NURS 473 Exam 1 | Questions and Answers (Complete Solutions)

NURS 473 Exam 1 | Questions and Answers (Complete Solutions) Public health nurses (PHNs) know they must approach a public health issue with an understanding of the related underlying risk factors to develop effective nursing interventions. They evaluate these risk factors from two perspectives: 1.Disease; individual 2.Intervention; government 3.Epidemic; population 4.Individual; population A nursing student is studying public health. She learns that, according to C.E.A. Winslow's definition, some of the goals of public health include disease prevention, promoting health, control of communicable infections, and __________________. 1.Risk assessment for disease 2.Promotion of primary care 3.Organization of medical and nursing services for the early diagnosis and preventive treatment of disease 4.Governmental safety regulations If the international medical community was working to contain several worldwide pandemics, they would look to the World Health Organization (WHO), which is: 1.The public health arm of the United Nations. 2.Working to improve health and well-being for the global population. 3.Working with nurses to promote public health interventions. 4.All of the above. The Institute of Medicine (IOM), now known as the Health and Medicine Division (HMD) of the National Academies of Sciences, Engineering, and Medicine, stated in their report, The Future of the Public's Health, that there are three core functions that society carries out to collectively support the optimum conditions for public health. Which one of the following is not one of these functions? 1.Prevention 2.Assessment 3.Policy development 4.Assurance With aging, there is an increased prevalence of both noncommunicable (chronic) and communicable disease (NCD). The most pressing issue from a public health perspective based on this increase is: 1.An increased demand for long-term care 2.An increased need for further research 3.Further exploration of the developmental stages related to aging 4.Decreased cost of medications. A PHN would like to use the Dahlgren-Whitehead model to help herself and other local practitioners understand health in populations. She understands that the Dahlgren-Whitehead ecological model assumes that: 1.There are multiple determinants of health, and thus multiple strategies are needed. 2.A population and environmental approach is essential. 3.Linkages and relationships are crucial. 4.All of the above. The PHN completed a community assessment and found that the obesity rate in one of the neighborhoods was higher than the other neighborhoods in the county. She suspects that this is partially due to limited access to full-service grocery stores and a lack of dedicated safe venues for exercise. Assuming her conclusion is correct, what category or categories of determinants of health would these issues within the community fall into? 1.Upstream determinants of health 2.Downstream determinants of health 3.Behavioral determinants of health 4.Genetic determinants of health Two PHNs working in a large urban community notice that community members are rarely engaged in the process of planning interventions aimed at addressing a particular increase in a specific disease in the community. For their next project, they include community collaboration as an essential component of the development, implementation, and evaluation of the program. When questioned by others, they report that there is evidence that community collaboration increases effectiveness and productivity, empowers the participants, strengthens social engagement, and ______. 1.Decreases disease rates 2.Ensures accountability 3.Increases the availability of treatment for the targeted disease 4.Improves screening rates Which one of the following scenarios is not an example of community collaboration? 1.Local service groups working to organize disaster relief for tornado victims 2.A city council passing an ordinance to stop smoking in restaurants 3.An advocacy group working with the local churches to improve health care for the indigent with mental health disorders 4.A school working with the local health department to start a school clinic Which layer of government is primarily responsible for issuing quarantines during a communicable disease outbreak? 1.Federal 2.State 3.Local 4.All of the above As a PHN in a small local public health department, you understand that based on federal mandates your public health department routinely performs all but which of the following? 1.Surveillance of disease at the local level 2.Investigation of disease outbreaks 3.Licensing of local hospitals 4.Quarantine The PHN recognizes that environmental science, epidemiology, biostatistics, biomedical sciences, and ____ form the foundational subjects of public health. 1.Economics 2.The humanities 3.Social and behavioral sciences 4.Anthropology As defined by the World Health Organization (WHO), an example of a health promotion intervention is ____ whereas a risk reduction/health protection intervention is ____. 1.Conducting a health fair; funding a school exercise program 2.Giving a free exercise class; conducting a flu vaccine outreach program 3.Providing flu medication free to older adults; a diet class for teenagers 4.Offering a tour of a hospital; a relaxation technique class From a health promotion perspective, how could an occupational health nurse advise a company to encourage its employees to work towards good health? 