Community: Exam 2

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ANS: B Sources of information about air quality include the Environmental Protection Agency (EPA) and the American Lung Association.

11. If a nurse wanted more information on indoor air quality, which website would be most helpful? a. The National Institutes of Health (NIH) b. The American Lung Association c. "Right to Know" d. The Occupational Safety and Health Administration (OSHA)

ANS: D Toxicology is the basic science that studies the health effects associated with chemical exposures. The other specialists would probably be able to provide some information, but the toxicologist would most likely provide information related to physiological processes.

1. A nurse wants to have a better understanding of the physiological effects of selected chemicals. Which of the following individuals would provide the most useful information to the nurse? a. Chemist b. Epidemiologist c. Pharmacologist d. Toxicologist

Which population would the nurse include in a community education session on sexually transmitted infections (STIs)? Select all that apply. One, some, or all responses may be correct. a) Adolescents b)Homosexual men c) Transgender clients d) Multiple sex partners e) Intravenous drug users

1. Adolescents 2. Homosexual men 3. Transgender clients 4. Multiple sex partners 5. Intravenous drug users

The nurse is working with parents in the community to decrease the incidence of poisonings in children younger than 5 years of age. Which information would the nurse include to meet this goal? Select all that apply. One, some, or all responses may be correct. a) Clean fruits and vegetables. b) Place locks on medicine cabinets. c) Use child-resistant medication caps. d) Keep the poison control center number near the phone. e) Store cleaning products in a locked cabinet.

1. Clean fruits and vegetables. 2. Place locks on medicine cabinets. 3. Use child-resistant medication caps. 4. Keep the poison control center number near the phone. 5. Store cleaning products in a locked cabinet.

A couple asks a community health nurse about using condoms as a method of contraception. Arrange the steps of using a condom in sequential order. 1. Throw the condom away. 2. The condom is unrolled on the erected penis. 3. Leave 0.5 inch of space at the tip of the condom. 4. Hold the rim of the condom in place when withdrawing. 5. Contraceptive jelly is squeezed onto the tip of the condom. 6. Open the package to remove the condom and check for breaks or holes.

1. Open the package to remove the condom and check for breaks or holes. 2. Contraceptive jelly is squeezed onto the tip of the condom. 3. The condom is unrolled on the erected penis. 4. Leave 0.5 inch of space at the tip of the condom. 5. Hold the rim of the condom in place when withdrawing. 6. Throw the condom away.

ANS: B, C, D The 2nd, 3rd, and 4th options are ways a nurse can assess the environment.

1. Which approach(s) can a nurse use when assessing environmental health risks? Select all that apply. a. Ask legislators to provide a list of environmental pollutants in the area. b. Develop a list of exposures associated with urban, rural, or suburban settings. c. Assess the risk by medium such as air, water, soil, or food. d. Divide the environment into functional locations: home, school, workplace, and community

A) Rate

1. Which is the primary method used to measure the existence of states of health or illness in a population during a given time period? A) Rate B) Ratio C) Relative risk ratio D) Sensitivity

A) Major cardiovascular-renal disease

1. Which was the leading cause of death in the United States in 1900? A) Major cardiovascular-renal disease B) Influenza and pneumonia C) Tuberculosis D) Gastritis, duodenitis, enteritis, and colitis

ANS: A Potential risks to health are concerns for professional nurses. It is the responsibility of the nurse to understand as much as possible about these risks: how to assess them, how to eliminate/reduce them, how to communicate and educate about them, and how to advocate for policies that support healthy environments.

1. Why is it important for nurses to understand the premises of environmental health? a. Nurses should be able to assess risks and advocate for policies that support healthy environments. b. Toxicologists often consult nurses about environmental pollutants. c. Pollutant exposures such as lead are reported by nurses to the Environmental Protection Agency. d. Many Americans live in areas that do not meet current national air quality standards.

ANS: B Point source means a single place from which the pollutant is released into the environment, whereas non-point source implies a more diffuse source of pollution.

10. Which is considered a non-point source of pollution? a. Hazardous waste site b. Animal waste from wildlife c. Chlorine poured down a well d. Stagnant water

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

10.Which formula should be used to calculate sensitivity? A) Number of true positives/ Number of true positives + Number of false negatives B) Number of true negatives/ Number of true negatives + Number of false positives C) Number of conditions or events within a designated period of time/ Population at risk during the same period of time X Base multiple D) Number of deaths from a specific disease /Number of cases of the same disease X 100

D) John Snow

10.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? A) William Farr B) John Graunt C) Florence Nightingale D) John Snow

ANS: A Environmental justice is the goal of campaigns seeking to improve the unequal burden of environmental risks borne by impoverished and minority communities. The Environmental Justice Act would be used in support of the nurse's position.

