Test 2 Flashcards
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After a class on important historical influences on community health care, the students are asked to describe the impact of the Shattuck Report. Which response indicates that the students have understood the information?
A) It influenced the speed with which health-focused bills passed the legislature.
B) The report set up the organizational structure of the U.S. Public Health Service.
C) It emphasized sanitary progress, forming the basis for current public health practice.
D) It de-emphasized the issues addressed in the Hebrew hygienic code
Ans: C
Feedback:
The Shattuck Report, a landmark document, made a tremendous impact on sanitary progress by addressing public health concepts and methods that form the basis of public health practice today. It did not affect getting bills passed by legislation, nor was it involved in setting up the organizational structure of the U.S. Public Health Service.
The Hebrew hygienic code, probably the first
Over the past century, many health-related changes have occurred, affecting morbidity and mortality. As community health nurses assess and plan for services in the community, an understanding of which of the following changes would the nurses need to integrate into their plans? Select all that apply.
A) High levels of chronic disease
B) Shortened life spans
C) Increased teen pregnancies
D) Abuse of multiple substances
E) Increased maternal mortality
F) Multidrug-resistant diseases
Ans: A, C, D, F
Feedback:
Issues today include high levels of chronic disease, an increase in teen pregnancies, abuse of multiple substances, and multidrug-resistant disease. Shortened life spans and increased maternal mortality were real issues in the 1900s but are significantly different today. With the shortened life span over 100 years ago, people were not living long enough to develop a long history of chronic disease. Maternal mortality was high 100 years ago as prenatal care and the technology of today do not exist.
During a presentation at a local health department, a community health nurse discusses how society has changed over the past 100 years and the influence that these changes have had on the community’s healthcare needs. Which of the following would the nurse include as a current societal event?
A) Large disparity in male/female wages
B) Rural to urban migration
C) Rampant child labor
D) Widespread violence
Ans: D
Feedback:
Today, society is faced with widespread violence and terrorism. Populated urban areas continue to lose people to the suburbs, while 100 years ago, people were leaving rural areas for urban areas. A century ago, child labor laws were just forming, and child labor was rampant.
When seeking employment, a community health nurse decides to focus the search on official health care agencies, based on the
understanding that these agencies are
A) voluntary.
B) tax-supported.
C) proprietary.
D) privately funded.
Ans: B
Feedback:
Official health care agencies, later called public health agencies, are tax-supported; thus, they must provide services determined by the federal, state, or local government. Voluntary or private agencies are privately funded. Proprietary health services are privately owned and managed and may be for
profit or nonprofit.
After describing the Public Health Service to a group of students, which description would
indicate the need for additional discussion?
A) It offers consultation through national
advisory health councils and special advisory committees made up of lay experts.
B) The Secretary of Health and Human Services
is ultimately responsible for it.
C) The Secretary of Health and Human Services
is an elected position.
D) A major function is to administer grants and
contracts with other government agencies.
Ans: C
Feedback:
The Secretary of Health and Human Services is a cabinet position. Cabinet positions are appointed by the President. The Public Health Service does offer consultation through national advisory health councils and special advisory committees made up of lay experts. The Secretary of Health and Human Services is ultimately responsible for the Public Health Service. A major function of the Public Health Service is to administer grants and contracts with other government agencies.
provision of care to clients in a clinic setting
at the local health department. This nurse is engaging in which core public health function?
A) Clinical
B) Assessment
C) Policy development
D) Assurance
Ans: D
Feedback:
The three core public health functions are assessment, policy development, and assurance. Assessment would involve assessing the community; policy development would involve helping to establish policies that will address the problems assessed; and assurance would involve making sure that the services indicated by policies (following assessment) are available to the community. Clinical care is not a core public health function.
Which of the following statements about the
core public health functions are true?
A) Public health nurses practice as partners with other public health professionals within these
core functions.
B) Assessment involves the actual provision of services.
C) Policy development relates to assessment.
D) Assurance means that the public health agency must directly provide the needed services.
Ans: A
Feedback:
Public health nurses practice as partners with other public health professionals within these core functions. Assessment does not involve the actual provision of services (assurance does). Public policy development builds on data from the assessment function. Assurance is the process of translating established policies into services. This function ensures that population-based services are provided, whether by public health agencies or private sources.
Which one of the following groups of actions fulfills the three core public health functions in their proper order?
A) Counting the number of kindergarten students who are fully immunized, encouraging the school officials to exclude children who are not fully immunized, and offering immunization clinics at the school
B) Identifying a source of pollution in the community, educating residents about precautions that should be taken when the pollution exceeds minimum standards, and asking legislators to apply sanctions to the responsible party for the source of pollution
C) Providing prenatal care for pregnant adolescents, determining how many pregnant adolescents currently attend the school, and encouraging school officials to provide an alternative school setting for pregnant adolescents
D) Lobbying for a citywide ban on smoking in public, providing smoking cessation services in the community, and reviewing mortality data to determine the number of people in the community who die each year from lung cancer
Ans: A
Feedback:
The three core public health functions are assessment, policy development, and assurance. Assessment is data collection; policy development would be based on the assessment; and assurance is the process of translating established policies into services. Counting the number of fully immunized kindergarten students would be an assessment; encouraging the school officials to exclude children who are not fully immunized would be policy development; and offering immunization clinics at the school would be an assurance. Identifying a source of pollution in the community would require assessing and educating residents about precautions that should be taken when the pollution exceeds minimum standards, which would be assurance, and asking legislators to apply sanctions to the responsible party for the source of pollution would be policy development. Providing prenatal care for pregnant adolescents would be assurance; determining how many pregnant adolescents currently attend the school would be assessment; and encouraging school officials to provide an alternative school setting for pregnant adolescents would be assurance. Lobbying for a citywide ban on smoking in public would be policy development; providing smoking cessation services in the community would be assurance; and reviewing mortality data to determine the number of people in the community who die each year from lung cancer would be assessment.
A community health nurse primarily works with mothers and their high-risk children, often referring them to various voluntary agencies for services. Which of the following would be examples of voluntary health?
agencies? Select all that apply.
A) American Diabetes Association
B) The U.S. Public Health Service
C) The National Institutes of Health
D) Women, Infants, and Children Program (WIC)
E) National Society for Autistic Children
F) Planned Parenthood Federation of America
Ans: A, E, F
Feedback:
The American Diabetes Association, the National Society for Autistic Children, and the Planned Parenthood Federation are examples of voluntary agencies supported by nonfederal funds and nonprofit organizations. The
U.S. Public Health Service, the National Institutes of Health, and the WIC program are federal agencies that receive federal funds to
operate; thus they are not voluntary agencies.
Which of the following best describes a
public health care agency?
A) The agency most often has a very specific
focus.
B) The agency is responsible for promoting and protecting the health of all within its jurisdiction.
C) The agency only employs nurses and
environmental health practitioners.
D) The agency can perform its work
independently with complete autonomy.
Ans: B
Feedback:
Unlike private organizations that tend to have a specific focus, government health agencies exist to accomplish the broad goal of protecting and promoting the health of the total population under their jurisdiction. Public health requires interdisciplinary and inter-organizational collaboration.
Which of the following statements best describes the difference between the function of public sector health care agencies and
private-sector health care agencies?
A) Private sector health services are complementary and supplementary to government health agencies.
