Community As Partner Theory And Practice in Nursing 7th edition by Anderson - Test Bank

1. The concept of prevention is a key component of modern community health practice. Which of the following is an example of primary prevention? A) Immunization clinic for seasonal influenza B) Blood pressure screening for hypertension C) Audiometric testing for hearing impairment D) Skin test for tuberculosis Ans: A Feedback: Providing an immunization clinic for seasonal influenza is an example of the specific health promotion component of primary prevention. Blood pressure screening for hypertension, audiometric testing for hearing impairment, and skin testing for tuberculosis are examples of secondary prevention. 2. The concept of prevention is a key component of modern community health practice. Which of the following is an example of secondary prevention? A) Wearing of protective devices to prevent injury B) Phenylalanine testing for phenylketonuria in infancy C) Physical therapy for stroke victims D) Exercise programs for heart attack victims Ans: B Feedback: Phenylalanine testing for phenylketonuria in infancy is an example of secondary prevention. Wearing of protective devices to prevent injury is an example of the specific health promotion component of primary prevention. Physical therapy for stroke victims and exercise programs for heart attack victims are examples of tertiary prevention. 3. The concept of prevention is a key component of modern community health practice. What is the goal of tertiary prevention? A) General health promotion, such as nutrition, hygiene, exercise, and environmental protection B) Specific health promotion, such as immunizations and the wearing of protective devices to prevent injuries C) Detect and treat a problem at the earliest possible stage when disease or impairment already exists D) Limit disability and rehabilitate or restore affected people to their maximum possible capacities Ans: D Feedback: The goal of tertiary prevention is to limit disability and rehabilitate or restore affected people to their maximum possible capacities. General health promotion, such as nutrition, hygiene, exercise, and environmental protection, as well as specific health promotion, such as immunizations and the wearing of protective devices to prevent injuries, are the goals of primary prevention. Detecting and treating a problem at the earliest possible stage when disease or impairment already exists is the goal of secondary prevention. 4. Which is true of descriptive epidemiology? A) It focuses on the distribution of frequencies and patterns of health events with groups in a population. B) It is the study of the distribution and determinants of health-related states or events in specified populations and the application of this study to improve health. C) It is people with a common characteristic, such as gender, age, and place of residence. D) It seeks to identify associations between a particular disease or health problem and its etiology. Ans: A Feedback: Descriptive epidemiology focuses on the distribution of frequencies and patterns of health events with groups in a population. Epidemiology is the study of the distribution and determinants of health-related states or events in specified populations and the application of this study to improve health. Population is defined as people with a common characteristic, such as gender, age, and place of residence. Analytic epidemiology seeks to identify associations between a particular disease or health problem and its etiology. 5. Which defines demography? A) Statistical study of human populations with reference to size and density, distribution, and vital statistics B) Information about significant characteristics of a population that influence community needs and the delivery of health care services C) Descriptions and comparisons of populations according to the characteristics of age; race; sex; socioeconomic status; geographic distribution; and birth, death, marriage, and divorce patterns D) Health implications that may or may not be addressed by the investigators Ans: A Feedback: Demography is the statistical study of human populations with reference to size and density, distribution, and vital statistics. Demographic statistics provide information about significant characteristics of a population that influence community needs and the delivery of health care services. Demographic studies provide descriptions and comparisons of populations according to the characteristics of age; race; sex; socioeconomic status; geographic distribution; and birth, death, marriage, and divorce patterns. These studies often have health implications that may or may not be addressed by the investigators. 6. When applying epidemiology and demography to the practice of community health, how is the prevalence rate calculated? A) (Number of new cases of specified health condition during time interval/Estimated midinterval population at risk) × 1,000 B) (Number of current cases of a specified health condition at a given point in time/Estimated population at risk at same point) × 1,000 C) (Number of deaths of infants aged < 1 year during time interval/Total live births during time interval) × 1,000 D) (Number of deaths from puerperal cases during 1 year/Number of live births during same year) × 100,000 Ans: B Feedback: Prevalence rate is calculated as (Number of current cases of a specified health condition at a given point in time/Estimated population at risk at same point) × 1,000. Incidence rate is calculated as (Number of new cases of specified health condition during time interval/Estimated midinterval population at risk) × 1,000. Infant mortality rate is calculated as (Number of deaths of infants aged < 1 year during time interval/Total live births during time interval) × 1,000. Maternal mortality rate is calculated as (Number of deaths from puerperal cases during 1 year/Number of live births during same year) × 100,000. 7. How is the specificity of a screening test calculated? A) True positives/Total diseased B) True negatives/Total not diseased C) False negatives/Total diseased or 1 – Sensitivity D) False positives/Total not diseased or 1 – Specificity Ans: B Feedback: Specificity (true-negative rate) is calculated as True negatives/Total not diseased. Sensitivity (true-positive rate) is calculated as True positives/Total diseased. False-negative rate is calculated as False negatives/Total diseased or 1 – Sensitivity. False-positive rate is calculated as False positives/Total not diseased or 1 – Specificity. 