11. A city has announced its plans to build a city dump near a community of poor and predominantly African-American citizens. Which of the following principles would the nurse be using when vocalizing opposition for this plan? a. Environmental justice b. Equal rights c. Primary prevention d. Risk protection

A) Epidemiologic triad

11.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? A) Epidemiologic triad B) Wheel of causation C) Web of causation D) Natural history

A) Incidence density

11.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? A) Incidence density B) Prevalence rate C) Relative risk ratio D) Specific rate

ANS: A Present work is the first "P".

12. A nurse is completing an exposure history using the mnemonic I PREPARE. What data would a nurse collect when asking questions about the first "P"? a. Present work b. Potential exposures c. Personal protective equipment use d. Problems with health

C) Relative risk ratio

12.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: A) Incidence density B) Prevalence rate C) Relative risk ratio D) Specific rate

C) Web of causation

12.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? A) Epidemiologic triad B) Wheel of causation C) Web of causation D) Natural history

ANS: D The Occupational Safety and Health Act (OSHA) was passed to ensure worker and workplace safety in all employment settings, including restaurants. Others may contribute to safety but do not have the full oversight of OSHA.

13. A high school student considering a job in the restaurant industry after graduation asks a nurse about workplace safety issues. Which of the following acts would the nurse most likely discuss with the student? a. Chemical Safety Information, Site Security, and Fuels Regulatory Act b. Comprehensive Environmental Response, Compensation, and Liability Act c. Food Quality Protection Act d. Occupational Safety and Health Act

ANS: C Assessment is always an important element of the nursing process. The third option is an example of the assessment phase of the nursing process.

13. A nurse fulfills the environmental health competency of "assessment and referral" when: a. Advocating for public policy changes b. Understanding policy framework and major pieces of legislation c. Completing an environmental health history d. Describing the scientific principles about environmental health

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

13.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? A) Initiate vaccinations for all people who have not yet been infected. B) Familiarize yourself with the signs and symptoms of the disease so that you can provide early diagnosis and treatment of it. C) Encourage any who think they might have symptoms of the disease to come to the community health clinic to be assessed as soon as possible, to prevent associated disabilities. D) Refer clients who have experienced neurological deficits because of the disease to a neurologist to begin rehabilitation.

B) Incidence rate

13.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? A) Incidence density B) Incidence rate C) Relative risk ratio D) Specific rate

ANS: C Waste incineration and power plants are major contributors after motor vehicles. Molds contribute to poor indoor air quality.

14. The greatest single source of air pollution in the United States is from: a. Waste incineration b. Power plants c. Motor vehicles d. Molds

D) Number of fetal deaths in one year /Number of live births plus fetal deaths in the same year X1000

14.Which formula should be used to calculate the fetal mortality rate? A) Number of deaths of children <1 year of age in one year / Number of live births in the same year × 1000 B) Number of fetal deaths plus infant deaths <7 days of age in one year/ Number of live births plus fetal deaths in same year × 1000 C) Number of deaths of children <28 days of age in one year/Number of live births in the same year ×1000 D) Number of fetal deaths in one year /Number of live births plus fetal deaths in the same year X1000

B) Actions are initiated to carry out the plan

14.Which occurs in the epidemiologic process that is similar to the implementation phase of the nursing process? A) Data are gathered from reliable sources B) Actions are initiated to carry out the plan C) Actions are evaluated and report prepared D) Further research is conducted if necessary

ANS: C The Clean Water Act sets basic structure for regulating pollutants to United States waters.

15. Which environmental law sets basic structure for regulating pollutants to United States waters? a. Safe Drinking Water Act b. Toxic Substance Control Act c. Clean Water Act d. Pollution Prevention Act

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

15.Which best describes a risk factor? A) Course of a disease or condition from the onset to resolution B) Primary measurement used to describe either the occurrence or the existence of a specific state of health or illness C) Probability or likelihood that a disease or illness will occur in a group of people who presently do not have the problem D) Characteristic or event that has been shown to increase the probability that a specific disease or illness will develop

B) 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 ×1000

15.Which formula should be used to calculate perinatal mortality rate? A) Number of deaths of children <1 year of age in one year /Number of live births in the same year × 1000 B) 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 ×1000 C) Number of deaths of children <28 days of age in one year/Number of live births in the same year ×1000 D) Number of fetal deaths in one year/ Number of live births plus fetal deaths in the same year x1000

ANS: C This standard requires employers to maintain a list of all hazardous chemicals that are used on site.