B) Public-sector healthcare agencies usually meet the needs of people with special needs.
C) Private sector health agencies are usually constrained in developing innovations in health care.
D) Public health sector agencies generally satisfy the healthcare needs of a community.
Ans: B
Feedback:
Private sector health services are complementary and supplementary to government health agencies, but this is not a difference between the two types of agencies. Private-sector healthcare agencies usually meet the needs of people with special needs, rather than public-sector healthcare agencies that focus on the entire population within their jurisdiction. Private-sector healthcare agencies are less constrained than public-sector healthcare agencies in developing innovations in healthcare. A part of the reason for the development of private-sector healthcare agencies is the impatience or dissatisfaction with government (public health) programs.
Which of the following statements best describes the difference between the function of public sector health care agencies and
private-sector health care agencies?
A) Public-sector healthcare agencies are more likely to pilot or subsidize demonstration projects.
B) Private-sector healthcare agencies are more
likely to promote health legislation.
C) Public-sector healthcare agencies are more likely to generate new research and innovation.
D) Private sector health care agencies usually
focus on needs that are met.
Ans: B
Feedback:
Private-sector health agencies are more likely to promote health legislation, whereas public-sector health care agencies are more likely to be responsible for carrying out health legislation. Private-sector healthcare agencies (not public) are more likely to pilot or subsidize demonstration projects and generate new research and innovation. Private-sector healthcare agencies strive to detect unmet
needs rather than meeting needs.
Which of the following statements about the International Health Organization is most accurate?
A) PAHO is completely separate from the WHO.
B) UNICEF promotes child and maternal health
and welfare globally.
C) WHO focuses primarily on developing
countries.
D) WHO and UNICEF are agencies of the
United Nations.
Ans: B
Feedback:
The United Nations International Children’s Emergency Fund (UNICEF) promotes child and maternal health and welfare globally. The Pan American Health Organization (PAHO) is the oldest continually functioning international health organization in the world and predates the World Health Organization (WHO). Initially, the PAHO was independent from the WHO but is now the WHO regional office for the Americas and receives part of its funding from the WHO. WHO focuses on the promotion of health worldwide, not just in developing countries. The United States Agency for International Development (USAID) focuses on developing countries. WHO and UNICEF are both agencies of the United Nations.
An instructor is preparing a class presentation on landmark health legislation. Which of the following would the instructor include as the most significant legislation that attempts to ensure access to health care for Americans?
A) Social Security Act
B) Hill-Burton Act
C) Patient Protection and Affordable Care Act
D) Omnibus Budget Reconciliation Act
Ans: C
Feedback:
The Patient Protection and Affordable Care Act is expected to provide access to health care for 30 million Americans when fully enacted. The Social Security Act had tremendous consequences for public health with revolutionary welfare insurance and assistance programs and the provision of financial assistance to form state and local health agencies. The Hill-Burton Act (1946), the Occupational Health and Safety Act (1970), and the Omnibus Budget Reconciliation Act (1981) are important acts that brought about changes in healthcare planning, safety, and funding.
A group of students is preparing for an examination on the various events serving as landmarks for health care legislation. The students demonstrate understanding of these events by identifying which of the following statements about particular landmark health legislation are true:? Select all that apply.
A) The Occupational Safety and Health Act provided protection to workers against personal injury or illness resulting from hazardous working conditions.
B) The Shepard-Towner Act provided funds to
states for hospital construction.
C) The Hill-Burton Act provided funds to states for the administration of programs to support the health and welfare of mothers and infants.
D) The Social Security Act Amendments of 1965 addressed a concern for some version of national health insurance.
E) The Omnibus Budget Reconciliation Act attempted to shift more power to states by consolidating categorical grants into four
block grants.
F) The Patient Protection and Affordable Care Act attempted to ensure the privacy of medical records.
Ans: A, D, and E
Feedback:
The Occupational Safety and Health Act provided protection to workers against personal injury or illness resulting from hazardous working conditions. The Hill-Burton Act provided funds to states for hospital construction. The Shepard-Towner Act provided federal funds to states for the administration of programs to support the health and welfare of mothers and infants. The Social Security Act Amendments of 1965 addressed a concern for some version of national health insurance. The Omnibus Budget Reconciliation Act attempted to shift more power to states by consolidating categorical grants into four block grants. The Health Insurance Portability and Accountability Act attempted to ensure the
privacy of medical records.
A community health nurse working at the local level is attending an in-service program about health care economics. The nurse asks the presenter, Why do I need to know this information? My focus is my clients. Which response by the presenter would be most appropriate?
A) You are required to know this information because your agency receives government funding.
B) You might be in management one day and have to deal with cost control and reimbursement. economics
C) Although it seems foreign to you, it’s an important topic that you might have to deal with someday.
D) This knowledge is important to the success of your practice and to the agency’s survival.
Ans: D
Feedback:
At the local level (the community health nurse and the employing agency), healthcare economics is very important for survival.
Resourceful use of time, talent, and materials will ensure that the services will be able to continue and that the agency stays viable.
Government funding, a future role in management, and dealing with the issue in the future are inappropriate and do not emphasize the importance of the effect of healthcare economics
When discussing the economics of health care with colleagues, the community health nurse addresses macroeconomic theory. Which of
The following would the nurse include?
A) Quantity of services available
B) Consumer’s willingness to buy services
C) Aggregate perspective of economic stability
D) Allocation of the available resources
Ans: C
Feedback:
Macroeconomic theory is concerned with the broad variables that affect the status of the economy as a whole, such as factors affecting aggregate consumption, production, investment, and international trade. The focus is on the larger view of economic stability and growth, providing a global or aggregate perspective. Microeconomic theory addresses supply (quantity of services available) and demand (consumer’s willingness to buy services) and studies how allocation and distribution affect consumer demand for
goods and services.
As part of a community-wide education program, a community health nurse is developing a teaching plan about Medicare. Which of the following would the nurse
include in the plan? Select all that apply.
A) It is a state health insurance program for
elderly and the disabled.
B) Medicare Part A covers medically necessary hospitalization, home care, hospice services, and limited-skilled nursing services.
C) Medicare Part D covers prescription drug costs.
D) Medicare Part A is supplementary and voluntary.
E) Medicare beneficiaries can make changes to their coverage at any time.
Ans: B, C
Feedback:
Medicare is a federal health insurance program that covers citizens and some legal aliens who are over 65 years old (not a state program). It also covers people with permanent disabilities or chronic renal disease at any age. Medicare Part A covers medically necessary hospitalization, home care, hospice services, and limited-skilled nursing services. Prescriptions are covered under Medicare Part
D. Medicare Part B is supplementary and voluntary. Medicare beneficiaries can make changes to their coverage during open enrollment periods.
After teaching a community group about the Medicaid program, which of the following would indicate to the nurse that additional
Is teaching necessary?
A) Medicaid has a monthly fee that recipients
must pay.
B) Medicaid is administered by each state.
C) Medicaid focuses on preventative services.
D) It is possible to be on both Medicare and
Medicaid.
Ans: A
Feedback:
Medicaid funds come to the states from the federal government. Each state determines who will receive what kinds of health care services. This makes it a uniquely different program in each state. Medicaid is a free program available to individuals on the basis of financial need and legal residency status. Medicaid has a major focus on preventative services, namely, infant, childhood, and elder immunization programs. Eligibility is determined based on financial need and residency status. Finally, some low-income
Medicare-eligible people also receive Medicaid.
