Community Health Ch 5-10

Over the course of a year, there were 42 cases of institution-associated pneumonia at a hospital. During that time, 3,102 clients were at risk for acquiring this infection, with 20,411 client-days. Which is the crude incidence rate of institution-associated pneumonia at this hospital?

1.35%

The nurse is conducting research on the relative risk of acquiring lung cancer as a result of being exposed to secondhand smoke. The nurse is studying two different groups. Group A includes 400 adults who do not smoke but are exposed to secondhand smoke in their home on a daily basis. Group B includes 400 adults who do not smoke and are not exposed to secondhand smoke in their home. Over the course of 10 years, 20 subjects in Group A are diagnosed with lung cancer, whereas only 2 subjects in Group B are diagnosed with lung cancer. Which is the relative risk ratio that would result from this study?

10

Over the course of a year, there were 42 cases of institution-associated pneumonia at a hospital. During that time, 3,102 clients were at risk for acquiring this infection, covering a total of 20,411 client-days. Which is the client density in terms of number of cases per 1,000 client-days at this hospital during this time?

2.1

Which occurs in the epidemiologic process that is similar to the diagnosis phase of the nursing process?

A tentative hypothesis is formulated

Which best describes a prospective study?

Analytic study in which participants are enrolled before the health outcome of interest has occurred

Who used statistics to improve public health in England?

Florence Nightingale

Which are recommendations made by the World Health Organization's Commission on Social Determinants of Health (CSDH)? (Select all that apply.)

Improve conditions under which all people are born, grow, live, work, and age Ensure more equitable distribution of power, money, and resources Expand knowledge of the social determinants of health

A 32-year-old African-American client is diagnosed with HIV. She is at her 6-month appointment following diagnosis and treatment. The client states that she has not revealed her diagnosis to her boyfriend 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. The client's behaviors reflect:

Inability to advocate for herself

The nurse is conducting a cross-sectional study of people who are HIV positive and their exposure to certain risk factors. Given the nature of this type of study, which would be true? (Select all that apply.)

Respondents are a sample that represents the entire population. Data represent a point in time. Data are gathered via a questionnaire or interview.

The nurse works at community clinic that provides various types of health screenings for members of the community. One day, the nurse provides tuberculin tests for a group of new hospital employees. Which type of screening procedure is this?

Selective screening

A woman arrives at the 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. Which is the nurse's best response to promote the client's health?

"You will not be protected against other strains of HIV or sexually transmitted infections (STIs)."

City A has a population of people who are exposed to HIV, whereas City B has a population of people who are considered nonexposed to HIV. There were 3,267 new HIV cases in a given year for City A, with a population (exposed) of 10,000,000. There were only 5 new HIV cases in the same year for City B, with a population (nonexposed) of 150,000. Which is the attributable risk of HIV occurring in City A in terms of cases per 100,000 population?

29.34

The nurse researches the relationship between frequent ingestion of fast foods and obesity. The nurse finds that in a population that eats at least five fast food meals per week on average, the incidence rate of people who are obese is 735/1,000 population. In the population that eats only one fast food meal per week on average, the incidence rate of people who are obese is 245/1,000 population. Based on these findings, what is the relative risk of developing obesity in those who eat at least five fast food meals per week?

3

In reviewing a study that considered the sensitivity of a particular screening test for HIV, the nurse found 21 true positives, 853 true negatives, 3 false positives, and 5 false negatives. What is the sensitivity of this test?

80.8%

The nurse wishes to conduct research on the number of cancer clients who are actively involved in exercise programs following chemotherapy. To prepare, the nurse reviews similar, published research studies. The nurse knows that maturation can be a threat to internal validity of the research study. Which is an example of maturation?

A client developed fatigue and was unable to complete the exercise program.

The nurse studies the association of lead poisoning with residence in a home that was built before 1970. Which needs to be established to show an association between these two variables?

