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.
A nurse uses Healthy People 2020 as a guide when planning health education in the community. Which of the following actions would be taken by the nurse?
a. Focus on avoiding cigarette smoking and using alcohol in moderation
b. Educate clients using primary and secondary levels of prevention
c. Use Bloom’s taxonomy when planning educational objectives
d. Design health fairs aimed at individuals
ANS: B
Healthy People 2020 focuses on implementing health promotion in priority areas using primary and secondary prevention. Understanding the three learning domains is crucial in providing ef-fective health care. Health fairs targeted at specific populations can provide a venue for provid-ing primary and secondary prevention.
The cognitive domain includes:
a. changes in attitudes and the development of values.
b. the performance of skills.
c. memory, recognition, understanding, reasoning, and problem solving.
d. memorization of one set of skills before moving on to the next.
ANS: C
The cognitive domain includes memory, recognition, understanding, reasoning, and problem solving. The affective domain includes changes in attitudes and the development of values. The psychomotor domain includes the performance of skills that require some degree of neuromuscu-lar coordination and emphasizes motor skills. Memorization of skills is only one part of the cogni-tive domain.
A nurse is teaching a client about how to complete a wound dressing change. Which of the fol-lowing conditions must be met before learning will occur?
a. Must be able to memorize the instructions, relay this information to a partner, and demonstrate the dressing change
b. Must master the dressing change at the time it is taught, repeat the demonstration for the nurse, and teach another person
c. Must be able to speak the language of the nurse, have time to practice the dressing change, and master the dressing change in a short time
d. Must have the necessary ability, a sensory image of how to carry out the dressing change, and an opportunity to prac-tice the dressing change
ANS: D
Before psychomotor learning occurs, the learner must have the necessary ability, a sensory image of how to carry out the skill, and an opportunity to practice the skill. This is the only option that contains all of the necessary requirements of the learner.
A health educator is trying to change a client’s attitudes about smoking. Which of the following domains would be used?
a. Cognitive
b. Affective
c. Psychomotor
d. Developmental
ANS: B
The affective domain is used to attempt to influence what individuals, families, communities, and populations feel, think, and value. The cognitive domain includes memory, recognition, un-derstanding, reasoning, and problem solving. The psychomotor domain includes the performance of skills that require some degree of neuromuscular coordination and emphasizes motor skills. Developmental domain is not one of the domains of learning.
The nurse is teaching a new diabetic client how to give himself an insulin injection. Which of the following domains would be used?
a. Developmental
b. Cognitive
c. Affective
d. Psychomotor
ANS: D
The psychomotor domain includes the performance of tasks that require some degree of neuro-muscular coordination and emphasizes motor skills. Developmental domain is not one of the do-mains of learning. The cognitive domain includes memory, recognition, understanding, reasoning, and problem solving. The affective domain is used to attempt to influence what individuals, fam-ilies, communities, and populations feel, think, and value.
A nurse is teaching a postpartum mother how to breastfeed her infant. The nurse notes that the mother is alert and agrees that breastfeeding is important to her and beneficial to her baby. The nurse outlines the expectations of breastfeeding for the mother and the baby. Considering the events of instruction, which of the following should the nurse do next?
a. Ask the mother about her previous experience with breastfeeding
b. Demonstrate how to position the baby for breastfeeding
c. Show the mother a video about breastfeeding
d. Have the mother demonstrate breastfeeding
ANS: A
Asking the mother about her previous experience with breastfeeding identifies her educational needs. Using the TEACH mnemonic, the first thing the nurse should do is “Tune in”: listen be-fore starting to teach; the client’s needs should direct the content. Thus, this should be done be-fore the nurse does any demonstration, showing of audiovisual resources, or return demonstra-tion.
A nurse has evaluated the learning needs of a community support group. Which of following steps should the nurse take when developing an educational program for them?
a. Consider any potential barriers to learning
b. Establish goals and objectives for the program
c. Select appropriate materials for the program
d. Assess the dynamics of the group
ANS: B
Instructional objectives need to be evaluated before a teaching program is designed. The five steps of the educational process are: (1) identifying educational needs, (2) establishing educa-tional goals and objectives, (3) selecting appropriate educational methods, (4) implementing the educational plan, and (5) evaluating the educational process.
A nurse is developing a goal for a client who is learning how to care for an ostomy. Which of the following would be most appropriate to develop?
a. The client will look at his stoma without disgust each time his ostomy bag comes off.
b. The client will be able to independently take care of his ostomy bag within three months.
c. The client will gather all ostomy supplies correctly each time his ostomy bag needs to be changed.
d. The client will successfully describe to the nurse how to care for his ostomy when he is asked.
ANS: B
Goals are broad, long-term expected outcomes. The correct answer describes something that will happen over a long period of time. The other choices describe objectives.
A community health nurse is writing an objective. Which of the following would be most appro-priate for the nurse to write?
a. Each member of the family will give an insulin injection to the client with accurate dosage 100% of the time for 10 consecutive trials.
b. The client will perform a blood sugar test on herself with an accurate blood sugar reading.
c. The community will take their children to receive immunizations within 1 month of the immunization due date.
d. Fifty percent of the eligible women seen in the clinic will return for their scheduled mammogram appointment.
ANS: A
Objectives are specific, short-term criteria that need to be met as steps toward achieving the long-term goal. They are written as statements of an intended outcome or expected change in behaviors and should be defined in measurable terms. The objective “each member of the family will give an insulin injection to the client with accurate dosage 100% of the time for 10 consecu-tive trials” contains the components of a written objective. “The client will perform a blood sugar test on herself with an accurate blood sugar reading” does not provide any measureable terms. “The community will take their children to receive immunizations within 1 month of the immun-ization due date” does not provide a measurable percentage of the members of the community. “Fifty percent of the eligible women seen in the clinic will return for their scheduled mammo-gram appointment” focuses on a long-term goal, rather than a short-term objective and does not provide a time frame for when this would be measured.
A nurse is using the educational process of selecting appropriate educational methods when plan-ning a community health program. Which of the following steps of the nursing process does this action most resemble?
a. Assessment
b. Evaluation
c. Implementation
d. Planning
ANS: D
Assessment would be identifying educational needs, evaluation would be evaluating educational process, and implementation would be implementing the educational plan. Planning is similar to selecting appropriate educational methods.
A nurse is teaching a group of clients newly diagnosed with diabetes how to give themselves in-jections. Which of the following formats would be most appropriate for the nurse to use?
a. Demonstration
b. Health fair
c. Lecture
d. Non-native language session
ANS: A
Demonstration also includes return demonstration. Giving injections can best be learned by see-ing the behavior being done. Health fairs target specific populations and are held in a variety of locations. Non-native language sessions are a way to adapt the health fair to a population that does not speak English. Lecture is a non-interactive method of teaching.
A nurse is implementing an educational program about the importance of being physically active. Which of the following steps would the nurse complete first?
a. Provide learning guidance
b. Present the stimulus
c. Gain the learner’s attention
d. Ask learners to recall prior learning
ANS: C
Gaining the learner’s attention must happen first before learning can take place. The following steps of implementation include telling the learners the objectives of the instruction, asking learn-ers to recall previous knowledge, presenting the essential materials, helping the learners apply the information, encouraging learning to demonstrate what they have learned, and providing feed-back to help learners improve their knowledge and skills.
A nurse is implementing a community health education program at a local church. Which of the following educational principles should the nurse implement when providing this education?
a. Refer to trustworthy sources
b. Use an active voice
c. Create the best learning environment
d. Accentuate the positive health behaviors of the participants
ANS: C
The environment must be conducive to learning for educational programs to be effective. The environment should be free of distractions and consistent with the message. The other strategies may assist with the educational program, but are not one of the major educational principles dis-cussed in the textbook.
A nurse is working with a group of clients diagnosed with diabetes and is teaching a class about avoiding the long-term effects of diabetes. The nurse begins the class by reviewing the basic physiology of diabetes, which was taught the week before. Which of the following principles of effective education is the nurse using?
a. Stimulating recall of prior learning
b. Gaining attention
c. Presenting the material
d. Providing learning guidance
ANS: A
The educator should have the learners recall previous knowledge related to the topic of interest. The principle of gaining attention should have been applied as the program started the week be-fore. Recall should be done before new material is presented and before learning guidance is pro-vided.
