laws and regulations.
d. the World Health Organization (WHO).
ANS: C
Requirements for disease reporting in the United States are mandated by state laws and regula-tions. These diseases are then reported to the CDC. State public health officials collaborate with the CDC to determine which diseases should be nationally notifiable. The federal government and WHO are not involved in disease reporting.
A community health nurse has recently become involved in surveillance. Which of the following describes the situation that the nurse is in?
a. Educating clients about influenza immunizations
b. Collecting information about occurrence of measles
c. Evaluating the effectiveness of an HIV/AIDS prevention program
d. Advocating for changes in the national disease reporting requirements
ANS: B
Surveillance gathers the “who, when, where, and what”; these elements are then used to answer “why.” Nurses are frequently involved in surveillance by collecting data, making diagnoses, in-vestigating and reporting cases, and providing information to the general public. Client educa-tion, program evaluation, and advocating for changes are not part of the surveillance process.
A nurse is working in a health department when a patient arrives who has been traveling to South America and has been diagnosed with malaria. Which of the following considerations should be made by the nurse?
a. The Morbidity and Mortality Weekly Report should be consulted to investigate the rate of malaria in the United States.
b. This is a disease that must be reported to the state health department.
c. The nurse should take precautions to wear a mask and gown to avoid exposure.
d. The patient is very ill and should be sent to the hospital immediately.
ANS: B
Malaria is on the list of infectious diseases notifiable at the national level. The Morbidity and Mortality Weekly Report is published weekly with the rates of disease; however, this would not be the first consideration by the nurse. Malaria is not spread by direct contact, rather from a bite from an infected mosquito. Malaria begins with flu-like symptoms, or the client may have very few symptoms.
A public health nurse (PHN) understands that the emergence of new infectious diseases is influ-enced by the:
a. increased availability of immunizations.
b. globalization of food supplies.
c. decreased use of child care facilities.
d. creation of sanitation systems in third world countries.
ANS: B
Globalization of food supplies is one of the many factors that can influence the emergence of in-fectious diseases. The increased use of childcare facilities could contribute to the emergence of new infectious diseases. The lack of sanitation systems in third world countries could contribute to the emergence of new infectious diseases. The increased availability of immunizations should decrease the emergence of diseases.
A nurse is providing information to a local newspaper about the presence of infectious diseases in the United States. Which of the following statements by the nurse is accurate?
a. “It is the goal of the WHO to prevent the transmission of the plague by avoiding direct contact with inflicted individuals.”
b. “Rabies is easily spread by contact with animals.”
c. “The United States is a certified polio free country.”
d. “The onset of tularemia is characterized by a distinct skin lesion often called a bull’s-eye lesion.”
ANS: C
The Americas are certified polio free. The plague is a vector-borne disease and cannot be spread by direct contact with inflicted individuals. Rabies is a rare event because of the widespread vaccination of dogs in the 1950s. The Americas were certified as polio free in 1994. The onset of Lyme’s disease is characterized by a bull’s-eye lesion.
The nurse provides footwear and gloves to leprosy clients to prevent trauma to their insensitive and deformed hands and feet. Which of the following best describes the intervention used by the nurse?
a. Primary level of prevention
b. Secondary level of prevention
c. Tertiary level of prevention
d. Primary health care
ANS: C
Tertiary prevention reduces complications through treatment and rehabilitation. Primary preven-tion seeks to reduce the incidence of disease by preventing occurrence. Secondary prevention seeks to prevent the spread of infection and/or disease once it occurs. Primary health care is con-sidered to be the essential health care services provided by physicians and other health care pro-viders.
A nurse administers a rabies immunization post-exposure to an animal bite. Considering the in-terventions used with infectious disease, which of the following levels of prevention is being used?
a. Primary prevention
b. Secondary prevention
c. Tertiary prevention
d. Assessment
ANS: B
Secondary prevention focuses on early detection and prompt treatment of disease, injury, or dis-ability. Primary prevention seeks to reduce the incidence of disease by preventing occurrence. Tertiary prevention reduces complications through treatment and rehabilitation. Assessment re-fers to the systematic collection of data.