What does a health nurse identify as a drawback to retrospective reimbursement? A) Spending was limited to the most necessary
tests and treatments.
B) Services for sickness were encouraged rather than wellness.
C) Consumers had to bear the increased
accountability for cost containment.
D) Payments for services were based on rates
calculated from predictions.
Ans: B
Feedback:
Retrospective payment is associated with encouraging sickness care rather than wellness services. Physicians and other providers were rewarded financially for treating illnesses and providing additional tests and services. Patients and providers often insisted on expensive or unnecessary tests and treatments. Neither consumers nor providers were accountable for containing costs. Retrospective payment involves reimbursement for a service after it has been rendered with payment of a fee occurring after the fact.
Which of the following statements about trends and issues influencing healthcare economics and community health services
delivery are true? Select all that apply.
A) The United States has the most cost-effective
health care system in the world.
B) One explanation for the high cost of the US healthcare Care System is the need to practice defensive medicine by ordering excessive
tests and x-rays.
C) In the United States, the health-related quality
of life is lower than in most other countries.
D) The United States ranks first among all WHO countries on a measure of how respectfully clients are treated.
E) In a survey published in 2009, most US physicians identified that their health care system worked well.
Ans: B, C, and D
Feedback:
The United States has one of the least cost-effective health care systems in the world. One explanation for the high cost of the US healthcare system is the need to practice defensive medicine by ordering excessive tests and x-rays. In the United States, the health-related quality of life is lower than in most other countries. The United States ranks first among all WHO countries on a measure of how respectfully clients are treated. In a survey published in 2009, most US physicians did not identify that their health care system
worked well.
Which of the following statements about
What care rationing is most accurate?
A) It will not occur in the United States because
of our country’s values.
B) The danger of rationing is that it compromises quality and effectiveness.
C) Rationing in health care has never been
practiced.
D) Advances in knowledge and technological
capabilities will eliminate the need for rationing in the future
Ans: B
Feedback:
The danger of rationing is that it compromises quality and effectiveness. Rationing has already been practiced in this country to some extent and for many years. Advances in knowledge and technological capabilities compound rationing decisions.
When describing managed competition as a potential solution to resolve the healthcare crisis, which of the following would be
included? Managed competition would
A) promote cost containment and universal
access to health care.
B) eliminate burdensome government
regulations.
C) reduce state and federal control over health
care delivery.
D) discourage consumers from making
responsible choices.
Ans: A
Feedback:
Managed competition would ideally promote cost containment and universal access to health care. Governmental regulations and control would still be present, as would insurance companies. Managed care would encourage consumers to make responsible choices.
Which statement regarding the potential
Which impact of health care reform on community health nursing is most accurate? A) Healthcare reform does not affect community
health nursing.
B) Community health nurses know that outcome research is unnecessary.
C) Public health nurses can lead the effort to make health care more accessible to all citizens.
D) Community health nurses will only be able to work in public health agencies.
Ans: C
Feedback:
Public health nurses can lead the effort to make health care more accessible to all citizens. Healthcare reform affects community health nursing. Community health nurses recognize the importance of outcome research to document the value of nursing interventions with at-risk populations.
Community health nursing has important ties
to both private and public health agencies.
An instructor is discussing the worldwide
distribution of AIDS. Which term would the instructor use to describe this situation? A) Epidemic
B) Pandemic
C) Endemic
D) Pathogenicity
Ans: B
Feedback:
Pandemic is the term used to describe an epidemic that is distributed worldwide. An epidemic refers to a disease occurrence that exceeds the normal frequency in a community or region. Endemic is used to describe the continuing presence of a disease or infectious agent in a given geographic area. Pathogenicity refers to an agent’s capacity to cause disease in a host.
After a class describing the contributions of Florence Nightingale to epidemiology, the instructor determines that the class needs additional instruction when they state which of the following is associated with
Nightingale?
A) Establishment of the need for a clean
environment
B) A sophisticated coding system for medical
conditions
C) Proper wound cleansing and bandaging techniques
D) Separation of infected individuals from those injured
Ans: B
Feedback:
Nightingale’s colleague, William Farr, is credited with developing a more sophisticated system for coding medical conditions.
Nightingale’s contributions included establishing the need for a clean environment, properly cleaning wounds and bandaging them, and separating infected soldiers from those who were injured.
When applying the epidemiologic triad model to a community’s plan of care, which of the following would the community health nurse
address?
A) Incidence, prevalence, and case fatality
B) Health, illness, and injury
C) Host, agent, and environment
D) Immunity, causation, and risk
Ans: C
Feedback:
The epidemiological purpose of this model is to demonstrate the relationship among host, agent, and environment. Each component has to be present to a certain degree for any disease, illness, or injury to exist or happen. If one component is missing, illness or injury will not occur. Incidence, prevalence, case fatality, health, illness, injury, immunity, causation, and risk are terms used in epidemiology but do not refer to the epidemiologic triad model.
Which of the following would the community health nurse identify as a key component of
the host?
A) Infectivity
B) Antigenicity
C) Virulence
D) Inherent resistance
Ans: D
Feedback:
The host, a susceptible human or animal, can sometimes have the ability to resist pathogens. This is called inherent resistance. Infectivity, antigenicity, and virulence are characteristics
of the agent
Which of the following statements apply to
the concept of causality? Select all that apply.
A) Causality is the relationship between cause and effect.
B) The chain of causation is the most recent
theory of causality.
C) The web of causation theory is the most
recent theory of causality.
D) The chain of causation clearly explains
causation in noninfectious diseases.
E) Epidemiology has changed its view of
causality over time.
Ans: A, C, and E
Feedback:
Causality is the relationship between cause and effect. The web of causation theory is the most recent theory of causality. Epidemiology has changed its view of causality over time. The chain of causation was the first theory of causality. The chain of causation could not sufficiently explain causation in noninfectious diseases because the chain of causation is too linear.
A community health nurse is explaining the chain of causation to a family that includes a child who has developed Lyme disease. The nurse correctly describes the opening in the child’s skin caused by the actual tick bite as
the
A) reservoir.
B) mode of transmission.
C) portal of entry.
D) host
Ans: C
Feedback:
The opening in the child’s skin caused by the actual tick bite is the portal of entry in the chain of causation. The mode of transmission would be the tick biting the child. The reservoir would refer to the tick. The host would be the child who has been bitten by the tick.
A community health nurse is integrating the epidemiology of wellness into practice. Which of the following would the nurse
include?
A) Lifestyle with its self-created risks
B) Communicable disease control
C) The natural history of disease
D) Vital statistics and reportable diseases
Ans: A
Feedback:
Today, there is an increased focus on lifestyle behaviors and how they relate to a person’s state of wellness or illness. It is a basic component of a wellness model.
Communicable disease control focuses on an illness state, not a wellness state, and is not part of a wellness model. The four states of the natural history of a disease or health condition are not part of the wellness model. Vital statistics and reportable diseases are not
part of the wellness model.
The nurse is examining the possibility that multiple factors are involved in the development of a disorder. The nurse is
applying which of the following?
