Community Nursing Exam #1 Questions and Answers

Community Nursing Exam #1 Questions and Answers 3. Which of the following is the primary focus of public health nursing? a. Families and groups b. Illness-oriented care c. Individuals within the family unit d. Promotion of quality of life ANS: D The key difference between community-based and community-oriented nursing is that community-based nurses deal primarily with illness-oriented care, whereas community-oriented nursesor public health nursesprovide health care to promote quality of life. 1. Which of the following best describes community-based nursing? a. A philosophy that guides family-centered illness care b. Providing care with a focus on the groups needs c. Giving care with a focus on the aggregates needs d. A value system in which all clients receive optimal care ANS: A By definition, community-based nursing is nursing that focuses on family-centered illness care to individuals and families in the community. 2. Which of the following best describes community-oriented nursing? a. Focusing on the provision of care to individuals and families b. Providing care to manage acute or chronic conditions c. Giving direct care to ill individuals within their family setting d. Having the goal of health promotion and disease prevention ANS: D By definition, community-oriented nursing has the goal of preserving, protecting, or maintaining health to promote the quality of life. All nurses may focus on individuals and families, give direct care to ill persons within their family setting, and help manage acute or chronic conditions. 4. Which of the following is responsible for the dramatic increase in life expectancy during the twentieth century? a. Technology increases in the field of medical laboratory research b. Advances in surgical techniques and procedures c. Sanitation and other public health activities d. Use of antibiotics to fight infections ANS: C Improvement in control of infectious diseases through immunizations, sanitation, and other public health activities led to the increase in life expectancy from less than 50 years in 1900 to more than 77 years in 2002. 5. A nurse is developing a plan to decrease the number of premature deaths in the community. Which of the following interventions would most likely be implemented by the nurse? a. Increase the communitys knowledge about hospice care. b. Promote healthy lifestyle behavior choices among the community members. c. Encourage employers to have wellness centers at each industrial site. d. Ensure timely and effective medical intervention and treatment for community members. ANS: B Public health approaches could help prevent about 70% of early deaths by influencing the way people eat, drink, drive, engage in exercise, and treat the environment. 6. Which of the following is a basic assumption of public health efforts? a. Health disparities among any groups are morally and legally wrong. b. Health care is the most important priority in government planning and funding. c. The health of individuals cannot be separated from the health of the community. d. The government is responsible for lengthening the life span of Americans. ANS: C Public health can be described as what society collectively does to ensure that conditions exist in which people can be healthy. 7. Which of the following actions would most likely be performed by a public health nurse? a. Asking community leaders what interventions should be chosen b. Assessing the community and deciding on appropriate interventions c. Using data from the main health care institutions in the community to determine needed health services d. Working with community groups to create policies to improve the environment ANS: D Although the public health nurse might engage in any of the tasks listed, he or she works primarily with members of the community to carry out core public health functions, including assessment of the population as a whole and engaging in promoting health and improving the environment. 8. Which of the following public health nurses most clearly fulfills the responsibilities of this role? a. The nurse who met with several groups to discuss community recreation issues b. The nurse who spent the day attending meetings of various health agencies c. The nurse who talked to several people about their particular health concerns d. The nurse who watched the city council meeting on local cable television ANS: B Any of these descriptions might represent a nurse communicating, cooperating, or collaborating with community residents or groups about health concerns. However, the nurse who spent the day attending meetings of various health agencies is the most representative, because in public health, concerns are broader than recreation, individual concerns are not as important as aggregate priorities, and watching television (a one-way form of communication) is less effective than interacting with others. 9. Which of the following best defines aggregate? a. A large group of persons b. A collection of individuals and families c. A group of persons who share one or more characteristics d. Another name for demographic group ANS: C An aggregate is defined as a collection of people who share one or more personal or environmental characteristics, such as geography or special interest. 10. A registered nurse was just employed as a public health nurse. Which question would be the most relevant for the nurse to ask? a. Which groups are at the greatest risk for problems? b. Which patients should I see first as I begin my day? c. With which physicians will I be most closely collaborating? d. With which nursing assistants will I partner the most? ANS: A Asking which groups are at greatest risk reflects a community-oriented perspective. The other possible responses reflect a focus on individuals. 