1.Lower insurance premiums for employees who demonstrate good health habits 2.Have employee exercise classes or discounted health club memberships 3.Have incentives for healthy eating 4.All of the above Diversity refers to all of but which of these concepts? 1.Race 2.Culture 3.Ethnicity 4.Environment SATA: Many of the emerging threats for public health are tied to increasing globalization. Which of the following reflect these globalization threats? (Select all that apply.) 1.Greater disparities between rich and poor 2.Greater need for newer technology 3.Greater distribution of tobacco and alcohol 4.Emergence or re-emergence of communicable diseases 5.Increased need for improved transportation SATA: Several nurses who work in the emergency department of an urban hospital notice during the evening shift that a number of children in a certain ethnic population have all come in presenting with similar symptoms. The first step the nurses take to address the issue is which of the following? (Select all that apply.) 1.Increase antibiotic therapy availability 2.Identify characteristics of the disease 3.Group patients by diagnosis 4.Notify the public health department 5.Assess the environment of the patients The six standards of practice for public health nursing include which of the following? (Select all that apply.) 1.Assessment 2.Population diagnosis and priorities 3.Outcomes identification 4.Planning 5.Mitigation Which of the following activities of PHNs reflect the PHN Core Competencies? (Select all that apply.) 1.Develop policy for handling a local quarantine. 2.Understand dietary restrictions when planning a program for new immigrants. 3.Create a financial plan for implementing a community-level health intervention. 4.Develop a treatment plan for persons with a specific communicable disease. 5.Analyze data to determine rates of disease in the community. In 2011, the National Prevention Strategy released a plan to increase the number of Americans who are healthy at every stage of life. Which of the following is not one of the strategic directions included in the strategy? 1.Eliminating health disparities 2.Building healthy and safe community efforts 3.Increasing access to care 4.Empowering people to make healthy choices PHNs in a county with an increase in measles during the outbreak used the natural history of disease framework to develop a primary prevention program aimed at preventing measles. Their first step was to: 1.Conduct an outreach to all parents to have their children vaccinated. 2.Educate health-care providers on the signs and symptoms of disease. 3.Start a screening program to identify persons who may have measles. 4.Provide an educational program for parents whose children have measles on the importance of keeping them home from school and away from public places. Based on recent studies on risk for disease, the nurse working in a primary care clinic in a poorer urban community decides to develop an educational program on the importance of including whole grains, fruits and vegetables in her patient's diets. To help guide the development of her program she first reviews the availability of fresh fruits and vegetables in the community. Her decision to gather information on these factors best reflects the________? 1.Ecological determinants of health 2.Social determinants of health 3.Individual behavioral determinants of health 4.Genetic determinants of health The school nurse in a school district in southwestern Texas is working with the school cafeteria to revise their healthy choices menus for the school year. They have used as their guide the 2012 national law that calls for school lunch programs to have larger portions of fruits and vegetables, less sodium, and no trans fats. To help increase the success of the program, the nurse conducted a survey of parents to learn more about the cultural aspects of food choices related to fruits and vegetables. Providing a culturally appropriate menu that meets federal guidelines for the school children represents: 1.An upstream approach 2.A tertiary prevention approach 3.A socioecological approach 4.A and C A PHN notices the rising incidence of H1N1 (swine flu) in a geographic area. The nurse considers possible interventions, knowing that the preclinical phase of H1N1 lasts: 1. 1 to 2 days 2. 2 to 4 days 3. 3 to 4 days 4. 5 to 7 days In the traditional public health prevention framework, the level of prevention that includes early detection and initiation of treatment for disease, or screening, is referred to as the: 1.Clinical level 2.Primary level 3.Tertiary level 4.Secondary level Attributable risk is the proportion of cases or injuries that would be eliminated if a risk factor did not occur, but the preventable fraction is: 1.The number of cases that actually occur in a given population at a specific point in time. 2.What could be achieved with a program implemented in a community setting within the at-risk population when community members actually participate in the program. 3.The number of cases that require intervention in a community setting within the at-risk population. 4.An estimation of the number of cases with the high-risk factor(s) among the at-risk population when community members actually participate in the program. Population attributable risk (PAR) is based on the assumption that the risk factor is removed from the entire population being targeted. It also can be used to calculate the cost benefit and the ____ of a prevention program. 