A) Chain of causation
B) Web of causation
C) Strength of association
D) Temporality
Ans: B
Feedback:
The web of causation is being used to apply the concept of multiple causes to explain the existence of health and illness states. It was a refinement of the chain of causation, such that it looked at the combination of multiple factors as implicated in the development of poor outcomes. The chain of causation focuses on one factor in the development of a condition. The strength of association is an element of causation in noninfectious diseases that refers to the ratio of disease rates in those with and without the causal factor. Temporality, also involved with the causation of noninfectious diseases, is an element in which exposure to the suspected factor must precede the onset of the disease.
The nurse is reviewing a research article that describes the use of the bacille Calmette Guerin (BCG) vaccine to prevent tuberculosis that was given to individuals who were exposed to leprosy. The individuals did not develop leprosy. The nurse interprets this as most accurately demonstrating which type
of immunity?
A) Herd immunity;
B) Passive immunity
C) Cross-immunity
D) Active immunity
Ans: C
Feedback:
Cross-immunity refers to a situation in which a person’s immunity to one agent provides immunity to a related agent as well. This immunity can be active or passive. Herd immunity describes the immunity level present in a population group. Passive immunity refers to short-term resistance acquired either naturally or artificially. Active immunity is long-term and can be acquired
naturally or artificially.
The nurse educator knows that a nursing student understands the basics of immunity when the student nurse states
A) Herd immunity only pertains to cows.
B) Active immunity can be attained via the use of vaccines.
C) passive immunity can be attained through the use of vaccines.
D) Cross-immunity is immunity that causes a person who is immune to one disease to also be immune to a completely different infectious agent.
Ans: B
Feedback:
Active immunity can be attained through the use of vaccines. Passive immunity is immunity that is given to a person, either by maternally provided protection for newborn infants or from antibody products that provide temporary resistance. Herd immunity describes the immunity level that is present in a population group. Cross-immunity is immunity that causes a person who is immune to one disease to also be also immune to a related infectious agent.
When assessing several populations, the nurse notes each population’s relative risk. Using the relative risk ratios below, which population would require a major emphasis for risk reduction intervention?
A) 0.59
B) 1.13
C) 1.79
D) 2.45
Ans: D
Feedback:
A relative risk >1.0 indicates that those with the risk factor have a greater likelihood of acquiring the disease than do those without it. For example, a relative risk ratio of 2.45 means that the exposed group is 2.45 times more likely to acquire the disease than the unexposed group. Therefore, interventions to reduce this population’s risk would be most important.
Which of the following statements about risk
is true? Select all that apply.
A) Risk is the probability that a disease or
unfavorable health condition will develop.
B) Risk means that the person who has the most
Negative influences will definitely develop the disease or unfavorable health condition.
C) Risk refers to positive and negative influences on a person’s likelihood of developing a specific disease.
D) Risk can be measured using the relative risk ratio, which is based on the ratio of incidence in an exposed group to the incidence rate in an unexposed group.
E) Risk is unimportant when determining the
most effective points for community health intervention.
Ans: A, C, and D
Feedback:
Risk is the probability that a disease or unfavorable health condition will develop. Risk also refers to positive and negative influences on a person’s likelihood of developing a specific disease. Relative risk ratio is a calculation of risk consisting of the ratio of incidence in an exposed group to the incidence rate in an unexposed group. Risk does not mean that the person who has the most negative influences will definitely develop the disease or unfavorable health condition; it refers to the probability that the person will develop the disease or unfavorable health condition. The relative risk ratio assists in determining the most effective points for community health intervention in regard to
particular health problems.
While visiting a family’s home, the community health nurse finds out that the two children in the home were exposed to chickenpox. Assessment of the children reveals no signs of fever or lesions. The nurse determines that the children may be in
stage of the disease?
A) Susceptibility
B) Subclinical disease
C) Clinical disease
D) Resolution
Ans: B
Feedback:
The children have been exposed but have not yet developed the signs of chickenpox. Therefore, they are in the subclinical disease stage. During the susceptibility stage, the disease is not present, and individuals have not been exposed. During the clinical stage, signs and symptoms are beginning to develop.
During the resolution stage, the disease causes
sufficient anatomic or functional changes to produce recognizable signs and symptoms.
For a communicable disease, would quarantine be most effective?
A) Susceptibility stage
B) Subclinical disease stage
C) Clinical disease stage
D) Resolution stage
Ans: B
Feedback:
Quarantine is the isolation of persons who are susceptible to a communicable disease and have been exposed to that communicable disease until the incubation period of the subclinical disease stage has passed.
Quarantining people during the susceptibility stage itself is not indicated, as individuals have not been exposed. The proper action for people who are in the clinical disease stage and beyond is isolation until the danger of spreading the communicable disease has
passed.
The nurse is reviewing actual census data for information for use in an epidemiologic study. Which of the following would the nurse be least likely to find?
A) Occupational status
B) Housing quality
C) Births recorded
D) Educational level
Ans: C
Feedback:
Vital statistics data provides information about the number of births recorded. The census includes information about age, sex, race, ethnic background, type of occupation, income gradient, marital status, educational level, and other standards such as housing quality. If the nurse is reviewing actual census data, she is least likely to find births recorded, which is vital statistics.
on the use of nursing home services and the common diagnoses of those using these services. Which source of information would be most appropriate for the nurse to investigate?
A) National Center for Health Statistics
B) Consumer Product Safety Commission
C) Environmental Protection Agency
D) Cancer disease registries
Ans: A
Feedback:
The National Center for Health Statistics provides valuable health prevalence data from surveys of Americans. Among the information available is the National Nursing Home Survey, which provides information on those who are using these services, their diagnoses, and other characteristics. The Consumer Product Safety Commission and Environmental Protection Agency would provide information about environmental issues. Cancer disease registries would provide information specific to the diagnosis of cancer.
Which of the following is true about
incidence and prevalence? Select all that apply.
A) Prevalence is the number of new cases of a
disease or health condition.
B) Incidence is the number of new cases of a
disease or health condition.
C) Prevalence refers to all of the people with a
particular health condition existing in a given population at a given point in time.
D) Incidence refers to all of the people with a particular health condition existing in a given population at a given point in time.
E) When determining if a disease is endemic in a specific area, the statistic that is most helpful is prevalence.
Ans: B, C, and E
Feedback:
Incidence is the number of new cases of a disease or health condition. Prevalence refers to all of the people with a particular health condition existing in a given population at a given point in time. When determining if a disease is endemic in a specific area, the statistic that is most helpful is prevalence.
A community health nurse is preparing to carry out an experimental epidemiologic study. Which of the following would be most
important for the nurse to do?
A) Focus the study on evaluating the cause of a disease
B) Ensure carefully controlled conditions during the study
C) Expose both groups to the same factor or
condition
D) Ensure that there are a substantial number of subjects
Ans: B
Feedback:
Experimental studies are carried out under carefully controlled conditions. In human populations, experimental studies should focus on disease prevention or health promotion rather than testing the cause of disease. The investigator exposes an experimental group to some factor and simultaneously observes a control group similar in characteristics to the experimental group but without the exposure factor. An experimental study need not be elaborated to provide important data.
A community health nurse is participating in a case-control observational study. Which of the following would most likely explain this?
type of study?