11. Making sure that essential community-oriented health services are available defines which of the core public health functions? a. Policy development b. Assessment c. Assurance d. Scientific knowledge-based care ANS: C Public health is based on scientific knowledge but is not a core function. The definition does not fit the terms assessment or policy development. 12. When talking to a womens group at the senior citizens center, the nurse reminded them that the only way the center would be able to afford to provide transportation services for them would be for them to continue to write letters to their local city council representatives requesting funding for such a service. What was the nurse trying to accomplish through this action? a. Ensure that the women did not expect the nurse to solve their problem b. Demonstrate that the nurse understood the womens concerns and needs c. Express empathy, support, and concern d. Help the women engage in political action ANS: D Public health nurses engage themselves and others in policy development and encourage and assist persons to communicate their needs to those with the power to take action. 13. The public health nurse has a clear vision of what needs to be done and where to begin to improve the health of the community. Why would the nurse spend time meeting with community groups to discuss the most important task to be addressed first? a. To increase the groups self-esteem b. To maintain communication links with the groups c. To make the groups feel good about their contribution d. To work with the groups, not for the groups ANS: D Historically, health care providers have been accused of providing care for or to people without actually involving the recipients in the decisions. Public health nursing is a with the peoplenot a to the people or for the peopleapproach to planning. 14. The nurse often has to make resource allocation decisions. Which of the following best describes the criterion the nurse should use in such cases? a. The specific moral or ethical principle related to the situation b. The cheapest, most economical approach c. The most rational probable outcome d. The needs of the aggregate rather than a few individuals ANS: D Although all of the choices represent components of a decision that the nurse might consider, the dominant needs of the population outweigh the expressed needs of one or a few people. 15. Which of the following actions best represents public health nursing? a. Assessing the effectiveness of the large high school health clinic b. Caring for clients in their home following their outpatient surgeries c. Providing care to children and their families at the school clinic d. Administering follow-up care for pediatric clients at an outpatient clinic ANS: A A public health or population-focused approach would look at the entire group of children being served to determine whether available services are effective in achieving the goal of improving the health of the school population. 16. Two nurses plan to walk under a huge downtown bridge where various homeless persons live. Why would the nurses go to such an unsafe area? a. To assess the needs of the homeless who live there b. To demonstrate their courage and commitment c. To distribute some of their own surplus clothes to those who can use them d. To share with various churches and other charities what is needed ANS: A In most nursing practices, the client seeks out and requests assistance. In public health nursing, the nurse often reaches out to those who might benefit from a service or intervention, beginning with assessment of needs. 1. Which of the following variables have led to a stronger commitment to population-focused services? (Select all that apply.) a. Economic turmoil and demand for high-technology care b. Emergence of new or drug-resistant infectious diseases c. Emphasis on overall health care needs rather than only on acute care treatment d. Threat of bioterrorism ANS: B, C, D As overall health needs become the focus of care in the United States, a stronger commitment to population-focused services is emerging. Threats of bioterrorism, anthrax scares, and the emergence of modern-day epidemics have drawn attention to population-focused safety and services. 2. Which of the following actions demonstrate(s) effective public health nursing practice in the community? (Select all that apply.) a. Epidemiologic investigations examine the environment for health hazards. b. New services are organized where particular vulnerable populations live. c. Partnerships are established with community coalitions. d. Staff members at the public health agency continue to increase in number. ANS: A, B, C Evidence that public health nurses are practicing effectively in the community would include these: organizing services where people live, work, play, and learn; working in partnerships and with coalitions; and participating in epidemiologic studies. 3. Why are nurses increasingly providing care in clients homes rather than in hospitals? (Select all that apply.) a. Home care is less expensive. b. It is much more efficient to give care in the home. c. Nurses prefer to give home care with individual attention. d. People prefer to receive care in their homes rather than in hospitals. ANS: A, D An increasing number of clients are receiving care in the home because it is less expensive and clients prefer to receive care in familiar and comfortable settings. It is not more efficient nor more convenient, since travel time has to be considered. Nurses differ as to their preferred employment setting. 1. A nurse is using analytic epidemiology when conducting a research project. Which of the following projects is the nurse most likely completing? a. Reviewing communicable disease statistics b. Determining factors contributing to childhood obesity c. Analyzing locations where family violence is increasing d. Documenting population characteristics for healthy older citizens ANS: B Epidemiology refers not only to infectious epidemics but also to other health-related events. Analytic epidemiology looks at the etiology (origins or causes) of disease. 