During a class on newborn care given at a local health department, a nursing student asks the par-ticipants to practice with baby dolls. Which of the following steps of promoting effective educa-tion is the student using?
a. Eliciting performance
b. Assessing performance
c. Enhancing retention and transfer of knowledge
d. Gaining attention
ANS: A
The step of eliciting performance includes encouraging the learners to demonstrate what they have learned. Gaining attention occurs at the beginning of the program. Assessing performance occurs at the end of the program. Enhancing retention and transfer of knowledge occurs as the learners are asked to apply the information to their lives and situations (not to the care of the dolls).
A nurse prepares for a presentation to a group of adults using strategies appropriate for adult learning. Which of the following concepts is being applied?
a. Authoritarianism
b. Learning style
c. Pedagogy
d. Andragogy
ANS: D
Andragogy is a term and model developed by Malcolm Knowles to describe learning strategies for adult learners. In pedagogy the teacher assumes full responsibility for making decisions about what will be learned, and how and when it will be learned. In authoritarianism the leader controls group movement and progress through interpersonal power. Learning style refers to how some-one learns best.
A nurse is working for a public health department as the community health educator. Which of the following is a potential barrier that a nurse may experience?
a. Working with clients with a low literacy level
b. Memorizing the information that is to be taught
c. Having a limited vocabulary
d. Lacking knowledge about how to gain participation
ANS: D
Educators may lack knowledge about how to gain participation. Participation can be fostered by asking open-ended questions, inviting participation, and planning small-group activities whereby a person responds based on the group rather than presenting his own information. Clients with low literacy levels and limited vocabularies are considered to be a learner-related barrier, not a barrier of the educator. Memorizing the information to teach may cause problems with the presentation but would not be a barrier for the educator.
A nurse is working with an individual who has a low literacy level. Which of the following barri-ers to learning should the nurse anticipate?
a. Asking for additional clarification of materials
b. Requesting to read the information later
c. Having a high level of anxiety
d. Being overly dependent on others
ANS: B
Individuals with a limited literacy may have a limited vocabulary and general knowledge and do not ask for clarification. They may focus on details and deal in literal or concrete concepts versus abstract concepts. They may select responses on a survey without necessarily understanding them and may be unable to understand math. They may have a low motivation to engage in learning or may drop subtle clues that they cannot read by stating they will look at information later or take it home. The level of anxiety may vary among these individuals; it is more common for these in-dividuals to request to read it later.
A client diagnosed with diabetes reports to the nurse that she has been learning more about con-trolling her blood sugars by reading information found on the Internet. Which of the following statements by the nurse would be appropriate?
a. “Looking at the date the content was posted on the website is important.”
b. “The Internet is an unreliable source of information and should not be used.”
c. “The best sources of information are found on pharmaceutical websites.”
d. “Your physician will provide you better information than the Internet.”
ANS: A
One of the ways to assess the reliability and validity of Internet sources is to look at its currency, including the dates when the content was posted and updated. The Internet has reliable infor-mation, but the quality of the information must be assessed. Pharmaceutical websites may have biased information. Physicians are another source of information, but this may or may not be better than what is found on the Internet.
When a nurse is evaluating the components of an educational program. Which of the following best describes the action that is being taken by the nurse?
a. Short-term evaluation
b. Educational product
c. Process evaluation
d. Long-term evaluation
ANS: C
Process evaluation means looking at the components of an educational program. The educational product is the outcome of the educational process. Short-term evaluation evaluates the immediate effects of a health program. Long-term evaluation is geared toward following and assessing the status of an individual, family, community, or population over time.
A nurse tells a coworker that she has been working on a regular basis with a group that demon-strates cohesion. Which of the following groups is the nurse most likely to describe?
a. A group with several leaders
b. A group with diverse attitudes and values
c. A group with a common goal
d. A group with efficient members
ANS: C
Cohesion is the attraction between individual members and between each member and the group. Group effectiveness improves as members work together toward group goals while still satisfying the needs of individual members. A group with several leaders may have difficulty obtaining co-hesion if each of the leaders has a different idea. Common attitudes and values among the group members will be important for the group to obtain cohesion. Efficiency does not play a role in developing cohesion.
A nurse recognizes the importance of group norms when planning community health education. Which of the following provides the best explanation for why this is important?
a. Allow for creativity and variety among group members
b. Influence members’ perception of community
c. Are helpful in evaluating the effectiveness of the group
d. Maintain the group through various supports to members
ANS: D
Group norms serve to maintain the group through various supports to members. They are the standards that guide, control, and regulate individuals and communities. They suggest what a group believes is important, what it finds acceptable or objectionable, or what it perceives as of no consequence. Group norms may limit the creativity and variety among the group members. Members’ perception of the community could be influenced by group norms, but this is not why this consideration should be made when planning community health education. Group norms are not used to evaluate the effectiveness of the group.
A group member has taken on the role of the “gatekeeper.” Which of the following actions would most likely be taken by this member?
a. Seek and accept the authority or direction of others
b. Guide and direct the group activity
c. Control outsiders’ access to the group
d. Focus the movement toward the main work of the group
ANS: C
The gatekeeper controls outsiders’ access to the group. The follower seeks and accepts the au-thority or direction of others. The leader guides and directs group activity. The task specialist focuses or directs movement toward the main work of the group.
A nurse uses the leadership behavior of reflecting when providing education to community members about how to lead healthy lifestyles. Which of the following actions is most likely being taken by the nurse?
a. Providing feedback on how behavior appears to others
b. Introducing new topics to the group
c. Verifying information through questions and restatement
d. Highlighting important points from the discussion
ANS: A
Reflecting involves giving feedback on how behavior appears to others. Advising introduces new topics. Clarifying verifies new information. Summarizing highlights the important points.
A leader controls members through rewards and often keeps members in the dark about the goals and rationale behind prescribed actions. What type of leadership does this describe?
a. Democratic
b. Patriarchal
c. Socialist
d. Paternal
ANS: B
Patriarchal is authoritative, whereas one may control members through rewards and threats. Pa-ternal leaders win respect and dependence through parent-like devotion. Democratic leadership is cooperative in nature and promotes and supports members’ involvement in all aspects of decision making and planning. Socialist leadership supports community ownership and involvement of the community.
An established group requests a teaching and learning session on hypertension. Which of the fol-lowing should the nurse expect with this type of group?
a. The group membership will change from week to week.
b. The members all have the same interests.
c. They prefer lectures rather than demonstrations.
d. The group already has operating methods that have been successful.
ANS: D
Nurses working with established groups should know that this type of group has membership ties and an existing structure that has proven to be successful. An established group would have a stable group membership. Learning occurs better in all groups with demonstrations instead of lectures. In an established group, they may be together because of a common interest, but may not share all of the same interests.
A nurse is working with a group focused on improving the health of the community. Which of the following interventions should be used by the nurse?
a. Make decisions for the group to move the process along
b. Invite business leaders to participate in the group process
c. Maintain members through recognition and encouragement
d. Teach topics that are of national importance
ANS: C
Maintaining members is an important intervention to facilitate group process. The topics that are taught should be of importance to the group. The group should be part of the decision-making process. The membership of the group should be maintained, inviting new members to the group may hinder the processes of the group.
Which Core Competency of communication is used by nurses engaged in group work?
a. Soliciting input from individuals and organizations
b. Using simple language when presenting information
c. Asking the group to develop the program of interest
d. Presenting material to lay audiences
ANS: A
Soliciting input from individuals and organizations is a communication competency. Various strategies should be used to present the information. The group should assist in determining the topic, but not developing the program. The material should be presented to professional and lay audiences.
A nurse is planning to evaluate an individual’s progress toward a health goal. Which of the fol-lowing components should be included in the evaluative process?
a. Type of teaching strategy used
b. Recognition of accomplishments in the group
c. Conflict that occurred in the group
d. The type of leadership in the group
ANS: B
Recognition of accomplishments in the group and of the group is built into the evaluative pro-cess. The type of teaching strategies used, types of leadership, and conflict are not part of the evaluative process of the group.
A nurse is using basic educational principles when conducting an effective educational program. Which of the following principles would the nurse most likely be using? (Select all that apply.)
a. Use a clear, succinct style
b. Use an active voice
c. Refer to Internet sources
d. Use aids to highlight key points
e. Repeat information several times
ANS: A, B, D
Using a clear, succinct style, active voice, and using aids to highlight key points are all basic ed-ucational principles that should be used by the nurse. Reliable sources must be used, and infor-mation found on the Internet is not always reliable. Repeating information is not an education principle.