16. Employees working with hazardous chemicals have the "right to know" about the chemicals they are working with through the creation of the: a. Material Safety Data Sheet b. Consumer Confidence Report c. Hazard Communication Standard d. Environmental Protection Agency

B) 1.35%

16.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? A) 0.21% B) 1.35% C) 1.52% D) 15.20%

C) Pathological onset, presymptomatic, manifestation of clinical disease

16.Which represents the correct order of the three stages of the natural history of disease? A) Pathological onset, manifestation of clinical disease, presymptomatic B) Presymptomatic, pathological onset, manifestation of clinical disease C) Pathological onset, presymptomatic, manifestation of clinical disease D) Manifestation of clinical disease, presymptomatic, pathological onset

ANS: C Permitting is a process by which the government places limits on the amount of pollution emitted into the air or water.

17. A nurse is addressing the problem of air pollution in the community. The first step in the process of controlling the pollution would be: a. Setting standards b. Monitoring c. Permitting d. Compliance

A) 2.1

17.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? A) 2.1 B) 13.5 C) 15.2 D) 152

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

17.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. A) The names of all people who have been infected by the virus B) The geographical area within which the outbreak has occurred C) A brief history of all of the other viral outbreaks that have occurred in the community in recent years D) The time of onset and duration of the outbreak E) The anticipated economic impact of the outbreak on the community

B) Wheel of causation

18.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? A) Epidemiologic triad B) Wheel of causation C) Web of causation D) Natural history

A) 80.8%

18.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? A) 80.8% B) 87.5% C) 93.7% D) 99.6%

ANS: D Environmental monitoring would be an inspection of a facility after a permit is obtained to observe whether the plans submitted in the permit application are being implemented as approved.

19. An inspection of a facility after a permit is obtained for the purpose of observing whether the plans submitted in the permit application are being implemented as approved is an example of which environmental protection strategy? a. Controlling pollution b. Waste minimization c. Land use planning d. Environmental monitoring

C) 29.34

19.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? A) 3.33 B) 13.55 C) 29.34 D) 32.67

A) Measure epidemiologic statistics before and after administering the flu shots. B) Plan and evaluate influenza vaccinations regularly. D) As new data regarding influenza vaccinations become available, modify the intervention accordingly.

19.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. A) Measure epidemiologic statistics before and after administering the flu shots. B) Plan and evaluate influenza vaccinations regularly. C) Interview clients regarding their perception of the effectiveness of the vaccinations and use these data in planning future vaccinations. D) As new data regarding influenza vaccinations become available, modify the intervention accordingly. E) Evaluate the success of your program by comparing its results with those in other communities.

ANS: B The use of a Geographic Information System (GIS) allows the public health nurse to apply the principles of epidemiology into practice. GIS allows nurses to code data so that it is related spatially to a place on earth and is helpful in determining concentrated areas for incidence of disease and illness.

22. When would it be appropriate for a nurse to use a Geographic Information System (GIS)? a. Recording client data collected at a foot clinic b. Determining neighborhoods that have an increased incidence of lead poisoning c. Evaluating effectiveness of a farm safety program d. Scheduling health promotion programs in the community

ANS: B Technology helps us understand environmental threats. The National Library of Medicine (NLM) databases are user-friendly and accessible on the Internet. The NLM website provides access to medical databases such as PubMed and GratefulMed, which can be searched for possible environmental linkages to illnesses using key terms.

2. A nurse wants to find information about environmental threats that are present in the community. Which of the following would be the best source of data for the nurse? a. CINAHL b. National Library of Medicine c. State health department d. Closest local library

ANS: A, B, C Families living in poverty are more likely to experience environmental justice issues such as disproportionate environmental exposures. Sub-standard housing, living closer to hazardous waste sites, working in more hazardous jobs, poorer nutrition, and less access to quality health care all contribute to this issue. Although limited education is related to poverty, it is not discussed as causing an increase in environmental exposure.

2. A public health nurse working with a family living in poverty recognizes that they are more likely to be exposed to environmental hazards because they have (select all that apply): a. Limited funds to pay for health care b. Poor nutrition c. Homes located closer to hazardous waste sites d. Less education

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

2.Which formula should be used to calculate a rate? A) Number of true positives/ Number of true positives + Number of false negatives B) Number of true negatives/ Number of true negatives + Number of false positives C) Number of conditions or events within a designated period of time/ Population at risk during the same period of time × Base multiple D) Number of deaths from a specific disease/ Number of cases of the same disease X 100

B) Aretaeus the Cappadocian

2.Who first described pulmonary tuberculosis in detail? A) Hippocrates of Cos B) Aretaeus the Cappadocian C) Claudius Galen D) Susruta

ANS: C The first phase is determining if a chemical is known to be associated with negative health effects (in animals or humans).

20. Which question would a nurse ask during the first phase of a risk assessment? a. Has the chemical been released into the environment? b. How much and by which route of entry can the chemical enter the body? c. Is the chemical known to be associated with a negative health effect? d. What is the prediction for potential harm?

