Community Health Nursing FINAL EXAM Questions and Answers correct

Community Health Nursing FINAL EXAM Questions and Answers correct Studies in analytic epidemiology differ from descriptive epidemiology because they seek to answer what kind of questions? The WHY questions. Descriptive epidemiology describes the distribution of disease, death, and other health outcomes in the population according to person, place, and time—the who, where, and when of disease patterns. Analytic epidemiology, by contrast, searches for the determinants of the patterns observed—the how and why of disease patterns. Nurses in community health often use epidemiology because in the community, it is often difficult to control the environment. Which statement demonstrates an epidemiological strategy for monitoring disease trends? a)A community health nurse (CHN) conducts a diabetic education class for newly diagnosed clients. b)A CHN investigates reported cases of whooping cough in an elementary school. c)A CHN organizes a health and wellness fair at the community health centre. d)A CHN participates on a county school board that addresses student health issues. A Nurses are a key part of the interdisciplinary team in community settings and are involved in the surveillance and monitoring of disease trends. A CHN teaches a client with asthma to recognize and avoid exposure to asthma triggers and assists the family in implementing specific protection strategies, such as removing carpets and avoiding pets. What level of intervention is represented by this practice? a) Assessment b) Primary prevention c) Secondary prevention d) Tertiary prevention B Primary prevention refers to interventions that promote health and prevent the occurrence of disease, injury, or disability. Interventions at this level are aimed at individuals and groups who are susceptible to disease but have no discernible pathology (i.e., they are in a state of prepathogenesis). A breast cancer screening program screened 8 000 women and discovered cancer in 35 women who had previously been diagnosed with breast cancer and in 20 women with no previous history of breast cancer. What is the prevalence rate of breast cancer in this scenario? a)Current and past breast cancer events in this population of women b)Newly diagnosed cases of breast cancer in this population of women c)Past breast cancer events in this population of women d)Population of women who had no evidence of breast cancer Current and past breast cancer events in this population of women (20+35/8000) The prevalence rate identifies the number of persons in a population that have a disease or experienced an event at a particular time (i.e., the number of existing [old and new] cases divided by the population at risk). One of the basic concepts in epidemiology is the concept of risk. How is risk can be defined? The probability that an event will occur within a specified time period. Notable developments in history have contributed to the science of epidemiology. List, in order of occurrence (earliest to most recent event), the following developments that contributed to this science. a) Germ theory, pasteurization, and antiseptic surgery b) Person, place, and time examined for influence on health c) Appearance of Ebola virus and drug-resistant forms of old diseases d) Effective vaccinations, immunizations, and mass screening programs implemented B, A, D, C A nurse is concerned about the accuracy of a purified protein derivative (PPD) test in identifying cases of TB exposure for follow-up chest X-ray. Which measure will help the nurse address the validity of the test? a)Reliability b)Sensitivity c)specificity d)variation B Validity of a screening test is measured by sensitivity and specificity. Sensitivity quantifies how accurately the test identifies those with the condition or trait. It represents the proportion of persons with the disease whom the test correctly identifies as positive (true positives). High sensitivity is needed when early treatment is important and when identification of every case is important. A description of health-related patterns in a population should take into account which information? a)The size of the population at risk during a specified time period b)The annual number of cases of the health-related event c) The ratio of the number of cases to the frequency of the health event d)The simple count of cases in the general population A Any description of disease patterns should take into account the size of the population at risk for the disease. That is, it should look not only at the numerator (the number of cases) but also at the denominator (the number of people in the population at risk) during the specified time period each was observed. Which study designs uses aggregate data, such as population rates, to determine the association between exposure and outcome? a)Case control studies b)Cohort studies c)Cross-sectional studies d)ecological studies Ecological studies Ecological studies use aggregate data, rather than data on individuals' exposures, characteristics, and outcomes. In ecological studies, the descriptive component considers variations in disease rates by person, place, or time. The analytic component in ecological studies tries to determine if there is a relationship between disease rates and variations in rates for possible risk (or protective) factors or characteristics. A business executive develops symptoms of the flu one day after returning by air from a cross-Atlantic business trip that ran for two consecutive, stressful 10-hour days. What relationships are illustrated by this development of flu symptoms? a)Person, place, and time b)Host, agent, and environment c)Risk and causality d)Morbidity and disease B Epidemiologists understand that disease results from complex relationships among causal agents, susceptible persons, and environmental factors. These three elements—agent, host, and environment—are called the epidemiological triangle, a model that is particularly suited to infectious disease epidemiology. Changes in one of the elements of the triangle can influence the occurrence of disease by decreasing or increasing a person's risk of disease. Twenty people attended a church picnic on the weekend. By Monday, four individuals exhibited symptoms of food poisoning. On Tuesday, the CHN records the addition of two new cases. What is the incidence rate for this