A nurse is educating the community about modifiable behaviors. Which of the following is the nurse most likely to discuss?
a. Smoking, poor diet, and alcohol consumption
b. Cancer, emphysema, and cardiovascular disease
c. Age and gender
d. Genetic abnormalities
ANS: A
Modifiable behaviors remain the major contributors to deaths in the United States. Tobacco use, poor diet, physical inactivity, and alcohol consumption are examples of modifiable behaviors. Cancer, emphysema, cardiovascular disease, gender, age, and genetic abnormalities are not modifiable behaviors.
A nurse is utilizing a disease-oriented approach when providing care to a client. Which of the following interventions will the nurse most likely provide?
a. Promotion of a greater level of positive health
b. Education about common disease processes
c. Acute care management of chronic disease
d. Education about medication compliance
ANS: D
A disease-oriented approach assumes that humans are composed of organ systems and cells; in this instance, health care focuses on identifying what is not working properly with a given system and repairing it. In this context, health behavior begins with patient compliance with health professionals’ recommendations. This approach does not promote a greater level of positive health as this would be related to health promotion. This approach does not provide education about common disease processes or acute care management of chronic disease.
The biomedical model defines health as the:
a. avoidance of illness.
b. absence of disease.
c. promotion of healthy behaviors.
d. protection from illness and disease states.
ANS: B
The biomedical model defines health as the absence of disease. It does not explain why populations remain healthy or how health is enhanced
The health-oriented perspective views:
a. health as the absence of disease.
b. human lifestyle based on one’s prescribed regime.
c. humans as complex and interconnected with the environment.
d. community education as the role of the registered nurse.
ANS: C
The health-oriented perspective includes the view that humans are complex and interconnected with others and the environment. Health behavior within this perspective involves a holistic view of lifestyle and interaction with the environment and not simply compliance with a prescribed regimen.
A nurse using the integrative model for community health promotion. Which of the following best describes how the nurse would apply the dimension of client system?
a. Concentrating on individual health behaviors
b. Studying client-centered initiatives
c. Providing multidimensional nursing care among various levels of clients
d. Focusing on disease-oriented care
ANS: C
The client system is multidimensional with nursing and health care targeting the multiple levels of clients. When the individual is the client, the environment includes the family, the broader aggregate, and the community of which the individual is a part. The nurse and health care provider are concerned with how these environments affect the individuals’ health. The focus for care is on health promotion, illness prevention, and illness care.
A public health nurse (PHN) collaborates with local community leaders to develop a local campaign educating about the importance of wearing a seat belt. Which of the following client systems of the integrative model does this describe?
a. Community
b. Aggregate
c. Family
d. Individual
ANS: A
Interventions to initiate or maintain healthy lifestyles must be multifocal. At the broadest level of care (community), nurses work with community leaders, other community residents, and health professionals to plan programs to promote optimal health for the community and its people. The community is the environment for the aggregate and is the system being applied.
A PHN collaborates with a physician’s clinic to increase the number of infants and toddlers who receive lead screening. According to the integrative model, what client system and focus of care are being addressed?
a. Aggregate level health promotion
b. Aggregate level illness prevention
c. Family level illness care
d. Individual level health promotion
ANS: A
Each succeeding level of the client system is more complex. In this situation, the PHN is working with an aggregate of infants and toddlers. The focus of care being addressed is health promotion, focusing on positive measures such as education for healthy living and promotion of favorable environmental conditions as well as periodic examinations, including well-child developmental assessment and health education. Illness prevention is linked to the negative view of the absence of disease. Illness care is the care provision of someone with the disease.
A nurse provides counseling to an obese client about the importance of good nutrition and regular exercise with the intention of helping the client avoid future chronic diseases associated with obesity. What client system and focus of care are being applied in this situation?
a. Family level health promotion
b. Individual level illness prevention
c. Aggregate level illness prevention
d. Individual level health promotion
ANS: B
The simplest level of the client system is the individual. The focus of care is illness prevention, directed at disease or disability prevention. Health promotion focuses on positive measures of health. The family level and aggregate level both focus on inclusion of more than one person.
When applying the integrative model for community health promotion, a nurse assesses the neighborhood for accessibility and adequacy of care to provide treatment for medical conditions. What client system does this describe?
a. Individual
b. Family
c. Aggregate
d. Community
ANS: D
The community focus includes the nurse assessing the community for accessibility and adequacy of care to provide treatment for medical conditions. This is the broadest client system as the nurse is examining the neighborhood. Individual focus is looking at individuals, family focuses on families, and aggregates focuses on populations.
A nurse provides a screening for school-aged children to screen for hearing deficits. Which of the following is being demonstrated by 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 disability. Primary prevention attempts to promote health and provide specific protection from disease. Tertiary prevention addresses rehabilitation and the return of people with chronic illness to maximal ability to function. Health promotion activities are interventions focused on improving one’s health.
According to Leavell and Clark, primary prevention consists of:
a. health promotion and rehabilitation.
b. health promotion and specific protection.
c. early diagnosis and prompt treatment.
d. health maintenance and early diagnosis.
ANS: B
Leavell and Clark stated that primary prevention includes health promotion and specific protection from disease. Tertiary prevention addresses rehabilitation and the return of people with chronic illness to maximal ability to function. Secondary prevention focuses on early detection and prompt treatment of disease, injury, or disability. Primary prevention attempts to promote health and provide specific protection from disease.
A client wears a seat belt whenever riding in an automobile. Which of the following best describes the client’s behavior?
a. Illness prevention
b. Health promotion
c. Specific protection
d. Health protection
ANS: C
Specific protection includes measures to reduce the threat of specific diseases or injury, such as hygiene, immunizations, use of seat belts, and the elimination of workplace hazards. Illness prevention is a behavior directed toward reducing the threat of illness. Health promotion focuses on positive measures such as education for healthy living and promotion of favorable environmental conditions. Health protection strategies include environmental measures to improve health and quality of life.
A 5-feet, 6-inch, 25-year-old female who weighs 120 pounds walks 5 miles a day because she has a long family history of early death from heart attacks and is refraining from a sedentary lifestyle. Which of the following best describes this example?
a. Health promotion
b. Illness prevention
c. Health maintenance
d. Health protection
ANS: B
The woman is exercising to prevent an illness that runs in her family. Illness prevention is a behavior directed toward reducing the threat of illness. Health promotion focuses on positive measures such as education for healthy living and promotion of favorable environmental conditions. Health maintenance focuses on maintaining health. Health protection strategies include environmental measures to improve health and quality of
A 5-feet, 6-inch, 25-year-old woman who weighs 120 pounds runs 5 miles a day because it improves her mood and energy level. Which of the following best describes this example?
a. Health promotion
b. Illness prevention
c. Health maintenance
d. Health protection
ANS: A
The woman is exercising to improve and promote her health. Health promotion is directed toward achieving a greater level of health. Illness prevention is a behavior directed toward reducing the threat of illness. Health maintenance focuses on maintaining health. Health protection strategies include environmental measures to improve health and quality of life.
A community is searching for additional funding so that a bike trail can be built in the community. Which of the following best describes this example?
a. Health promotion
b. Illness prevention
c. Specific protection
d. Health protection
ANS: D
Health protection strategies include environmental measures to improve health and quality of life. Health promotion is directed toward achieving a greater level of health. Illness prevention is a behavior directed toward reducing the threat of illness. Specific protection includes measures to reduce the threat of specific diseases or injury, such as hygiene, immunizations, use of seat belts, and the elimination of workplace hazards.
Which of the following statements is correct?
a. Genes, biology, and health behavioral choices account for 75% of population health.
b. Medical care accounts for 25% of population health.
c. Physical and social environments account for 75% of population health.
d. Genes, biology, and health behavioral choices account for 25% of population health.
ANS: D
Genes, biology, and health behavioral choices account for 25% of population health and social determinants of health, including medical care; the physical and social environment account for the remaining 75%.
The National Prevention Strategy provides:
a. recommendations on what can be done to improve population health.
b. assistance in interpreting Healthy People 2020.
c. a basis for public health nursing practice.
d. health risk appraisal instruments.
ANS: A
The National Prevention Strategy offers recommendations on what can be done to improve population health in specified contexts and across goal areas. This document does not assist in interpreting Healthy People 2020, providing a basis for public health nursing practice, or providing health risk appraisal instruments.