8. How does the web of causation view a health condition? A) The result of individual factors B) As an indirect cause of a condition C) Interrelated variables are rarely involved in the cause of a particular outcome. D) Complex interrelationships of numerous factors interacting to increase or decrease the risk of disease Ans: D Feedback: The web of causation views a health condition as the result not of individual factors but of complex interrelationships of numerous factors interacting to increase or decrease the risk of disease. The web identifies a disease as a direct, not indirect, result of a condition and almost always as a result of interrelated variables. 9. How is the proportionate mortality rate calculated? A) (Number of deaths due to a specific cause/Total number of deaths from all cases) × 100 B) (Number of deaths of infants aged < 1 year during time interval/Total live births during time interval) × 1,000 C) (Number of deaths from puerperal cases during 1 year/Number of live births during same year) × 100,000 D) (Number of live births during a time interval/Estimated midinterval population) × 1,000 Ans: A Feedback: Proportionate mortality rate is calculated as (Number of deaths due to a specific cause/Total number of deaths from all cases) × 100. Infant mortality rate is calculated as (Number of deaths of infants aged < 1 year during time interval/Total live births during time interval) × 1,000. Maternal mortality rate is calculated as (Number of deaths from puerperal cases during 1 year/Number of live births during same year) × 100,000. Crude birth rate is calculated as (Number of live births during a time interval/Estimated midinterval population) × 1,000. 10. If the community experiences 2,000 motorcycle fatalities, of which 1,900 are male and 100 are female, what would be the proportion of males killed in motorcycle accidents? _______% Ans: 95 Feedback: A proportion is one number divided by another in which the numerator is a subset of the denominator (i.e., is included in the denominator) and is expressed as a percentage. In this example, the percentage of males to females would be 1,900/2,000 multiplied by 100, which equals 95%. 11. Rates enable researchers to compare different populations in terms of health problems or conditions. When preparing a report to support a research project, using which time frame would be most consistent with the majority of report interpretation data? A) Day B) Week C) Month D) Year Ans: D Feedback: The majority of rates are based on data from a calendar year, which may also present some difficulties. Populations may increase or decrease during a calendar year. To adjust for population changes over the year, the midyear population estimate is generally used because the population at risk cannot be determined accurately. 12. The nurse is comparing populations with different distributions of obesity. Which rate will be helpful in making a comparison of heart disease mortality? A) Crude rate B) Specific rate C) Adjusted rate D) Incidence rate Ans: C Feedback: The adjusted rate is a summary measure in which statistical procedures remove the effect of differences in the composition of the various populations. Rates computed for a population as a whole are crude rates. Rates calculated for subgroups are specific rates. Incidence rates measure those exposed and not exposed to a suspected factor. 13. Which describes relative risk? A) Incidence among those exposed/incidence rate among those not exposed B) Odds of having the condition when the suspected factor is present/odds of having the condition when not exposed to the factor C) Measures the difference between the incidence rates for those exposed and those not exposed to the risk factor D) Identifies whether those in the exposed group will develop the disease or condition when compared with those not exposed Ans: A Feedback: The relative risk expresses the risk ratio of the incidence rate of those exposed and those not exposed to the suspected factor. Odds ratio is a simple mathematical ratio of the odds in favor of having a specific health condition when the suspected factor is present and the odds in favor of having the condition when the factor is absent. Attributable risk measures the difference between the incidence rates for those exposed and those not exposed to the risk factor. Relative risks and odds ratios provide a point estimate (a number) that identifies whether those in the exposed group will develop the disease or condition when compared with those not exposed. 14. Which is an example of an external relative risk factor? A) Age B) Exercise C) Gender D) Race Ans: B Feedback: The concept of relative risk applies when one group of people clearly is exposed and another is not exposed to an external factor such as cigarette smoke, exercise, or foods high in saturated fat. However, it may be confusing to see relative risks applied to internal factors such as age, race, or gender. 15. Which defines a dependent variable? A) Constant characteristic or phenomenon and the health conditions being studied B) Control group and comparison group of the research study C) Outcome or result that the investigator is studying which can change D) Presumed cause of or contributor to variation in the variable Ans: C Feedback: The dependent variable is the outcome or result that the investigator is studying. The dependent variable can change (e.g., health status, knowledge, behavior). Characteristics or phenomena and the health conditions being studied are the variables. Control groups and comparison groups are essential to ensure that associations between variables can be examined. The presumed “cause” of or contributor to variation in the dependent variable is the independent variable. 