Community Exam 1 ch. 4,5,6

You are preparing a chart to review epidemiologic statistics of the community. Using your knowledge that the primary way to demonstrate prevention or control of a health problem is to compare epidemiologic statistics, when should this review be done?

Before and after implementation of the health service

Calculation of rates provides the best indicators of the probability that a specific state of health will occur. What is the correct formula for calculation of a rate?

C

Your committee has established the need for a sick child clinic in an impoverished neighborhood. The demographic data have been collected and you are ready to meet with a committee of local businessmen who are willing to support the project financially. The plan is for the committees to combine to facilitate the establishment of the clinic. Using a transtheoretical model, what level of readiness would you determine the committees have achieved?

Preparation

A variety of rates can be calculated according to need, including incidence, prevalence, adjusted, and specific rates. What rate measures the number of people in a given population who have influenza at a given point in time?

Prevalence

You are compiling data about the community for the last 12 months. Using your knowledge about epidemiology as a research methodology you have been asked to document rates. What is a rate?

Primary measurement used to describe either the occurrence or the existence of a specific state of health or illness

The local clinic is dedicated to the well adult and child. It has evening hours and offers varied programs for the community. The programs include smoking cessation, child care, weight loss through nutrition, and blood pressure clinics, to name a few. How would you explain the level of prevention used in this setting to your colleagues?

Primary prevention

Measuring the magnitude or frequency of a state of health determines the characteristics of those who are at high risk. What is the primary method used to measure the existence of states of health or illness in a population during a given time period?

Rate

As the community health nurse you have to compile community programs based on primary, secondary, and tertiary prevention measures. Using your knowledge that Leavell and Clark developed a conceptual model for the natural history of any disease affecting humans, what is an example of tertiary prevention?

Rehabilitation measures that enable the individual to function at maximum capability

Incidence rates for groups exposed to a second-hand smoke are compared with the incidence rates for people who are not exposed to second-hand smoke. What does this measure?

Relative risk ratio

What is the measure of the probability that people without a certain condition will develop that condition over a period of time?

Relative risk ratio

A variety of rates can be calculated according to need, including incidence, prevalence, adjusted, and specific rates. What is the name of the rate represented when detailed rates are calculated using the number of people in the smaller subgroups of the population in the denominator?

Specific

A variety of rates can be calculated according to need, including incidence, prevalence, adjusted, and specific rates. What is an adjusted rate?

Statistical procedure that removes the effects of differences in the composition of a population, such as age, when comparing one to another.

As a community health nurse you know that early attempts to understand illness and disease focused on the study of the experiences of individual people. Using this knowledge, how would you define epidemiology to a group of nursing students?

Study of the distribution and determinants of states of health and illness in human populations

Before screening projects are undertaken, the sensitivity and specificity of screening levels or test values should be carefully reviewed. What statistical measures do sensitivity and specificity evaluate?

Validity and reliability

HP 2010 is a guidepost for nurses and interdisciplinary teams in community and public health. What actions would you take to meet the primary goals for HP 2010 in a high-school setting as a resource for the school nurse? (Select all that apply)

Y Establish a tobacco cessation program for students and faculty. N Create a hearing and speech evaluation program. Y Establish a committee to create a self-sustaining sports and physical activity program. Y Create a program to educate staff and students regarding the impact of substance abuse on the student's body and prevention tactics. N Establish an English as a second language program for students.

Secondary HIV prevention or positive prevention is used when caring for African-American women living with HIV by addressing which of the following behavioral risks? (Select all that apply)

Y Interpersonal mistrust N Financial stability Y Poor adherence to treatment Y Active participation in treatment programs N Compromised self-advocacy in sexual relationships

Jacqueline K, age 19, is diagnosed as HIV positive. Which behaviors might be indicators related to noncompliance with her drug regimen and require further assessment? (select all that apply)

Y Negative affectivity Y Indifference to self-advocacy in sexual relationships N Goal oriented related to treatment plan N Client's expression of concern for the health and well-being of her children Y Client's expression of concern regarding the ability to pay for her medications

You are working in a facility that provides hospice care for clients with cancer diagnoses. You recognize that the care provided in this facility is tertiary in nature. You ask the student nurse observing your care to develop a plan for her clients that would include the tenets of tertiary prevention. The plan would include the following: (select all that apply)

Y Palliative care Y Pain control N Isolation Y Supportive spiritual development N Diminished involvement of significant others

You have to document the course of your client's condition from the onset to resolution Using your knowledge about the natural history of most illnesses, what stages will be included in the documentation?

Y Pathological onset stage Y Presymptomatic stage Y Manifestation of clinical disease N Resolution

Specific rates calculated by person, place, and time provide the best description of a health condition. What specific rate is represented by:

Cause-specific mortality rate

You have just completed a new client assessment on a patient in the community. Using your knowledge that a common process is to assess individuals for risk factors that have been associated with a disease or illness, what are risk factors?