1.Cost effectiveness 2.Necessity 3.Population ecology 4.Percent of repeat participants The PHNs within the public health department experiencing a measles outbreak decide to do Public Service Announcements (PSAs) on TV aimed at improving vaccination rates among the population, and letting parents know they can come to the PHD clinic to have their children vaccinated. The county their department serves has a large population of Mexican American families, so they work together with the Mexican American community to make sure the PSAs are culturally relevant. Which learning theory best matches their approach? 1.Constructivism 2.Cognitivist 3.Bandura's theory of social learning 4.Behaviorism A patient diagnosed with diabetes buys books, reads articles, talks with knowledgeable people, informs himself about what he can do to improve his health, and takes action. The nurse recognizes that this method of adult learning is best described as: 1.Pedagogy 2.Andragogy 3.Constructivism 4.Humanism A nurse working in a busy primary care clinic wonders why Mr. Smith, a 65-year old insulin dependent man recently diagnosed with type 2 diabetes, keeps coming back with elevated A1Cs. The nurse knows that he has given Mr. Smith the literature on how to manage type 2 diabetes and, as time allowed, reviewed it with him. He doesn't understand why Mr. Smith is still struggling with managing his disease. What should he check first before providing Mr. Smith with more information? 1.His level of health literacy 2.Whether or not he can afford his medication 3.His eating habits 4.His routine for checking his A1C Two nurses working in a head, nose, and throat oncology unit noticed that many of their patients not only smoked but used alcohol. They had been to a recent conference and learned about evidence-based screening tools for alcohol use that were different from the tool they were currently using. They approached the director of the unit and suggested that they use the newer screening tools. Screening for alcohol use is primarily done: 1.Only with persons whose clinical presentation appears to indicate heavy alcohol use. 2.Only to detect those who are currently using alcohol to avoid an interaction with treatment modalities. 3.Only to detect those who may have an alcohol use disorder 4.To detect those at risk for disease or injury who do not yet meet the criteria for having an alcohol use disorder as well as those who may have an alcohol use disorder. A clinical group of nursing students was assigned, during their public health rotation, to the local public health department (LPHD). The LPHD was just beginning to start a "Breast is Best" campaign in the community. The students were asked to come up with ideas for the campaign. The LPHD had found that the lowest breastfeeding rates were in one of the ethnic communities. The students agreed to conduct a preliminary outreach program with pregnant women coming to the LPHD's prenatal clinic that had the highest number of women in that ethnic group. This is an example of what level of intervention using the Substance Abuse and Mental Health Services Administration (SAMSHA) framework? 1.Universal 2.Indicated 3.Primary 4.Selected When screening for, monitoring, and diagnosing disease, a health-care provider always evaluates a measurement tool for which of the following attributes? (Select all that apply.) 1.Reliability 2.Validity 3.Functionality 4.Sensitivity 5.Specificity To assess the prevalence of a disease in a population, a public health nurse (PHN) can use the prevalence pot to help better understand the occurrence of disease in her or his community. The prevalence pot: (Select all that apply.) 1.Depicts the total number of current cases in the population. 2.Takes into account duration and incidence of the disease. 3.Includes assessing the total number of cases of a disease taking into account all of the stages of the disease. 4.Is a method of calculating the potential number of new cases in a population. 5.Determines the amount of primary medications used to treat diseases in a certain population. Based on the Social-Ecological model of health, which of the following are components of health? (Select all that apply.) 1.Physical environments 2.Social environments 3.Social relations 4.Political systems 5.Health-care systems John Snow, considered the founder of epidemiology, realized the source of the London's cholera epidemic through: 1.Developing a frequency distribution of deaths. 2.Mapping of the food supply. 3.Interviewing the families of the sick. 4.Performing autopsies. The history and development of epidemiology has gone through several developmental phases. The nursing student learns that these phases came about in history in what order? 1.Risk factor phase, infectious disease phase, and sanitary phase 2.Infectious disease phase, risk factor phase, and sanitary phase 3.Sanitary phase, infectious disease phase, and risk factor phase 4.Agent phase, host phase, and environment phase A public health nurse (PHN) is asked by the hospital administration to find out why there are so many pediatric asthma patients coming to the emergency department (ED) for treatment and to develop a plan to reduce admissions by 10%. The PHN knows the first step, prior to developing an intervention, is to understand the multiple risk factors involved. Which framework would best help the PHN understand the multiple risk factors contributing to asthma in this population? 