A statistical relationship between lead poisoning and residence in a home built before 1970

The nurse reviews published research studies on the number of heart clients who are actively involved in exercise programs following a heart attack in preparation of conducting similar research. Using knowledge of research validity, which threat to external validity must be considered?

A subject pedaling faster on the stationary bicycle whenever an examiner walks in the room

A 19-year-old client is diagnosed as HIV positive. Which behaviors might be indicators of noncompliance with her drug regimen and require further assessment? (Select all that apply.)

A) Depression B) Indifference to self-advocacy in sexual relationships E) Client's expression of concern regarding the ability to pay for her medications

The nurse decides to use the health belief model for a wellness walking program for older adults. The walk is to begin each day at 8 PM. Each day a different participant is to start a chain of phone calls to other participants to remind all to attend. The nurse informs the clients in the clinic that walking will improve their overall health and well-being. Two older adults show up the first night and none the second. Which information should the nurse gather to explain the failure of the program? (Select all that apply.)

A) The severity of the physical challenge related to the client population B) What stands in the way of taking action toward the goal of health promotion C) The presence or absence of cues needed for the program to achieve success

Which correctly defines sensitivity?

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

Which occurs in the epidemiologic process that is similar to the implementation phase of the nursing process?

Actions are initiated to carry out the plan

Which exemplify clinical interventions (the level just above the middle of the health impact pyramid)? (Select all that apply.)

Administration of insulin injections for diabetes Treatment of hypertension

Health People 2020 (HP 2020) is a guidepost for nurses and interdisciplinary teams in community and public health. New focal areas for HP 2020 include

Adolescent health Genomics Social determinants of health

Advantages of a case-control study include: (Select all that apply).

Allows for the examination of multiple exposures for a single outcome Is generally quicker and less expensive to conduct than cohort studies Requires fewer case-subjects

A 34-year-old client is recovering from a below-the-knee amputation secondary to a motor vehicle accident. The nurse meets with the client to update his care plan, and client states that he knows that he will walk again. He asks for physical therapy schedules and timelines for prosthetics on the basis of his healing process. On the basis of knowledge of the theory of reasoned action, the client's behavior reflects:

An enhanced ability to meet his goals on the basis of his intention and behaviors

Who first described pulmonary tuberculosis in detail?

Aretaeus the Cappadocian

The nurse prepares community program objectives that are specific, measurable, achievable, relevant, and time bound (SMART) to help in planning interventions and establishing measurement systems to evaluate programs and outcomes. Which is a measurable objective?

Blood pressure for children aged 12 to 18 years in Marks School will be reduced by 5% after petting the dog for 1 day in March 2019.

Select the examples of social marketing. (Select all that apply.)

Brochure placed in obstetricians' offices promoting the benefits of breastfeeding Billboard illustrating the dangers of texting while driving Posters placed in college dormitories encouraging condom use

The nurse reviews published research studies on clients with developmental disabilities who receive music therapy once a week. Using knowledge of research studies, what type of research study would entail an in-depth analysis of one group of developmentally disabled individuals and the effects of music therapy?

Case

The nurse reviews a published analytical research study that compares one group of clients who developed diabetes mellitus before the start of the study with a group of clients without diabetes mellitus. Which type of study design was used in this study?

Case control

The nurse decided to approach local organizations for financial and in-kind support for a new community health initiative. On which local resources can the nurse draw? (Select all that apply.)

Catholic church Branch of Bank of America Car dealership

The nurse wishes to determine how many people in the city die from heart attacks each year per 100,000 population. Which type of rate is the nurse attempting to calculate?

Cause-specific mortality rate

Which best describes a risk factor?

Characteristic or event that has been shown to increase the probability that a specific disease or illness will develop

The nurse conducts a study that will follow a group of subjects for two decades. It involves one group of subjects who have a risk factor for developing diabetes and another group who do not have a risk factor. The goal is to establish a cause-and-effect relationship between the existence of the risk factor and the occurrence of diabetes. Which study design would be most appropriate?