Which of the following describes one advantage of the Health Belief Model (HBM)?
a. It is one of the most recently developed models based on evidence-based practice principles.
b. It can reduce the incidence of diseases and disabilities.
c. It can assist with planning programs to increase an individual’s motivation to take positive health action.
d. It promotes individual’s participation in community-based screening programs.
ANS: C
It can assist with planning programs to increase an individual’s motivation to take positive health action. This theory was one of the first theories of health behavior, which began in the 1950s. The model contains six components that attempt to determine what motivates an individual to adopt a health behavior. There is nothing to support that the use of this model will reduce the incidence of diseases and disabilities. It focuses on motivation of changing health behaviors, not participating in screening programs.
A nurse is using the HBM when developing health programs in the community. Which of the following is the nurse most likely involved in?
a. Conducting group risk appraisal and risk reduction
b. Considering the factors that will motivate the participants to change their health behaviors
c. Completing a community wellness inventory
d. Considering legislative changes that are necessary to improve environmental living conditions and sanitation
ANS: B
The HBM can assist with planning programs to increase an individual’s motivation to take positive health action. The model contains six components that attempt to determine what motivates an individual to adopt a health behavior. Conducting a group risk appraisal and risk reduction, completing a community wellness inventory, and considering legislative changes do not address an individual’s motivation to adopt a health behavior.
A nurse is using Anderson and McFarlane’s model to complete a community health assessment. Which of the following information about the community would the nurse be collecting?
a. Resources available to promote health
b. Interactions among subsystems
c. Physical environment
d. Demographics
ANS: B
A community health assessment must include information about the subsystems and interactions of the total community with the systems external to it. This model does not address the resources available to promote health, physical environment, or demographics.
The Framingham Heart Study was successful in:
a. providing information on the effectiveness of risk-reduction interventions.
b. documenting the relationship between social variables and heart disease.
c. identifying factors contributing to the development of coronary heart disease (CHD).
d. demonstrating the effects of mass media in modifying high-risk behavior.
ANS: C
The Framingham Heart Study identified factors contributing to the development of CHD and high blood pressure. By collecting periodic health assessments and morbidity and mortality data, major risk factors associated with CHD mortality were identified. The investigators used health risk appraisals to relate the risk factors in well individuals to the probability of future cardiovascular disease. This study did not provide information on the effectiveness of risk-reduction interventions, document the relationship between social variables and heart disease, or identify factors contributing to the development of heart disease.
A nurse is performing interventions at the individual level of care. Which of the following is the nurse most likely completing? (Select all that apply.)
a. Teaching well-balanced nutrition to a mother with a malnourished child
b. Providing a parent age-specific information for immunizations
c. Assessing the community for other cases of malnutrition
d. Assessing other families on the same street for similar problems
e. Planning a social marketing campaign about seat belt safety
ANS: A, B
Teaching well-balanced nutrition and age-specific information about immunizations are the only interventions that focus on individuals. The other examples relate to families and the community.
Which community-based programs resulted in equally favorable health risk changes for both control and treatment groups? (Select all that apply.)
a. Framingham Heart Study
b. Stanford Five-City Heart Disease Prevention Program
c. North Karelia Study
d. Minnesota Heart Health Program
e. Dutch Heart Health Community Intervention
ANS: B, C, D, E
The Stanford Five-City Heart Disease Prevention Program, North Karelia Study, Minnesota Heart Health Program, and Dutch Heart Health Community Intervention provided beginning scientific evidence for the implementation of community-level risk reduction programs, although the results were modest and often not statistically significant. The Framingham Heart Study identified factors contributing to the development of CHD and high blood pressure.
What occurs during biological terrorism?
a. The intentional release of hazardous chemicals into the environment
b. Environmental and occupational exposure to biological toxins
c. Immunity to toxins related to repeated exposures
d. An intentional release of viruses, bacteria, or other toxins
ANS: D
An intentional release of viruses, bacteria, or other toxins would be described as biological terror-ism. Chemical terrorism is the intentional release of hazardous chemicals into the environment for the purpose of harming or killing. Surveillance is used to monitor environmental and occupational exposures. Immunity to toxins after repeated exposures does not occur during biological terror-ism.
Which problem does a health department usually have the legal authority to investigate?
a. Pandemics
b. Unusual clusters of illness
c. World trends of disease
d. Cases of the common cold and pneumonia
ANS: B
Powers of local government include surveillance of unusual clusters of illness. A health depart-ment does not have legal authority to investigate pandemics, world trends of disease, and cases of the common cold and pneumonia.
Which is a feature of public health surveillance?
a. Sharing of the results with others
b. Defining public health policy
c. Evaluating interventions
d. Planning national programs
ANS: A
One of the features of public health surveillance is sharing of the results with others. Defining public health policy, evaluating interventions, and planning national programs are all purposes of surveillance, not features.
A nurse is conducting disease surveillance. Which of the following describes the rationale for this action?
a. To eradicate a disease before it starts
b. To establish a baseline rate of disease oc-currence and patterns of spread
c. To target populations for triage
d. To reduce the incidence of heart disease in a community
ANS: B
Disease surveillance helps establish baseline rates of disease occurrence and patterns of spread to make it possible to initiate a rapid response to an outbreak. Disease surveillance is unable to erad-icate a disease before it starts, to target populations for triage, or to reduce the incidence of heart disease in a community. However, disease surveillance does make it possible to initiate a rapid response to an outbreak of a disease or an event that can cause a health problem.
A hospital is using surveillance. Which of the following describes the rationale for this action?
a. To protect the public against isolated pa-tients
b. To eliminate pathogens from the environ-ment
c. To improve quality of care and outcomes
d. To decrease the incidence of ventila-tor-acquired pneumonia
ANS: C
Hospital surveillance is used to improve quality of care and outcomes. An example is an infection that occurs in patients who had procedures at that facility. Reduction of the incidence of venti-lator-acquired pneumonia is one reason why a hospital uses surveillance, but it does not address the entire issue. Hospital surveillance is unable to eliminate pathogens from the environment and cannot protect the public against isolated patients.
A community coalition monitors the increasing obesity rate of children in their schools. Based on this data, they consider a variety of programming options which may possibly help decrease this trend. What was the purpose of conducting this surveillance?
a. Protect the children from diseases that affect obese children
b. Teach parents that obesity will not be tolerated in this community
c. Educate children on surveillance techniques
d. Demonstrate that new clinical and effective protocols need to be developed
ANS: D
Ongoing surveillance in a community can lead to new clinical and effective protocols to address an issue. Ongoing surveillance makes it possible to have ongoing monitoring in place to ensure that disease and event patterns improve rather than deteriorate. This surveillance cannot protect children from diseases, teach parents that obesity will not be tolerated, or educate children on surveillance techniques.
A nurse is using surveillance to collect outcome data. What information would most likely be collected?
a. Number of clinic services which use evidence-based protocols
b. Proportion of the population vaccinated against influenza
c. Incidence of breast cancer in the population
d. Probability of a bioterrorism attack occurring in the community
ANS: C
Outcome data focus on change in health status; incidence rates are one example of this type of information. Process data focus on what is done, such as services provided or protocols for health care delivery. An example of process data is collection of data about the proportion of the eligi-ble population vaccinated against influenza in any 1 year.
A nurse practitioner reports a case of gonorrhea to the local health department. Which type of surveillance system is being used?
a. Active
b. Passive
c. Sentinel
d. Special
ANS: B
In the passive system, case reports are sent to local health departments by health care providers. In the active system, the public health nurse may begin a search for cases through contacts with local health providers and health care agencies. In the sentinel system, trends in commonly occur-ring diseases or key health indicators are monitored. Special systems are developed for collecting particular types of data and may be a combination of active, passive, and/or sentinel systems.
A public health nurse (PHN) is investigating an outbreak of salmonellosis in a community. Which type of surveillance system is being used?
a. Active
b. Passive
c. Sentinel
d. Special
ANS: A
In the active system, a PHN begins to search for cases through contacts in the community. The nurse names the disease and gathers data about existing cases to try to determine the magnitude of the problem. In the passive system, case reports are sent to local health departments by health care providers. In the sentinel system, trends in commonly occurring diseases or key health indi-cators are monitored. Special systems are developed for collecting particular types of data and may be a combination of active, passive, and/or sentinel systems.