16. An association may meet all the criteria for causation and later be shown to be false or factitious because of factors that were not known at the time the study was done. Investigators must interpret results with great caution; they rarely consider a cause “proven.” Which is a widely used criterion for evaluating causation? A) Association is not strong. B) Association is not specific. C) Association is temporally correct. D) Association is the result of a confounding variable. Ans: C Feedback: Six widely used criteria for evaluating causation are the association is strong; the association is consistent; the association is temporally correct; the association is specific; the association is not the result of a confounding variable; and the association is plausible and consistent with current knowledge. 17. Which is likely the most comprehensive source of health-related data for the United States? A) Census data B) Notifiable disease reports C) Surveillance data D) Vital statistics Ans: A Feedback: The census is probably the most comprehensive source of health-related data for the United States. The CDC/U.S. Public Health Service reports data collected by state and local health departments on legally reportable diseases and periodically requests voluntary reporting of nonnotifiable health conditions of special interest. Notifiable diseases are frequently referred to as “reportable diseases.” Surveillance data pertain to the occurrence of specific diseases, the analysis and interpretation of these data, and the dissemination of information about the data. Vital statistics are legal data; however, legality does not guarantee validity. The major deficiency of this category of data for epidemiologic research purposes is the possible incompleteness of population coverage. 18. When using medical and hospital records for community health research, Berkson's bias refers to what concept? A) Creating the likelihood of finding a false association between the two or more illnesses B) Autopsy records have an inherent bias because the client's illness was fatal. C) National Electronic Disease Surveillance System provides an integrated surveillance system that transmits public health laboratory and clinical data via the internet. D) Health records provide a representative or valid picture of community health. Ans: A Feedback: Berkson's bias creates the likelihood of finding a false association between the two illnesses. Although medical and hospital records contain comprehensive information about patients seeking services, they do not provide a completely representative or valid picture of community health. Not all clients with health problems receive medical attention; so medical records are biased by including only those that do. Also, medical documentation is not always complete. Hospitalized patients are also more likely to have coexistent illnesses. The National Electronic Disease Surveillance System is a conduit to exchange information health information to public health departments; however, it is only voluntary. 19. When doing a lecture on the epidemiologic triangle, it is important to differentiate each component. When asked a question about what causes a disease, it is important to understand that this organism is called what? A) Agent B) Environment C) Factor D) Host Ans: A Feedback: In the epidemiologic triangle model, the agent is an organism capable of causing disease. The host is the population at risk for developing the disease. The environment is a combination of physical, biologic, and social factors that surround and influence both the agent and the host. 20. The person–place–time model examines the characteristics of the people affected, place or location, and the time period involved. In studying infant mortality, what is considered an example of the person in the model? A) Rural community B) Urban community C) Infant and maternal factors D) Trends in mortality Ans: C Feedback: In studying infant mortality according to this model, infant and maternal factors are considered traits of “person.” Aspects of “place” are such factors as whether the community is rural or urban and affluent or poor. Aspects of “time” include seasonal or age-specific patterns or trends in mortality. 1. When asked about the beginning of public health nursing, the best response would include which of the following? A) Public health nursing is a term started in the mid-1900s. B) The public health nurse provided care to people in communities as far back as the 1890s. C) Public health nursing began when clinics opened that provided community health assistance. D) The public health nurse was recognized after the term public health nursing was identified. Ans: B Feedback: Lillian Wald coined the term public health nurse in 1893. Nurses have had a rich practice in the community, transforming both individual and public health for the poor and disenfranchised through political advocacy long before the 20th century. The public health nurse was one who provided health care to people within a community. Public health nursing started before coining the term public health nurse. 2. Which of the following reflects the major constructs of the nursing paradigm? A) Health, environment, client, and nurse B) Client, community outreach center, nursing, health, and illness C) Society, medicine, nursing, and interactions among individuals D) Psychosocial development, discipline, nursing, and client Ans: A Feedback: The process by which nurses develop healing or caring relationships in the community reflects interactions among the four major constructs of the nursing paradigm: health, environment, client, and nurse. 3. Partnerships between community members and health care professionals are critical. For these partnerships to be successful promoting awareness and understanding of a community's health needs, the partners must have which type of relationship? A) Independent B) Dependent C) Collaborative D) Autonomous Ans: C Feedback: Partnerships between community members and health care professionals are critical for collaborative decisions that promote awareness and understanding of a community's health needs. Community health nurses have power to develop healing relationships or capacity-building activities that promote health and to empower others to engage community members in collaborative efforts, partnerships, and coalitions. 