occurrence? Two new cases divided by 16 at risk An incidence rate quantifies the rate of development of new cases in a population at risk (persons without the event or outcome of interest but who have a chance of experiencing it). Which test measure is affected by the prevalence of disease in the screened population? a)sensitivity b)specificity c)Predictive value d)Validity C Although sensitivity and specificity are relatively independent of the prevalence of disease, predictive values are affected by the level of disease in the screened population and by the sensitivity and specificity of the test. CHNs practising within the comprehensive school health framework spend significant amounts of time focusing on the prevention of health issues in schoolchildren at a stage that is early enough to avoid risk factors arising in the first place. This is an example of which type of prevention? Primordial prevention Primordial prevention focuses on preventing risk factors for health issues from ever occurring. Research about primordial prevention continues to demonstrate its importance for policy development and population health promotion. A school nurse is working with the school council of an elementary school to improve the health status of preschoolers in a lower socioeconomic rural community that has a high population of Indigenous youth. Given the demographics of this community, the nurse believes this population is at increased risk for which concern? a)asthma b)allergies c)poor nutrition d)poisoning C Low-income and minority families are at increased risk for poor nutrition. Promoting good nutrition and dietary habits is one of the most important aspects of maintaining child health. The first 6 years in a child's life are the most important for developing sound lifetime eating habits. The quality of nutrition has been widely accepted as an important influence on growth and development. It is now becoming recognized as having an important role in disease prevention. Which statement(s) supports the need for a preventive focus for men's health? a)Men tend to avoid medical help as long as possible. b)More males die at birth. c)Men frequently engage in risk-taking behaviour. d)Men experience fewer episodes of chronic disease. A, C What is the number one killer of women in Canada, and a major cause of disability in this population? CVD Once considered a disease of men, cardiovascular disease is now the number one killer of women in Canada and is a major cause of disability. The onset of cardiovascular disease in women is approximately 10 years later than in men. The mortality of 40% of Canadian women can be attributed to cardiovascular disease. The total of all changes, not just physiological changes, that occur in a person with the passing of time can best be referred to as which of the following? a)Aging b)Geriatrics c)GErontology d)Elder care A Aging is not defined from a purely physiological perspective. It is more appropriately defined as the total of all changes that occur in a person with the passing of time. Influences on how one ages come from several domains that include the physiological processes, as well as psychological, sociological, and spiritual processes. Which chronic health problem adversely affects the aging experience but is difficult to estimate the numbers affected or the costs associated with managing it? a)Iatrogenic drug reactions b)Immobility c)Incontinence d)Intellectual impairment C Urinary incontinence often contributes to institutional care and social isolation. For this reason, it is difficult to estimate the numbers of individuals affected and the cost of incontinence. It is important to address continence routinely in the assessment process, identify the type of incontinence, and intervene appropriately. The later years of life for many older adults marks a period of abruptly changing social dynamics over which the older adult has very little control and resulting in which phenomena? a)dementia b)age-assoc memory impairment c)instability d)increased spiritual awareness D What is the single most important factor in the improvement of the health status of women and their families? a)Access to reproductive health services b)The economic status of women c)The education of women d)The longevity of women C Worldwide, the education of women is the single most important factor in the improvement of the health of women and their families. As women are educated, their socioeconomic status improves and mortality rates decline. Because women's financial stability is closely linked to health outcomes, it is essential to promote policies that support the advancement of women. Being female and having a family history are risk factors for which health concern? a)depression b)CVD c)cancer d)osteoporosis A Depression is a particularly serious problem for women. A number of factors contribute to depression in women, including biological factors (genetics, gonadal hormones) and psychosocial factors (life stress, trauma, interpersonal relationships). Risk factors for depression include being unemployed and having a chronic disease. CHNs recognize that the prevalence of chronic disease increases with the lengthening of the lifespan and the presence of highly technical care. What then is a priority of focus for community health nursing activities for individuals who have a chronic illness? a)The elimination of signs of the chronic illness b)The elimination of the symptoms of the chronic illness c)Healing the body, mind, and spirit d)Palliation and prevention measures C In chronic illness, a cure is not expected, so community health nursing activities need to be more holistic, addressing function, wellness, and psychosocial issues. With chronic illness, the focus is on healing (a unique process resulting in a shift in the body, mind, and spirit system) rather than curing (the elimination of signs and symptoms). What comprises the unit of care when the CHN approaches the family as client? a)The family group, with the community in the background b)The individual family members, with the community in the background c)The family group, with the individual family members in the background d)The individual family members, with the family group in the background C For CHNs, it is important in clinical practice to distinguish between caring for the "individual as client" with the family as the context for