, Question 1
A community health nurse is prioritizing interventions for a county where the
crude incidence of a preventable condition is stable, but the age-adjusted
incidence has risen sharply over five years. Which interpretation best supports
the health promotion plan's rationale?
A. The stable crude rate indicates the condition is adequately controlled
and resources should be redirected.
B. The rising age-adjusted rate suggests a true increase in risk not
explained by population aging, warranting targeted intervention.
C. The divergence between rates reflects random variation and should be
reassessed before any planning.
D. The age-adjusted rate is less valid than the crude rate for community
planning because it discards actual case counts.
Correct Answer: B - The rising age-adjusted rate suggests a true
increase in risk not explained by population aging, warranting
targeted intervention.
RATIONALE
Age-adjustment removes the confounding effect of population aging,
so a rising adjusted rate signals a genuine increase in disease risk that
justifies intervention. A stable crude rate can mask rising risk when
the population is aging. Crude rates are not inherently superior for
planning; adjusted rates are preferred for comparing risk over time or
across populations.
Question 2
Which statement most accurately reflects the role of the PRECEDE-PROCEED
model in developing a community health promotion plan?
A. It focuses exclusively on downstream individual behavior change after
the intervention is implemented.
B. It emphasizes a unidirectional linear process beginning with outcome
Page 2
, evaluation.
C. It guides systematic assessment of social, epidemiologic, behavioral,
and environmental determinants before intervention design.
D. It replaces the need for community engagement because it relies on
expert-driven planning.
Correct Answer: C - It guides systematic assessment of social,
epidemiologic, behavioral, and environmental determinants
before intervention design.
RATIONALE
PRECEDE-PROCEED is a planning framework that begins with
social, epidemiologic, behavioral, and environmental assessment to
identify determinants prior to designing interventions. It is not purely
downstream, not unidirectional from outcomes, and explicitly values
community participation rather than replacing it.
Question 3
A health promotion plan proposes a community garden to improve nutrition.
Which evaluation metric best represents an impact-level (not outcome-level)
indicator?
A. Percentage of participants with BMI reduction at 12 months
B. Number of garden plots constructed and planted
C. Increase in daily servings of fruits and vegetables among participants
at 6 months
D. Reduction in county diabetes prevalence over 10 years
Correct Answer: C - Increase in daily servings of fruits and
vegetables among participants at 6 months
Page 3
, RATIONALE
Impact evaluation measures intermediate behavior or risk-factor
changes, such as dietary intake, that precede long-term health
outcomes. Plot construction is a process measure; BMI reduction and
county diabetes prevalence are outcome measures over longer
horizons.
Question 4
When presenting a health promotion plan to a community coalition, the nurse
must address a stakeholder who argues that the intervention is unnecessary
because 'people just need to make better choices.' Which framing best advances
the plan while respecting the stakeholder?
A. Acknowledge personal responsibility while presenting data on
structural barriers and the evidence that environmental supports improve
choice-making.
B. Reject the stakeholder's view as victim-blaming and proceed with the
presentation.
C. Remove the intervention's environmental components to avoid
conflict.
D. Agree that individual choice is the sole determinant and shift the plan
to education only.
Correct Answer: A - Acknowledge personal responsibility while
presenting data on structural barriers and the evidence that
environmental supports improve choice-making.
RATIONALE
Effective stakeholder engagement validates individual agency while
introducing evidence that social and environmental determinants
shape behavior, supporting a multi-level plan. Dismissing the
stakeholder, weakening the intervention, or abandoning environmental
strategies undermines both the evidence base and coalition buy-in.
Page 4
A community health nurse is prioritizing interventions for a county where the
crude incidence of a preventable condition is stable, but the age-adjusted
incidence has risen sharply over five years. Which interpretation best supports
the health promotion plan's rationale?
A. The stable crude rate indicates the condition is adequately controlled
and resources should be redirected.
B. The rising age-adjusted rate suggests a true increase in risk not
explained by population aging, warranting targeted intervention.
C. The divergence between rates reflects random variation and should be
reassessed before any planning.
D. The age-adjusted rate is less valid than the crude rate for community
planning because it discards actual case counts.
Correct Answer: B - The rising age-adjusted rate suggests a true
increase in risk not explained by population aging, warranting
targeted intervention.
RATIONALE
Age-adjustment removes the confounding effect of population aging,
so a rising adjusted rate signals a genuine increase in disease risk that
justifies intervention. A stable crude rate can mask rising risk when
the population is aging. Crude rates are not inherently superior for
planning; adjusted rates are preferred for comparing risk over time or
across populations.
Question 2
Which statement most accurately reflects the role of the PRECEDE-PROCEED
model in developing a community health promotion plan?
A. It focuses exclusively on downstream individual behavior change after
the intervention is implemented.
B. It emphasizes a unidirectional linear process beginning with outcome
Page 2
, evaluation.
C. It guides systematic assessment of social, epidemiologic, behavioral,
and environmental determinants before intervention design.
D. It replaces the need for community engagement because it relies on
expert-driven planning.
Correct Answer: C - It guides systematic assessment of social,
epidemiologic, behavioral, and environmental determinants
before intervention design.
RATIONALE
PRECEDE-PROCEED is a planning framework that begins with
social, epidemiologic, behavioral, and environmental assessment to
identify determinants prior to designing interventions. It is not purely
downstream, not unidirectional from outcomes, and explicitly values
community participation rather than replacing it.
Question 3
A health promotion plan proposes a community garden to improve nutrition.
Which evaluation metric best represents an impact-level (not outcome-level)
indicator?
A. Percentage of participants with BMI reduction at 12 months
B. Number of garden plots constructed and planted
C. Increase in daily servings of fruits and vegetables among participants
at 6 months
D. Reduction in county diabetes prevalence over 10 years
Correct Answer: C - Increase in daily servings of fruits and
vegetables among participants at 6 months
Page 3
, RATIONALE
Impact evaluation measures intermediate behavior or risk-factor
changes, such as dietary intake, that precede long-term health
outcomes. Plot construction is a process measure; BMI reduction and
county diabetes prevalence are outcome measures over longer
horizons.
Question 4
When presenting a health promotion plan to a community coalition, the nurse
must address a stakeholder who argues that the intervention is unnecessary
because 'people just need to make better choices.' Which framing best advances
the plan while respecting the stakeholder?
A. Acknowledge personal responsibility while presenting data on
structural barriers and the evidence that environmental supports improve
choice-making.
B. Reject the stakeholder's view as victim-blaming and proceed with the
presentation.
C. Remove the intervention's environmental components to avoid
conflict.
D. Agree that individual choice is the sole determinant and shift the plan
to education only.
Correct Answer: A - Acknowledge personal responsibility while
presenting data on structural barriers and the evidence that
environmental supports improve choice-making.
RATIONALE
Effective stakeholder engagement validates individual agency while
introducing evidence that social and environmental determinants
shape behavior, supporting a multi-level plan. Dismissing the
stakeholder, weakening the intervention, or abandoning environmental
strategies undermines both the evidence base and coalition buy-in.
Page 4