A nurse is presenting information to the county health department about potential bioterrorism threats. Which of the following agents would the nurse discuss in this presentation?
a. Smallpox
b. West Nile Virus
c. Severe acute respiratory syndrome (SARS)
d. Novel influenza A (H1N1)
ANS: A
Susceptibility to smallpox is 100% in the unvaccinated and fatality rate is estimated at 20-40% or higher. The agents of highest concern are anthrax, plague, smallpox, botulism, tularemia, and se-lected hemorrhagic viruses. West Nile Virus, SARS, and H1N1 are not viruses that would be used for bioterrorism.
A PHN would like to increase the immunization coverage of infants and toddlers. Which of the following strategies would be appropriate for the nurse to use?
a. Read the Mortality and Morbidity Weekly Report to learn about vaccinations
b. Require that children have all their immunizations before going to public school
c. Track children known to be at risk for underimmunization
d. Lead teams of health care workers to enforce laws related to immunizations
ANS: C
Tracking children known to be at risk for underimmunization is a function of PHNs who work in health departments where immunizations are given and tracked. Reading the Mortality and Mor-bidity Weekly Report, requiring that children have all of their immunizations before attending school, and leading teams of health care workers would not be as effective in increasing immun-ization coverage for this population.
Food intoxication is caused by:
a. toxins produced by bacterial growth and chemical contaminants.
b. bacterial, viral, or parasitic invasion of food.
c. overcooking of meat and produce.
d. adding too many spices or ingredients to food.
ANS: A
Food intoxication is caused by toxins produced by bacterial growth, chemical containments, and a variety of disease-producing substances found naturally in certain foods such as mushrooms and some seafood. Bacterial, viral, or parasitic invasion of food is not a cause of food intoxica-tion. Food intoxication is not caused by overcooking meat or adding too many ingredients to food.
The most common vector-borne disease in the United States is:
a. malaria.
b. yellow fever.
c. Lyme disease.
d. Rocky Mountain spotted fever.
ANS: C
Lyme disease is the most common vector-borne disease in the United States, with over 30,000 confirmed cases and probable cases reported to CDC in 2012. Yellow fever and Rocky Mountain spotted fever are both vector-borne diseases, but are not the most common. Malaria is most prev-alent vector-borne disease worldwide.
A nurse is caring for a client who has been diagnosed with West Nile Virus. Which of the fol-lowing types of illness does the client have?
a. Food-borne
b. Vector-borne
c. Water-borne
d. Zoonoses
ANS: B
West Nile virus is carried by a mosquito, which is a vector. Food-borne illnesses are carried by food. Water-borne illnesses are transmitted through water. Zoonoses are infections that are transmitted from vertebrate animal to a human under natural conditions.
A community health nurse investigates an outbreak of pinworm at a local day care center. In or-der to minimize the spread of infection, which of the following suggestions would the nurse pro-vide to the day care workers?
a. Close the day care until all surfaces are cleaned.
b. No action is necessary because it is easily treated with oral vermicides.
c. Using good hand washing is important to prevent the transmission.
d. Every child in the day care should be treated because they all are probably infected.
ANS: C
Transmission of pinworm occurs through the fecal-oral route, so good hand washing after toilet-ing is essential. It is not necessary to treat all children or close the day care. It is necessary that action be taken, as without any action being taken, the pinworm outbreak will continue.
What is the best method for preventing health care-associated infections?
a. Perform good hand washing before and after approaching every patient.
b. Prevention is almost impossible due to the high infection rates in hospitals.
c. Isolate every patient having surgery.
d. Use contact isolation for every patient at risk.
ANS: A
Hand washing is the best way to prevent infection. If good hand washing is in place, it is not necessary to isolate patients or implement contact isolation. Prevention is possible with the use of good hand washing.
A nurse promotes the use of universal precautions by all health care workers. Which of the fol-lowing best describes the action that was taken by the nurse?
a. Primary prevention
b. Secondary prevention
c. Tertiary prevention
d. Health care-associated infection
ANS: A
Primary prevention refers to those interventions aimed at preventing the occurrence of disease, injury, or disability. Secondary prevention seeks to prevent the spread of infection and/or disease once it occurs. Tertiary prevention reduces complications through treatment and rehabilitation. Health care-associated infections are prevented through the use of good hand washing.