A) Description of patterns of occurrence of
illness and injury in a population;
B) Investigation of development of health illnesses
conditions over a long period of time
C) Studying of a cohort with evaluation of
variables associated with the disease or injury
D) Comparison of persons with and without a
Health and illness conditions
Ans: D
Feedback:
Comparing people with and without a certain condition is known as a case-control study. A study that describes patterns of occurrence in a population is a descriptive study. Following people over a long period of time is a longitudinal study. And cohorts are groups studied over time.
After teaching a group of students about the various types of epidemiologic research studies that can be done, the instructor determines that the teaching was effective when the students describe a community trial
as which of the following?
A) A type of experimental study conducted at the
community level
B) An inexpensive type of analytic research
study
C) A study that gathers volunteers for the experimental group
D) A way to locate health problems in a variety
of communities
Ans: A
Feedback:
A community trial is conducted as an experimental study with large populations. Some of the community receives treatment, while the other part does not. This is probably the most expensive type of experimental study. It involves a great number of subjects, the support of the governmental forces as well as the population involved, a large number of staff over a long period of time, and the cost of the intervention itself. When a whole community is involved, individuals are not approached to be volunteers. What makes it a community study is that the entire community is part of the study. The health problem was identified prior to the implementation of the study. The introduction of an intervention in one community with no introduction in a similar community forms the study population, and the health problem being studied is then monitored between the two populations. The health problem has to be identified first in this
type of study.
When using descriptive epidemiology, which type of study would the community health nurse expect to include?
A) Prevalence study
B) Case-control study
C) Cohort study
D) Count study
Ans: D
Feedback:
Descriptive epidemiology includes investigations that seek to observe and describe patterns of health-related conditions that occur naturally in a population. The simplest measure of a description is a count. Prevalence, case-control, and cohort studies are types of studies involved with analytical
research.
epidemiologic study from the first step to the last.
A) Collect the data.
B) Identify the problem.
C) Analyze the findings.
D) Disseminate the findings.
E) Review the literature.
F) Develop conclusions and applications.
G) Design the study.
Ans: B, E, G, A, C, F, D
Feedback:
The proper order of the steps in the epidemiologic study from the first step to the last is to identify the problem, review the literature, design the study, collect the data, analyze the findings, develop conclusions and
applications, and disseminate the findings.
When implementing an epidemiologic research study, which of the following would the community health nurse complete as the
final step?
A) Analyze the data
B) Design the study
C) Disseminate findings
D) Review the literature
Ans: C
Feedback:
The last step in the research process is to disseminate the findings. After identifying the problem and reviewing the literature, the researcher designs the study, collects the data, analyzes the findings, and develops
conclusions and applications.
When reporting the identification of a communicable disease and need for investigation, which of the following must be
notified first?
A) Centers for Disease Control (CDC)
B) State health department
C) Local health department
D) National Reported Disease list
Ans: C
Feedback:
The local health department is the initial point of notification for a communicable disease investigation. Each local health department or agency will investigate the specific disease. The CDC is the federal agency that provides guidance and recommendations for each state health department. The state health department may be the primary agency or the guiding agency for local disease control policies. States use the National Reported Disease list as guidance for State
reportable diseases
Which of the following are appropriate communicable disease prevention interventions that may be implemented by community health nurses? Select all that
apply.
A) Immunization of children and adults
B) Disease investigation and case/contact finding
C) Diagnosing cases of communicable diseases
D) Prescribing treatment for communicable
diseases
E) Environmental interventions
F) Community Education
Ans: A, B, E, F
Feedback:
Appropriate interventions that may be implemented by community health nurses include
immunizations of children and adults, environmental interventions, community education,
screening programs, and disease
investigation and case/contact finding.
Which of the following statements accurately describes the important steps that a community health nurse must take prior to contacting an individual for an interview regarding communicable disease? Select all that apply.
A) Review the information received from the
news media reporter for completeness
B) Review disease information, including the reservoir, incubation period, infectious period, symptoms, and treatment
C) Take all appropriate treatments to the
interview site
D) Investigate only laboratory-confirmed
communicable diseases
E) Eradicate the disease
Ans: A, B
Feedback:
Steps to take prior to contacting an individual regarding communicable disease include
reviewing the information received from the reporters for completeness (this refers to the
individual reporting the communicable disease to the public health agency and not the news
media reporter); clarifying that the disease is suspect or lab confirmed (some infections can be reported if they meet a set of clinical criteria or are part of a larger outbreak for which the case definition has been identified even without laboratory confirmation); review the case definition;review the disease information
(including reservoir, incubation period, infectious period symptoms, and treatment); and identifying the specific questionnaire for the reported disease orusing a generic disease investigation form and reviewing the questionnaire. It is not appropriate
for the community health nurse to take all treatments to the interview site as the goal of this interview is to assess. Community health nurses may investigate laboratory-confirmed or suspected diseases. Eradication of the disease is the last step in investigating a disease, and interviewing an individual regarding a communicable disease is one of the first steps in the process of investigation.
Which of the following entities would the community health nurse know are required to
report known or suspected cases of reportable diseases in every state in the United States?
Select all that apply.
A) Physicians, dentists, and nurses
B) Laboratory directors
C) Any individual who knows of or suspects the
existence of a reportable disease
D) Medical examiners
E) Administrators of schools and child care
centers
Ans: A, D, E
Feedback:
In most states, reporting known or suspected cases of a reportable disease is generally
considered to be an obligation of physicians, dentists, nurses, and other health professionals; medical examiners; and administrators of hospitals, clinics, nursing homes, schools, and child care centers. Some states also require or request reporting from laboratory directors, and any
individual who knows of or suspects the existence of a reportable disease.
A community health nurse is presenting a program about hepatitis prevention and risk
reduction to a local community group. The nurse determines that the group has understood the
program when they identify which method is the major mode of
transmission for hepatitis B?
A) Oral-fecal route
B) Exposure to contaminated blood
C) Airborne droplet nuclei
D) Infected rodents, such as mice and rats
Ans: B
Feedback:
Hepatitis B can occur in certain high-risk groups, including injected drug users,
heterosexuals with multiple partners, and homosexual men. Hepatitis A is transmitted by the fecal-oral route. TB is transmitted by airborne droplet nuclei. Hantavirus is
transmitted via infected rodents.
When reviewing the trends in communicable diseases for a county, the community health
nurse notes that there was an increased incidence of Lyme’s disease. The nurse develops a plan for prevention and control, integrating the understanding that this disease
is most likely transmitted by which mode?
A) Vector
B) Airborne
C) Vehicle-borne
D) Direct
Ans: A
Feedback:
In the United States, vector-borne illnesses have received renewed attention with
accumulating information about Lyme’s disease, transmitted to humans by a tick vector. Airborne transmission occurs through droplet nuclei, such as sneezing or coughing. Indirect or vehicle-borne transmission occurs when the infectious agent is transported via contaminated inanimate objects such as air, water, or food. Direct transmission occurs via the immediate transfer of infectious agents from a reservoir to a new susceptible host, such as through touching. biting, kissing, or
sexual intercourse.
After a community health nurse implements an educational program for a local
community group about food safety, which statement indicates that the teaching was successful?
A) Handwashing is unnecessary if we use
gloves.
B) After cooking the meat, we’ll put it on the
same platter that we used for the raw meat.
C) Our cooked foods should be cooled quickly.
D) If we peel the carrots, we don’t need to wash them before eating.