4. When planning the integration of health resources in a community, which of the following people would be the best to lead this effort? A) Physicians B) Nurse practitioners C) Social workers D) Nurses Ans: D Feedback: Nurses have long been at the forefront of integrating health resources by forming partnerships with clients, families, and communities. Community health nurses have the power to develop healing relationships or capacity-building activities that promote health and to empower others to engage community members in collaborative efforts, partnerships, and coalitions. Physicians, nurse practitioners, and social workers serve a specific purpose once the nurse identifies the needs of the individuals within a community. 5. When developing an agenda in a community to effect change, which person(s) would be primary to engage in the development of this agenda? A) Community medical director B) Academic experts C) Individual client D) Community members Ans: D Feedback: A basic tenet of community empowerment is that the community defines its own agenda. Community participation is a crucial element in engaging community members to develop agendas that serve as a cohesive force to mobilize the community toward a process of change. 6. The historical focus of nursing in the community has been replaced by site-managed care systems in the United States. Where is the primary base when planning interventions for this system? Select all that apply. A) Community B) Home C) Primary care clinic D) Hospital E) Long-term care facility Ans: C, D Feedback: Our historical focus of nursing in the community has been replaced by “site-managed care systems,” such as hospitals and primary care clinics, that require the client to come to a facility, rather than the nurse providing care within the community. 7. In moving away from a disease prevention health care system, the focus of nursing has shifted to which type of health care? A) Primary B) Secondary C) Tertiary D) Both primary and secondary Ans: A Feedback: Our challenge as community health nurses is to transform our health care system into one that reflects the values and needs of our communities based on the concepts of primary health care. 8. When planning interventions within a site-managed care system, the planners need to look closely at which type of health care to meet the current model standards? A) Aggregate community-based health care B) Individual medical care C) Family-based health care D) Family- and community-based health care Ans: B Feedback: Modern health care emphasizes individualized medical care as opposed to providing aggregate community-based health care. Our present “system” of health care has not served our profession well and has resulted in fragmented programs and limited return on improving the overall health in communities. 9. Which of the following approaches would be best to implement when trying to modify unhealthy behaviors? A) Focus on medical professionals curing of diseases. B) Mobilize community members to focus on curing diseases. C) Mobilize community members to take an active role in the delivery of services. D) Mobilize community members to involve in the decision-making process to improve health. Ans: C Feedback: There are three approaches to community participation in health programs commonly used by different countries. One is the medical approach, which is focused on curing diseases and is controlled by the medical profession. The second is a health services approach, which mobilizes people to take an active role in the delivery of services based on modifying unhealthy behaviors. The third is a community development approach, in which people are involved in the decision-making process to improve health. The first two approaches to health care are called “top-down” approaches, in which experts prescribe their values of health care for the public. The third approach is at the grassroots level, in which members within the community determine what health care services should be provided. It is more consistent with the principles of primary health care. 10. Which approach to health care is applied through participatory research as a pathway to community empowerment? A) Medical B) Health services C) Community development D) Medical and health services Ans: C Feedback: The community development approach is at the grassroots level, in which members within the community determine what health care services should be provided. The medical and health services approaches to health care are called “top-down” approaches, in which experts prescribe their values of health care for the public. 11. There are three essential components for community participation in health programs. Select the answer that best reflects one of the essential components. A) Framework to define the community B) Participation is a passive, ongoing process. C) Decisions made through participation must be effective. D) People have the right and power to make decisions that affect their lives. Ans: A Feedback: Essential components for community participation include the following: a framework to define the community; shared awareness by members of the community; and mechanisms to mobilize the community to recognize its needs and develop a culture of participation. 12. Empowerment through participation has three essential components to which nurses must be sensitive in order for community transformations to occur. Which statement best describes one of the essential components? A) Shared awareness by members of the health care community B) Mechanisms to mobilize the community to recognize its needs C) Suggest ways to develop a culture of community participation. D) People have the right to choose. Ans: D Feedback: Participation is an active process, not a process in which one group or organization imposes its values on the community, but a process of mutuality, in which all have voice. Participation involves choice, implying people have the right and the power to make decisions that affect their lives. Decisions made through participation must have the potential to be effective, and there must be social systems to allow decisions to be implemented. 13. Which best describes how community health nurses can help a community achieve their common goals? A) Maintenance B) Transforming C) Empowerment D) Implementation Ans: C Feedback: Through community empowerment, nurses can provide a moral voice to inspire change to regain our historical roots as vanguards of the community. Through empowerment, community health nurses can enable people to make decisions and to act on issues they believe are essential to their health or well-being. The other answer choices are not directly related to the empowerment of communities to achieve a set of goals. 