1.The epidemiological triangle 2.The ecological model 3.The epidemiological constants 4.The web of causation Jane works for the public health department with the primary job of conducting outbreak investigations. There has been a recent outbreak of hepatitis A. She has collected data on the number of new cases among the contacts of initial (primary) cases, divided it by the number of people in the population at risk, and then multiplied it by a given multiplier. She is calculating the: 1.Prevalence. 2.Incidence. 3.Secondary attack rate. 4.Attack rate. A public health nurse is comparing the prevalence of type 2 diabetes in two counties in Ohio. From an epidemiological perspective these are: 1.Independent rates. 2.Mortality rates. 3.Dependent rates. 4.Morbidity rates. When comparing the body mass index (BMI) of obese women in two cities, John found that the average BMI of City A was higher than that of City B. However, when he concluded that a woman in City A will have a higher BMI than a woman in City B, his conclusion was an example of ______________. 1.An odds ratio. 2.An ecological fallacy. 3.A causality. 4.A relative risk. To better understand the risk factors for the high prevalence of asthma in her school, the school nurse gets approval to send out an anonymous survey to the parents. She is seeking preliminary data on how many of the students who may have asthma are exposed to secondary smoke. Questions for the parents include information about their children's history of asthma and whether anyone living in the home smokes. Which study design best describes her study? 1.Case-control study 2.Cross-sectional study 3.Cohort study 4.Outbreak investigation A control or "no disease" group is needed for study on risk factors associated with oral cancer. The nurses conducting the study decide to use a group of patients with skin cancer as their controls because these patients are at the same facility. Having another type of cancer could itself be a risk factor and is a potential limitation in the study. This variable, having another type of cancer, would be called a(n): 1.Confounder. 2.Right censoring. 3.Case-control. 4.Odds ratio. An epidemiologist uses the epidemiological triangle to explain the occurrence of disease by looking at the three main components of the model: the host, the environment, and the agent. The PHN understands that the agent could be one of many types except: 1.Biological and chemical. 2.Nutritive. 3.Physical. 4.Ecological. John has just taken a job as a PHN at the local public health department in a high-income county adjacent to a large metropolitan area. He has been asked to work with the team that does outbreak investigations and conducts surveillance. As part of John's work in outbreak investigations, which three precipitating factors, also known as the epidemiological constants, should he consider to help guide these investigations? 1.Person, agent, and time 2.Host, agent, and time 3.Person, place, and environment 4.Person, place, and time John has just taken a job as a PHN at the local public health department in a high-income county adjacent to a large metropolitan area. He has been asked to work with the team that does outbreak investigations and conducts surveillance. John has also assumed responsibility for surveillance of sexually transmitted infections (STIs). The primary purpose of surveillance of STIs at the local public health department is to be able to: 1.Determine the prevalence of disease over time and provide reports to the state health department. 2.Study person-related variables or factors to help provide increased access to treatment. 3.Calculate percent change in a demographic variable to assess changes over time. 4.Identify a possible rise in cases above the endemic level and take action. John has just taken a job as a PHN at the local public health department in a high-income county adjacent to a large metropolitan area. He has been asked to work with the team that does outbreak investigations and conducts surveillance. There has been an outbreak of measles in the county that his public health department serves. John was asked to put together an alert to parents related to the outbreak. What is one aspect of this type of outbreak that presents substantial challenges to persons working in a local public health department like John's? 1.Poor access to medical care 2.Person-to-person transmission 3.Low economic status. 4.Inadequate sanitation systems A young couple with a family history of cystic fibrosis meets with a nurse to ask about preconception testing using genetic markers for early identification of the disease to help them make childbearing decisions. The area of study that has helped health-care providers and families answer these questions is called: 1.The Human Genome Project 2.Behavioral Risk Factor Surveillance System (BRFSS) 3.Ecological epidemiology 4.Genomics In a large urban public health department (PHD), Sam, the PHD's epidemiologist, is concerned about upward trends related to type 2 diabetes over the past 5 years. To help identify the key risk factors, Sam begins to examine three categories of risk central to epidemiology. These categories include all of the following except: 1.Prevalence 2.Behavioral 3.Environmental 4.Genetic Yin is a nurse in a rural primary care clinic. One of the issues that has arisen is how to address patients who come in asking about testing for BRCA1 and BRCA2, the tumor suppressing genes that, if mutated, may indicate hereditary breast and ovarian cancer. Yin reads up on the issue and tells her colleagues that there are arguments against genetic testing for BRCA1 and BRCA2 that include all of the following except: 1.The cost of the test is high. 2.The evidence to the effectiveness of the test is limited. 