Cohort

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

Crude

A 27-year-old client 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. The client's social background places her at risk for: (Select all that apply.)

Decreased safe sex behaviors Increased risk for HIV/AIDS Increased risk of depression

The nurse identifies 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 costs and promote the benefits of the project.

Absenteeism due to illness has increased recently in the local middle school. The increase is noted to be related to exacerbation of asthma symptoms in the student population. Which would be the most effective approach in decreasing absenteeism among this population?

Develop an asthma education and surveillance program that addresses students, families, and faculty members.

An immigrant from Guatemala, age 47, is admitted to the coronary care unit with congestive heart failure. This is the fourth admission for this client, and the physician believes that the client's inability to adhere to his diet and medication regimen is the reason for his frequent admissions. The physician refers the client to the local community health nurse, on discharge from the hospital. Which would be most appropriate for the nurse to include in this client's plan of care?

Developing culturally relevant and gender-sensitive interventions

The nurse researches whether the community would benefit from monthly blood pressure clinics. Which system level would such an intervention address?

Downstream

The nurse conducts a class on the basics of nutrition to a group of obese adults. The nurse counsels the audience, telling them that they need to change their behaviors. By the end of the class, the nurse has lost the audience. To enhance audience participation and learning in the next class, the nurse should:

Encourage the group to participate in the decision making

The nurse graphs the distribution of influenza cases by the time of onset of influenza. Which would be the result of this work?

Epidemic curve

In researching cases of West Nile virus in the community, the nurse explores how the interactions among people infected with this virus, mosquitoes, and the environment they share contribute to outbreaks of this disease. Which epidemiologic model is used in this case?

Epidemiologic triad

You have heard rumors in the hospital where you work of an Ebola outbreak in your community and you would like to investigate it further. Which of the following should be your first step in the investigation?

Establish the existence of the outbreak

Clients in the nurse's caseload have been requested to participate in a therapeutic trial about H1N1 influenza. Using knowledge of trials, the nurse tells the clients that the trial:

Focuses on limiting the spread of H1N1 influenza

The nurse decided to use a learning model based on Skinner with a client with diabetes to improve compliance with dietary and blood glucose assessment requirements. Which would be the best way to implement this program?

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

Who is considered the first epidemiologist?

Hippocrates of Cos

Which most accurately describes the purpose of force field analysis?

Identifying the forces driving the change and those resisting it

The nurse wishes to measure the number of cases of staph infections that occur in a hospital over the course of 1 year per total client-days during that year. Which measure should the nurse use?

Incidence density

The nurse wishes to calculate the probability of persons in your county developing chronic obstructive pulmonary disease over the course of a year. Which measure should the nurse use?

Incidence rate

The nurse is conducting a study on how regular physical activity affects the risk for developing lung cancer among smokers. One group leads a sedentary lifestyle whereas the other has agreed to undergo regular supervised exercise in the gym of a local hospital. During the study, the sole treadmill in the gym broke down and was unable to be used for the last half of the study. Several study participants who preferred the treadmill to other machines did not exercise as long or as intensely as they might otherwise have. Which threat to the external validity of the study does this represent?

Interaction of history and intervention

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

Interpersonal mistrust Poor adherence to treatment Compromised self-advocacy in sexual relationships

The nurse wishes to conduct a study on the effectiveness of animal-assisted therapy in alleviating symptoms of depression. One group of subjects would attend regular counseling sessions in the company of a dog, whereas the other group would attend regular counseling sessions without a dog present. In this study, the dogs would represent:

Intervention

Multiple family units in an underserved neighborhood have children who have not been vaccinated per health guidelines. The nurse researches the problem and establishes a well-child clinic within walking distance to the neighborhood. The clinic is poorly attended. Which would be the nurse's best action to revise the program and improve attendance to the clinic?

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

Which changes in the environment (second level from the bottom of the health impact pyramid) make the choice for a healthy behavior the default or easy choice? (Select all that apply.)