What information is shared among agencies when they collaborate to implement a quality sur-veillance system?
a. How to use algorithms to identify which events should be investigated
b. Who is to blame for a disease outbreak
c. What shelters will be used and by whom
d. How political action will be necessary to ensure public health
ANS: A
Collaboration promotes the development of plans and a directory of emergency responses. How to use algorithms is a key type of information that is shared. Blaming others is not part of collab-oration. Determining what shelters will be used and by whom is not the priority for collaboration. How political action will be necessary to ensure public health is not a priority for collaboration.
What does each state do with the information that it receives about notifiable diseases?
a. Uses the information for surveillance purposes
b. Reports the information to the local branch of the World Health Organization (WHO)
c. Transmits the data electronically, weekly, to the Centers for Disease Control and Prevention (CDC)
d. Does nothing with the information
ANS: C
Data is transmitted weekly to the CDC through the National Electronic Telecommunications System for Surveillance. States need to transmit the information to the CDC rather than only keeping its own records. The reports are sent to the CDC, not to the WHO.
A nurse is applying the Minnesota Model of Public Health Interventions: Applications for Public Health Nursing Practice steps of surveillance. Which of the following describes the initial action that the nurse would take?
a. Analyze data
b. Consider whether surveillance is appropriate to the situation
c. Evaluate the impact of the surveillance
d. Collect data
ANS: B
The first step in this model considers whether the surveillance was appropriate. Analyzing data is the fifth step in this model. Evaluation of the impact of the surveillance is the last step of the model. Collecting data is the fourth step in this model.
A large amount of data related to hypertension rates is collected in a community. The data is an-alyzed. Which of the following describes the next step in the surveillance process?
a. Collecting data from multiple valid sources
b. Evaluating the impact on the surveillance system
c. Interpreting the data and disseminating it to decision makers
d. Asking political officials to finance a hypertension clinic
ANS: C
After data is collected and analyzed, the findings must be disseminated. Collection of data is the step described in this scenario and the question asks what must be done next. Evaluating the im-pact on the surveillance system occurs after dissemination. Dissemination may occur to a broader audience than only political officials.
What information is included in a case definition?
a. The precise point of contact
b. Laboratory confirmation
c. Source of contamination
d. Clinical symptoms
ANS: D
Each case has a unique set of criteria based on what is known about the particular disease. It may include clinical symptoms, laboratory values, and epidemiologic criteria. The precise point of contact, laboratory confirmation, and source of contamination are not part of a case definition.
What was the purpose of the CDC creating the first list of standard case definitions for notifiable diseases?
a. Some diseases were underreported and others were overreported.
b. There was no central office to collect data.
c. Some people refused to notify officials when diseases were seen.
d. No one knew where to report the infor-mation that was collected.
ANS: A
The initial work was done by the CDC because diseases were overreported or underreported. Before this time, state and local health departments used many different criteria for identifying cases of reportable diseases. There was a central office to collect the data and providers knew that this information needed to be reported, but what was being reported by departments was different.
A nurse is completing a disease investigation. Based on the clinical symptoms presented, it is as-sumed that the individual has measles. However, there has been no laboratory evidence docu-menting that this individual has the disease. Which of the following types of cases is the nurse investigating?
a. A suspected case
b. A confirmed case
c. A prolonged case
d. An identified case
ANS: A
A suspected case is a clinically compatible case of illness without isolation. A confirmed case is a clinically compatible case that is laboratory confirmed by isolation. A prolonged case and identi-fied case are not types of cases discussed in the text.
The SARS (severe acute respiratory syndrome) outbreak was an epidemic that spread over sever-al countries. Which of the following terms describes what happened?
a. Hyperendemic
b. Pandemic
c. Mixed outbreak
d. Holoendemic
ANS: B
A pandemic refers to the epidemic spread of the problem over several countries or continents. If a problem is considered hyperendemic, there is a persistently (usually) high number of cases. A mixed outbreak is a common source followed by secondary exposures related to person-to-person contact. Holoendemic implies a highly prevalent problem found in a population commonly ac-quired early in life.
A person has returned from overseas and it is determined that he has Q fever. Which of the fol-lowing must occur?
a. This is not a disease that is on the notifia-ble list; nothing need be reported.
b. The case must be reported to the state and local health departments.
c. The patient must be isolated immediately.
d. The patient will probably die, so it is not reportable.
ANS: B
Q fever is on the notifiable list and must be reported to the state and local health departments. Thus, it needs to be reported, but does not imply immediate isolation or probable death.
A nurse is collecting morbidity data. Which of the following would be the source that the nurse would use?
a. Vital statistics reports
b. Birth records
c. Death certificates
d. Specialized disease registries
ANS: D
There are many sources of morbidity data (rate of disease incidence), including specialized dis-ease registries. Vital statistics reports, birth records, and death certificates are part of mortality data.
A college student goes to the Student Health Center with an extremely swollen neck. The ad-vanced practice nurse determines that he has mumps. His roommate also is experiencing malaise and a sore throat. Which of the following defines these two students?
a. Mixed outbreak
b. Common source
c. Point source
d. Propagated outbreak
ANS: C
A point source outbreak involves all persons exposed becoming ill at the same time, during one incubation period. A mixed outbreak is a common source followed by secondary exposures re-lated to person-to-person contact. A common source outbreak refers to a group exposed to a common noxious influence such as the release of noxious gases. A propagated outbreak does not have a common source and spreads gradually from person to person over more than one incuba-tion period
A nurse is investigating a potential bioterrorism attack. Which of the following evidence would a nurse find if a bioterrorism attack occurred?
a. A large number of cases of influenza
b. A case of cholera in a local politician fol-lowing a trip to India
c. Dengue fever in a group of students who just returned from a mission trip
d. An unusual illness in a population
ANS: D
Unusual illness in a population should trigger an investigation that may signal a covert bioterror-ism attack. Cases of influenza, cholera, and dengue fever in a group would not be considered unexpected illnesses.
A nurse is using public surveillance. Which of the following describes the actions involved? (Se-lect all that apply.)
a. Estimating the magnitude of an influenza outbreak
b. Determining the geographical distribution of gonorrhea cases
c. Detecting an epidemic of whooping cough
d. Reducing the prevalence of obesity
e. Determining the incidence of cardiovas-cular disease
ANS: A, B, C
Estimating the magnitude of the problem, determining geographic distribution of an illness, and detecting epidemics are all uses of public surveillance. Reduction of the prevalence of obesity and determining the incidence of cardiovascular disease are not how public health surveillance is used.
A staff nurse has demonstrated the ability to be competent as a participant in surveillance and investigation activities. Which of the following skills would you expect that nurse to possess? (Select all that apply.)
a. The ability to identify appropriate data sources
b. The ability to communicate effectively using written reports
c. The ability to collaborate with community agencies
d. The ability to create a budget
e. The ability to interpret laboratory findings
ANS: A, B, C, D
The staff nurse must have analytic assessment skills, communication skills, and community di-mensions of practice to be a participant in surveillance and investigation. The ability to interpret laboratory findings is not a core competency.
Which are the objectives of a disease investigation? (Select all that apply.)
a. Enhance the knowledge of the nurse working in public health
b. Control and prevent disease or death
c. Identify factors that contribute to the dis-ease outbreak/event occurrence
d. Implement measures to prevent occur-rences
e. Participate in the core functions of public health
ANS: B, C, D
The objectives of an investigation are to control and prevent disease or death, identify factors that contribute to the disease outbreak/event occurrence, and implement measures to prevent oc-currences. Enhancing the knowledge of the nurse working in public health and participating in the core functions of public health are not objectives of an investigation.
Which statement about poverty is true?
a. All cultures view poverty as a pitiful existence.
b. Most cultures want to improve the plight of the poor.
c. Dangerous environments are present in all cultures.
d. Western cultures view poverty negatively.
ANS: D
The meaning of poverty differs across cultures. Western cultures view poverty negatively, whereas other cultures often respect the poor.
A nurse is working in the community during the industrial revolution. Which of the following population groups would have been least likely to receive community assistance?
a. Widowed women
b. Orphaned children
c. Mentally ill
d. Injured laborers
ANS: C
Mentally ill individuals were considered undeserving poor and did not receive any community assistance. Widowed women, orphaned children, and injured laborers were deserving poor because their poverty was considered to be beyond their control.
