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Community Practice Exam 2

In which type of research project would the nurse primarily use analytic epidemiology as a tool?

1. Communicable disease statistics
2. Determining locations where family violence is increasing
3. Contributing factors to childhood obesity
4. Documenting population characteristics for healthy older citizens

Contributing factors to childhood obesity
Several small communities requested help from the state department of health for improving their teenage pregnancy rate. Which community should the nurse suggest get funds first?

1. Community B—with 45 single teenage pregnancies in a city of 1000
2. Community D—with 90 single teenage pregnancies in a city of 1500
3. Community C—with 90 single teenage pregnancies in a city of 2000
4. Community A—with 23 single teenage pregnancies in a city of 500

Community D—with 90 single teenage pregnancies in a city of 1500
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). What does this finding represent?

1. Incidence
2. An epidemic
3. Risk
4. Prevalence

Prevalence
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. What is the attack rate?

1. 70%
2. 90%
3. 100%
4. 63%

90%
There are 250 new cases of chicken pox in a town of 125,000 people. What is the incidence of this disease?

1. Twenty cases per 1,000 population.
2. Two hundred cases per 30,000 population.
3. Twenty cases per 500 population.
4. Two cases per 1,000 population.

Two cases per 1,000 population.
What statistic do countries use to compare the success of their health care systems?

1. Cause-specific mortality rate
2. Attack rate
3. Infant mortality rate
4. Cause-specific morbidity rate

Infant mortality rate
Which model would be helpful to the nurse in examining the various factors that can lead to disease and suggesting several areas where the nurse could possibly intervene to reduce future incidence of disease?

1. Epidemiologic triangle
2. Health promotion
3. Web of causality
4. Levels of prevention

Web of causality
A nurse is investigating bacteria that have caused a health problem in the community. Only some of the people exposed to the bacteria have become ill. What could account for this?

1. Chemical agent factors
2. Host factors
3. Physical agent factors
4. Environmental factors

Host factors
What will the nurse who wishes to assess the status of a community’s health examine?

1. Health care manpower
2. Health facilities
3. Community awareness
4. Vital statistics

Vital statistics
Why do community health nurses try so hard to encourage members of the community to be partners in health programs?

1. Doing so is a moral obligation for community health nurses
2. Such partners will encourage their neighbors and friends to attend
3. Participation in planning results in having a vested interest in the outcome.
4. Having many partners helps publicize the programs in the involved neighborhoods

Participation in planning results in having a vested interest in the outcome
Which persons might be MOST effective key informants for a nurse new to the community?

1. Health board members
2. Federal senators and representatives
3. State public health official
4. Local politicians, such as the town mayor

Local politicians, such as the town mayor
During the assessment phase, the nurse compiles and interprets available data and draws conclusions as to the community’s strengths and concerns. Why might the nurse go on to continue to observe and interview key informants?

1. To generate nonstatistical data such as values, beliefs, and perceived needs
2. To encourage community partners to feel they “own” the data
3. To confirm the nurse’s initial findings and conclusions
4. To ensure that others agree with the nurse’s plans for interventions

To generate nonstatistical data such as values, beliefs, and perceived needs
A new nurse is overwhelmed with the needs of the community. In deciding which problem should have first priority, the nurse should choose:

1. A problem that is very easy and inexpensive to address
2. A problem in an area in which the nurse is very comfortable and has a great deal of expertise
3. A problem that affects the most disadvantaged residents in the community, since there is a moral obligation to do so
4. A particular problem that is of high concern to the community

A particular problem that is of high concern to the community
Which objective is most appropriate for the development of a community-oriented nursing care plan?

1. All monitored patients will receive abortive therapy for lethal dysrhythmias within 3 minutes of dysrhythmia recognition.
2. Of mothers receiving nutrition counseling, 80% will identify five sources of calcium by the end of class.
3. 95% of children will be immunized by 1 year of age.
4. There will be a 25% reduction in health disparities by 2007.