Iodization of salt Restrictions on smoking in public places Changing food manufacturing to eliminate trans fats

Who was one of the first people to study patterns of disease in populations and analyzed the weekly reports of births and deaths in London, the results of these analyses becoming the precursor of modern vital statistics?

John Graunt

Who was the best known epidemiologist of the 19th century and used population data and personal observations to investigate the epidemic of cholera that occurred from 1848 through 1854?

John Snow

The nurse researches the role of nurse-managed health centers in the city. Which are common characteristics of these centers? (Select all that apply.)

Led by advanced-practice nurses Emphasize health promotion, disease prevention, and health education Provide clinical practice for nursing students and faculty Offer specialized programs to meet the needs of specific population aggregates

Which was the leading cause of death in the United States in 1900?

Major cardiovascular-renal disease

The nurse is in charge of the flu vaccination program in the community. Which actions should the nurse take when planning and evaluating this program? Select all that apply.

Measure epidemiologic statistics before and after administering the flu shots. Plan and evaluate influenza vaccinations regularly. vaccinations and use these data in planning future vaccinations. As new data regarding influenza vaccinations become available, modify the intervention accordingly.

The nurse is in charge of a local community program that uses a logic model as a planning and communication tool. Which key components are included in this model? (Select all that apply.)

Milestones for completing a community health clinic Plan to conduct cholesterol screenings Need for a nurse practitioner to manage the clinic Possible locations for the health clinic

Which most accurately describes how disease patterns have changed from 1900 to the present?

Morbidity and mortality from noninfectious diseases have increased

The nurse is conducting a study that will consider how heart clients respond to various interventions following a heart attack. The nurse is concerned about the threat that testing could pose to the internal validity of the study. How might testing affect the study?

Multiple measurements of participants' cortisol levels could cause stress in the participants and thus influence their cortisol levels, thereby altering the outcome of the study.

Which formula should be used to calculate a rate?

Number of conditions or events within a designated period of time /Population at risk during the same period of time X Base multiple

Which formula should be used to calculate the infant mortality rate?

Number of deaths of children <1 year of age in one year/ Number of live births in the same year X1,000

Which formula should be used to calculate the fetal mortality rate?

Number of fetal deaths in one year/ Number of live births plus fetal deaths in the same year X 1000

Which formula should be used to calculate perinatal mortality rate?

Number of fetal deaths plus infant deaths <7 days of age in one year/ Number of live births plus fetal deaths in the same year X 1000

Which formula should be used to calculate sensitivity?

Number of true positives/Number of true positives + Number of false negatives

The nurse works in a facility that provides hospice care for clients with cancer diagnoses. The nurse recognizes that the care provided in this facility is tertiary in nature. The nurse develops a plan for the clients that would include the tenets of tertiary prevention. The plan would include:

Palliative care Pain control Supportive spiritual development

Which represents the correct order of the three stages of the natural history of disease?

Pathological onset, presymptomatic, manifestation of clinical disease

A 43-year-old African-American client 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, the nurse finds her intelligent and goal oriented. In addition to her need for education and follow-up regarding her HIV diagnosis and treatment, which associated condition should the nurse most consider when caring for this client?

Posttraumatic stress disorder

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

Preparation

Which rate measures the number of people in a given population who have influenza at a given point in time?

Prevalence

The nurse is participating in study that considers the effect that use of netting around beds has on the incidence of malaria in a community of subjects in Africa. Which type of study would be best for this purpose?

Preventive

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 immunizations and classes on fire safety, health education, and car safety, to name a few. How would the nurse explain the level of prevention used in this setting to your colleagues?

Primary

Which most accurately defines "rate"?

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

After successfully implementing and managing a smoking cessation program in an inner-city neighborhood for 5 years, the group expands the efforts to include a nearby rural community. After a challenging first year, the nurse finds that with a few modifications the program is proving successful in the rural setting, as well. Which essential component of program design has been established by success in the rural community?