Which statement about poor people living in the seventeenth century is accurate?
a. They were likely alcoholics or prostitutes.
b. They were ashamed to be living in poverty.
c. They traveled from community to community for food and shelter.
d. They would be given assistance by their community.
ANS: D
The Elizabethan Poor Laws began in seventeenth-century England by helping the poor receive help within the boundaries of their original community. Needy travelers would not be helped and were sent back to their original community where they would be helped by their own folk. It was no disgrace to live in poverty because nearly everyone was poor.
A nurse is trying to provide effective nursing care to poor persons, families, and populations in a variety of settings. Which of the following actions should be taken by the nurse?
a. Move to the area where people are living to understand their plight
b. Understand the concept of poverty on many levels
c. Take a trip abroad to see how poverty exists in other countries
d. Become fully immersed in the concept of poverty for at least a year
ANS: B
Understanding the concept of poverty with historical, social, political, economic, biological, psychological, and spiritual dimensions is the first step in providing effective care to this population. It is not necessary to move to the area, take a trip abroad, or become immersed in the concept of poverty in order to provide effective nursing care to this population
A nurse is providing care to populations who are from different socioeconomic and cultural backgrounds. Which of the following barriers should the nurse be aware of that may prevent full engagement in a relationship?
a. Fears and misconceptions related to poverty
b. Lack of tangible and emotional resources
c. Lack of knowledge about people who live in poverty
d. Perception that the poor don’t need to be poor
ANS: A
Fears and misconceptions of nurses related to poverty is a barrier that may prevent nurses from fully engaging in relationships with people who come from different socioeconomic and cultural backgrounds. It is important for the nurse to be a good listener, individualize care, and avoid making inappropriate assumptions about their needs. It is important to listen to the stories of their lives as well as examine social and cultural definitions and considerations related to poverty.
A nurse is trying to break down the barriers between the health care professionals and people who live in poverty. Which of the following actions should be taken by the nurse?
a. Maintain a strict professional demeanor
b. Call the client by name
c. Keep client appointments as scheduled
d. Smile and be friendly to clients
ANS: B
By calling the client by name, nurses can then begin the process of breaking down barriers of fear, isolation, uncertainty, and the unknown. It is important for the nurse to be a good listener, individualize care, and avoid making inappropriate assumptions about their needs. It is important to listen to the stories of their lives as well as examine social and cultural definitions and considerations related to poverty.
A nurse is forced to evaluate his beliefs, values, and knowledge about poverty. Which of the following experiences most likely explains the situation the nurse is experiencing?
a. A client asking for a small amount of money at a clinic
b. Setting up a homeless shelter
c. Making a home visit to a home that is unkempt
d. Reading about poverty in a textbook
ANS: C
Nurses’ behaviors in situations are influenced by their relationship with clients. It is important to evaluate clients and populations in the context of the environment to develop nursing interventions. Reading a book is not adequate. Setting up a homeless shelter or having a client ask for money does not force the nurse to self-reflect as much as when the nurse is in the client’s environment.
Which factor influences the growing number of poor persons in the United States?
a. Increase in company earnings
b. Changes in the labor force
c. Better access to quality education
d. Adequate welfare benefits
ANS: B
Changes in the labor force affect the growing number of poor persons in the United States. Decreased company earnings, decreased access to education and job skills, and inadequate welfare benefits also influence the growing number of poor persons.
A nurse is working with a family who has an income above the federal income guidelines, but is unable to meet their living expenses. Which of the following terms best describes this family?
a. Persistent poverty
b. Near poor
c. Impoverished
d. Neighborhood poverty
ANS: B
The near poor are persons and families whose income is above the federal income guidelines but insufficient to meet living expenses. Persistent poor refers to individuals and families who remain poor for long periods and who pass poverty on to their descendants. Neighborhood poverty refers to geographically defined areas of high poverty, characterized by run-down housing, high unemployment rates, and poorer health outcomes. Impoverished refers to those living in poverty.
The public health nurse (PHN) is taking care of a poor family, whose parents, grandparents, and great-grandparents also have been poor. Which of the following terms best describes this family?
a. Near poor
b. Persistent poor
c. Impoverished
d. Neighborhood poverty
ANS: B
Persistent poor refers to individuals and families who remain poor for long periods and who pass poverty on to their descendants. The near poor are persons and families whose income is above the federal income guidelines but insufficient to meet living expenses. Neighborhood poverty refers to geographically defined areas of high poverty, characterized by run-down housing, high unemployment rates, and poorer health outcomes. Impoverished refers to those living in poverty.
A nurse is referring to the federal income guidelines. Which of the following best describes why the nurse is completing this action?
a. To determine financial eligibility for government assistance programs
b. To calculate statistical occurrences in the community
c. To identify those with inadequate resources for basic needs
d. To provide guidelines for reform of social programs
ANS: A
Federal income guidelines are used primarily to determine financial eligibility for government assistance programs. The Poverty Threshold Guidelines are used primarily for statistical purposes. The federal income guidelines do not identify those with inadequate resources for basic needs or provide guidelines for reform of social programs.
A nurse is discussing eligibility for federal food assistance with a family. Which federal guideline would a nurse refer to when considering financial eligibility?
a. Poverty Threshold Guideline
b. Consumer Price Index (CPI)
c. Federal Income Poverty Guideline
d. Temporary Assistance to Needy Families (TANF)
ANS: C
The Federal Income Poverty Guideline is issued by the U.S. Department of Health and Human Services and is used to determine if a person or family is financially eligible for assistance or services from various federal programs. The Poverty Threshold Guidelines are used primarily for statistical purposes. The CPI is a measure of the average change over time in the prices paid by households for a fixed market basket of consumer goods and services. TANF is a program, not a guideline, that assists families in need.
Which group has the highest rate of poverty?
a. Children
b. Teenagers
c. Women
d. Older adults
ANS: A
In 2012, 21.6% of those 18 years or less were living in poverty. Poverty is highest among children, and in 2012, it was 21.8% higher than any other age group.
Which is a characteristic of persons living in poverty?
a. Longer life expectancy
b. Simple health problems
c. Higher rates of chronic illness
d. Fewer hospitalizations
ANS: C
Not only do persons living in poverty have higher rates of chronic illness, but less access to care. They have a shorter life expectancy, more complex health problems, and hospitalization rates greater than those for persons with higher incomes.
A nurse refers a client to an assistance program that requires the individual to find a job and/or enroll in job training program. Which program is being used?
a. Aid to Families with Dependent Children (AFDC)
b. Medicaid
c. TANF
d. Women, Infants, and Children (WIC)
ANS: C
TANF requires participants to find jobs and/or enroll in job training programs. The current TANF program was formerly called AFDC. Medicaid provides health insurance to poor families, but does not require participants to find jobs. WIC provides food vouchers entitling participants to free nutritious foods and infant formulas from local grocers, but does not require participants to find jobs.
A nurse is conducting a community assessment in a poor neighborhood. Which of the following is the nurse most likely to find?
a. Fewer minority groups
b. Increased exposure to environmental hazards
c. More available health care services
d. Lower rates of crime and substance abuse
ANS: B
Poor neighborhoods are more likely to have exposure to environmental hazards. Lower socioeconomic neighborhoods have been linked with poorer general health status, chronic conditions, mortality, birth outcomes, disability, injury and violence, and other health indicators. They are more likely to have higher rates of crime and poorer access to health care services.
A community health nurse is caring for an individual who is experiencing crisis poverty. Which of the following characteristics would this individual most likely display?
a. Episodic homelessness
b. Physical disability
c. Mental disability
d. Drug abuse
ANS: A
Episodic homelessness is a characteristic of crisis poverty. Physical disability, mental disability, and drug abuse would be considered in persistent poverty.
The community health nurse is caring for a client who is living in persistent poverty. Which of the following best describes this client?
a. Severe mental illness
b. Transient homelessness
c. Victim of domestic violence
d. Temporary housing
ANS: A
Those who are in persistent poverty typically are older, with physical and mental disabilities, alcohol and other drug abuse, severe mental illness, chronic health problems, and significant family difficulties. Transient homeless persons, victims of domestic violence, and persons with temporary housing would be considered in crisis poverty.
Which statement about homelessness is true?
a. Homeless persons are not found in rural areas.
b. Gentrification can lead to homelessness.
c. Deinstitutionalization led to a small number of homeless.
d. Community-based clinics provide much needed health care.
