NR-392 – Quality and Safety Examines patient
safety principles, quality improvement methods,
risk reduction strategies, healthcare standards,
and performance measurement.
Section 1: Foundations of Community Health Nursing (Q1-15)
Question 1
A community health nurse is planning a program to reduce childhood obesity.
Which action best reflects a population-focused approach?
A) Providing one-on-one dietary counseling to obese children
B) Advocating for healthier school lunch menus and daily physical education
C) Distributing BMI screening results to parents
D) Referring obese children to a weight management clinic
Rationale: Population-focused care targets entire groups or communities through
policy, systems, and environmental changes. Individual counseling is important but
secondary to upstream interventions.
Question 2
Which core public health function is being demonstrated when a nurse investigates
a cluster of Legionnaires' disease cases in a community?
A) Assurance
B) Policy development
C) Assessment
D) Quality improvement
Rationale: Assessment includes systematic data collection and analysis of health
status. Investigating disease clusters is part of assessment (surveillance and
diagnosis of community health problems). Assurance refers to ensuring services
are available.
Question 3
,A nurse is using the Precede-Proceed Model to plan a smoking cessation
program. Which step occurs first?
A) Identifying intervention strategies
B) Conducting a social and epidemiological assessment
C) Implementing the program
D) Evaluating process outcomes
Rationale: Precede-Proceed begins with social, epidemiological, and behavioral
assessments to understand quality of life, health problems, and
behavioral/environmental factors.
Question 4
A community health nurse notices that a rural county has no public transportation
and only one grocery store with high prices. This finding primarily affects which
determinant of health?
A) Genetics
B) Access to healthy food and social environment
C) Health care system quality
D) Individual behavior
Rationale: Food deserts and lack of transportation are social determinants of
health (economic stability, neighborhood/built environment). These affect
population health more than individual choices.
Question 5
Which level of prevention is a nurse using when providing directly observed
therapy (DOT) for a patient with active tuberculosis?
A) Primary prevention
B) Secondary prevention
C) Tertiary prevention
D) Primordial prevention
Rationale: DOT for active TB is secondary prevention (early detection and
treatment to prevent spread and complications). Primary prevention prevents
disease onset (vaccination). Tertiary prevents disability.
,Question 6
A nurse is conducting a community windshield survey. Which observation is
most relevant to community health?
A) Number of stop signs at intersections
B) Presence of abandoned buildings with trash accumulation
C) Types of trees planted along sidewalks
D) Color of street lights
Rationale: Windshield surveys assess community environment, housing,
sanitation, safety. Abandoned buildings and trash indicate potential health hazards
(rodents, injury, crime).
Question 7
Which ethical principle is primarily applied when a nurse advocates for a
community to have access to clean drinking water?
A) Autonomy
B) Justice
C) Beneficence
D) Nonmaleficence
Rationale: Justice refers to fair distribution of resources and burdens. Access to
clean water is a social justice issue. Beneficence (doing good) is related but justice
is more specific to equity.
Question 8
A community health nurse is evaluating a program's effectiveness in reducing teen
pregnancy rates. Which data source is most appropriate?
A) Hospital admission records
B) Vital statistics (birth records)
C) School attendance records
D) Police arrest reports
, Rationale: Vital statistics (birth certificates) provide population-level data on
births by maternal age. Hospital records miss births outside hospitals or those not
captured.
Question 9
A nurse is using the Milio Framework to guide a community nutrition program.
Which statement reflects this framework?
A) "We should focus on individual nutrition choices."
B) "Health behaviors are influenced by available options and social norms."
C) "Only physicians should advise on nutrition."
D) "Genetics is the primary factor in obesity."
Rationale: Milio’s framework emphasizes that population health is shaped by the
availability and affordability of healthy options, not just individual decisions.
Question 10
A public health nurse identifies an outbreak of hepatitis A linked to a local
restaurant. Which action is the priority?
A) Close the restaurant permanently
B) Conduct contact tracing and provide immune globulin to exposed
individuals
C) Publish the restaurant name in the newspaper
D) Wait for laboratory confirmation before acting
Rationale: Hepatitis A post-exposure prophylaxis (immune globulin or vaccine
within 14 days) prevents secondary cases. Contact tracing and rapid notification
are public health priorities.
Question 11
Which is the most accurate measure of a community's health status?