2. A nurse is employed as a nurse epidemiologist. Which of the following activities would most likely be completed by the nurse? a. Eliciting the health history of a client presenting with an illness b. Evaluating the number of clients presenting with similar diseases c. Performing a physical examination of an ill client d. Providing treatment and health education to a client with a disease ANS: B Epidemiology differs from clinical medicine, which focuses on the diagnosis and treatment of disease in individuals. Epidemiology monitors the health of the population. 3. Which of the following actions by Florence Nightingale demonstrates her role as an epidemiologist? a. She convinced other women to join her in giving nursing care to all the soldiers. b. She demonstrated that a safer environment resulted in decreased mortality rate. c. She obtained safe water and better food supplies and fought the lice and rats. d. She met with each soldier each evening to say goodnight, thereby giving psychological support. ANS: B Nightingale examined the relationship between the environment and the recovery of the soldiers. Using simple epidemiological measures, she was able to show that improving environmental conditions and adding nursing care decreased the mortality rates of the soldiers. Nightingale used statistics to document decreased mortality rates when the environmental factors were improved. 4. Which of the following statements describes how nursing in the community is more challenging than nursing in an acute care setting? a. There is limited access to information useful to the nurse in giving care in the community. b. More paperwork and forms are required when giving care in the home. c. It is more challenging to control the environment in the community. d. Specialization isnt possible in the community setting. ANS: C In the community, nurses often use epidemiology, since the factors that affect the individual, family, and population group cannot be as easily controlled as in acute care settings. It is essentially impossible to control the environment in the community. 5. Several small communities have applied for grant funding from the state department of health to help decrease their teenage pregnancy rate. Which of the following communities should the nurse suggest receive funding first? a. Community Awith 23 single teenage pregnancies in a city of 500 b. Community Bwith 45 single teenage pregnancies in a city of 1000 c. Community Cwith 90 single teenage pregnancies in a city of 2000 d. Community Dwith 90 single teenage pregnancies in a city of 1500 ANS: D Without doing any actual math, it should be fairly obvious that 23:500, 45:1000, and 90:2000 are all about the same proportion but that 90:1500 is a larger proportion. Doing the math, the pregnancy rates of A, B, and C are 45-46:1000, whereas the rate in Community D is 60:1000. 6. Between 2000 and 2005, 1000 of 10,000 young women ages 17 to 20 years at a university tested positive for a sexually transmitted infection (STI). Of the 1000 diagnosed STIs, 300 were gonorrhea and 500 were chlamydia. Which of the following statements best summarizes these findings? a. The proportion of cases of gonorrhea to all STIs was 300:1300. b. The proportion of cases of gonorrhea to chlamydia was 300:500. c. The proportion of cases of gonorrhea to all STIs was 50%. d. The proportion of STIs to the total population was 100:1000. ANS: D A proportion is a ratio in which the denominator includes the numerator. If the proportion is small, we can express the number per 1000. The answer of 300:1300 adds the total of the numerator to the denominator, which is unnecessary because the gonorrhea cases were already included in the denominator. In the answer of 300:500, the ratio comparing gonorrhea to chlamydia does not meet the epidemiological definition of proportion (i.e., the denominator must contain the numerator). Although proportions may be expressed as percentages, in the answer of 50% the percentage reflects the number of gonorrhea cases to all STIs, which doesnt summarize the total STI problem. The answer of 100:1000 correctly summarizes that 1000 of 10,000 (or 100:1000) young women had the problem. 7. The nursing staff has attempted to screen the entire African-American population in the community for diabetes. Which of the following would provide immediate verification of the success of the nursing staffs efforts? a. An epidemic of diabetes will be recognized. b. The incidence of diabetes will increase in the community. c. The prevalence of diabetes will decrease in the community. d. The risk for diabetes in the community will increase. ANS: B If the screening has been successful, more diabetes will be diagnosed and, hopefully, treated. Thus, the incidence of new cases will increase. Overall, prevalence will also increase, but that is not one of the answer options. 8. In a particular community, several high school students were diagnosed with diabetes mellitus Type 2 during the annual high school health fair. Over the next few years, the nursing staff developed and implemented educational programs about the risk factors for diabetes mellitus Type 2 and proper nutrition. Which of the following would be most useful for the nurses to use to determine if they are having any impact? a. The epidemic of diabetes in the high school is gradually ending. b. The incidence of diabetes is slowly decreasing during screening events. c. The prevalence of diabetes is slowly decreasing during screening events. d. The risk for diabetes is slowly increasing over time. ANS: B Incidence rates and incidence proportions are the measure of choice to study etiology because incidence is affected only by factors related to the risk of developing disease and not to survival or cure. Prevalence is a fairly stable number over time, but incidence reacts more quickly to changes in risk factors or intervention programs. If the educational programs are having the desired impact, the incidence of diabetes being diagnosed will decrease in future screenings. 