ANS: B
When urban housing is upgraded, the supply of low-income housing drops. It is often said that when neighborhoods were “gentrified” or upgraded, they reduced the ability of the poor people to live in them because they became unaffordable for poorer former residents. Homeless can be found in both rural and urban areas. Deinstitutionalization of the chronically mentally ill individuals from public psychiatric hospitals in the 1980s increased the number of homeless persons. After this happened, federal and state governments failed to allocate the needed funds to provide community-based services.
A person is already homeless and is receiving shelter. Which type of housing is being used?
a. Low income
b. Supportive
c. Emergency
d. Adequate
ANS: C
Emergency housing is shelter for persons who are already homeless. These shelters typically are only open at night and in many cities only on extremely cold nights.
The original goal of deinstitutionalization was to:
a. reduce state costs of caring for the chronically mentally ill.
b. replace state psychiatric hospitals with community-based treatment programs.
c. modernize psychiatric hospitals.
d. allow mentally ill persons to live on their own to test their life skills.
ANS: B
The original goal was to replace large psychiatric hospitals with community-based treatments centers. However, federal and state governments failed to allocate the needed funds.
Which statement regarding the effects of homelessness on health is accurate?
a. Peripheral vascular disease and hypertension are lessened by this lifestyle.
b. The incidence and virulence of infections are decreasing.
c. Trauma is a significant cause of death and disability.
d. Crowded living conditions result in decreased risk for exposure to infections.
ANS: C
Intended and unintended injuries such as traumas are a significant cause of morbidity and mortality in the homeless. Those who are homeless are at greater risk for peripheral vascular disease and hypertension. Because of their poor living conditions, a minor skin injury or infections left untreated can result in widespread infection.
A nurse is providing primary prevention when working with the homeless. Which of the following best describes what is being implemented?
a. Providing emergency housing aid
b. Creating drug and alcohol treatment options
c. Offering effective job training programs
d. Evaluating comprehensive case management programs
ANS: C
Offering effective job training programs is an example of primary prevention—attempting to prevent the problem before it occurs. Emergency housing is secondary prevention. Drug and alcohol treatment and comprehensive case management are tertiary preventions.
A nurse is providing secondary prevention when working with the homeless. Which of the following best describes what is being implemented?
a. Employer incentives
b. Safe sex education
c. Comprehensive case management
d. Soup kitchens
ANS: D
Secondary preventive services target persons on the verge of homelessness as well as those who are newly homeless. An example of secondary prevention is a soup kitchen. Employer incentives and safe sex education are primary prevention strategies; comprehensive case management is a tertiary prevention strategy.
A nurse is planning to assist homeless clients at a local shelter with finding community resources to meet their health care needs. Which of the following actions should the nurse take before interacting with this population?
a. Change personal views about homelessness
b. Understand the concepts of homelessness
c. Receive special training about where to locate homeless people
d. Have experience in mental health nursing and counseling
ANS: B
To implement effective nursing interventions for homeless clients, nurses need to be aware of their own beliefs and values about the homeless as well as understand the concepts of homelessness.
A nurse is implementing an intervention at both the primary and tertiary levels of prevention. Which of the following best describes the nursing intervention?
a. Providing emergency shelter housing
b. Offering physical and mental health services
c. Developing a targeted case management program
d. Establishing a needle exchange program
ANS: D
Establishing a needle exchange program could be considered both primary (preventing a problem before it occurs by helping clients avoid disease transmission) and tertiary (working with a population who already has a “problem” of drug abuse). Providing emergency shelter housing and offering physical and mental health services are both secondary and tertiary prevention interventions. Developing a targeted case management program is secondary prevention.
A nurse is analyzing the media images that influence society’s beliefs about poor persons. Which of the following is the nurse most likely to see? (Select all that apply.)
a. Poor persons are often cast as lazy, shiftless folk.
b. Poor people are shown receiving food at soup kitchens.
c. Criminals are portrayed as poor, desperate persons.
d. Homeless people are seen sleeping on park benches.
e. Criminals are seen as individuals who have been discriminated against.
ANS: A, B, C, D
The media is a powerful influence on how people view poverty. Media images of persons who are poor influence and are influenced by cultural attitudes and values. Poor persons may be cast in negative ways by the media, which influences what we believe to be true about poor persons
Why is it difficult to know the exact number of homeless persons? (Select all that apply.)
a. Homeless people refuse to provide demographic information.
b. Many homeless people refuse to be interviewed.
c. It is difficult to generalize from one location to another.
d. Some persons experience short intervals of homelessness.
e. Homeless individuals are most likely hiding within the community.
ANS: B, C, D
Those who are homeless are hard to find since they may sleep in boxcars, on building roofs, in doorways, or under freeways or pedestrian overpasses; temporarily stay with friends or family; refuse to be interviewed or deliberately hide the fact that they are homeless; have only short or intermittent episodes of being without a home; or may not fit in a general category.
Which statement about migrant and seasonal farm workers is true?
a. There are more than 10 million working in the United States.
b. The majority are Mexican.
c. Most are employed in the Northeastern states.
d. Thirty-five percent are undocumented workers.
ANS: B
The majority of migrant farm workers are foreign-born (72%) and predominantly Mexican (68%). Estimates suggest there are approximately 1.0 to 1.8 million hired farmworkers. Five states account for 65% of all farm workers: (1) California, (2) Florida, (3) Washington, (4) Oregon, and (5) North Carolina. Of the migrant and seasonal farmworkers, 52% have legal authorization to work in the United States.
Which statement about migrant and seasonal farm workers is true?
a. The economic status of migrant workers has improved over the last decade.
b. This is a transient population that does not need nursing care.
c. Most migrant workers are eager to accept health care services.
d. Availability of food in the United States depends on these individuals.
ANS: D
Availability and affordability of food in the United States depends on these individuals, yet their economic and social status has not changed significantly over the past decades. Most migrant workers do not seek out health care services.
A nurse is working with a client whose principal employment is in agriculture on a seasonal basis and has established temporary housing in the area while employed. Which of the following terms best describes this laborer?
a. Seasonal farm worker
b. Migrant farm worker
c. Transient worker
d. Share cropper
ANS: B
A migrant farm worker is a laborer whose principal employment is in agriculture on a seasonal basis and, for the purposes of such employment, establishes a temporary abode. A seasonal farmworker returns to his permanent residence, works in agriculture for at least 25 days or parts of days, and does not work year round only in agriculture. A transient worker moves from place to place to find work. A share cropper is a tenant farmer who uses part of the crop to pay for rent.
The nurse is caring for a migrant family. During the interview, the mother tells the nurse that the family follows an Eastern migratory stream originating in southern Florida. Which of the following statements is accurate?
a. This is one of the migratory streams that migrant farm workers traditionally follow.
b. This is a unique migratory pattern.
c. This is a traditional family-generated migratory pattern.
d. This is an unpredictable pattern that may lead the family through southern California.
ANS: A
Migrant workers traditionally have followed one of three migratory streams: (1) Eastern, originating in Florida; (2) Midwestern, originating in Texas; and (3) Western, originating in California.
A nurse plans to collect data about morbidity and mortality among migrant workers in a community. Which of the following barriers is the nurse most likely to encounter?
a. Difficulty securing a stable population
b. Lack of resources
c. Unwilling participants
d. Fear of deportation
ANS: A
Accurate morbidity and mortality data are difficult to obtain due to farm workers leaving when no longer working, going back to their home to receive medical services, and decreases in infectious diseases that are easier to record.
Which of the following health problems ranks as one of the top five problems for farm workers aged 5 to -19 years?
a. Dental problems
b. Communicable diseases
c. Gastrointestinal problems
d. Stress
ANS: A
Farm workers of all ages consistently have more dental disease than the general population.
Which of the following disorders has been identified as an occupational health risk for agricultural workers?
a. Stroke
b. Heart disease
c. Diabetes
d. Cancer
ANS: D
Cancer is an identified but not well-documented health problem for migrant farm workers associated with their exposure to chemicals. Other identified health risks are musculoskeletal injuries, traumatic injuries, respiratory problems, dermatitis, infectious diseases, and eye problems.
What effect does alcohol consumption have on migrant farm workers?
a. Provides relaxation and is important for migrant workers’ well-being
b. Adds additional risks to pesticide exposure
c. Poses safety hazards for farm workers
d. Allows migrant workers to sleep better, thus improving daytime productivity
ANS: C
Alcohol can contribute to farm-related injuries. Drug and alcohol use has been identified as a significant source of stress. Alcohol can also contribute to health problems, greater risk for human immunodeficiency virus (HIV), violence in camps/home sites, domestic violence, and decreased funds for personal and family needs.