Of mothers receiving nutrition counseling, 80% will identify five sources of calcium by the end of the class
A community health nurse drives through her assigned community before visiting the community groups scheduled for the day. She then drives through the community again that evening before going home. From a community nursing perspective, what might be the nurse’s reason for driving through the community twice in the same day

1. When leaving in the evening, the nurse has more time to write down the results of the earlier assessment
2. Driving through twice allows the nurse to see the community when many residents are at work or at school and then again when most are at home.
3. Repeating the experience ensures that the nurse absorbed all the relevant details.
4. On the second trip, the nurse can carefully confirm the results of the first assessment.

Driving through twice allows the nurse to see the community when many residents are at work or at school and then again when most are at home
A nurse wants to have a greater understanding of the physiological effects of selected chemicals. From whom would the nurse be most likely to find useful information?

1. Epidemiologist
2. Chemist
3. Pharmacologis
4. Toxicologist

Toxicologist
What is a useful first step in assessing potential environmental health risks in a community?

1. Surveying community members
2. Performing a windshield survey
3. Conducting health risk assessments of randomly selected individuals
4. Reviewing facility permits and consumer confidence reports

Performing a windshield survey
A community citizen reports to the public health department nurse that the city water in one neighborhood has had an unusual taste for the past few months. What action should the nurse take first?

1. Notify the Environmental Protection Agency (EPA).
2. Consult the Centers for Disease Control and Prevention
3. Check the most recent consumer confidence report.
4. Place a call to the poison control center

Check the most recent consumer confidence report
A nurse wants to help keep the community environment safe. What is the best action he can take?

1. Conserve water by bathing less often.
2. Replace all his appliances with new energy-efficient ones
3. Downsize to a smaller living space
4. Reduce, reuse, and recycle

Reduce, reuse, and recycle
What is the purpose of local health departments making unannounced inspections of local restaurants?

1. To provide exposure to oversight
2. To enforce local laws and regulations
3. To monitor employee safety
4. To ensure compliance

To ensure compliance
After hearing of plans to build a city dump near a community of poor and predominantly African-American citizens, what principle might cause a nurse to want to help block the proposed site for consideration?

1. Environmental justice
2. Equal rights
3. Risk protection
4. Primary prevention

Environmental justice
Which action represents secondary prevention to reduce environmental health risks?

1. Referring a child with toxic lead levels to a neurologist
2. Teaching parents of a 2-year-old about the dangers of lead-based paint in older homes
3. Collecting blood specimens from preschool children to check for lead levels
4. Meeting with local government officials to request that the city clean up a hazardous vacant lot

Collecting blood specimens from preschool children to check for lead levels
Which countries bear the greatest burden of disasters?

1. Developing countries with limited resources
2. Industrialized countries with much to lose
3. Water-boundary regions that are prone to floods and hurricanes
4. Arid regions that are prone to drought

Developing countries with limited resources
Which of the following defines a disaster?

1. Devastation that cannot be relieved without assistance
2. When the event results in multiple injuries and deaths as well as property damage
3. Devastation that covers a broad geographic area
4. Any event that results in multiple deaths

Devastation that cannot be relieved without assistance
What is the purpose of disaster planning?

1. To increase global stability
2. To prevent disasters from occurring
3. To improve overall community functioning
4. To manage response to disasters

To manage response to disasters
When does disaster management begin?

1. Before the disaster occurs
2. Immediately following the disaster
3. During the disaster
4. During the recovery period

Before the disaster occurs
Which organization would direct nurses’ response to a countrywide disaster?

1. American Red Cross
2. The local public health department
3. Centers for Disease Control and Prevention
4. Office of Emergency Management

Office of Emergency Management
The nurse is assigned to the county committee on disaster preparedness. What would be the goal as the nurse helps write the disaster plan?

1. Differentiate the defined roles of the first responders in the field
2. Have clear lines of authority to prevent confusion in the field
3. Keep the plan simple, realistic, and flexible to implement
4. Be as detailed and specific as possible regarding who does what where

Keep the plan simple, realistic, and flexible to implement
What is the first and most important aspect in minimizing the damage from a bioterrorism attack?