Program replication

The nurse reads a research article that reviews causality. Using knowledge of research designs, which types of design examine causality? (Select all that apply.)

Quasi-experimental Experimental Randomized, control group

The nurse is preparing a research study on the number of heart attacks in the community and the number of individuals who are actively involved in exercise programs following a heart attack. Using knowledge of research study design, which gold standard for a research design should be considered?

Randomized, control group

The nurse is preparing to do a research study on the effects of tight insulin control for diabetes. Using the knowledge that epidemiologic research can be descriptive or analytical, which would be the strongest study design to consider?

Randomized, control group

Which is the primary method used to measure the existence of states of health or illness in a population during a given time period?

Rate

The community health nurse addresses an outbreak of viral spinal meningitis in the community. Referring to Leavell and Clark's natural history of disease model, which example of tertiary prevention might the nurse consider in this situation?

Refer clients who have experienced neurological deficits because of the disease to a neurologist to begin rehabilitation.

A 47-year-old client and three members of his neighborhood have had their homes robbed and belongings scattered. The client 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

Incidence rates for groups exposed to a secondhand smoke are compared with the incidence rates for people who are not exposed to secondhand smoke. This will measure the:

Relative risk ratio

The nurse reviews the job descriptions of the community health workers who work with community health nurses and other members of the program team. These workers are responsible for: (Select all that apply.)

Serving as a cultural and language bridge to members of target population Providing health education and outreach to community Offering assistance in accessing services

Which ensures that a study's results are not due to chance alone?

Setting the p value to .05

The nurse wishes to compare the number of persons aged 40 to 49 years who die each year with the midyear population of persons in this age range, per 100,000 population. Which type of rate is the nurse attempting to calculate?

Specific

Which correctly defines an adjusted rate?

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

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

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

The nurse is reviewing the sources of funding for the local community health intervention program on smoking cessation. In the federal grant proposal, the nurse elaborates on all the various local organizations and private foundations that have pledged to support the program after initial funding from the grant ends. The nurse also explains the plan for ongoing fundraising efforts for the program for years to come. With these comments, the nurse is attempting to establish which essential component of funding?

Sustainability

Using the tenets of secondary prevention, the committee seeks to establish an HIV/AIDS clinic. The nurse states 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. Which presents the best rationale for the nurse's suggestion?

The hospital can more easily implement programs of care for the clients.

The nurse has been requested to investigate the outbreak of H1N1 in the community. In documenting the outbreak, which should be included in its description? Select all that apply.

The names of all people who have been infected by the virus The geographical area within which the outbreak has occurred The time of onset and duration of the outbreak

The best description of a type II error is that it occurs when:

The null hypothesis is accepted when it is false.

Which characterize health inequities? (Select all that apply.)

Unfair Resulting from social injustices Avoidable

Which aspects of Lewin's change theory will help people visualize and create needed change? (Select all that apply.)

Unfreezing the status quo Changing or moving to a new state Refreezing to sustain the change or changes made

As an advocate for leukemia research, the nurse along with many others succeeded in urging the U.S. Congress to debate and vote on a bill that significantly increases federal funding for this research. Which system level would such an intervention address?

Upstream

The nurse is conducting a study on heart clients who are actively involved in exercise programs following a heart attack. The nurse should consider which as a threat to internal validity?

Using a variety of stationary bicycles for stress testing

The nurse explores all of the possible factors that contribute to coronary artery disease in the community as links in multiple interrelated chains. Which epidemiologic models is the nurse using?

Web of causation

In researching an outbreak of malaria in the developing nation where the nurse currently works, the nurse decides to not focus on the role of mosquitoes in transmitting the disease but on how the physical environment of the community, biological aspects of the community, and social customs interact to affect the prevalence of this disease. Which epidemiological model is the nurse using?

Wheel of causation

Who in the history of epidemiology developed mortality surveillance systems, addressed basic epidemiologic concepts, and is considered the founder of modern statistics?

William Farr