A nurse is caring for a client who has been diagnosed with a parasitic infection. Which of the following information should the nurse know when caring for this client?
a. The medication to prescribe to treat these infections
b. The nature and symptoms of all parasitic illnesses
c. What specimens to collect and how and when to collect them
d. Public policy about parasitic infections
ANS: C
Nurses need to be cognizant about what specimens to collect, how and when to collect, and what laboratory techniques to use. Proper specimen collection is necessary so that the clinical diagnosis can be confirmed. It is not necessary for the nurse to know the signs and symptoms for all para-sitic infections in order to provide care for the client. Public policy about parasitic infections is not important to know when providing care for the client.
Which elements of surveillance does a nurse use? (Select all that apply.)
a. Mortality registration
b. Epidemic field investigation
c. Laboratory reporting
d. Individual case investigation
e. Application of research
ANS: A, B, C, D
There are 10 basic elements of surveillance. Mortality registration, epidemic field investigation, laboratory reporting, and individual case investigation are among them. Application of research is not part of the 10 basic elements of surveillance.
A nurse is utilizing the provisions created by the Ryan White HIV/AIDS Treatment Extension Act. Which of the following interventions is the nurse most likely performing?
a. Increasing AIDS awareness in the community
b. Determining available health care services for HIV-infected individuals
c. Preventing the transmission of AIDS to children from their mothers
d. Allowing persons in the final stages of HIV to die with dignity
ANS: B
This act provides emergency services, services for early intervention and care, and drug reim-bursement programs for HIV-infected individuals.
Which part of the immunological system suffers the greatest damage as a result of HIV infec-tion?
a. Dendrite cells
b. CD4+ T-lymphocytes
c. Macrophages
d. Monocytes
ANS: B
When HIV enters the body, a person may experience a mononucleosis-like syndrome, referred to as a primary infection, which lasts for few weeks. This may go unrecognized. The body’s CD4 white blood cell count drops for a brief time when the virus is most plentiful in the body. The dendrite cells, macrophages, and monocytes are not as severely damaged as the CD4 cells.
HIV transmission can occur through:
a. exposure to blood.
b. insect bites.
c. sharing of school supplies.
d. toilets.
ANS: A
HIV can be transmitted through exposure to blood. HIV is not transmitted by insect bites, shar-ing of school supplies, or toilets.
A public health nurse (PHN) is reviewing Healthy People 2020 to determine where to prioritize programming for the county health department. Based on Healthy People 2020, which of the following areas would the nurse most likely plan to implement programming?
a. Reduce the rate of HIV transmission among adults and adolescents
b. Eliminate sexually transmitted diseases (STDs) from developed countries
c. Reduce deaths from gonorrhea
d. Increase awareness about HIV in lesbian females
ANS: A
One of the Healthy People 2020 objectives is reducing the number of cases of HIV infection among adults and adolescents. Eliminating STDs from developed countries, reducing deaths from gonorrhea, and increasing awareness about HIV among lesbian females are not addressed by Healthy People 2020.
A nurse is examining the route of HIV transmission for a newly diagnosed HIV client. Which of the following would most likely be discovered by the nurse?
a. Having contact with an HIV-positive individual who is coughing
b. An infant receiving breast milk from an HIV-positive mother
c. Receiving a mosquito bite while in Africa
d. Being near an HIV-positive individual who is sneezing
ANS: B
HIV can be transmitted through breast milk. HIV is not transmitted by coughing, sneezing, or mosquito bites.
A nurse is caring for a client who is HIV positive. Which of the following roles of the nurse would be the most important for the nurse to implement?
a. Advocate, lobbying for AIDS research
b. Counselor, discussing implications of future sexual activity
c. Role model, providing supportive care
d. Policy maker, addressing laws governing privacy rights of HIV-positive persons
ANS: C
The priority role of the nurse should be role model, as nurses must be role models because many HIV-positive patients are stigmatized. The need to be an advocate and policy maker does not address the individual needs of the client. The nurse is able to counsel the client while providing supportive care.