care, and the "family as client" and, therefore, the unit of care. In the former instance, the individual family member is the unit of care, with the family members in the background in their context as resource. In the latter instance, the family group is the unit of care and the individual is in the background. Nursing interventions and approaches for helping individuals and families assume that an active role in their care should focus on empowerment rather than enabling. What is the underlying principle of empowerment? a)Client dominance b)Decreased competence c)Professional dominance d)Professional-client partnership Professional-client partnership Empowerment's underlying assumption is one of partnership between the professional and the client, as opposed to one in which the professional is dominant. Families are assumed to be either competent or capable of becoming competent. A nurse in community health is conducting an assessment of a family of four. During the assessment, the nurse collects information about previous generations of the family and siblings which is used to create a diagram for the family that displays the family unit across generations. What is this diagram called? Genogram When the CHN asks a family questions such as "What has changed between you and your spouse since your child's head injury?" the nurse is conceptualizing the family from which perspective? a)Family as the context, or structure b)Family as client c)Family as a system d)Family as a component of society C The focus is on the family as client, and the family is viewed as an interacting system in which the whole is more than the sum of its parts. This approach simultaneously focuses on individual family members and the family as a whole. The interactions between family members become the target for nursing interventions. The systems approach to family always implies that when something happens to one family member the other family members are affected. Which process helps families to begin viewing the family unit (and for the family to view themselves) in a different, more positive, light? a)Transition b)Commendation c)Circular communication d)Resilience B This means that the health professional praises the family for patterns in behaviour that are family strengths within the family unit. Using commendations as an intervention helps to change family functioning in the cognitive domain. When nurses use a family strengths approach, the family focuses on its visions and hopes for the future. Why is it important to understand family demographics? a)This understanding will help the community health nurse (CHN) determine if the family is lower or higher functioning. b)This understanding will help the CHN forecast stresses and developmental changes experienced by families. c)This understanding will help the CHN consider the impact of Determinants of Health on family function. d)This understanding will help the CHN identify family as an interacting system in society. This understanding will help the CHN forecast stresses and developmental changes experienced by families. Which one of the following major family social theories is a useful framework for assessing families and health? a)Structure-function theory b)Systems theory c)Developmental theory d)Interactional theory A The structure-function theory perspective is a useful framework for assessing families and health. Illness of a family member results in the alteration of family structure and function. Implementation of the community health nursing process occurs during which stage of a home visit? a)engagement b)assessment c)intervention d)termination e)evaluation A A CHN is conducting a parenting class for prospective parents that will focus on the development of new skills, identification of needed resources, planning, and other preparations for the arrival of a newborn. This intervention is addressing a potential risk to family health, associated with which element? a)biology b)behaviour c)environment d)transition D Transition is the movement from one developmental or health stage or condition to another, one that may be a time of potential risk for families. Even events that are generally viewed as being positive can place stress on a family. The normative event of the birth of a child requires considerable changes in family structures and roles. Furthermore, family functions are expanded from previous levels, requiring families to add new skills and establish additional resources. Why is treating the family as a client unit fundamental to the practice of community health nursing? a)Family variations are becoming more acceptable. b)Families are a consistent presence over the lifetime of care. c)Community norms are based on family health habits. d)Family nursing is intuitive and based largely on common sense. B Families are responsible for providing or managing the care of individual family members. Within the current health care system, families are significant members of health care teams, since they are the ever-present factor. Families are now expected to take more responsibility for assisting in the health care of ill family members. During the assessment of a family with a son who is living with acquired immune deficiency syndrome (AIDS), a CHN asks questions such as "Which family member is best at getting your son to take his medications on time?" and "Who in the family is most worried about how AIDS is transmitted?" The nurse is using which type of circular questioning? a)Triadic questioning b)Hypothetical/future-oriented questioning c)Behavioural effect questioning d)Difference questioning D Circular communication happens between people as each person influences the behaviour of the other. Difference questions explore differences between people, relationships, time, ideas, or beliefs. The extent of social and cultural cohesion within a community is related to which health concern in Indigenous communities? a)Heart disease b)Suicide c)Type 2 diabetes d)Obesity B Cultural continuity has been found to moderate suicide risk in Indigenous communities. The other diseases (heart disease, type 2 diabetes and obesity) relate to environment, lifestyle, poverty, and access to health care. Which steps toward decolonization would be important for the CHN to take in a community development activity with an Indigenous community? a) Committing to collective action in