Which factor may limit access to care for migrant farm workers?
a. Unwillingness to seek affordable health care
b. Lack of knowledge regarding services
c. Availability of 24-hour health care services
d. Adequate transportation
ANS: B
Because of isolation, migrant farm workers lack usual sources of information regarding available services. Migrant workers typically are unable to afford health care, have limited services available, and may not have adequate transportation to get to health care services.
Which statement is true about health care services for migrant workers?
a. Clinics are usually found within walking distance from work.
b. Undocumented workers fear deportation when using clinics.
c. Health care records are kept by workers to allow for continuation of services.
d. Clinics are most often open on weekends and keep evening hours.
ANS: B
Clinics are usually a great distance from work and offer health services only during work hours. Health records do not typically follow the client.
A nurse is assessing a client who has had an acute exposure to a pesticide. Which of the following symptoms is the client most likely to display?
a. Memory loss
b. Musculoskeletal problems
c. Cancer
d. Infertility
ANS: A
Memory loss is a symptom that is displayed following an acute exposure to a pesticide. Musculoskeletal problems, cancer, and infertility are from chronic exposure.
A nurse is caring for a migrant farm worker who has been working in the agricultural industry for the past 10 years. When questioned about environmental hazards, the client reports regular exposure to pesticides. Which of the following is the client at increased risk of developing?
a. Cancer
b. Memory loss
c. Skin rashes
d. Headaches
ANS: A
Chronic exposure to pesticides may lead to cancer. Acute exposure to pesticides may cause memory loss, skin rashes, and headaches.
A nurse is assessing the occupational health risks of a migrant farm worker. Which health risk is the nurse most likely to find?
a. Denial of care when going to the emergency room
b. Difficulty obtaining affordable health insurance
c. Increased exposure to chemicals and work-related injuries
d. Episodic violence from farm owners and employers
ANS: C
Occupational health risks for migrant farm workers include working conditions, exposure to chemicals, and using machinery. Denial of care and difficulty obtaining health insurance are not occupational health risks. Episodic violence from farm owners is not a known occupational health risk.
Which legislation changed the availability of federal services accessible to certain immigrants to the United States?
a. Migrant Health Act of 1962
b. Supplemental Security Income (SSI)
c. Welfare reform legislation of 1996
d. Food stamps
ANS: C
The Welfare reform legislation of 1996 changed the availability of federal services accessible to certain immigrants in the United States. The Migrant Health Act provides funds for primary and supplemental health services to migrant workers and their families. Because of the welfare reform legislation of 1996, many legal immigrants and unauthorized immigrants are ineligible for services such as SSI and food stamps.
A nurse is implementing a primary prevention strategy for migrant workers. Which of the following activities would the nurse most likely implement?
a. Caring for persons afflicted with pesticide exposure
b. Setting up clinics for persons with HIV
c. Doing research in the field related to heat stress
d. Educating about prevention of such illnesses as HIV and infectious diseases
ANS: D
The primary level of prevention often includes education for the prevention of diseases, measures to reduce pesticide exposure, and immunizations. Caring for persons afflicted with pesticide exposure, setting up clinics for persons with HIV, and doing research in the field related to heat stress are examples of tertiary prevention.
A nurse is implementing a primary prevention strategy. Which of the following activities would the nurse most likely implement?
a. Urine screening for pesticide exposure
b. Tuberculosis (TB) skin testing
c. Treatment of lead poisoning
d. Reduction of pesticide exposure
ANS: D
Reduction of pesticide exposure is an example of primary prevention. Urine screening and TB skin testing are secondary prevention, and treatment of lead poisoning is tertiary prevention.
A nurse is implementing a secondary prevention strategy. Which of the following activities would the nurse most likely implement?
a. Monitoring for prenatal care
b. Treatment for anemia
c. HIV prevention
d. Tetanus immunization
ANS: A
Monitoring for prenatal care is an example of a secondary prevention strategy. Treatment for anemia is tertiary prevention, and HIV prevention and tetanus immunization are primary prevention strategies.
A nurse is implementing a tertiary prevention strategy. Which of the following activities would the nurse most likely implement?
a. Diabetes screening
b. Rehabilitation for musculoskeletal injury
c. Birth control
d. Pregnancy testing
ANS: B
Rehabilitation for musculoskeletal injury is an example of tertiary prevention. Diabetes screening and pregnancy testing are secondary prevention strategies, and birth control is a primary prevention.
A nurse is working from a client who is part of the Mexican culture and is experiencing a folk illness. Which of the following actions by the client should the nurse anticipate?
a. Prefer to seek care with a folk healer
b. Consult the female leader of the family
c. Rely on Western medicine to cure the ailment
d. Become isolated and not seek care
ANS: A
There are four common folk illnesses that a nurse may encounter with the Mexican client: (1) mal de ojo (evil eye), (2) susto (fright), (3) empacho (indigestion), and (4) caida de mollera (fallen fontanel). When faced with one of these illnesses, the traditional Mexican individual would prefer to seek care with a folk healer. Healers known as curanderos, herbalistas, and espiritualistas are often sources of health care for folk illnesses.
A nurse is polite and non-confrontational when working with the family of a migrant worker. Which of the following concepts is the nurse demonstrating?
a. Simpatía
b. Respeto
c. Dignidad
d. Personalismo
ANS: A
Simpatía means having polite, non-confrontational relationships with others. Respeto means respect, dignidad means dignity, and personalismo is relating to the individual.
A nurse is educating migrant women to serve as links between the existing health care agencies and the migrant farm worker family. Which of the following best describes the role of these women?
a. Migrant head start workers
b. Outreach care workers
c. Physician assistants
d. Nurse aides
ANS: B
Because these outreach workers are members of the migrant community, they are trusted and know the culture and the language. Physician assistants and nurse aides do not serve in this lay person role in the community.
A nurse is providing care for a Mexican client who has sustained a farm injury. If a major decision about the client’s treatment needs to be made, who would most likely make that decision?
a. The male head of the family
b. The wife/mother
c. The person needing services
d. The crew leader
ANS: A
The male is considered to be the major decision maker in the family, whereas the female is considered the caretaker.
A nurse is planning to provide culturally effective care to Mexican migrant farm workers. Which of the following strategies should be used by the nurse?
a. Learn how to speak Spanish to improve communication
b. Understand that traditional beliefs and practices are more common among the well-educated population
c. Consult the female head of household about health care matters
d. Recognize that cultural backgrounds of the workers will vary depending on their place of origin
ANS: D
It would be incorrect to assume that all Mexicans have the same cultural beliefs. The nurse must remember that beliefs and practices differ between regions and localities of a country, and among individuals. Mexico is a multicultural country; therefore, the cultural backgrounds of Mexican immigrants vary depending on their place of origin.
A nurse is partnering with an organization to improve affordable housing in rural areas of the country. Which of the following best describes who the nurse is collaborating with?
a. Housing Assistance Council (HAC)
b. Local housing authority
c. Temporary Assistance for Needy Families (TANF)
d. Public Housing Development for Families
ANS: A
HAC is a nonprofit organization whose mission is to improve affordable housing in rural areas. TANF is a program that assists families in need. The local housing authority provides public housing assistance. Public Housing Development for Families promotes the development of local strategies for affordable public housing.
A nurse is a political advocate for the migrant population. Which of the following best describes the action being taken by the nurse?
a. Upholding immigration laws and deporting illegal aliens
b. Passing laws to improve the living conditions of migrant farm workers
c. Educating communities about the health problems of migrant farm workers
d. Learning to speak Spanish for better communication with migrant farm workers
ANS: C
Political advocacy can include educating communities about these individuals. This education helps to provide legislators and policy makers at local, state, and national levels with the information needed to make policy decisions
Which factors are challenges of the migrant lifestyle? (Select all that apply.)
a. Leaving one’s home every year
b. Traveling
c. Experiencing uncertainty regarding work and housing
d. Lack of resources
e. Middle income wages
ANS: A, B, C, D
Leaving one’s home every year, traveling, experiencing uncertainty regarding work and housing, and lack of resources are some of the challenges of the migrant lifestyle. The specifics for payment differ depending on the location and type of work. Reports of average income for farmworkers have varied.