1. Detecting an increase in people with similar signs and symptoms
2. Identifying typical chemical or biological agents
3. Recognizing areas of vulnerability within an area
4. Identifying factors that put people at risk

Detecting an increase in people with similar signs and symptoms
On the second day after a disaster, a male colleague tells the nurse he has a splitting headache. The nurse notes the colleague is feeling irritable and having difficulty focusing. How should the nurse respond to the complaint of headache?

1.Explain that the headache and problems focusing are probably the result of worry, so he should concentrate on the work at hand and deal with emotions later.
2. Explain to the worker that this is a common problem when multitasking under pressure and suggest that he focus on one task at a time.
3. Explain that he is experiencing signs and symptoms of psychological stress and recommend that he take some time off for a break.
4. Suspect dehydration and encourage the worker to drink more fluids.

Explain that he is experiencing signs and symptoms of psychological stress and recommend that he take some time off for a break.
What level of prevention is being used by a nurse who is helping to develop a community-wide disaster management plan?

1. Secondary prevention
2. Tertiary prevention
3. Primary prevention
4. All prevention levels

Primary prevention
A nurse seriously considered copying last month’s surveillance report and changing the date since the number of occurrences per month had not noticeably changed in the entire time the nurse had worked at the local department. If the data are always about the same, why spend time continuing to collect and report it?

1. To determine a local baseline rate and immediately notice any change
2. Because it is still part of the nurse’s responsibilities, even if it is a waste of time
3. Because such data are legally required
4. To determine differences among communities in need for state assistance

To determine a local baseline rate and immediately notice any change
Why is it so crucial that nurses be knowledgeable about public health surveillance?

1. Because nurses are often the first to recognize and respond to a problem
2. Because nurses are typically the ones to interact with the public and the media
3. Because nurses are employed in public health agencies
4. Because nurses are responsible for ensuring that action is taken when necessary

Because nurses are often the first to recognize and respond to a problem
Why would a rural public health nurse spend time reviewing death certificates?

1. To evaluate effectiveness of health promotion programs
2. To obtain mortality data for the local area
3. To ensure that local causes of death are consistent with national causes of death
4. To confirm that no local health problems are beginning

To obtain mortality data for the local area
In which situation would the nurse use active surveillance?

1. The nurse is asked to report the incidence of a specific nonreportable common problem in the community.
2. A real-time ongoing communication channel is established to monitor a particular symptom.
3. Several children become ill with GI upset at one local school.
4. A newspaper wants to know the incidence of asthma in the community

Several children become ill with GI upset at one local school
Several children were hospitalized for severe vomiting and diarrhea. Why would the nurse continue to pursue the cause of the illness even after the children have been discharged from the hospital?

1. Because the children’s parents need to know whom to sue for their medical expenses
2. So that the children’s families know the public health department cared about them
3. To confirm that the symptoms were due to an infectious disease
4. So that action could be taken to avoid any such future episodes

So that action could be taken to avoid any such future episodes
Which aspect of a biological agent is probably the most frightening to those exposed?

1. The agent’s invasiveness
2. The agent’s infectivity
3. The agent’s pathogenicity
4. The agent’s virulence

The agent’s virulence
What are the steps in program management?

1. Assess, plan, implement, evaluate
2. Identify, initiate, implement
3. Organize, operationalize, mobilize, subsidize
4. Substantiate, negotiate, evaluate

Assess, plan, implement, evaluate
What is the ultimate goal of program planning?

1. Prevent unnecessary duplication of services
2. Avoid unanticipated conflicts in the program development phase
3. Ensure adequate funding to meet the program’s resource requirements
4. Ensure that health care services are acceptable, equal, effective, and efficient

Ensure that health care services are acceptable, equal, effective, and efficient
A nurse is planning a program to teach cardiac health at the senior citizens center. Which of the following is an effectively written objective for the program?

1. By the end of the program each participant will report walking at least 30 minutes a day at least 5 days out of 7.
2. By the end of the program each participant will voice a commitment to walk at least 30 minutes a day.
3. Each participant will voice a commitment to engage in physical exercise each day.
4. By the end of the program each participant will understand the need for physical exercise

By the end of the program each participant will report walking at least 30 minutes a day at least 5 days out of 7
What is the most important question to be considered for summative evaluation of a program designed to decrease obesity in school-age children?

1. What is the program cost compared with the program benefit?
2. Has obesity in school-age children decreased?
3. Are school-age children satisfied with the program?
4. Can parents and guardians support the program requirements?

Has obesity in school-age children decreased?
A committee of health care professionals would like to establish a countywide program to improve Hispanic immigrant access to culturally competent health care services. Which person might be most helpful as a key informant?

1. Hospital administrator
2. National expert on cultural competency
3. Politician or county official
4. Hispanic community leader

Hispanic community leader
The nurse who wishes to conduct a needs assessment on a limited budget would most likely eliminate which data source?

1. Focus groups
2. Surveys
3. Community forums
4. Examination of community indicators

Surveys
Evaluation is under way for a statewide program to decrease teen injury and death associated with teens who drive while under the influence of alcohol. Which question would best assess a summative evaluation of the program?

1. Are program participants continuing to attend the programs, and do their satisfaction scores indicate that they are pleased with the program?
2. How do statistics for injuries and deaths associated with drunk driving compare for teens in the year following the program?
3. What problems are identified as the program is implemented?
4. How does the amount of alcohol intake by teens compare before and after participants enter into the program?

How do statistics for injuries and deaths associated with drunk driving compare for teens in the year following the program?
Which program exemplifies an emphasis on tertiary prevention?

1. Providing cardiovascular fitness evaluations at annual health fairs
2. Providing a diabetes management program for persons with diabetes mellitus
3. Setting up free blood pressure screening at popular department stores and supermarkets
4. Developing an in-school clinic that provides birth control counseling and contraception

Providing a diabetes management program for persons with diabetes mellitus
The nurse admits uncertainty over how to address the needs of a group of clients. The long -term nurse in the area suggests that the nurse review published evidence based clinical guidelines. How can the nurse know that these guidelines are reliable?

1. Because the guidelines have been published.
2. Because they are based on research and expert opinion.
3. Because the long term nurse trusts them.
4. Because the agency supports their use.

Because they are based on research and expert opinion
What led to legislation such as the National Health Quality Improvement Act, which focused attention on poor quality of care?

1. Media such as films highlighted the reality of current medical care
2. The number of malpractice claims had increased.
3. A very famous movie and television star died as the result of a medical error.
4. Publicity about a few unfortunate cases caused consumers to become concerned.

The number of malpractice claims had increased
Which quality management recommendation or process exemplifies tertiary prevention?

1. At the yearly employee picnic, teams compete in putting out trash can fires and racing while carrying mock victims , using safe evacuation techniques.
2. Mock fire drills are carried out twice a year to assess response and readiness in the event of a real fire.
3. All new employees complete a program on fire safety that details what to do in the event of a fire.
4. After evaluation of response to an actual fire, new procedures implemented in the fire response protocol are distributed to employees.

After evaluation of response to an actual fire, new procedures implemented in the fire response protocol are distributed to employees.
The pharmacist sent up the wrong medication for the patient. The nurse filled out an incident report when the error was discovered. What will be the likely outcome when the quality improvement team reviews the incident report?

1. The CQI team will try to determine how the error occurred.
2. The pharmacist will be disciplined.
3. The pharmacist will be reported to the state pharmacy board.
4. The nurse will receive a commendation for recognition of the error.

The CQI team will try to determine how the error occurred.
Which problem might be cause for increasing quality assurance efforts?

1. Personnel complaints about schedules and workload
2. Constantly increasing costs of giving care
3. Client complaints, injury, or death
4. Reduced governmental reimbursement (Medicare and Medicaid)

Client complaints, injury, or death

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