solidarity with awareness of past harms that continue to impact the community b)Staying away from past in order for the community to build anew c)Ensuring strong boundaries between communities to persevere traditional ways of doing things d)Developing select individual leaders who can then bring development back to the community A Self awareness and awareness of past harms (that continue to occur and impact communities) are first steps to decolonization. These ways of thinking must, however, result in taking collective action in solidarity with the community. What community experiences support distal Determinants of Health? a)Intergenerational language classes b)A thriving community recreation centre c)Rural and remote representation on economic and resource development committees d)Graduation from an Indigenous law program C Distal Determinants of Health arise from political, economic, and social realities and include colonialism, racism, and social exclusion, and repression of self-determination. Inclusion in economic and resource development supports this determinant of health. In which activity is the CHN practising trauma-informed care? a)The CHN provides information about community resources for the client in distress. b)The CHN explores systematic desensitization techniques to address a client's fears. c)The CHN draws on extended family and a circle of support into the care plan. d)The CHN seeks to understand the role of a client's history of violence when providing support around parenting. D What was a part of the waves of colonization of Indigenous people in Canada? a)Relocation b)Criminalization of culture c)Environmental stewardship d)Residential school system A, B, D Which would be included in the broader Aboriginal Determinants of Health? a)territory b)migration c)colonization d)Cultural continuity All of the above The National Aboriginal Health Organization identified additional Determinants of Health that affect Indigenous peoples. These include: Colonization, Globalization, Migration, Poverty, Access, Cultural Continuity, Territory and Self-determination. What is an example of a proximal determinant of health? a)Intergenerational language classes b)A thriving community recreation centre c)Rural and remote representation on economic and resource development committees d)Graduation from an Indigenous law program D Proximal Determinants of Health are conditions that directly affect the health of individuals such as health behaviours, employment, income, social status, education and food security. Graduation from an Indigenous law program represents education and supports the proximal Determinants of Health. What might the CHN do when using a risk reduction approach to a diabetes education program in an Indigenous community? a)Teaching about high blood pressure and other risk factors for diabetes b)Supporting implementation of an activity program c)Teaching about nutrition and healthy eating d)Supporting implementation of a healthy weights program All of the above An elderly Inuit woman lives in a small, remote village in northern Canada. She has been diagnosed with hypertension and diabetes, but rarely makes it to the regional clinic in a distant town for checkups. What is this woman most likely to experience? a)Disenfranchisement b)Health disparities c)Subjective poverty d)Resilience B Vulnerable populations often are more likely than the general population to suffer from health disparities. Health disparities refer to the wide variations in health services and in health status among certain population groups defined by specific characteristics. A CHN working in an inner-city clinic in an area with high poverty and unemployment rates recognizes the need for outreach to pregnant teens for which reason? a)Teens delay seeking prenatal care b)Teens benefit from prenatal education c)Teens avoid high-risk situations d)Teens fear their partner's reaction A Some teens delay seeking pregnancy services because they do not recognize signs of pregnancy, such as breast tenderness and a late period. Once they discover they are pregnant, these young women may still delay seeking care, since they falsely hope that the pregnancy will just go away. A teen also may delay seeking care in order to keep the pregnancy a secret from family members, who may pressure her to terminate the pregnancy, or because she does not want to have a gynecological examination. Which one of the following situations is more prevalent in poor neighbourhoods? a)cancer b)food security c)A lower sense of belonging d)One-parent families D Which of the following situations is a challenge faced by deinstitutionalized individuals who are living with mental health conditions? a)Continuity of care due to limited community-based services b)Cost of hospitalization for treatment of exacerbation of illness c)Higher rates of employment and stigmatization over a lifetime d)Supportive networks that decrease caregiver burden and homelessness A Deinstitutionalization of individuals with mental health conditions has been a major part of mental health reform. The goal was to improve the quality of life for people with mental health disorders by providing services in communities where they live, rather than in large institutions. Community-based services, however, are not always in place in the community, so continuity of care has become a problem. The harm reduction approach to substance abuse focuses on health promotion and disease prevention. Within this approach, what would be considered a primary prevention strategy to address substance abuse? a)Assess for recreational drug use. b)Destroy the myth of good drugs versus bad drugs. c)Encourage children to "just say no." d)Refer to an addiction treatment program. B Nurses are knowledgeable in medication administration and understand the potential dangers of substance misuse as well as careful physical assessment. CHNs need to influence the health of clients by destroying the myth of good drugs versus bad drugs. Which of the following situations is addressed by creating opportunities and removing barriers to achieving the health potential of all people? a)Health disparities b)Health risks c)Health inequity d)Harm reduction C Health inequity refers to differences in health that could be avoided if reasonable action was taken, and therefore these differences are considered to be unfair and socially unjust.