Ans: B
Feedback: Cooled foods should be cooled quickly. Surfaces, hands, and utensils should be washed in warm, soapy water (even when gloves are used, gloves do not prevent cross-contamination). Foods, when cooked, should not come into contact with dishes, utensils, or containers used when the foods were raw and uncooked. Foods that are to be eaten raw and
uncooked should be washed thoroughly in clean water. This includes foods (e.g., carrots) that are to be peeled that grow on the ground or come in contact with soil.
A community health nurse is teaching a group of clients about infection control and
mentions the role of vectors in transmitting diseases. Which of the following would be examples?
of some common vectors? Select all
that apply.
A) Chemicals
B) Mosquitoes
C) Salmonella
D) Fleas
E) Roaches
Ans: B, D, E
Feedback:
A vector is a nonhuman carrier of disease organisms that can transmit diseases directly to humans. Examples would include mosquitoes, fleas, and roaches. Various chemicals are not
vectors and Salmonella is
an infectious agent.
Which of the following statements about modes of transmission are true? Select all that
apply.
A) Direct transmission requires contact with a
contaminated, inanimate material.
B) Indirect transmission is also known as
vehicle-borne illness.
C) Food- and water-related illnesses are considered to be spread by indirect transmission.
D) Vector transmission requires contact with a
nonhuman carrier, such as an animal or insect.
E) Airborne transmission commonly occurs from coughing and sneezing.
Ans: B, C, D, E
Feedback:
Direct transmission occurs by immediate transfer of infectious agents from a reservoir to a new susceptible host. Indirect transmission requires contact with a contaminated inanimate material and is also known as vehicle-borne illness. Food- and water-related illnesses are
considered to be spread by indirect transmission. Vector transmission requires contact with anonhuman carrier such as an
animal or insect. Airborne transmission commonly occurs from
coughing and sneezing.
Community health nurses practice within the three levels of prevention. Which of the
following would the community health nurse engage in at the primary level of prevention for
communicable disease control? Select all
that apply.
A) Providing TB skin test to children entering
kindergarten
B) Administering immunizations to senior
citizens
C) Teaching kindergarten students to wash their hands
D) Encouraging parents to complete their
children’s immunizations
E) Providing chest x-rays to people with positive TB skin tests
F) Administering prompt treatment for the
symptoms of gonorrhea
Ans: B, C, and D
Feedback:
Primary prevention interventions include administering immunizations, teaching about
hand washing, and encouraging adherence to the recommended schedule for childhood
immunizations. Providing TB skin testing and chest x-rays and promptly treating symptoms of gonorrhea are examples of interventions at
the secondary level of prevention.
The nurse educator has just discussed the education of aggregates using mass media with targeted health messages. Which of the following statements by the nursing student would demonstrate the student’s ability to
analyze and apply the information?
A) Television would be the most important venue of mass media to educate the general public, as everyone has a television.
B) The target audience must be assessed for educational level, salience of the issue,
involvement in the issue, and access to the
media channel used.
C) Pamphlets should be assessed to make sure
They are at a twelfth grade reading level.
D) It is unnecessary to consider culture when
planning the health message.
Ans: B
Feedback:
To effectively deliver a health promotion and disease-prevention message, the message
must reach the target (at-risk) population.
This requires correct identification of the characteristics of the target audience in terms of educational level, salience of the issue, involvement of the target audience with the issue, and access of the target audience to the media channels used. Cultural issues affect people’s interpretation of messages and must be considered in the presentation of a disease prevention message to ethnic and racial minority groups. Television may not be the most important venue for mass media to educate the general public. Pamphlets may not be the best way to educate the
aggregate, and the reading level of any literature must be specific for the target audience. Cultural issues affect people’s interpretation of messages and must be considered in the presentation of a disease prevention message to ethnic and racial minority groups.
A community health nurse has identified the index case. The nurse is involved in which
of the following?
A) Contact investigation
B) Screening
C) Isolation
D) Quarantine
Ans: A
Feedback:
The index case (diagnosed person) results from contact investigation and partner
notification. Screening describes programs that deliver a testing procedure to detect disease in groups of asymptomatic, apparently healthy individuals. Isolation refers to the separation of the infected person from others for a period of communicability to limit transmission; quarantine
refers to restrictions placed on healthy contacts of an infectious case for the duration of the incubation period. Contact investigation and notification is one of two approaches to secondary prevention of communicable diseases.
The three main approaches to the tertiary
Prevention of communicable disease includes which of the following?
A) Education, immunization, and screening
B) Screening, immunization, isolation and
quarantine
C) Case and contact investigation, notification,
and treatment
D) Care and treatment, isolation and quarantine, and safe handling and control of infectious wastes
Ans: D
Feedback:
The three main approaches to the tertiary prevention of communicable disease include
care and treatment, isolation and quarantine, and safe handling and control of infectious wastes. The primary prevention techniques for communicable disease include education, immunization, and screening. The secondary prevention techniques for communicable disease include case and contact investigation,
notification, and treatment.
If an agency discards used needles and syringes in plastic milk jugs, which of the four
key elements of an infectious waste management program that are applicable to community practice would the agency be
violating?
A) Health professionals must be able to correctly distinguish biohazardous waste from
biomedical waste.
B) The waste management program must have administrative support and authority to
institute practice guidelines.
C) Handling of the infectious wastes must be
minimized. Containers should be rigid, leak-resistant, and impervious to moisture.
D) An enforcement or evaluation mechanism
must be in place to ensure that the potential for exposure to infectious waste is met.
Ans: C
Feedback:
The handling of infectious waste must be minimized. Containers should be rigid and leak-proof. resistant and impervious to moisture; they should have sufficient strength to prevent rupture or tearing under normal conditions; and they should be sealed to prevent leakage. Containers for sharps must also be puncture-resistant. Other key elements of an infectious waste managementprogram that are applicable to community practice include that health professionals must be able
to correctly distinguish biohazardous waste from biomedical waste; the waste management program must have administrative support and authority to institute practice guidelines; and an
enforcement or evaluation mechanism must be in place to ensure that the potential
for exposure to infectious waste is met.
The community health nurse determines that the adult population in the community has
an increased incidence of vaccine-preventable disease. Which of the following are factors that
may contribute to low vaccination levels
among adults? Select all that apply.
A) Lack of comprehensive vaccine delivery systems to the public and private sectors for
adults (similar to the Vaccines for children)
program for children)
B) Lack of statutory requirements for vaccination of adults
C) Health care providers may lack current information about recommended adult
immunizations and may miss opportunities to vaccinate adults during contacts in offices,
outpatient clinics, and hospitals.
D) Adults fear injections for immunizations but do not worry about adverse effects after
vaccination.
E) A multitude of comprehensive vaccination programs exist in settings where healthy
Adults congregate at workplaces and other locations.
Ans: A, B, C
Feedback:
Low vaccination levels among adults are associated with several factors: limited
comprehensive vaccine delivery systems that are available; lack of statutory requirements for vaccination of adults; and frequently missed opportunities for vaccinating adults during contacts in offices, outpatient clinics, and hospitals. Additionally, there is a lack of comprehensive vaccination programs in settings where healthy adults congregate, and clients and providers may fear adverse
reactions after vaccination.
A community health nurse would recommend
pneumococcal vaccine for which group?