A) Number of hospitals per capita
B) Life expectancy at birth
C) Annual health care expenditures
D) Number of nurses per population
safety principles, quality improvement methods,
risk reduction strategies, healthcare standards,
and performance measurement.
Section 1: Foundations of Community Health Nursing (Q1-15)
Question 1
A community health nurse is planning a program to reduce childhood obesity.
Which action best reflects a population-focused approach?
A) Providing one-on-one dietary counseling to obese children
B) Advocating for healthier school lunch menus and daily physical education
C) Distributing BMI screening results to parents
D) Referring obese children to a weight management clinic
Rationale: Population-focused care targets entire groups or communities through
policy, systems, and environmental changes. Individual counseling is important but
secondary to upstream interventions.
Question 2
Which core public health function is being demonstrated when a nurse investigates
a cluster of Legionnaires' disease cases in a community?
A) Assurance
B) Policy development
C) Assessment
D) Quality improvement
Rationale: Assessment includes systematic data collection and analysis of health
status. Investigating disease clusters is part of assessment (surveillance and
diagnosis of community health problems). Assurance refers to ensuring services
are available.
Question 3
,A nurse is using the Precede-Proceed Model to plan a smoking cessation
program. Which step occurs first?
A) Identifying intervention strategies
B) Conducting a social and epidemiological assessment
C) Implementing the program
D) Evaluating process outcomes
Rationale: Precede-Proceed begins with social, epidemiological, and behavioral
assessments to understand quality of life, health problems, and
behavioral/environmental factors.
Question 4
A community health nurse notices that a rural county has no public transportation
and only one grocery store with high prices. This finding primarily affects which
determinant of health?
A) Genetics
B) Access to healthy food and social environment
C) Health care system quality
D) Individual behavior
Rationale: Food deserts and lack of transportation are social determinants of
health (economic stability, neighborhood/built environment). These affect
population health more than individual choices.
Question 5
Which level of prevention is a nurse using when providing directly observed
therapy (DOT) for a patient with active tuberculosis?
A) Primary prevention
B) Secondary prevention
C) Tertiary prevention
D) Primordial prevention
Rationale: DOT for active TB is secondary prevention (early detection and
treatment to prevent spread and complications). Primary prevention prevents
disease onset (vaccination). Tertiary prevents disability.
,Question 6
A nurse is conducting a community windshield survey. Which observation is
most relevant to community health?
A) Number of stop signs at intersections
B) Presence of abandoned buildings with trash accumulation
C) Types of trees planted along sidewalks
D) Color of street lights
Rationale: Windshield surveys assess community environment, housing,
sanitation, safety. Abandoned buildings and trash indicate potential health hazards
(rodents, injury, crime).
Question 7
Which ethical principle is primarily applied when a nurse advocates for a
community to have access to clean drinking water?
A) Autonomy
B) Justice
C) Beneficence
D) Nonmaleficence
Rationale: Justice refers to fair distribution of resources and burdens. Access to
clean water is a social justice issue. Beneficence (doing good) is related but justice
is more specific to equity.
Question 8
A community health nurse is evaluating a program's effectiveness in reducing teen
pregnancy rates. Which data source is most appropriate?
A) Hospital admission records
B) Vital statistics (birth records)
C) School attendance records
D) Police arrest reports
, Rationale: Vital statistics (birth certificates) provide population-level data on
births by maternal age. Hospital records miss births outside hospitals or those not
captured.
Question 9
A nurse is using the Milio Framework to guide a community nutrition program.
Which statement reflects this framework?
A) "We should focus on individual nutrition choices."
B) "Health behaviors are influenced by available options and social norms."
C) "Only physicians should advise on nutrition."
D) "Genetics is the primary factor in obesity."
Rationale: Milio’s framework emphasizes that population health is shaped by the
availability and affordability of healthy options, not just individual decisions.
Question 10
A public health nurse identifies an outbreak of hepatitis A linked to a local
restaurant. Which action is the priority?
A) Close the restaurant permanently
B) Conduct contact tracing and provide immune globulin to exposed
individuals
C) Publish the restaurant name in the newspaper
D) Wait for laboratory confirmation before acting
Rationale: Hepatitis A post-exposure prophylaxis (immune globulin or vaccine
within 14 days) prevents secondary cases. Contact tracing and rapid notification
are public health priorities.
Question 11
Which is the most accurate measure of a community's health status?
A) Number of hospitals per capita
B) Life expectancy at birth
C) Annual health care expenditures
D) Number of nurses per population