3.The test is difficult to perform. 4.Less than 10% of all breast cancers are genetically based. The state public health department has been tracking syphilis, as mandated by the Centers for Disease Control and Prevention, with little change in the incidence rate over time. Recently, however, incidence rates indicate they may have an outbreak. They deploy health-care professionals, including nurses, to further investigate beginning with a review of medical records. The first type of surveillance conducted is an example of _______________ surveillance and the second type of surveillance conducted is an example of______________ surveillance. 1.Both are examples of passive surveillance. 2.Passive and active 3.Both are examples of active surveillance. 4.Active and passive A PHN recognizes that which of the following are types of cohort studies? (Select all that apply.) 1.Prospective 2.Retrospective 3.Historical 4.Longitudinal 5.Statistical A team of community members and Monique, a PHN from the public health department, have come together to do a community assessment of an Italian American community located in a large city. The community members ask Monique what type of data they will need to collect. She explains that they should begin with demographic data that includes: 1.Insurance company preference 2.Vaccination rates 3.Educational levels 4.Disease rates A team of community members and Monique, a PHN from the public health department, have come together to do a community assessment of an Italian American community located in a large city. Monique explains to the team that information about the health status of the community would be an important part of their assessment. She explains that this includes all of the following factors except: 1.Mortality rates 2.Morbidity rates 3.Health-care services and resources in the community 4.Prevalence and incidence of disease A team of community members and Monique, a PHN from the public health department, have come together to do a community assessment of an Italian American community located in a large city. Monique and the community members discuss the type of assessment they are conducting. They have decided to complete an assessment to include the demographic data about the people living within the community, the assets within the community, such as the local health department capacity, and the identification of problems and issues in the community, such as unmet needs, health disparities, and opportunities for action. The type of assessment they are doing is called a: 1.Rapid needs assessment 2.Comprehensive community assessment 3.Population-focused assessment 4.Health impact assessment A team of community members and Monique, a PHN from the public health department, have come together to do a community assessment of an Italian American community located in a large city. To help guide the team, Monique suggests that they chose a tool for the assessment. She explains that one can be obtained from: 1.National Institute of Occupational Safety and Health (NIOSH) 2.Affordable Care Act (ACA) 3.Institute of Medicine (IOM)'s report The Future of Public Health 4.Centers for Disease Control and Prevention (CDC) Community Health Assessment and Group Evaluation (CHANGE) A PHN goes to a factory to find out why employees are missing so many workdays. What type of assessment would be the most appropriate in this case? 1.Setting-specific assessment 2.Health impact assessment 3.Problem or health issue-based assessment 4.Population-focused assessment To develop maintenance and survival strategies for a community in the event of an emergency, a PHN looks for useful places, persons, and systems. This part of the assessment is called: 1.Capacity building. 2.Needs assessment. 3.Participatory research. 4.Asset mapping. A team at a large urban hospital has partnered with other hospitals and the department of health to conduct a comprehensive community assessment. They reviewed a number of possible tools to guide their assessment and chose the Mobilizing for Actions through Planning and Partnerships (MAPP) strategic model. They chose this tool because all but which of the following were included: 1.Assessing, diagnosing, developing an intervention 2.A comprehensive method for evaluating health systems 3.Implementing the intervention 4.Evaluating the effectiveness of the intervention A PHN is using the MAPP model to conduct an assessment within the community and has reached Phase 3, performing the four assessments. The analysis of the legislation, technology, and other external positive and negative influences that have an impact on the promotion and protection of the public's health is called a: 1.Community themes and strengths assessment. 2.Forces of change assessment. 3.Community health status assessment. 4.Local public health system assessment (LPHSA). A PHN was asked to come to a town that was having some noticeable health problems. Driving through town, the nurse noted that there were many for-sale signs, as well as very little green space and some trash in the street. This pre-assessment phase is called a: 1.Community themes and strengths assessment. 2.Community Health Assessment and Group Evaluation (CHANGE). 3.Community health status assessment. 4.Windshield survey. A relatively permanent statistical subdivision of a county that averages between 2,500 and 8,000 inhabitants is called a: