NURS 420 Exam 2 ch 10-15, 17, & 18

A client is using a primary prevention strategy to prevent infectious disease. Which of the following actions is the client most likely taking? A. A client receives a tetanus booster every 10 years B. A client receives a tetanus booster after stepping on a nail C. A client receives tetanus immunoglobulin after stepping on a nail D. A client with tetanus is given antibiotics & is placed on seizure precautions

A. A client receives a tetanus booster every 10 years Tetanus boosters given before exposure are a measure of primary prevention because exposure has not yet occurred.

A nurse has invited community members to participate as full partners in creating changes to improve the health of the community. Which of the following may be an unexpected consequence of this action? A. A change in the distribution or redistribution of power and influence B. An increase in awareness of the importance of health C. Continued ongoing interest in community health activities D. Improved family functioning and involvement in health activities

A. A change in the distribution or redistribution of power and influence Collaborative practice models involving the community & nurses in joint decision-making & specific nursing roles are required. Nurses mist remember that collaboration means shared roles & a cooperative effort in which participants want to work together.

A woman & man who have come to the health clinic & begin to argue loudly. "You have me an STI!" the man yells. The woman screams back, "Not me. I don't have an STI!" Which of the following statements would be most appropriate for the nurse to say to them? Select all that apply. A. "Actually, you're very fortunate to have been tested, so you & your partner can begin treatment before more serious damage is done." B. "Some STIs may not have any symptoms, so you need to be tested for other conditions & treated if necessary." C. "Sometimes the test is inaccurate, so before getting too upset, you should ask to be tested again." D. "You may be able to get treatment from your pharmacist so you won't have to be embarrassed like this again." E. "Some STIs are spread in ways that are non-sexual in nature."

A. "Actually, you're very fortunate to have been tested, so you & your partner can begin treatment before more serious damage is done." B. "Some STIs may not have any symptoms, so you need to be tested for other conditions & treated if necessary." C. "Sometimes the test is inaccurate, so before getting too upset, you should ask to be tested again." Often cases of gonorrhea & chlamydia are asymptomatic, so treatment may not be sought & these infections are spread to others through sexual activity. Similarly, during latency, syphilis has no symptoms. It should be noted, however, that STI test results can sometimes be incorrect & the coexistence of other medical conditions may cause a false-positive test result. Having a partner retested, if the were negative, would also suggest retesting the first person.

A school nurse asks a class about the ways HIV can be transmitted. Which of the following comments by a student indicates a need for additional teaching? A. "I wouldn't sit next to someone with HIV." B. "Having unprotected sex with someone who is infected spreads HIV." C. "Sharing needles when shooting up drugs spreads HIV." D. "Transfusions of blood products that are contaminated can spread HIV."

A. "I wouldn't sit next to someone with HIV." HIV is not transmitted through casual contact such as touching or hugging someone who has HIV infection. It is not transmitted by insects, coughing, sneezing, office equipment, or sitting next to or eating with someone who has HIV infection.

A nurse explained to a new mother that because she had tested positive for the hepatitis B virus, her newborn son would need the hepatitis B vaccine immediately and then also an immune globulin injection. "Wait," said the new mother. "Why is my son getting two shots?" Which of the following statements would be the best response by the nurse? A. "One injection protects your son, while the other encourages his body to build up immunity." B. "One shot keeps your son from getting sick, while the other is a typical vaccine to prevent you from accidentally infecting him." C. "Since you've already been infected with the virus, your son needs twice as much protection." D. "The second shot is just to make sure the first one works."

A. "One injection protects your son, while the other encourages his body to build up immunity." Because infected persons may not have any symptoms, all pregnant women should be tested for HBsAg. If the mother tests positive, her newborn needs hepatitis B immune globulin to provide passive immunity & thus prevent infection. In addition, the newborn is given the hepatitis B vaccine at birth, with two follow-up injections, to build active immunity to the infection. One of the shots provides passive immunity & the other provides active immunity. The active immunity continues to be built up by receiving two follow-up injections weeks later.

Statistics clearly demonstrate that there are significantly more cases of a disease in one particular neighborhood than in all the rest of the city. Assuming all else is the same, which of the following is the most likely explanation for a single neighborhood having such a different pattern of illness? A. A cultural or ethnic concentration in the neighborhood B. The geographical location of the neighborhood within the city C. A statistical fluke without meaning D. The time of year the different statistics were collected throughout the city

A. A cultural or ethnic concentration in the neighborhood Although any explanation is possible, the most probable reason is that there is a cultural or ethnic concentration in that particular neighborhood that has a different lifestyle pattern, resulting in different health outcomes.

A nurse believes a new mouth care procedure (MCP) is causing more mouth problems than it is helping to avoid. Which of the following must be present for the nurse to go to administration with confidence that the new mouth care procedure (MCP) is causing problems? Select all that apply. A. A plausible explanation of how the new MCP could cause harm B. A strong feeling that the MCP is the cause C. Consistently seeing mouth inflammation in many of the patients who have received the MCP D. Documentation from patient records that mouth inflammation in clients did not occur until after the new procedure was implemented E. A less expensive option for appropriate oral care

A. A plausible explanation of how the new MCP could cause harm C. Consistently seeing mouth inflammation in many of the patients who have received the MCP D. Documentation from patient records that mouth inflammation in clients did not occur until after the new procedure was implemented

Which of the following is the most probable cause of the increase in new emerging infectious diseases? A. Activities or behavior of humans, including changes in the environment B. Increasing urbanization & growth in new housing materials C. New infectious agents are evolving throughout the world D. Overpopulation in many areas, creating a need to reduce global population

A. Activities or behavior of humans, including changes in the environment Most of the emergence factors are consequences of activities & behavior of the human hosts & of environmental changes such as deforestation, urbanization, & industrialization.

Which of the following explains why contagious infections are becoming a central focus of public health? Select all that apply. A. Americans are fearful of terrorists using biological agents B. Awareness of human susceptibility to animal diseases has been publicized C. Drug-resistant strains of old diseases have evolved D. Media coverage exaggerates the dangers of exposure to crowds E. The American population has become more health conscious in the last 20 years

A. Americans are fearful of terrorists using biological agents C. Drug-resistant strains of old diseases have evolved New infectious diseases & new forms of old diseases, such as drug-resistant strains of TB, have emphasized the dangers of infectious diseases. Potential threats from terrorist use of infectious agents have also emphasized infectious diseases.

Which of the following biological warfare agents poses the greatest bioterrorism threat to a community? A. Anthrax B. Botulism C. Smallpox D. Tularemia

A. Anthrax Because of factors such as the ability to become an aerosol, the resistance to environmental degradation, & a high fatality rate, inhalational anthrax is considered to have an extremely high potential for being the single greatest biological warfare threat.

Which of the following places best describes where the incidence of Vancomycin-resistant Staphylococcus aureus (VRSA) & methicillin-resistant S. aureus (MRSA) is currently rising? A. Areas where people share dressing or bathing facilities B. Daycare centers & schools C. Long-term care facilities D. Senior citizen centers

A. Areas where people share dressing or bathing facilities VRSA & MRSA remain problems for people who acquire the bacteria in the hospital, but there is a growing incidence of community-acquired MRSA in places where people closely share facilities such as locker rooms, prisons, & other close bathing areas.

Which of the following best represents an example of infectious disease spreading via a vector? A. Being bitten by an infected mosquito B. Disease spreading from infected mother to infant via the placenta C. A group of partygoers hugging & shaking hands D. Two persons, one of whom is infected, sharing a glass of soda

A. Being bitten by an infected mosquito Vectors include mosquitoes, which can transmit the infectious agent by biting the host.

A nurse is examining all of the various factors which can lead to disease. Which of the following models would the nurse most likely use? A. Epidemiologic triangle B. Health promotion C. Levels of prevention D. Natural history of disease

A. Epidemiologic triangle The epidemiologic triangle categorizes factors as agent, host, or environment. The model encourages the health care provider to examine all the influences that lead to increased risk.

A male client visits the clinic office reporting a yellow-green discharge from his penis. Which of the following STIs has the client most likely contracted? A. Gonorrhea B. Syphilis C. Herpes simplex virus 2 D. Human papillomavirus

A. Gonorrhea The symptoms for gonorrhea in a male include a burning sensation when urinating, or a white, yellow-green discharge from the penis.

Which of the following statements best explains why HSV-2 infection is more challenging for a client than gonorrhea infection? A. HSV-2 is a viral infection that is both chronic & incurable B. HSV-2 is extremely expensive to treat C. HSV-2, like HIV, is almost impossible to diagnose in the early stages D. Once a person has been treated for HSV-2, the person is immune to further outbreaks

A. HSV-2 is a viral infection that is both chronic & incurable Unlike gonorrhea, there is no cure for HSV-2 infection; it is considered a chronic disease.

The administration at a local medical center examines the trends in health problems when developing long-range plans for staffing & space allocation. Which of the following sources of information would be most helpful? A. Local data drawn from a professional survey in the city B. The National Health Interview Survey C. The National Hospital Discharge Survey D. The state's vital statistics

A. Local data drawn from a professional survey in the city The National Health Interview Survey & the National Hospital Discharge Survey both provide information on the health status & behaviors of the national population. For many studies, however, the only way to obtain the needed information is to collect the required data in a study specifically designed to investigate a particular question.

Two women seem to agree on almost everything from favorite music to favorite media stars to the best way to prepare a meal. Which of the following best explains this similarity in the two women? A. They are both members of the same birth cohort B. They are close friends C. They attended the same school D. They both go the same church

A. They are both members of the same birth cohort Being close friends is probably the result of the similarity rather than the cause. However, being born at about the same time would mean both women have lived through similar social events & media occurrences & therefore would have much in common. Going to the same school or the same church, depending on the size of the institutions, might not result in any personal interaction whatsoever.

A nurse just accepted a position in community health and has been assigned to a neighborhood very close to where she lives. Which of the following best describes the rationale for this assignment? A. To allow participant observation by the nurse B. To ensure that the nurse would care about her intervention outcomes C. To maximize convenience and minimize commuting time for the nurse D. To save gasoline in these difficult economic times

A. To allow participant observation by the nurse Such an assignment allows for participant observation or the deliberate sharing in the life of a community. If the nurse lives in the community, activities such as participating in clinical organizations & church life & reading the newspaper give the nurse "observations" of the community's life.

Which population is best protected against pertussis by the DTaP vaccine? A. Young children B. The pre-teen C. The teen D. Adult

A. Young children More than 200,000 children previously got pertussis each year. Two vaccines protect against this disease: DTaP protects young children from diphtheria, tetanus, & pertussis; & Tdap protects preteens, teens, & adults.

Which of the following best explains why chlamydia is a major focus of public health efforts? A. It has more serious long-term outcomes than other STDs B. It can cause problems in infants born to infected mothers C. It is not frequently seen in the United States D. It is so difficult & expensive to treat

B. It can cause problems in infants born to infected mothers Like gonorrhea & other STDs, chlamydia can cause neonatal complications in infants born to infected mothers.

A mother felt very guilty that her baby was born HIV positive. When the nurse suggested the usual DPT & MMR immunizations, the mother was extremely upset. "Don't you know HIV children are immunosuppressed?" she exclaimed. Which of the following would be the nurse's best response? A. "All children have to have these immunizations before they can attend school." B. "Being HIV positive, your child is more likely to catch an infection & be very ill if not immunized." C. "I'm so sorry; I forgot for a moment your child was HIV positive." D. "The American Pediatric Association requires all health care providers to offer these immunizations to all parents; it is your choice whether or not to accept them."

B. "Being HIV positive, your child is more likely to catch an infection & be very ill if not immunized." Because of impaired immunity, children with HIV infections are more likely to get childhood diseases & suffer serious consequences of the diseases. Therefore, DPT, IPV, & MMR vaccines should be given at regularly scheduled times for children infected with HIV. Although this child is HIV positive, there is no medical reason why the child should not be immunized.

When a nurse discovers that a woman has been treated for cervical cancer, the nurse asks the woman whether she has ever been tested for HIV or other STDs. The woman is offended and asks why the nurse would ask her such a thing. Which of the following statements would be the best response from the nurse? A. "Cervical cancer treatments may decrease immunity, so that it is easier to acquire STDs." B. "Cervical cancer usually is caused by HPV, and often the presence of one STD is accompanied by other STDs." C. "The presence of an STD in women with cervical cancer may lead to congenital defects in offspring." D. "The presence of an STD in a woman with a history of cervical cancer has been associated with a relapse of the cancer after treatment."

B. "Cervical cancer usually is caused by HPV, and often the presence of one STD is accompanied by other STDs." The link between HPV infection & cervical cancer has been established & is associated with specific types of the virus. In 80-90% of cases of cervical cancer, evidence of HPV has been found in the tumor.

A client diagnosed with tuberculosis (TB) asks why the nurse is required to watch the client swallow the medication each day. Which of the following statements is the best response by the nurse? A. "Clients with TB are often noncompliant, so if I directly observe, you will be sure to take the drugs that have been ordered." B. "This therapy is recommended to make sure that you receive the treatment you need & the infection doesn't become resistant to drugs." C. "This is to make sure you take your medication if your condition becomes so advanced that you do not have enough cerebral oxygenation to remember." D. "Tuberculosis medications are very expensive so this method ensures that government money doesn't get wasted on those who will not take the drugs."

B. "This therapy is recommended to make sure that you receive the treatment you need & the infection doesn't become resistant to drugs." It is important to be respectful to clients & to consider their perspective & psychological health while also responding truthfully. Directly observed therapy (DOT) programs for TB medication involve the nurse observing & documenting individual clients taking their TB drugs. When clients prematurely stop taking TB medications, there is a risk that the TB will become resistant to the medications. This can affect an entire community of people who are susceptible to this airborne disease. DOT ensures that TB-infected clients receive adequate medication.

The public health nurse comes to the hospital to see a client just diagnosed with hepatitis A. The nurse says, "I'm sorry to bother you when you're not feeling well, but I need to ask you a few questions." Which of the following questions would be most appropriate for the nurse to ask the client? Select all that apply. A. "Do you know how you got this infection?" B. "Who lives with you?" C. "Where are you employed?" D. "Where do you usually eat?" E. "Are you sexually active?"

B. "Who lives with you?" C. "Where are you employed?" E. "Are you sexually active?" The nurse should ask about sexual contacts & ask who (if anyone) lives with the client because the named individuals will need to have immune globulin administered to hopefully prevent the spread of hepatitis A & a community epidemic. The nurse should also ask about the client's place of employment because certain settings warrant special considerations. For example, in restaurants, hospitals, daycare centers, or other institutions, the lack of careful hand-washing by an infected food-handler, contaminated produce, or contaminated water.

A student reports to the college health nurse that her academic work has been going downhill because of lack of sleep. "My 3-year-old probably misses her babysitter since she has started going to the big daycare center. She hasn't been sleeping well & keeps scratching her bottom. Hopefully, she'll adapt to daycare soon." Which of the following information should the nurse provide to the student? A. "Dry skin in winter weather can cause itchiness; try to put on lotion before bedtime." B. "Your daughter may have pinworms; let me teach you how to check for this." C. "Perhaps your child is not developmentally ready for group play." D. "Try to arrange more one-on-one time with your 3-year-old."

B. "Your daughter may have pinworms; let me teach you how to check for this." Enterobiasis (pinworm infection) is the most common helminthic infection in the U.S. with about 42 million cases a year. This infection is seen most often among children in institutional settings. Pinworms cause itching, especially around the anus, which can result in a lack of sleep for both child & caregiver.

Which of the following of the most common vector-borne diseases is a result of travelers introducing the disease to the U.S.? A. Dengue B. Malaria C. Onchocerciasis (river blindness) D. Yellow fever

B. Malaria Globally, malaria is the most prevalent vector-borne disease, with over 2.4 billion people at risk & more than 275 million cases reported each year. The vast majority of cases in the U.S. are in travelers & immigrants returning from countries where malaria transmission occurs, many from sub-Saharan Africa & South Asia.

A man is diagnosed with prostate cancer. Which of the following data should the nurse know to answer the man when he asks, "What are the chances I'll survive this thing?" A. Attack rate B. Case fatality rate C. Cause-specific morbidity rate D. Crude mortality rate

B. Case fatality rate The case fatality rate (CFR) is the proportion of persons diagnosed with a particular disorder (i.e., cases) who die within a specified period. The CFR is considered an estimate of the risk of death within that period for a person newly diagnosed with the disease. Persons diagnosed with a particular disease often want to know the probability of surviving; the CFR provides that information.

Which of the following best explains why some health clinics allow clients to be tested for HIV anonymously with no record of the client's name, address, or contact information? A. Client doesn't actually ever have to be told the results of the test B. Client may be engaged in illegal activities (drug use) C. Client plans on not paying for the test, & collection agencies will not be able to harass them D. Client wants to be sure care providers don't share results with their family

B. Client may be engaged in illegal activities (drug use) An advantage of anonymous testing may be that it increases the number of people who are willing to be tested, because many of those at risk are engaged in illegal activities. The anonymity eliminates their concern about the possibility of arrest or discrimination. The client is given an identification code number that is attached to all records of the test results & is not linked to the person's name & address. Thus, the client is able to know the results of the test while staying anonymous.

A nurse is using analytic epidemiology when conducting a research project. Which of the following projects is the nurse most likely completing? A. Reviewing communicable disease statistics B. Determining factors contributing to childhood obesity C. Analyzing locations where family violence is increasing D. Documenting population characteristics for healthy older citizens

B. Determining factors contributing to childhood obesity Epidemiology refers not only to infectious epidemics but also to other health-related events. The goal of analytic epidemiology is to discover determinants of outcomes - the how & the why. Analytic epidemiology looks at the etiology (origins or causes) of disease. It discusses the disease in terms of how & why.

Which of the following best describes the characteristic appearance of lesions of human papillomavirus (HPV)? A. Solitary growth with elevated borders & a central depression B. Elevated growths with a "cauliflower" appearance C. Thin-walled pustules that rupture to form honey-colored crusts D. Vesicles that ulcerate & crust within 1-4 days

B. Elevated growths with a "cauliflower" appearance HPV causes genital warts that appear as textured surface lesions, with what is sometimes described as a cauliflower appearance. The warts are usually multiple & vary between 1-5 mm in diameter.

Which of the following components of the epidemiologic triangle contributes most to a female client developing a vaginal infection caused by fungi after successful treatment of her strep throat with antibiotics? A. Agent B. Environment C. Host D. Agent & host

B. Environment The antibiotic therapy eliminates a specific pathological agent, but it also may alter the balance of normally occurring organisms in the woman's body, which causes a change in the vaginal environment & allows normally present fungi to proliferate, resulting in a yeast infection.

A nurse is employed as a nurse epidemiologist. Which of the following activities would most likely be completed by the nurse? A. Eliciting the health history of a client presenting with an illness B. Evaluating the number of clients presenting with similar diseases C. Performing a physical examination of an ill client D. Providing treatment & health education to a client with a disease

B. Evaluating the number of clients presenting with similar diseases Epidemiology monitors the health of the population by examining measures of morbidity, especially incidence proportions, incidence rates, & prevalence proportions & learning about the risk for disease, the rate of disease development, & the levels of existing disease in a population, respectively. Epidemiology differs from clinical medicine, which focuses on the diagnosis & treatment of disease in individuals.

Which of the following objectives is most appropriate for the development of a community-oriented nursing care plan? A. All monitored patients will receive abortive therapy for lethal dysrhythmias B. Of mothers receiving nutrition counseling, 80% will identify five sources of calcium by the end of class C. 95% of children will be immunized by 1 year of age D. There will be a 25% reduction in health disparities by 2015

B. Of mothers receiving nutrition counseling, 80% will identify five sources of calcium by the end of class Objectives must be precise, behaviorally stated, & measurable.

A nurse is planning to host a health screening at a large urban mall. Which of the following variables will help the nurse determine which screenings should be included? Select all that apply. A. Adequate space for persons to lie down after testing until side effects are reduced B. Health problems for which the specific population is at risk C. Whether adequate privacy can be obtained for the invasive or embarrassing procedures D. Whether health care providers are available to follow up on any positive screening results E. Ability to provide the individual health screenings free to the public

B. Health problems for which the specific population is at risk D. Whether health care providers are available to follow up on any positive screening results The screening tests should be reliable, valid, fast, & inexpensive. Results should be known immediately. Ethically, nurses should not screen for any problem unless they can refer those with positive results to a source for follow-up testing & treatment. The screening tests should have few side effects, be minimally invasive, & be capable of detecting enough new cases to warrant the effort & expense. No tests should be used to that have negative side effects, are invasive, or cause embarrassment.

A nurse is assessing a community's openness to change. Which of the following variables indicate that the community is ready? A. Commitment to current processes & policies B. High socioeconomic status in the community as a whole C. Long history of dependence on the community health agency & its staff D. Minimal level of social participation by community members

B. High socioeconomic status in the community as a whole The ability to change is often directly related to higher socioeconomic status; a perceived need for change; the presence of liberal, scientific, & democratic values; & a high level of social participation by community residents.

Which of the following statistics is used by countries to compare the success of their health care systems? A. Attack rate B. Infant mortality rate C. Proportionate mortality ratio D. Cause-specific mortality rate

B. Infant mortality rate Infant mortality is used around the world as an indicator of overall health & availability of health care services.

Which of the following is the number one cause of death worldwide? A. Chronic diseases (heart disease, cancer, stroke) B. Infectious diseases C. Injuries (accidental or purposeful) D. Terrorism

B. Infectious diseases Infectious diseases are still the number one cause of death worldwide. In countries with higher standards of living, where people live longer, chronic diseases - heart disease, cancer, & stroke - are the leading causes of death.

A student comes to the college health clinic with typical cold symptoms of fever, sneezing, and coughing, but the nurse also notes small white spots on the inside of the student's cheeks. Which of the following actions should be taken by the college health nurse? A. Inform all students, staff, and faculty of a possible rubella epidemic B. Inform all students, staff, and faculty of a possible measles epidemic C. Reassure the student that it is just a bad cold and will soon pass D. Tell the student to take two acetaminophen and drink lots of fluids

B. Inform all students, staff, and faculty of a possible measles epidemic Measles is an acute, highly contagious disease that, although considered a childhood illness, is often seen in the U.S. in adolescents & young adults. Symptoms include fever, sneezing, coughing, conjunctivitis, small white spots on the inside of the cheek (Koplik spots), & a red, blotchy rash beginning several days after the respiratory signs.

A nurse is concerned about the prevalence of tuberculosis among migrant farm workers. Which of the following activities would be best to use when implementing tertiary prevention? A. Administer purified protein derivative (PPD) to contacts of those with tuberculosis B. Initiate directly observed therapy (DOT) for tuberculosis treatment C. Provide education about the prevention of tuberculosis to members of the migrant community D. Use skin tests to screen migrant health workers for tuberculosis infection

B. Initiate directly observed therapy (DOT) for tuberculosis treatment Tertiary prevention is carried out among persons already infected with the disease.

A nurse is working toward an objective to "increase to at least 90% the proportion of all pregnant women who receive first trimester prenatal care." During which of the following phases of the nursing process would determination of the objective occur? A. Assessment phase B. Planning phase C. Implementation phase D. Evaluation phase

B. Planning phase Evaluation begins in the planning phase, when foals & measurable objectives are established, & goal-attaining activities are identified.

A nurse is concerned about the high incidence of STDs in the community college population & sets up a special STD screening. Which of the following groups of students would be encouraged to attend? Select all that apply. A. Sexually active students currently receiving treatment for an STD B. Sexually active students who had been screened the previous year C. Students who claimed to not be sexually active & do not plan to become sexually active D. Students who are sexually active but never go all the way E. Students who are freshmen or new transfers

B. Sexually active students who had been screened the previous year D. Students who are sexually active but never go all the way Those who are at risk to develop the problem should be encouraged to attend the screening. This should be anyone who is or plans to be sexually active to any degree. Those already diagnosed with the problem are not at risk, because they already have the condition & are no longer a risk for developing it.

Which of the following actions by Florence Nightingale demonstrates her role as an epidemiologist? A. She convinced other women to join her in giving nursing care to all the soldiers B. She demonstrated that a safer environment resulted in decreased mortality rate C. She obtained safe water & better food supplies & fought the lice & rats D. She met with each soldier each evening to say goodnight, thereby giving psychological support

B. She demonstrated that a safer environment resulted in decreased mortality rate Nightingale examined the relationship between the environment & the recovery of the soldiers. Using simple epidemiological measures, she was able to show that improving environmental conditions & adding nursing care decreased the mortality rates of the soldiers.

In which of the following cases would the school nurse be correct to advise the parents of an HIV-infected child to keep the child home from school? Select all that apply. A. The child develops allergies with sneezing B. The child is unable to control body secretions C. The nurse is not comfortable with being responsible for the child D. There is an outbreak of chickenpox in the school E. The child persists in biting behavior

B. The child is unable to control body secretions D. There is an outbreak of chickenpox in the school E. The child persists in biting behavior Not attending school may be advisable if cases of childhood infections, such as chickenpox or measles, occur in the school, because the immunosuppressed child is at greater risk for suffering complications. Alternative arrangements, such as homebound instruction, might be instituted if a child is unable to control body secretions or displays biting behavior.

The nursing staff has attempted to screen the entire African-American population in the community for diabetes. Which of the following would provide immediate verification of the success of the nursing staffs efforts? A. An epidemic of diabetes will be recognized B. The incidence of diabetes will increase in the community C. The prevalence of diabetes will decrease in the community D. The risk for diabetes in the community will increase

B. The incidence of diabetes will increase in the community If the screening has been successful, more diabetes will be diagnosed &, hopefully, treated. Thus, the incidence of new cases will increase.

In a particular community, several high school students were diagnosed with DM type 2 during the annual high school health fair. Over the next few years, the nursing staff developed & implemented educational programs about the risk factors for DM type 2 & proper nutrition. Which of the following would be the most useful for the nurses to use to determine if they are having any impact? A. The epidemic of diabetes in the high school is gradually ending B. The increase of diabetes is slowly decreasing during screening events C. The prevalence of diabetes is slowly decreasing during screening events D. The risk for diabetes is slowly increasing over time

B. The increase of diabetes is slowly decreasing during screening events Incidence rates & incidence proportions are the measure of choice to study etiology because incidence is affected only by factors r/t the risk of developing disease & not to survival or cure. If the educational programs are having the desired impact, the incidence of diabetes being diagnosed will decrease in future screenings. Prevalence is a fairly stable number over time, but incidence reacts more quickly to changes in risk factors or intervention programs.

A woman is sitting in a corner of the clinical waiting room, crying audibly. The nurse asks, "What's wrong? Can I help?" The woman responds, "They just told me I have a positive mammogram & I need to see my doctor for follow-up tests. I know I'm going to die of cancer. How can I tell my family?" Which of the following information does the nurse need to know in order to help the woman cope with this finding? A. The negative predictive value of mammography B. The positive predictive value of mammography C. The reliability of mammography D. The validity of mammography

B. The positive predictive value of mammography The positive predictive value is the proportion of persons with a positive test who actually have the disease, interpreted as the probability that an individual with a positive test has the disease.

Five students oder meals at a local restaurant. Which of the following students are at highest risk for illness? Select all that apply. A. The first student asks for a salad with chicken strips & dressing on the side B. The second student asks for a hamburger, very rare C. The third student orders a tuna salad sandwich with extra mayonnaise D. The fourth student orders a breakfast meal with two very soft-poached eggs & toast E. The fifth student asks for a vegetable platter & a side of hummus

B. The second student asks for a hamburger, very rare D. The fourth student orders a breakfast meal with two very soft-poached eggs & toast E. The fifth student asks for a vegetable platter & a side of hummus The best protection against food borne pathogens is to thoroughly cook food before eating it. Salmonella is also transmitted by undercooked foods such as eggs, poultry, dairy products, vegetables & seafood.

Which of the following types of study should the nurse researcher choose if the goal is to identify the long-term benefits & risks of a particular nursing intervention for senior citizens living in the community? A. Cross-sectional study B. Ecologic study C. Clinical trial D. Retrospective analysis

C. Clinical trial The goal of a clinical trial is to evaluate the effectiveness of an intervention. Clinical trials are generally the best way to show causality.

Which of the following best describes the current goal in relation to communicable diseases? A. To control political borders so diseases cannot spread further B. To exterminate specific infectious agents one by one C. To expand health care facilities to improve infectious disease treatment D. To achieve worldwide immunization to control new cases

B. To exterminate specific infectious agents one by one The goal of prevention & control programs is to reduce the prevalence of a disease to a level at which it no longer poses a major public health problem. In some cases, diseases may even be eliminated or eradicated.

The advanced practice nurse explains that the client has an upper respiratory infection (URI) & suggests several measures that might make the client more comfortable. Which of the following best describes why the nurse doesn't just prescribe antibiotics as the client repeatedly requests? Select all that apply. A. Antibiotics are expensive, whereas the support measures would be almost free of cost B. Viral diseases are not affected by antibiotics C. Clinics cannot afford to continually give antibiotics to anyone who asks for them D. The more antibiotics are prescribed, the more infectious agents develop resistance to such drugs E. Antibiotics are not particularly effective against coughs & nasal congestion

B. Viral diseases are not affected by antibiotics D. The more antibiotics are prescribed, the more infectious agents develop resistance to such drugs Antibiotics are not effective against viral diseases. The inappropriate prescribing of antibiotics contributes to the growing problem of infectious agents that have developed resistance to once-powerful antibiotics.

Which of the following public health actions has been particularly instrumental in reducing childhood infectious diseases in the U.S.? A. Answering parents' questions about the safety & importance of vaccines today B. Educational campaigns to all health care providers about the importance of immunizations whenever a child is seen C. "No shots, no school" legislation, which legally requires children to be immunized before school D. Offering all immunizations to all children free of any charge

C. "No shots, no school" legislation, which legally requires children to be immunized before school Vaccines are one of the most effective methods of preventing & controlling communicable diseases. One of the most effective programs has been the "no shots, no school" legislation, which has resulted in the immunization of most children by the time they enter school.

A man loudly protests his increased property tax bill right after the public health department has made a plea for more funds. "Why," he asks, "should my tax dollars be used to pay for their children to be immunized?" Which of the following would be the best response by the nurse? A. "Immunizations are required by law, & if their parents can't afford it, you & I will have to pay for it." B. "It's just the right thing to do." C. "Only by making sure most kids are immunized can we stop epidemics that might hurt all of us." D. "We're a religious God-fearing community, & we take care of each other."

C. "Only by making sure most kids are immunized can we stop epidemics that might hurt all of us." Herd immunity is the resistance of a group of people to invasion & spread of an infectious agent because a high proportion of individual members of a group are resistant to the infection. Higher immunization coverage will lead to greater herd immunity, which in turn will block the further spread of the disease.

An instructor is reviewing Salmonella infections with her class. Which of the following comments indicates that the student needs further review on how Salmonella is spread? A. "Certain pets & farm animals may be Salmonella carriers." B. "It is possible to transmit Salmonella by person-to-person contact." C. "Salmonella may be spread by spores that form once contaminated blood is exposed to the air." D. "Salmonella outbreaks are usually due to contaminated meat, poultry, & eggs."

C. "Salmonella may be spread by spores that form once contaminated blood is exposed to the air." Anthrax (not Salmonella) forms spores when infected blood is exposed to the air.

A nurse is providing education to a client about the use of PrEP. Which of the following statements would the nurse include as part of this teaching? A. "Side effects of PrEP include extreme lethargy & joint pain." B. "PrEP has been shown to be effective in preventing transmission of the disease from sharing needles." C. "The effectiveness of PrEP will depend on your adherence to the medication regimen." D. "PrEP will prevent you from contracting HIV & hepatitis B."

C. "The effectiveness of PrEP will depend on your adherence to the medication regimen." PrEP is a new HIV prevention method for people who do not have the infection but would like to reduce their risk of becoming infected. PrEP requires taking a pill to prevent the HIV virus from getting into the body. This prevention method requires strict adherence to taking the medication & having regular HIV testing.

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. Which of the following best describes the attack rate? A. 63% B. 70% C. 90% D. 100%

C. 90% The attack rate is the proportion of persons exposed to an agent who develop the disease. Because 63 of the 70 persons became ill, the attack rate is 63:70 or 90%.

A new nurse is overwhelmed with the needs of the community. Which of the following should be the first priority of the nurse? A. A problem that affects the most disadvantaged residents in the community B. A problem that is very easy and inexpensive to address C. A problem that is of high concern to the community D. A problem in an area in which the nurse has a great deal of expertise

C. A problem that is of high concern to the community Choice of priority must depend on the community's awareness of the problem - & their motivation to improve it.

A nurse is administering a tuberculosis skin test to a client who has AIDS. Which of the following results should the nurse anticipate when using this screening test? A. Decreased positive predictive value B. Decreased reliability C. Decreased sensitivity D. Decreased specificity

C. Decreased sensitivity Persons with immune deficiencies may have a negative tuberculosis skin test even though they are infected. Sensitivity is the extent to which a test identifies those individuals who have the condition being examined. AIDS is an acquired immune deficiency; thus, clients with AIDS may have a false-negative response to TB skin tests; that is, they have the disease but the test is not sensitive enough to detect infection in these individuals. Therefore, there is decreased sensitivity with those clients.

. Which of the following actions would a nurse take to reduce the high incidence of coronary artery disease (CAD) in a community? A. Introduction of a heart-healthy curriculum beginning in the first grade, presentations on diet & exercise for the community at large, & special education sessions for high-risk populations B. Provision of online activities related to prevention of cardiac disease, smoking reduction programs, & blood pressure screenings C. Distribution of handouts, including age-appropriate games, self-assessments, & education on heart-healthy lifestyles; availability of community screenings for hyperlipidemia in persons age 35 & older; & walking programs for those affected with CAD D. Enrollment of clients with CAD into cardiac rehabilitation programs, routine evaluation of effectiveness of CAD treatment regimens, & participation in clinical trials that evaluate interventions for those diagnosed with CAD

C. Distribution of handouts, including age-appropriate games, self-assessments, & education on heart-healthy lifestyles; availability of community screenings for hyperlipidemia in persons age 35 & older; & walking programs for those affected with CAD Distributing handouts includes all three levels of prevention to target all members of the population. Targeting all members of the population & implementing all levels of prevention increase the likelihood of positive outcomes for the community as a whole.

A community health nurse drives through an assigned community before visiting the community groups scheduled for the day. The nurse then drives through the community again that evening before going home. Which of the following best describes the nurse's reason for driving through the community twice in the same day? A. On the second trip, the nurse can carefully confirm the results of the first assessment B. Repeating the experience ensures that the nurse absorbed all the relevant details C. Driving through twice allows the nurse to see the community when many residents are at work or at school & then again when most are at home D. When leaving in the evening, the nurse has more time to write down the results of the earlier assessment

C. Driving through twice allows the nurse to see the community when many residents are at work or at school & then again when most are at home When doing a windshield survey as part of community assessment, the nurse should observe two times: one during the day when people are at work & children are at school & a second time in the evening after work is done & school is out. It is likely that different things are occurring in the community when the nurse drives through the community at different times.

A nurse reports that in comparison to all the children in a particular school, the children who are members of the Cub Scouts have 0.3 risk for obesity before entering the sixth grade. Which of the following recommendations would the nurse make to the new parents of two boys who had just moved into this school's neighborhood? A. Discourage the parents from enrolling their sons in Cub Scouts because of the risk B. Don't say anything about Cub Scouts, because it isn't relevant to nursing care C. Encourage the parents to enroll their sons in Cub Scouts D. Share the finding & let the parents draw whatever conclusions they feel appropriate

C. Encourage the parents to enroll their sons in Cub Scouts Relative risk is an estimation of the risk of acquiring a problem for those who are exposed compared with those who are unexposed. As the risk for obesity is less for those that are members of Cub Scouts, joining the group is protective & reduces the incidence among members.

Which of the following sexually transmitted diseases can be prevented through immunization? A. Chlamydia B. Gonorrhea C. Hepatitis B D. Genital Herpes Simplex

C. Hepatitis B Hepatitis B infection can be prevented by immunization; vaccines for the remaining options are not yet available.

A nurse is investigating a bacterial illness that has caused a health problem in the community. Only some of the people exposed to the bacteria have become ill. Which of the following factors best explains why this would have happened? A. Chemical agent factors B. Environmental factors C. Host factors D. Physical agent factors

C. Host factors The epidemiologic triangle includes the agent, host, & environment. The bacteria were the agent so chemical & physical agents are not relevant. The environment was apparently the same for everyone, since all were exposed to the bacteria. Therefore, only differences in host factors can explain why some became ill & some were able to fight off the bacterial infestation.

A nurse is focusing on the process dimension of a community's health. Which of the following interventions will the nurse most likely implement? A. Assessing the health care services available in a community B. Establishing screening programs to diagnose diseases as early as possible so that the treatment can begin C. Implementing health promotion activities such as education programs D. Planning for new programs to be developed based on identified needs

C. Implementing health promotion activities such as education programs When the emphasis is on the process dimension - usually the level of intervention of the nurse in community health - the best strategy is usually health promotion, such as various primary prevention strategies.

Which of the following data would most likely be collected in a syndromic surveillance system? A. Incidence of bioterrorism attacks B. Number of air travelers C. Incidence of school absenteeism D. Number of influenza vaccines administered

C. Incidence of school absenteeism Syndromic surveillance systems use existing health data in real time to provide immediate analysis & feedback to those charged with investigation & follow-up of potential outbreaks.

Which of the following statements describes how nursing in the community is more challenging than nursing in an acute care setting? A. There is limited access to information useful to the nurse in giving care in the community B. More paperwork & forms are required when giving care in the home C. It is more challenging to control the environment in the community D. Specialization isn't possible in the community setting

C. It is more challenging to control the environment in the community In the community, nurses often use epidemiology, since the factors that affect the individual, family, & population group cannot be as easily controlled as in acute care settings. It is essentially impossible to control the environment in the community.

Which of the following is the most common vector-borne disease in the U.S.? A. Babesiosis B. Ehrlichiosis C. Lyme disease D. Rocky Mountain spotted fever

C. Lyme disease Lyme disease became a nationally notifiable disease in 1991 & is now the most common vector-borne disease in the U.S.

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). Which of the following terms best describes this data? A. An epidemic B. Incidence C. Prevalence D. Risk

C. Prevalence Prevalence is the measure of existing disease in a population at a particular time. Incidence refers to new cases, whereas prevalence means all cases.

Which of the following symptoms suggests smallpox as opposed to the more common & much less dangerous chickenpox? Select all that apply. A. Child appears only mildly ill until late stages in smallpox B. Lesions appear in various stages in the same area of the body rather than all at once C. Rash lesions are most abundant on the face & extremities, not on the trunk D. Rash occurs 2-4 days after sudden onset of fever rather than with the fever E. Vesicles do not collapse when punctured

C. Rash lesions are most abundant on the face & extremities, not on the trunk D. Rash occurs 2-4 days after sudden onset of fever rather than with the fever E. Vesicles do not collapse when punctured Symptoms of smallpox include rash lesions on face & extremities ("centripetal"), rash that occurs 2-4 days after onset of fever, & vesicles that are deep seated & do not collapse on puncture.

A nurse is practicing in the community but also has the community as the target of practice. Which of the following best describes the activities of this nurse? A. Providing care to an active caseload of 50 families in the neighborhood B. Inviting all the parents of asthmatic children in the school to meet together for mutual support C. Sharing assessment findings & health goals with every community group that will listen D. Writing articles for the local newspaper highlighting the various programs & services of the local health department

C. Sharing assessment findings & health goals with every community group that will listen Meeting with all interested community groups is the only way to keep the focus on the community rather than on individuals.

A nurse advises a client with osteoporosis to have three servings of milk or dairy products daily. Which of the following levels of prevention is being used by the nurse? A. Primary prevention B. Secondary prevention C. Tertiary prevention D. Treatment, but not prevention

C. Tertiary prevention Interventions that prevent worsening of a condition are tertiary prevention activities. In this instance, the client already has a health problem (osteoporosis). By advising adequate dairy intake, the nurse aims to ensure that enough calcium is available to limit worsening of the osteoporosis.

A nursing staff has successfully screened for diabetes in the community. Which of the following might best persuade the health board to increase funding for diabetic clinics in this community? A. An epidemic of diabetes is now recognized & must be addressed B. The incidence of diabetes is now higher than previously recognized in the community C. The prevalence of diabetes is now higher than previously recognized in the community D. The risk for diabetes in the community could decrease if funding is received

C. The prevalence of diabetes is now higher than previously recognized in the community Prevalence is a fairly stable number. Prevalence proportions reflect duration in addition to the risk for getting the disease. Prevalence is useful in planning health care services because it is an indication of the level of disease existing in the population & therefore the size of the population in need of services

Persons in an auditorium may have been exposed to a disease. If they are infected, it is crucial that they receive immediate treatment & not take the disease home to their families. Which of the following characteristics would be most important to consider when selecting the screening test to be used? A. The negative predictive value B. The positive predictive value C. The sensitivity of the test D. The specificity of the test

C. The sensitivity of the test Because it is most important to identify every case, the sensitivity of the test is crucial. High sensitivity is needed when early treatment is important & when identification of every case is important.

Which statement made by the nurse best describes the effect vaccines have had on TB? A. Tuberculosis is no longer a threat in most of the world B. Tuberculosis has developed resistance to all antibiotics C. The treatment has helped greatly to reduce the incidence of TB in the United States D. The incidence of TB has remained constant since the 20th century

C. The treatment has helped greatly to reduce the incidence of TB in the United States In 1900, communicable diseases were the leading causes of death in the United States. Since that time, improved sanitation & nutrition, the discovery of antibiotics, & the development of vaccines has ended some epidemics such as diphtheria & typhoid fever & greatly reduced the incidence of others such as TB.

Which of the following provides the best explanation as to why people do not immediately seek medical treatment when the first become ill with HIV? A. They are afraid to get tested for fear that the results will be positive B. They avoid the problem (maybe it will go away) C. They don't recognize their symptoms as possibly being due to HIV D. It is too expensive to get an HIV test

C. They don't recognize their symptoms as possibly being due to HIV When HIV enters the body, it can cause a flu-like syndrome referred to as a primary infection or acute retroviral syndrome. This may go unrecognized. An antibody test at this stage is usually negative, so the person or a medical provider may not recognize the illness as HIV.

A school nurse wants to decrease the incidence of obesity in elementary school children. Which of the following describes a secondary prevention intervention that the nurse could implement? A. Giving a presentation on the importance of exercise & physical fitness B. Designing a game in which students select healthy food choices C. Weighing students to identify those who are overweight D. Putting students on a diet if they weigh greater than 20% of their ideal weight

C. Weighing students to identify those who are overweight Secondary prevention refers to interventions that increase the probability that a person with a condition will have the condition diagnosed early. Health screenings are the mainstay of secondary prevention. Weighing students & assessing whether the weight is higher than recommended will allow for early intervention so that obesity may be avoided.

In the United States, which group is most affected by a new HIV diagnosis? A. Women having heterosexual relationships B. White IV drug abusers C. Young Black gay & bisexual men D. Men who have sex with other men

C. Young Black gay & bisexual men Although new HIV diagnosis in general has declined, young Black gay & bisexual men are the most affected, with an 94% increase in diagnosis.

A student asks the nurse as the student health clinic how AIDS is diagnosed. Which of the following statements would be the best response by the nurse? A. "A diagnosis of AIDS is made when a screening test called an enzyme-linked immunosorbent assay (ELISA) is confirmed by the Western blot test." B. "A diagnosis of AIDS is made when antibodies to HIV are detected about 6 weeks to 3 months following possible exposure." C. "A diagnosis of AIDS is made when antibodies to HIV reach peak levels of 1000/mL of blood." D. "A diagnosis of AIDS is made when CD4 T-lymphocytes drop to less than 22 cells/mm."

D. "A diagnosis of AIDS is made when CD4 T-lymphocytes drop to less than 22 cells/mm." AIDS is defined as a disabling or life-threatening illness caused by HIV; it is diagnosed in a person with a CD4 T-lymphocyte count of less than 22 cells/mL with or without documented HIV infection.

A client who is very upset says to the nurse, "But we always used a condom! How could I have genital warts?" Which of the following would be the best response by the nurse? A. "Are you positive you always used a condom?" B. "Condoms don't always work." C. "The condom might have had a tear in the latex." D. "Contact may have occurred outside the area that the condom covers."

D. "Contact may have occurred outside the area that the condom covers." Warts may grow where barriers, such as condoms, do not cover, & skin-to-skin contact may occur. The challenge of HPV prevention is that condoms do no necessarily prevent infection. Thus, even with correct usage & the use of undamaged condoms, transmission may still occur.

A high school student is planning to volunteer at the hospital after school, so he or she needs to have a Mantoux test before beginning. Which of the following information should the nurse provide to the new volunteer? A. "I will be using tiny tines to administer the TB antigen to the skin on your arm." B. "Notify the clinic immediately if you experience any redness or itching at the test site." C. "The areas should be kept dry until you return; cover it with plastic wrap when bathing." D. "You will need to return in 2-3 days to have any reaction interpreted."

D. "You will need to return in 2-3 days to have any reaction interpreted." The Mantoux test is a TB skin test that involves a 0.1-mL injection containing 5 tuberculin units of PPD tuberculin (not tines as in the TB tine test). The site should be examined for a reaction 48-72 hours (2-3 days) after injection.

A nurse was reading PPD tests 24 hours after another nurse had administered them. Which of the following findings would cause the nurse to interpret the test as positive? A. 15 mm of erythema in a client with HIV infection B. 5 mm of induration in an immigrant from a country where TB is endemic C. A 5-mm ruptured pustule with purulent drainage in a homeless client D. 10 mm of swelling and increased firmness in a client recently released from a correctional facility

D. 10 mm of swelling and increased firmness in a client recently released from a correctional facility For a PPD test to be positive, induration (swelling with increased firmness) must be present. A diameter of 10-mm induration would be a positive finding in an immigrant from a region with high TB infection.

Which of the following is the best brief definition of community? A. A geographic area or political division under common leadership B. A group sharing a common bond such as a profession or occupation C. A group working together to confront a common problem D. A social group with common goals within a geographic area

D. A social group with common goals within a geographic area According to WHO, a community is "A group of people, often living in a defined geographical area, who may share a common culture, values & norms, & are arranged in a social structure according to relationships, which the community has developed over a period of time.

Several small communities have applied for grant funding from the state department of health to help decrease their teenage pregnancy rate. Which of the following communities should the nurse suggest receive funding first? A. Community A - with 23 single teenage pregnancies in a city of 500 B. Community B - with 45 single teenage pregnancies in a city of 1000 C. Community C - with 90 single teenage pregnancies in a city of 2000 D. Community D - with 90 single teenage pregnancies in a city of 1500

D. Community D - with 90 single teenage pregnancies in a city of 1500 The pregnancy rates of A, B, & C are 45-46;1000, whereas the rate in Community D is 60:1000.

There is great concern in the nurse's community over 3 local cases of West Nile virus. Which of the following actions should the nurse take to get the community involved in addressing this problem? A. Ask the state department of health for assistance B. Demand that everyone over age 65 become immunized immediately C. Encourage immunization of all children under 12 D. Have an educational campaign to remove any containers of standing water

D. Have an educational campaign to remove any containers of standing water Periodic outbreaks of West Nile virus appear to result from a complex interaction of multiple factors, including weather - especially hot, dry summers followed by rain, which influences mosquito breedings sites & population growth. Removing standing water will remove mosquito breeding sites.

Which of the following infectious disease interventions best represents the use of secondary prevention? A. Clients with HIV infection are encouraged to use condoms to protect sexual partners B. Clients with HIV infection are given medications to improve immunological response C. Health care workers are encouraged to receive annual vaccinations for influenza D. Health care workers are required to have a tuberculosis skin test or chest X-ray

D. Health care workers are required to have a tuberculosis skin test or chest X-ray TB screening for health care workers is an example of secondary prevention. TB skin tests & chest X-ray are methods of TB screening.

During an outbreak of hepatitis A, nurses are giving injections of hepatitis A immunoglobulin to selected susceptible persons. Which of the following best describes the type of immunity that will follow the administration of these injections? A. Active immunity B. Long-lasting immunity C. Natural immunity D. Passive immunity

D. Passive immunity Passive immunity refers to immunization through the transfer of a specific antibody from an immunized individual to a non-immunized individual, such as the transfer of antibody by the administration of antibody-containing preparation (immune globulin or antiserum). Passive immunity from immune globulin is almost immediate but short-lived. It often is induced as a stopgap measure until active immunity has had time to develop after vaccination.

At a town meeting with public health officials to discuss a communicable disease outbreak, a nurse is asked to explain what is meant by the phrase "a virulent organism." The nurse explains that this means the organism causing the disease is able to do which of the following? A. Bypass normal immunological response mechanisms B. Invade major organ systems C. Produce toxins & poisons that weaken the body D. Produce very severe physical reactions

D. Produce very severe physical reactions Virulence is the ability to produce a severe pathological reaction.

A principal comments to the school nurse that it seems there are a lot more problems with asthma among the students than there were before the school was remodeled a couple of years ago. The nurse investigates the principal's observation by reviewing all the school records to determine visits to the health office because of asthma by week & month for the past 5 years. Which of the following best describes the type of study the nurse is conducting? A. Descriptive epidemiological study B. Ecological study C. Prospective cohort study D. Retrospective cohort study

D. Retrospective cohort study Retrospective cohort studies rely on existing records to define a cohort that is classified as having been exposed or unexposed at some time in the past. In this case, the issue is whether there is some health risk in the new building addition that is increasing frequency of visits to the school nurse because of asthma.

A client is being treated for secondary syphilis. Which of the following signs & symptoms would the nurse anticipate the client would exhibit? A. Chancre at the site of entry B. Jaundice C. Difficulty coordinating muscle movements D. Skin rash without itching

D. Skin rash without itching Secondary syphilis occurs when the organism enters the lymph system & spreads throughout the body. Signs include skin rash on one or more areas of the body & do not cause itching. Other symptoms may include fever, swollen lymph glands, sore throat, patchy hair loss, headaches, weight loss, muscle aches, & fatigue.

Persons often point out that smokers choose to light their cigarettes, alcoholics lift the glass to their mouth, and drug addicts inject or ingest their drugs. Which of the following statements best describes why nurses don't simply focus on helping persons who engage in poor health behaviors to behave appropriately? A. Addicts don't have the willpower to change their behavior B. It is too rewarding to continue the behavior for a person to be able to change C. Laws and policies must reward good healthy behaviors and punish unhealthy behaviors to help individuals recognize the importance of change D. Society must offer healthy choices, offer support, and practice helpful policies

D. Society must offer healthy choices, offer support, and practice helpful policies Change for the benefit of the community client must often occur at several levels, ranging from the individual to society as a whole. Lifestyle-induced health problems cannot be solved simply by asking or encouraging individuals to choose health-promoting habits. Society also must provide health choices.

The nurse is trying to determine if a disease occurrence needs to be reported to the state health department. Which of the following resources should the nurse use to answer this question? A. Centers for Disease Control & Prevention Weekly Report B. Communicable Diseases Weekly Report C. Nationally notifiable infectious diseases on the CDC website D. State health department website

D. State health department website Requirements for disease reporting in the U.S. are mandated by state rather than federal law. The list of reportable diseases varies by state.

During which of the following activities is the nurse in community health acting as a partner in change? A. Administering vaccinations to preschoolers B. Analyzing community problems to determine the best interventions C. Establishing an elder-care center for older adults living with family members who work D. Teaching anger management skills to a group of teens in a halfway house

D. Teaching anger management skills to a group of teens in a halfway house Content-focused roles often are considered change agent roles, whereas process roles are called change partner roles. Change partner roles include those of enabler-catalyst, teacher of problem-solving skills, & activist agent. Teaching anger management skills to a group of teens in a halfway house demonstrates the use of a change partner role of teacher of problem-solving skills.

A client was clearly very relieved when an HIV test came back negative. "Thank goodness. I've had sex several times without a condom, & when one of my friends said he was sick, I think I panicked." Which of the following would be most important to emphasize to the client immediately? A. Abstinence is the only way to be certain you are HIV free B. Sex should be restricted to one partner C. The test could be wrong & the client might still have an HIV infection D. The test would not cover any recent infection, so if the client has had recent unprotected sex, the test should be repeated in 3 months

D. The test would not cover any recent infection, so if the client has had recent unprotected sex, the test should be repeated in 3 months The client needs to understand that the test cannot identify infections that may have been acquired within the previous 3 months before the test. Appearance of the HIV antibody can take up to 12 weeks; thus, this test could be negative now, but positive in 3 months.

Which of the following statements best explains why many health care providers are more afraid of getting hepatitis B (HBV) than HIV? A. Everyone would assume the person infected with hepatitis B is a drug user B. Having HBV would mean no further employment in health care C. The fatality rate is higher & occurs sooner with HBV D. There is no treatment for HBV, which can be a very serious illness

D. There is no treatment for HBV, which can be a very serious illness Unlike HIV, there is no treatment for hepatitis B, & although some persons never have symptoms & others fight off the disease, many suffer from chronic hepatitis B, a very serious illness. Others may become chronic carriers of the disease.

A teacher recommends that surveys to obtain data on drug use be given to high school students when they meet for various school organizations. Which of the following best describes why the nurse would reject this suggestion? A. This method of data collection would result in classification bias B. This method of data collection would result in confounding bias C. This method of data collection would result in personal bias D. This method of data collection would result in selection bias

D. This method of data collection would result in selection bias Any study is subject to bias resulting from selective choice. There may be a difference between students who choose to belong to an organization & students who choose not to join an organization. Selection bias occurs when selection procedures are not representative of the population as a whole. In this instance, the goal is to determine drug use of all students at the school. If only students who join school organizations are selected, those who do not join organizations will not be represented.

During the assessment phase, the nurse compiles & interprets available data & draws conclusions as to the community's strengths & concerns. Which of the following best describes why the nurse would also conduct interviews with key informants? A. To ensure that others agree with the nurse's plans for interventions B. To confirm the nurse's initial findings & conclusions C. To encourage community partners to feel they "own" the data D. To generate non-statistical data such as values, beliefs, & perceived needs

D. To generate non-statistical data such as values, beliefs, & perceived needs Data generation is the process of developing data that do not already exist, through interaction with community members, individuals, families, or groups. Such information might include the community's knowledge & beliefs, values & sentiments, & goals & perceived needs.

Before beginning to survey the community to assess its health needs & strengths, the nurse reviews various documents, including local statistical data & the minutes of the previous meeting of the health care agency. Which of the following best explains why the nurse would start with this activity? A. To avoid confronting the community until the nurse is thoroughly oriented B. To become familiar with previous goals & priorities of the agency C. To help get a better understanding of the assigned community D. To save time & effort & perhaps have new insights

D. To save time & effort & perhaps have new insights The nurse uses previously gathered data because it saves time & effort.

The correctional health nurse is doing a quick assessment on a newly admitted inmate who is HIV positive. Which of the following diseases should the inmate receive screening for immediately? A. Herpes zoster B. Hepatitis B C. Hepatitis C D. Tuberculosis

D. Tuberculosis HIV-infected persons, who live near one another, such as in correctional facilities, must be carefully screened & deemed noninfectious before admission to such settings. A person with HIV is more susceptible to opportunistic infections, the most common if which is TB.

A nurse has only a regular blood pressure cuff when conducting a health screening for all of the residents of a community. Which of the following may be lacking when obtaining blood pressure readings? A. Reliability B. Sensitivity C. Specificity D. Validity

D. Validity Validity is the accuracy of a test or measurement, or how closely it measures what it claims to measure. With only one regular BP cuff, the nurse cannot obtain accurate measurements on those who are extremely obese or extremely thin. A thigh cuff & a pediatric cuff would allow the nurse to obtain accurate—that is, valid—measurements.

A nurse is examining various factors that lead to disease & suggesting several areas where nurses could intervene to reduce future incidence of disease. Which of the following models would the nurse most likely use? A. Epidemiologic triangle B. Health promotion C. Levels of prevention D. Web of causality

D. Web of causality The web of causality model recognizes the complex interrelationships of many factors interacting to increase or decrease the risk for disease.

Between 2010 & 2015, 1000 of 10,000 young women age 17 to 20 years at a university tested positive for a sexually transmitted infection (STI). Of the 1000 diagnosed STIs, 300 were gonorrhea & 500 were chlamydia. Which of the following statements best summarizes these findings? A. The proportion of cases of gonorrhea to all STIs was 300:1300 B. The proportion of cases of gonorrhea to chlamydia was 300:500 C. The proportion of cases of gonorrhea to all STIs was 50% D. The proportion of STIs to the total population was 100:1000

d. The proportion of STIs to the total population was 100:1000 A proportion is a ratio in which the denominator includes the numerator. If the proportion is small, we can express the number per 1000. The answer of 100:1000 correctly summarizes that 1000 of 10,000 (or 100:1000) young women had the problem.