A nurse is working in a public health center. A patient who has been newly diagnosed as HIV positive comes for counseling. By law, which of the following actions must be taken by the nurse?
a. Give antiviral medications to the patient
b. Ask the person to name all of his or her sexual contacts
c. Refer the patient to the social worker as someone possibly needing case management
d. Report the HIV-infected person to the state health department
ANS: D
It is mandatory to report HIV cases by name in all states, although not all states require viral load and CD4 counts. There are not laws in place that mandate administration of medications, naming of sexual contacts, or referral to case management.
In comparison with HIV infection in adults, HIV infection in infants and children:
a. has the same signs and symptoms.
b. has a shorter incubation period.
c. has a longer survival period.
d. is detected by using the same tests.
ANS: B
HIV infection in infants and children has a shorter incubation period. The physical signs and symptoms in children are different and include failure to thrive, unexplained persistent diarrhea, developmental delays, and bacterial infections such as tuberculosis (TB) and severe pneumonia. Detection is made through different tests in infants of infected mothers than from those who are over 18 months. The effectiveness of antiretroviral therapy in pregnant women and newborns in preventing transmission from mother to fetus or infant has made pediatric HIV rates decline sharply; thus, these children are less likely to contract the virus.
A nurse counsels a client to have the enzyme-linked immunosorbent assay (EIA) test. Which of the following best describes the rationale for this test?
a. To indicate the presence of the antibody to HIV
b. To reveal whether or not the client has AIDS
c. To isolate the HIV virus
d. To confirm HIV after having a positive Western blot
ANS: A
The EIA is used to indicate the presence of the antibody to HIV. To minimize false positive re-sults, the Western blot is used as a confirmatory test to verify the results. The EIA does not iso-late the virus, nor does it reveal whether the individual has symptomatic AIDS.
A nurse is examining a child in the early stages of HIV infection. Which of the following would the nurse expect to find?
a. Failure to thrive and developmental delays
b. Kaposi’s sarcoma and developmental delays
c. Toxoplasmosis and oral candidiasis
d. Fatigue and shortness of breath
ANS: A
Early symptoms of pediatric HIV infection include failure to thrive and developmental delays. Kaposi’s sarcoma and oral candidiasis are common opportunistic diseases later in the disease process. Fatigue is a symptom seen with hepatitis and TB.
The most common reportable infectious disease in the United States is:
a. gonorrhea.
b. syphilis.
c. herpes.
d. chlamydia.
ANS: D
The most common reportable infectious disease in the United States is chlamydia. Gonorrhea is the second most commonly reported infectious disease. Syphilis and herpes are not among the most common reportable infectious diseases in the United States.
A nurse is caring for a client who has been diagnosed with a bacterial sexually transmitted infec-tion (STI). Which of the following infections does this client most likely have?
a. Trichomonas
b. HIV
c. Syphilis
d. Genital warts
ANS: C
Trichomonas, HIV, and genital warts are caused by viruses. Syphilis is caused by bacteria.
A nurse is assisting an employer who has hired an individual who has been recently diagnosed with HIV. Which of the following interventions would be most appropriate for the nurse to im-plement?
a. Educate about how to reduce the risk of breaching the employee’s confidentiality
b. Explain how to inform coworkers about avoiding HIV transmission
c. Facilitate obtaining medical insurance coverage for the HIV-infected employee
d. Describe the early signs and symptoms of HIV infection
ANS: A
Nurses frequently work in the education role, and employers may need assistance in dealing with HIV-infected employees. Disclosing a worker’s infection to other workers, terminating employ-ment, and isolating an infected worker are examples of situations that have led to litigation be-tween employees and employers. Thus, the priority will be to protect the employer from litiga-tion.
Pelvic inflammatory disease (PID) is a common complication of:
a. gonorrhea.
b. syphilis.
c. chlamydia.
d. herpes.
ANS: A
PID is a common complication of gonorrhea. PID is not a common complication of syphilis, chlamydia, or herpes.