Characteristics or events that have been shown to increase the probability that a specific disease or illness will develop

You have been requested to investigate the outbreak of H1N1 in the community. Using your knowledge about epidemiologic research, what is an outbreak?

Course of a disease or condition from the onset to resolution

The community health nurse is measuring the occurrence of chronic obstructive pulmonary disease being investigated in the entire population. What rate does this represent?

Crude

To provide more valid descriptions of the frequency of various states of health, it is necessary to use ratios, proportions, or rates. There are several maternal and infant rates that can be measured. Which calculation represents the fetal mortality rate?

D

You have identified the specific indicators and focal areas needed to establish immunization and well-child clinics in a low-income neighborhood. What actions are needed to meet the health outcomes of the project?

Develop a plan to meet the cost and promote the benefits of the project.

Absenteeism in the local middle school due to illness is increased. The increase is noted to be related to exacerbation of asthma symptoms in the student population. What would you suggest to the school to decrease absenteeism among this population?

Develop a student/family/faculty-based program dedicated to education and surveillance.

You have to prepare a short presentation on the history of epidemiology. Using your knowledge about history of statistics, who used statistics to improve public health in England?

Florence Nightingale

You have decided to use a learning model based on Skinner to change the dietary habits of a diabetic client to enhance compliance with her diet and finger stick blood sugar levels. How would you implement this program?

Give rewards for a lower blood sugar level and a food diary that reflected moderate dietary compliance.

You have to prepare a short presentation on the history of epidemiology. Using your knowledge about the history of epidemiology, who is considered the first epidemiologist?

Hippocrates of Cos

When there are unequal periods of observation for study subjects, it may be necessary to use a person-time denominator in the calculation of incidence rates. What does this technique measure?

Incidence density

Multiple family units in an underserved neighborhood have children who have not been vaccinated per health guidelines. You research the problem and establish a well-child clinic within walking distance to the neighborhood. The clinic is poorly attended. What changes would you make to revise your program and improve attendance to the clinic?

Interview members of the neighborhood to determine why they do not use the clinic.

You have to prepare a short presentation on the history of vital statistics. Using your knowledge about the fact that the study of illness in groups of people developed gradually, who analyzed the weekly reports of births and deaths in London and as a result these analyses became the precursor of modern vital statistics?

John Graunt

According to the chart, what is the crude incidence of institution-associated pneumonia in an acute care setting?

1.5

You have to prepare a short presentation on the history of epidemiology. Using your knowledge about population data, who was the best known epidemiologist of the 19th century who used population data and his own observations to investigate the epidemic of cholera that occurred from 1848 through 1854?

John Snow

You are comparing the current leading causes of death in the community to those at the beginning of the 20th century. Using your knowledge about the importance of looking at changing demographics, what was the leading cause of death in the United States in 1900?

Major cardiovascular-renal disease

Before screening projects are undertaken, the sensitivity and specificity of screening levels or test values should be carefully reviewed. What is the correct formula for sensitivity?

A

Indices of the health of a community, region, or country include comparisons of general mortality rates and maternal infant rates. What is the correct formula for the maternal infant rate?

A

D.A., age 27, comes from a background of physical and sexual abuse. Violence victimization continued with her partners until recently. She is currently in a support group for victims of abuse. Her social background places her at risk for (select all that apply)

N Increased safe sex behaviors. Y decreased safe sex behaviors. N decreased risk for HIV/AIDS. Y increased risk for HIV/AIDS. Y increased risk of depression.

You are preparing for the new community health nurse orientation about the care of individual and community clients. Using your knowledge about the community who has the best potential to link environmental exposure to illness and disease?

Nurse

Sandy, age 43, is an African-American woman who is HIV positive. She has a personal history of abuse, which ended when her husband died 2 years ago. When counseling the client about adherence to her treatment plan, you find her intelligent and goal oriented. In addition to education and follow-up regarding her medical needs what other diagnosis should you take into consider when caring for Sandy?

PTSD

Before screening projects are undertaken, the sensitivity and specificity of screening levels or test values should be carefully reviewed. What is sensitivity?

Ability of a test to correctly identify people who have a health problem; the probability of testing positive if the health problem is truly present

You are making a graph for the new community health nurse orientation about the similarities between the nursing process and the epidemiologic process. Based on your knowledge of these important processes, what occurs in the epidemiologic process that is similar to the implementation phase of the nursing process?

Actions are initiated to implement the plan.