A) 1-year-old children
B) 30-year-old adults who have simple
respiratory tract infections
C) Adults over 65 who have COPD
D) Healthy adults in their 50s
Ans: C
Feedback:
Primary prevention includes a pneumococcal vaccine, especially for high-risk groups.
ages 2 years old and up, including those with chronic diseases, immune-suppressing health
conditions, or those who are asplenic.
Reimmunization is recommended only for high-risk children or adults over 65 years old who had their first vaccination before age 65. The vaccine is not effective in children younger than 2 years of age and is not recommended for the healthy population
between the ages of 2 and 65 years.
Which of the following statements about
Is immunization the most accurate?
A) Immunization is helpful in the spread of all
communicable diseases.
B) Immunization cannot provide herd immunity.
C) Immunization is the process of introducing a form of a disease-causing organism into a
person’s system to promote the development
of antibodies that will resist the disease.
D) Immunization is the process of administering antibodies to a person.
Ans: C
Feedback:
Immunization is the process of introducing a form of a disease-causing organism into a
person’s system to promote the development of antibodies that will resist the disease. There are many communicable diseases that a vaccine is not known for. Immunization can help to promote herd immunity. Immunization does not involve the administration of
antibodies to a person
A family member has developed tuberculosis
(TB) and the remainder of the family members are undergoing tuberculosis skin testing to
determine their status. The nurse assesses the indurations and determines that a family member with which size induration is positive for TB.
A) 2 mm
B) 3 mm
C) 4 mm
D) 5 mm
Ans: D
Feedback:
An induration of 5 mm or more is considered positive for individuals in close contact
with others who have TB. Indurations <5 mm are not considered positive.
The community health nurse observes an increase in the development of multidrug
resistant tuberculosis. The nurse understands that a major reason for this occurrence is
individual clients would most likely be
A) political and social response to declining rates of TB over the past decade.
B) a reduction in funding for surveillance and
research.
C) noncompliance with the therapy for the full,
recommended period.
D) a premature sense that TB has been defeated.
Ans: C
Feedback:
On an individual-case basis, the most common means by which resistant organisms are
acquired by noncompliance with therapy for the full, recommended period.
Factors that seem to contribute to the overall increase in multidrug-resistant tuberculosis include the political and social response to declining rates of TB over past decades, which has resulted in funding cuts for surveillance, treatment, and research, and a premature sense that TB was defeated.
Which of the following statements about the prevention of sexually transmitted diseases
is true? Select all that apply.
A) Many people who have HIV infection can stave off AIDS by the use of medications
during the HIV stage of the spectrum.
B) Screening programs have actually reduced the incidence of Chlamydia as infected people are identified and treated.
C) The proper use of condoms prevents transmission of all sexually transmitted
infections.
D) Expedited partner treatment can prevent the spread of Chlamydia and gonorrhea.
E) It is not possible for a person who has a HSV-2 infection to transmit the infection to other sex partners if sexual contact is only practiced when the person does not have any
visible sores.
Ans: A, B, D
Feedback:
Many people who have HIV infection can stave off AIDS by the use of medications
during the HIV stage of the spectrum.
Screening programs have actually reduced the incidence of Chlamydia, as infected persons are identified and treated. Expedited partner treatment can prevent the spread of Chlamydia and gonorrhea. The proper use of condoms reduces the risk of sexually transmitted infection transmission but does not eliminate the transmission of all sexually transmitted infections. It is possible for a person who has HSV-2 infection to transmit the infection to other sexual partners if
Sexual contact is practiced even when the infected partner does not have a visible sore.
Which one of the following statements is true about the consequences of biologic
terrorism with anthrax and smallpox?
A) Anthrax is not usually spread by person-to-person contact, so is not a good agent of
biological terrorism.
B) Smallpox is globally eradicated and therefore does not present a problem.
C) Most adults are immune to smallpox due to
routine immunization.
D) As many as one in five persons who become ill with cutaneous anthrax die, and inhaling anthrax can cause death in 3 to 5 days.
Ans: D
Feedback:
The case-fatality rate for cutaneous anthrax is 5% to 20%. Inhalation anthrax initial
The symptoms are mild and nonspecific but progress to respiratory distress, fever, shock, and expected death within a matter of days.
Anthrax is not usually spread by person-to-person contact, but it has been demonstrated to be an agent of biologic terrorism via spores that were placed in mail right after the 2001 terrorist attacks. Many adults are not immune to smallpox as it has not been used for routine
immunization for 40 years.
Which of the following statements about
Confidentiality, privacy, and discrimination are the most accurate.
A) It is permissible for a community health nurse to reveal the name and any other personal health information of a person who has a communicable disease to the public health authorities.
B) It is permissible for a community health nurse to tell the contacts of a person who is
infected with a communicable disease, which disease they have been exposed to, and the name of the source.
C) It is permissible for any health care provider
to report any cases of known or suspected communicable diseases to the news media.
D) Only the identity of the index case of a
communicable disease needs to be protected.
Ans: A
Feedback:
It is permissible and necessary for a community health nurse to reveal the name and any other personal health information of a person who has a communicable disease to the public health authorities. It is important that the contacts of a person who is infected with a communicable disease, which they have been exposed to, are not acceptable for the community health nurse to reveal the identity of the source. It is permissible and often helpful for
a community health nurse to involve the news media in informing the public of information
about the specific disease, including mode of transmission, prevention, and treatment options, but not the identities of the cases. It is important to assure the individual being interviewed that the information will be maintained in a confidential manner and that the goal is care and treatment.
A community health nurse is presenting an in-service for a group of other community
health nurses about the ecological perspective of environmental health. Which of the following
would the nurse incorporate into the program?
when describing this concept?
A) The study of governmental and private sector
regulations of the environment
B) A technological view of strategies for
preventing illness and injury
C) Identification of not only the physical environment but also the social and cultural
factors that exist for populations
D) The role of the community health nurse in
preventing injury, disease, and illness
Ans: C
Feedback:
The ecological perspective identifies not only the physical environment but also the
social and cultural factors that exist for populations. Nurses who display this type of approach
provide a more comprehensive level of care. It is not a study of the governmental and private
sector regulations, a technological view, or the nurse’s role in preventing injury,
disease, and illness.
When applying the ecological perspective to environmental health, a community health
nurse integrates which of the following
concepts as most essential?
A) Primary prevention is limited in this area.
B) The need for foresight in designing
innovations
C) No one factor can be viewed in isolation.
D) Implications of scientific advances are fully
understood.
Ans: C
Feedback:
With the ecological perspective, no one factor can be viewed in isolation. The preventive
approach involves all three levels of prevention, of which primary prevention is the most
important. This approach also requires foresight in designing innovations and involves
implications associated with the unprecedented advances in science and
technology.
Which of the following concepts is used by public health professionals to illustrate that the determinants of health interact to affect
health?
A) Precautionary principle
B) Ecological perspective
C) Sustainability
D) Upstream focus
Ans: B
Feedback:
The ecological perspective is used by public health professionals to illustrate that the determinants of health interact to affect health. The precautionary principle states that in the absence of clear data that indicates the safety of an action, chemical, or material that poses a threat to human health, it should not be used. Sustainability is the ability to meet the needs the present without compromising the ability of future generations to meet their own needs. Upstream focus identifies the root causes of
disease and manufacturers of illness.
Which of the following statements about an
Upstream focus is the most accurate?
A) The upstream approach does not focus on
socioeconomic factors and the environmental origins of disease and health problems.
B) The focus of an upstream approach is the
institution and system level.
C) The upstream approach pertains to the purity
of water supplies.
D) The focus of an upstream approach is healthy
lifestyle issues.
Ans: B
Feedback:
The focus of an upstream approach is at the institution and system level, not just healthy lifestyle issues. The upstream approach does focus on socioeconomic factors and the environmental origins of disease and health problems. The upstream approach does not pertain to the purity of water supplies.
When the public health nurse uses an upstream approach to improve heart health, the
nurse would examine which one of the
following factors?
A) Unhealthy diets
B) Decreased physical activity
C) Smoking tobacco
D) Lack of safe places to exercise
Ans: D
Feedback:
The upstream approach focuses on factors at the institutional and system level rather than looking at healthy lifestyle issues. Healthy diets, increased physical activity, and smoking cessation are all healthy lifestyle issues The root causes of the decreased physical activity would include a lack of safe places to exercise.
A public health nurse who uses the upstream approach would likely focus on which one
of the following contributors to unhealthy diets:
in the community?
A) Consumer preference for sweet, greasy, and
salty foods
B) Marketing strategies of fast food businesses
C) Busy lifestyles within the community
D) Individual acceptance of obesity
Ans: B
Feedback:
A public health nurse who uses the upstream approach would likely focus on factors that
are at the institutional and system level rather than looking solely at healthy lifestyle issues. Consumer preference for sweet, greasy, and salty foods; busy lifestyles within the community; and individual acceptance of obesity are lifestyle issues. The marketing strategies of fast food businesses are one root cause of unhealthy diets in the community.
The nursing student is preparing a report for class relating to Healthy People 2020 and
environmental health. Which of the following should be included in this report? Select all
that apply.
A) The agency that prepared this initiative is the
World Health Organization.
B) The overall goal is to <promote health for all
through a healthy environment.
C) The document provides instructions for people in the community regarding how to protect their own health.
D) One of the six focus areas is global
environmental health.
E) The document provides guidance for nurses to
identify targets for health.
Ans: B, D, E
Feedback:
The overall goal of Healthy People 2020 is to promote health for all through a healthy environment. The document does provide guidance for nurses to identify targets for health (not instructions for individuals). The six areas that are focused on include outdoor air quality, surface and ground water quality, toxic substances and hazardous wastes, homes and communities, infrastructure and surveillance, and global environmental health. The agency that prepared this initiative is the U.S. Department of Health and Services.
Which one of the following statements about assessment (one of the core public health
functions) and how it can be applied to
What environmental health is most accurate?
A) Assessment includes the investigation of
health hazards, surveillance of health issues, examining causes, and assessing needs.
B) Assessment is least valuable when related to
where the person attends school.
C) It is not necessary for nurses to have a background in the environmental health sciences.
D) Assessment should be limited to the general population and should not include the increased vulnerability of certain groups.
Ans: A
Feedback:
Assessment includes the investigation of health hazards, surveillance of health issues, examining causes, and assessing needs. With assessment, priority should be given to locations where people spend the majority of their time (home, work, school). Where persons attend school is too limiting as many people do not go to school and the priority should be given to home and work. The ability to perform critical assessments for environmental health requires
background in the environmental health sciences. Public health nurses must also be aware of the
increased vulnerability of certain groups.
The core public health function of policy development related to environmental health
includes which one of the following?
A) Policy development is best left to legislators.
B) To be an effective advocate for change, it is only necessary that the nurse speak out.
C) There are many ways for public health nurses
to participate in policy development related to environmental health.
D) Public health nurses are public servants and
therefore cannot advocate for public policy.
Ans: C
Feedback
There are many ways for a public health nurses to participate in policy development related to environmental health that start with the nurse being informed about the hazards in the community, existing legislation that protects people in the community, and governmental and nongovernmental groups in communities that can be partners in the efforts to protect health They may write letters to their legislators, inform community members, and write letters to the editors of local newspapers and periodicals. Nurses can also present testimony at public forums or hearings. Policy development is not best left to legislators. It is important for nurses to
advocate for policy development to care for the environment. Public health nurses are public
servants, and that is why they must advocate for policy development that favors the environment.
A community health nurse is enacting policy development by preparing a presentation for
a group of state health officials about the issue of water pollution in the United States. Which of
The following would the nurse include?
Select all that apply.
A) Globally, the availability of clean water is becoming a very serious threat to human survival.
B) Water pollutants consist solely of chemicals.
C) Recently, there has been an increase in concern about pharmaceuticals contaminating water supplies.
D) All water that is to be consumed is regulated through the EPA.
E) The people most vulnerable to serious health problems are the very young, the very old,
and the immune-compromised.
Ans: A, C, E
Feedback:
Globally, the availability of clean water is becoming a very serious threat to human survival. Recently, there has been an increase in concern about pharmaceuticals contaminating water supplies. The people most vulnerable to serious health problems are the very young, the very old, and the immune-compromised. Water pollutants consist of organic and
inorganic chemicals, contamination with microbes, pharmaceuticals, pesticides and insecticides,
and radionuclides. The EPA only regulates public water systems.
A community health nurse is working with the local health departments to educate the citizens about the effects of radon exposure and its link to possible illness. Which of the following would the nurse identify as being a major health concern associated with radon?
A) Skin cancer
B) Lung cancer
C) Diarrhea
D) Cardiovascular disease
Ans: B
Feedback:
Radon is a leading cause of death from lung cancer. Skin cancer is associated with sun exposure. Diarrhea and cardiovascular disease are not associated with radon exposure.
During a community program about food safety, a participant asks, <I know it is
It is important to use safe food practices to avoid microbial contamination, but what other possible
risks are there with our food supply?= Which response by the nurse would
be most appropriate?
A) Nothing is more of a problem than foodborne illness.
B) Risks occur only at food production and not
handling or consumption.
C) Radiating food is something that really
doesn’t occur in the United States.
D) A recent concern has been raised about
genetically modified foods being marketed.
Ans: D
Feedback:
There are many possible risks to the food supply, some even having more serious effects than food-borne illness. Risks occur at all points from food production to food consumption. Radiating food does occur in the United States. A recent concern has been raised about genetically modified foods being marketed. Genetically modified foods may interfere with the safety of food for human consumption and also questions about the ecological impact and
sustainability have been raised.
Which of the following groups of people have increased vulnerability to environmental
hazards to human health related to food?
Select all that apply.
A) Pregnant women are likely to transmit their exposure to chemicals, pesticides, and toxins
to the unborn fetus.
B) Persons who have altered immunity are more likely to be affected by food exposures.
C) Middle-aged males
D) Children are more susceptible to hazards due
to their immature gastrointestinal systems and increased food intake per size.
E) Adult women who are non-childbearing
Ans: A, B, D
Feedback:
Pregnant women are likely to transmit their exposure to chemicals, pesticides, and toxins
to the unborn fetus. Persons who have altered immunity are more likely to be affected by food
exposures. Children are more susceptible to hazards due to their immature gastrointestinal systems and increased food intake per size. Middle-aged males and adult women who are non-childbearing adults are not especially vulnerable to environmental hazards to human health.