9. This year 600 of 8000 young women ages 17 to 20 years at a university health center tested positive for a sexually transmitted infection (STI). Which of the following terms best describes this data? a. An epidemic b. Incidence c. Prevalence d. Risk ANS: C Because we do not have baseline data, we have no way to conclude that this is an epidemic with higher-than-normal results from the screening. Incidence refers to new cases, whereas prevalence means all cases. We dont know whether the finding represents the first time a woman was told she had an STI or whether she had previously been diagnosed with the problem. Therefore, we cant say whether these are new cases (incidence), but the results do represent all cases (prevalence). Risk is the probability of developing an STI, but no risk factors are discussed. 10. A nursing staff has successfully screened for diabetes in the community. Which of the following might best persuade the health board to increase funding for diabetic clinics in this community? a. An epidemic of diabetes is now recognized and must be addressed. b. The incidence of diabetes is now higher than previously recognized in the community. c. The prevalence of diabetes is now higher than previously recognized in the community. d. The risk for diabetes in the community could decrease if funding is received. ANS: C If more people are now being diagnosed with diabetes and need support, more ongoing services will be needed for this population. Incidence may go up and down, but prevalence is a fairly stable number. 11. A public health nurse found that out of the 70 people who ate the potato salad at a school picnic, 63 developed symptoms of food poisoning. Which of the following best describes the attack rate? a. 63% b. 70% c. 90% d. 100% ANS: C The attack rate is the proportion of persons exposed to an agent who develop the disease. Because 63 of the 70 persons became ill, the attack rate is 63:70, or 90%. 12. A man is diagnosed with prostate cancer. Which of the following data should the nurse know to answer the man when he asks, What are the chances Ill survive this thing? a. Attack rate b. Case fatality rate c. Cause-specific morbidity rate d. Crude mortality rate ANS: B The case fatality rate (CFR) is the proportion of persons diagnosed with a particular disorder (i.e., cases) who die within a specified period. The CFR is considered an estimate of the risk for death within that period for a person newly diagnosed with the disease. Persons diagnosed with a particular disease often want to know the probability of surviving. The CFR provides that information. 13. Which of the following statistics is used by countries to compare the success of their health care systems? a. Attack rate b. Infant mortality rate c. Cause-specific morbidity rate d. Cause-specific mortality rate ANS: B Infant mortality is used around the world as an indicator of overall health and availability of health care services. 14. A nurse is examining all of the various factors which can lead to disease. Which of the following models would the nurse most likely use? a. Epidemiologic triangle b. Health promotion c. Levels of prevention d. Natural history of disease ANS: A The epidemiologic triangle categorizes factors as agent, host, or environment. The model encourages the health care provider to examine all the influences that lead to increased risk. Levels of prevention are actions taken to improve health outcomes. Health promotion addresses health improvement, not the risk for disease. 15. A nurse is examining the various factors that lead to disease and suggests several areas where nurses could intervene to reduce future incidence of disease. Which of the following models would the nurse most likely use? a. Epidemiologic triangle b. Health promotion c. Levels of prevention d. Web of causality ANS: D The web of causality model recognizes the complex interrelationships of many factors interacting to increase or decrease the risk for disease. Causal relationships (one thing or event causing another) are often more complex than the epidemiologic triangle conveys. With all the various antecedents identified, the nurse can then decide in which areas interventions are possible. 16. Which of the following actions would a nurse take to reduce the high incidence of coronary artery disease (CAD) in a community? a. Introduction of a heart-healthy curriculum beginning in the first grade, presentations on diet and exercise for the community at large, and special education sessions for high-risk populations b. Provision of online activities related to prevention of cardiac disease, smoking reduction programs, and blood pressure screenings c. Distribution of handouts, including age-appropriate games, self-assessments, and education on heart-healthy lifestyles; availability of community screenings for hyperlipidemia in persons age 35 and older; and walking programs for those affected with CAD d. Enrollment of clients with CAD into cardiac rehabilitation programs, routine evaluation of effectiveness of CAD treatment regimens, and participation in clinical trials that evaluate interventions for tho ANS: C Education in schools, the community, and high-risk populations focuses only on primary prevention activities. Online activities focus only on primary and secondary prevention. Efforts focused only on those who already have CAD are not primary prevention. Distributing handouts includes all three levels of prevention to target all members of the population. Targeting all members of the population and implementing all levels of prevention increase the likelihood of positive outcomes for the community as a whole. 17. A school nurse wants to decrease the incidence of obesity in elementary school children. Which of the following describes a secondary prevention intervention that the nurse could implement? a. Giving a presentation on the importance of exercise and physical fitness b. Designing a game in which students select healthy food choices c. Weighing students to identify those who are overweight d. Putting students on a diet if they weigh greater than 20% of their ideal weight ANS: C Secondary prevention refers to interventions that increase the probability that a person with a condition will have the condition diagnosed early. Health screenings are the mainstay of secondary prevention. Weighing students and assessing whether the weight is higher than recommended will allow for early intervention so that obesity may be avoided. 18. A nurse advises a client with osteoporosis to have three servings of milk or dairy products daily. Which of the following levels of prevention is being used by the nurse? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Treatment, but not prevention ANS: C Interventions that prevent worsening of a condition are tertiary prevention activities. In this instance, the client already has a health problem (osteoporosis). By advising adequate dairy intake, the nurse aims to ensure that enough calcium is available to limit worsening of the osteoporosis. 19. A nurse has only a regular blood pressure cuff when conducting a health screening for all of the residents of a community. Which of the following may be lacking when obtaining blood pressure readings? a. Reliability b. Sensitivity c. Specificity d. Validity ANS: D Validity is the accuracy of a test or measurement, or how closely it measures what it claims to measure. With only one regular BP cuff, the nurse cannot obtain accurate measurements on those who are extremely obese or extremely thin. A thigh cuff and a pediatric cuff would allow the nurse to obtain accuratethat is, validmeasurements. 20. A nurse is administering a tuberculosis skin test to a client who has AIDS. Which of the following results should the nurse anticipate when using this screening test? a. Decreased positive predictive value b. Decreased reliability c. Decreased sensitivity d. Decreased specificity ANS: C Persons with immune deficiencies may have a negative tuberculosis skin test even though they are infected. Sensitivity is the extent to which a test identifies those individuals who have the condition being examined. AIDS is an acquired immune deficiency; thus, clients with AIDS may have a false-negative response to TB skin tests; that is, they have the disease but the test is not sensitive enough to detect infection in these individuals. Therefore, there is decreased sensitivity with those clients. 21. Persons in an auditorium may have been exposed to a disease. If they are infected, it is crucial that they receive immediate treatment and not take the disease home to their families. Which of the following characteristics would be most important to consider when selecting the screening test to be used? a. The negative predictive value b. The positive predictive value c. The sensitivity of the test d. The specificity of the test ANS: C Because it is most important to identify every case, the sensitivity of the test is crucial. High sensitivity is needed when early treatment is important and when identification of every case is important. 22. A woman is sitting in a corner of the clinical waiting room, crying audibly. The nurse asks, Whats wrong? Can I help? The woman responds, They just told me I have a positive mammogram and I need to see my doctor for follow-up tests. I know Im going to die of cancer. How can I tell my family? Which of the following information does the nurse need to know in order to help the woman cope with this finding? a. The negative predictive value of mammography b. The positive predictive value of mammography c. The reliability of mammography d. The validity of mammography ANS: B The positive predictive value is the proportion of persons with a positive test who actually have the disease, interpreted as the probability that an individual with a positive test has the disease. 23. The administration at a local medical center examines the trends in health problems when developing long-range plans for staffing and space allocation. Which of the following sources of information would be most helpful? a. Local data drawn from a professional survey in the city b. The National Health Interview Survey c. The National Hospital Discharge Survey d. The states vital statistics ANS: A The National Health Interview Survey and the National Hospital Discharge Survey both provide information on the health status and behaviors of the national population. For many studies, however, the only way to obtain the needed information is to collect the required data in a study specifically designed to investigate a particular question. 24. Statistics clearly demonstrate that there are significantly more cases of a disease in one particular neighborhood than in all the rest of the city. Assuming all else is the same, which of the following is the most likely explanation for a single neighborhood having such a different pattern of illness? a. A cultural or ethnic concentration in the neighborhood b. The geographical location of the neighborhood within the city c. A statistical fluke without meaning d. The time of year the different statistics were collected throughout the city ANS: A Although any explanation is possible, the most probable reason is that there is a cultural or ethnic concentration in that particular neighborhood that has a different lifestyle pattern, resulting in different health outcomes.