A person diagnosed with syphilis presents with signs and symptoms of rash, sore throat, and muscle and joint pain. Which of the following stages of syphilis is the client most likely experi-encing?
a. Congenital
b. Primary
c. Secondary
d. Tertiary
ANS: C
A person with signs and symptoms of a rash, sore throat, and muscle/joint pain is experiencing the secondary stage of syphilis. Primary syphilis occurs when the bacteria produce infection in the form of a chancre at the site of entry. Tertiary syphilis usually occurs several years after initial infection and is rare in the United States because the disease is usually cured in its early stages with antibiotics. Congenital syphilis is transmitted transplacentally.
Which type of hepatitis would likely be found where sanitation is inadequate?
a. A
b. B
c. C
d. D
ANS: A
Hepatitis A would likely be found where sanitation is inadequate. Hepatitis B and C are spread through blood and body fluids. Hepatitis D can only exist in people who are already infected with Hepatitis B.
Which of the following groups would be most likely to receive an injection of prophylactic im-mune globulin for possible exposure to hepatitis A?
a. Persons who have had direct contact with blood
b. Those who ate at the same restaurant as the person with hepatitis A
c. All health care workers
d. All those who had household or sexual contact with persons with hepatitis A
ANS: D
Those who have been in close contact with persons who develop hepatitis A should receive im-mune globulin. The other groups do not describe populations in direct contact with the person who has hepatitis A.
The most chronic blood-borne infection in the United States is:
a. hepatitis A.
b. hepatitis B.
c. hepatitis C.
d. HIV.
ANS: C
The most chronic blood-borne infection in the United States is hepatitis C. Hepatitis A virus is most commonly transmitted through the fecal-oral route. Sources may be water, food, feces, or sexual contact. The hepatitis B virus (HBV) is spread through blood and body fluids and, like HIV, is a blood-borne pathogen. HIV is transmitted through exposure to blood, semen, trans-planted organs, vaginal secretions, and breast milk. Although hepatitis B and HIV are both blood-borne pathogens neither are the most chronic infection like hepatitis C.
The case rate of new TB is highest among which ethnicity in the United States?
a. African American
b. Native American
c. White American
d. Asian American
ANS: D
Of the new cases, 59% are foreign-born persons living in the United States, with Asians and Hispanics being the most common ethnic groups, representing 30% and 28% of national TB cas-es. The TB rates for African American, Native American, and White American are lower than the Asian and Hispanic populations.
A nurse screens blood products, donor organs, and tissues for the hepatitis C infection. Which of the following best describes this nursing action?
a. Primary prevention
b. Secondary prevention
c. Tertiary prevention
d. Health promotion
ANS: A
Primary prevention refers to those interventions aimed at preventing the occurrence of disease, injury, or disability. Screening blood products, organs, and tissues for infection protects the pop-ulation from exposure to hepatitis C, which prevents them from contracting the disease. Second-ary prevention includes screening for diseases to ensure their early identification, treatment, and follow-up with contact to prevent further spread. Tertiary prevention focuses on chronic care and rehabilitation. Health promotion focuses on the primary prevention activities to promote health and prevent disease.
A nurse is uncomfortable discussing such topics as sexual behavior and sexual orientation when counseling clients and avoids this topic with clients. Which of the following is the most likely outcome of this avoidance?
a. Potential risks and risky behaviors will not be identified.
b. Transmission of STDs will remain unchanged.
c. Clients will develop a trusting relationship with health care providers.
d. The nurse will be violating the laws in several states.
ANS: A
It is important that nurses be able to discuss these topics to help prevent and control STDs. Without discussion of these topics, it is possible that clients will not be aware that they have an STD and may transmit it to others. Thus, the transmission of STDs may increase. A trusting rela-tionship with a health care provider may or may not develop and is not dependent on whether these issues are discussed. There are not laws that mandate nurses to discuss sexual behavior and sexual orientation with clients.