Mr. Guerra, age 47, a native of Guatemala, is admitted to the hospital with congestive heart failure to the coronary care unit. This is the fourth admission for Mr. Guerra, and the physician feels that the client's inability to adhere to his diet and medication regimen is the reason for his frequent admissions. A referral is made to the community health nurse upon Mr. Guerra's discharge from the hospital. You would implement a plan of care that would include

developing culturally relevant and gender-sensitive interventions.

Carlene, age 32, is an African-American woman diagnosed with HIV. She is here for her 6-month appointment postdiagnosis and treatment. The client states that she has not revealed her diagnosis to her boy friend because she is afraid that he will leave. She expresses feelings of anger because she must put her feelings and illness aside or be abandoned. Carlene's behaviors reflect

inability to advocate for herself.

James Bates, age 47, and three members of his neighborhood have had their homes robbed and belongings scattered. He contacts the police, and with their assistance, develops a neighborhood watch. The watch is organized and 24 families have been recruited to participate. The watch will be active throughout vacation months and as needed. This organization is representative of

relapse prevention model.

During the orientation of the new community health nurse to your agency you are describing epidemiologic models. Using your knowledge about the various epidemiologic models, what model strongly emphasizes the concept of multiple causation while de-emphasizing the role of agents in explaining illness?

web of causation

During the orientation of the new community health nurse to your agency you are describing epidemiologic models. Using your knowledge about the various epidemiologic models, what epidemiologic model de-emphasizes the agent as the sole cause of disease while emphasizing the interplay of physical, biological, and social environments?

wheel of causation

The study of illness and causes of death in groups of people began in the 17th century. You have to prepare a short presentation on the history of epidemiology. Using your knowledge about the history of epidemiology, who was considered the founder of modern statistics?

william farr

You have decided to use the health belief model for your well-elder clinic "walking program." The walk is to begin each day at 8 PM and each day a different elder is to start a phone tree to remind all to attend. You inform the clients in the clinic that walking will improve their overall health and well-being. Two elders show up the first night and none the second. What information would you gather to explain the failure of the program? (select all that apply)

Y The severity of the physical challenge related to the client population Y What stands in the way of taking action toward the goal of health promotion Y The presence or absence of cues needed for the program to achieve success N The presence or absence of a strong team leader among the elders N The need to increase persuasion when implementing the program

Mr. Sandstrom, age 34, is recovering from a below-the-knee amputation secondary to a motor vehicle accident. You meet with the client to update his care plan and Mr. Sandstrom states that he knows that he will walk again. He asks for physical therapy schedules and time lines for prosthetics based on his healing process. Based on your knowledge of the theory of reasoned action, the client's behavior reflects

an enhanced ability to meet his goals based on his intention and behaviors.

A woman arrives at your clinic for a routine appointment. She has been HIV positive for 3 years and states she is doing well. She currently is involved in a relationship with a man who is HIV positive. She states that she is not consistent with safe sex practices due to her significant other's preferences and feels uncomfortable asking him to wear a condom. To promote your clients health you state the following:

"You will not be protected against other strains of HIV or STIs."

According to the chart, what is the incidence per 100 patient days of institution-associated pneumonia in long- term care setting?

0.73

You are describing the classic model to the new community health care nurse. Using your knowledge that this model is based on the belief that health status is determined by the interaction of the characteristics of the host, agent, and environment, not by any single factor, what is this model commonly called?

Epidemiologic triad

You have to prepare a short presentation on the history of epidemiology of tuberculosis. Using your knowledge about the history of epidemiology, who first described pulmonary tuberculosis in detail?

Aretaeus the Cappadocin

What is the term for the difference between the incidence rates in a group of people exposed to HIV in Africa and a group of people not exposed to HIV in Africa?

Attributable

To provide more valid descriptions of the frequency of various states of health, it is necessary to use ratios, proportions, or rates. There are several maternal and infant rates that can be measured. Which calculation represents the perinatal mortality rate?

B

You are invited to conduct a class on December 8. The audience is a group that will attend an AA meeting after the clinic. During the class, you instruct the audience in the basics of nutrition. You answer questions asked by the audience by counseling them. You tell them that they just need to change their behaviors. You lose your audience. What changes would you make to the class to enhance audience participation and learning?

Encourage the group to participate in the decision making.

The RN is graphing the distribution of influenza cases by the time of onset of influenza. What does this represent?

Epidemic curve

You are making a graph for the new community health nurse orientation about the similarities between the nursing process and the epidemiologic process. Based on your knowledge of these important processes, what occurs in the epidemiologic process that is similar to the diagnosis phase of the nursing process?

Tentative hypothesis is formulated.

Utilizing the tenets of secondary prevention, your committee seeks to establish an HIV/AIDS clinic. You state that it is important for the location of the clinic to be associated with the local hospital. The committee states that the cost of the clinic associated with the hospital is higher than one that is free standing. You explain the rationale for your suggestion in the following manner:

The hospital can address programs of care for the clients.