14. Trust, faith, and hope are significant concepts that relate closely to developing relationships and ultimately empowerment. For empowerment to be successful, people need to utilize which concept? A) Critical thinking B) Maintaining the “status quo” C) Examining the community outside oneself D) Incorporating theoretical concepts Ans: A Feedback: It is through the process of critically thinking and evaluation that people are ultimately empowered. For empowerment and communication to be successful, people must engage in critical thinking, continually evaluating and reevaluating the premises behind their thoughts. 15. According to Quinn, which is the most complete definition of a right-relationship? A) One pattern of organization within the system that supports and encourages actualization at any level. B) Two patterns of organization within the system that support, encourage, and allow actualization and self-transcendence at any level. C) Any pattern of organization within the system that supports, encourages, allows, or generates self-transcendence—at any and all levels. D) Any pattern of organization within the system that supports, encourages, allows, or generates actualization and self-transcendence—at any and all levels. Ans: D Feedback: Quinn (1997) defined right-relationship as “any pattern of organization within the system that supports, encourages, allows, or generates actualization and self-transcendence—at any and all levels.” 16. Community partnerships develop through a process of empowerment. Which characteristic would indicate a community displays empowerment? Select all that apply. A) Faith in all people of the community B) Hope that dialogue will be established within the health care community C) Mandate positive transformations benefiting the community as a whole D) Discussion grounded in critical thinking without fear of repercussion E) Power differences between and within communities Ans: A, D Feedback: Four characteristics of an empowered community are faith in people; trust established through dialogue; hope in positive transformations benefiting the community as a whole; and discussions grounded in critical thinking without fear of repercussions by those who are in power. 17. Nurses work to empower communities not for domination or control of people, but rather to facilitate the development of others to promote change. Empowerment is gained through critical dialogue. Which characteristic of this dialogue is correct? A) Enables communities to see individuals as the same to impact change for the betterment of humanity B) Enables communities to see their inequities to transform their environment through healing interventions C) Enables communities to envision the key physical characteristics necessary to encourage individual progress of community members D) Enables communities to negotiate with others who have similar viewpoints about the health of the community Ans: B Feedback: The emergence of a healing consciousness in which communities envision a mind–body–spirit connection with humanity can only occur through dialogue. Dialogue provides the critical mass for community transformations to take place. Dialogue enables communities to see their inequities and transform their environment through healing interventions. This spirit of openness implies people are willing to listen to others and negotiate with an understanding of opposing viewpoints. Empowerment is a process of hope, trust, faith, and critical thinking based on mutual concerns and love for other human beings. Empowerment is a dualistic interactive process involving investment in understanding yourself and others and a willingness to impact change for the betterment of humanity. 18. Which of the following represents research that is problem focused and involves all participants? A) Action B) Participatory C) Qualitative D) Quantitative Ans: B Feedback: Participatory research is problem-focused or context-specific research centered on a particular problem involving all participants. Participatory research is similar to action research, in which each person or group engaged in the process is committed to improvement through continuous interaction among dialogue, research, action, reflection, and evaluation. Quantitative research refers to a study in which items can be counted or measured and statistics can be used to analyze the results. Qualitative research refers to a study that involves phenomena as they naturally occur. 19. Which statement best represents a core principle of participatory and action research? A) Community members and the researchers should strive to achieve mutual goals. B) The community health nurse for the research project determines the research agenda. C) The process should be laissez faire and empower the participation of a wide range of community members. D) The relationship between health care experts and community members must be kept confidential. Ans: A Feedback: The six core principles of participatory and action research are as follows: the participants in the research project determine the research agenda; the research project should benefit the community as a whole and allow community members to make informed decisions and act collectively; the relationship between health care experts and community members should be a collaborative effort based on the principles of shared dialogue; community members should have access to all information and knowledge from which they might normally be excluded; the process should be democratic and empower the participation of a wide range of community members; and community members and the researchers should strive to achieve mutual goals. 20. Emancipatory inquiry provides a framework to expand the political consciousness of the disenfranchised in a community. Who identifies the important problems for this inquiry? A) Community members B) Community health nurse C) Community health professionals D) Community medical director Ans: A Feedback: The problems examined through emancipatory inquiry are those that community members believe are important and not necessarily those identified by health professionals in the community. Nurses are challenged to awaken the spirit of social change among those who are most vulnerable in our communities.