A nurse is educating intravenous (IV) drug users about sharing equipment. Which of the follow-ing information would be appropriate for the nurse to include in this education?
a. Tell the clients to throw away their equipment after one use
b. Educate the clients on using full-strength bleach on their drug paraphernalia for 30 seconds
c. Suggest limiting the number of people who share the equipment
d. Provide clean needles and syringes to whoever wants them
ANS: B
Using bleach on the needles and syringes is a way to decrease cross-contamination. This is the last-resort option. People who inject drugs are difficult to reach for health care services, so providing them education is important so that they can protect themselves and others as they most likely will not throw away their equipment, or be selective about whom they share their equipment with. Providing needles and syringes does not provide the appropriate education to prevent the spread of disease
A nurse is teaching a client diagnosed with gonorrhea how to prevent reinfection and further spread. Which of the following describes the action taken by the nurse?
a. Primary prevention
b. Secondary prevention
c. Tertiary prevention
d. Primary health care
ANS: B
Secondary prevention focuses on early detection and prompt treatment of disease, injury, or dis-ability. Primary prevention refers to those interventions aimed at preventing the occurrence of disease, injury, or disability. Tertiary prevention focuses on chronic care and rehabilitation. Pri-mary health care refers to the first line of care provided to patients typically by a physician or other health care provider.
The nurse teaches the family of an AIDS client about managing symptomatic illness by prevent-ing deteriorating conditions, such as diarrhea, skin breakdown, and inadequate nutrition. Which of the following best describes the action taken by the nurse?
a. Primary prevention
b. Secondary prevention
c. Tertiary prevention
d. Primary health care
ANS: C
Tertiary prevention includes those interventions aimed at disability limitation and rehabilitation from disease, injury, or disability. Primary prevention refers to those interventions aimed at pre-venting the occurrence of disease, injury, or disability. Secondary prevention focuses on early detection and prompt treatment of disease, injury, or disability. Primary health care refers to the first line of care provided to patients typically by a physician or other health care provider.
A community health nurse visits a homeless shelter to provide directly observed therapy (DOT) to several clients who have been diagnosed with TB. Which of the following best describes the rationale for this nursing intervention?
a. Homeless clients do not care about their health.
b. Homeless clients do not have access to medications.
c. Poor adherence can result in drug resistance.
d. These medications are so powerful, clients must be observed for reactions.
ANS: C
Poor adherence has led to antibiotic resistant strains. These clients may care about their health but may have difficulty adhering to the treatment regimen. Medications to treat TB are available to the homeless population. The concern with the antimicrobial treatment is with non-adherence, not with side effects
The nurse is counseling a female who has recently tested positive for HIV. Which of the follow-ing will the nurse educate that the client is responsible for? (Select all that apply.)
a. Have regular medical evaluations and follow-ups
b. Donate blood and plasma to others who are positive for the disease
c. Inform health care providers about the HIV infection
d. Consider the risk of perinatal transmission
e. Disclose her HIV infection to her employer
ANS: A, C, D
A person who is infected with HIV should have regular medical evaluations and follow-up ap-pointments; not donate blood or plasma; inform health care providers about the HIV infection; and consider the risk of perinatal transmission and follow-up with contraceptive use.
What is the purpose of providing education across the three levels of prevention? Education:
a. enables clients to attain optimal health.
b. identifies and treats health problems early to eliminate disability.
c. enables populations to break into individuals.
d. teaches people about Healthy People 2020.
ANS: A
Health education enables clients to attain optimal health, prevent health problems, and identify and treat health problems early to minimize disability. Elimination of disability may not be possi-ble. Health education does not teach about the Healthy People 2020 document or break popula-tions into individuals.
Which statement about education is true?
a. It emphasizes the provider of knowledge and skills.
b. It emphasizes the recipient of knowledge and skills.
c. It is a process of gaining knowledge and expertise.
d. It results in behavioral change.
ANS: A
Education is the establishment and arrangement of events to facilitate learning. Education em-phasizes the provider’s role in providing knowledge and skills. Learning emphasizes the recipient of knowledge and skills. Education does not necessarily result in change, as change is typically not easy for most people. Education is designed to effect changes in the knowledge, skills, and attitudes, not necessarily expertise.