A) Epidemic curve

20.The nurse graphs the distribution of influenza cases by the time of onset of influenza. Which would be the result of this work? A) Epidemic curve B) Epidemiologic descriptive study C) Incidence density D) Incidence rate

C) Florence Nightingale

20.Who used statistics to improve public health in England? A) William Farr B) John Graunt C) Florence Nightingale D) John Snow

ANS: C Citizens can reduce air pollution by doing their part, which can include choosing less-polluting cars.

21. What action can a nurse take on an individual level to reduce pollution in the environment? a. Provide a tax incentive to factories that do not pollute. b. Make laws related to allowed levels of pollution in the area. c. Choose a less-polluting car. d. Move to an area with less pollution.

D) Establish the existence of the outbreak

21. 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? A) Identify the names of the people infected by the virus B) Formulate and test hypotheses as to the most probable causative factors C) Implement a plan for control of the outbreak D) Establish the existence of the outbreak

D) 10

21.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? A) 0.5 B) 1 C) 5 D) 10

ANS: D Nurses have historically made discoveries related to chemical exposure when people presented with signs and symptoms related to known chemical toxicity. The first two options are modern methods.

3. How have nurses historically learned to identify a possible relationship between environmental chemical exposures and their potential harm? a. Extrapolation by toxicologists b. Biomonitoring c. Completing chemistry courses d. Observing signs and symptoms in clients

A) Number of deaths of children <1 year of age in one year / Number of live births in the same year X 1000

3.Which formula should be used to calculate the infant mortality rate? A) Number of deaths of children <1 year of age in one year / Number of live births in the same year X 1000 B) 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 X1000 C) Number of deaths of children <28 days of age in one year/Number of live births in the same year X1000 D) Number of fetal deaths in one year/ Number of live births plus fetal deaths in the same year X 1000

A) Hippocrates of Cos

3.Who is considered the first epidemiologist? A) Hippocrates of Cos B) Aretaeus the Cappadocian C) Claudius Galen D) Susruta

ANS: A Toxicology is the study of the health effects associated with chemical exposures.

4. The basic science applied to understanding the health effects associated with chemical exposures is: a. Toxicology b. Pharmacology c. Chemistry d. Environmental epidemiology

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

4.Which correctly defines an adjusted rate? A) Statistical procedure that removes the effects of differences in the composition of a population, such as age, when comparing one with another B) Measure of the probability that people without a certain condition will develop that condition over a period of time C) Measure of the number of people in a given population who have an existing condition at a given point in time D) Detailed rates that are calculated using the number of people in the smaller subgroups of the population in the denominator

D) A tentative hypothesis is formulated

4.Which occurs in the epidemiologic process that is similar to the diagnosis phase of the nursing process? A) Data are gathered from reliable sources B) Healthcare needs and assets are identified C) Goals and objectives for care are established D) A tentative hypothesis is formulated

ANS: A, C, D Advocacy roles of the community-oriented nurse include attending policy meetings to obtain health-related information, holding public meetings (or serving on panels at meetings) to provide health-related information, serving on health-related committees, and informing local media about environmental hazards in the community.

5. Which of the following actions would a nurse take when serving as an advocate for the community? (Select all that apply.) a. Asking questions related to health implications at policy meetings b. Calling the local health department to report problems at the hospital c. Serving as a source of information at public meetings d. Volunteering to serve on health-related committees

C) Prevalence

5.Which rate measures the number of people in a given population who have influenza at a given point in time? A) Adjusted B) Incidence C) Prevalence D) Specific

A) William Farr

5.Who in the history of epidemiology developed mortality surveillance systems, addressed basic epidemiologic concepts, and is considered the founder of modern statistics? A) William Farr B) John Graunt C) Florence Nightingale D) John Snow

C) Crude

6.The nurse is measuring the occurrence of chronic obstructive pulmonary disease being investigated in the entire population. Which rate does this represent? A) Adjusted B) Attack C) Crude D) Incidence

D) Morbidity and mortality from noninfectious diseases have increased.

6.Which most accurately describes how disease patterns have changed from 1900 to the present? A) Morbidity and mortality from infectious diseases have increased. B) Morbidity and mortality from unintentional injuries have decreased. C) Morbidity and mortality from chronic degenerative conditions have decreased. D) Morbidity and mortality from noninfectious diseases have increased.

ANS: D Scientists who study how pollutants travel in air, water, and soil are geologists, meteorologists, and chemists.

7. A public health nurse is organizing a multidisciplinary team to address the issue of water pollution in the community. The most likely members that would be invited to address this issue would be: a. Physicians, water sanitation workers, and occupational therapists b. Pharmacologists, radiologists, and epidemiologists c. Nurse practitioners, pharmacologists, and environmentalists d. Geologists, meteorologists, and chemists

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

7.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? A) An outbreak that occurs when there is an increased incidence of a disease beyond that which is normally found in the population B) Model based on the belief that health status is determined by the interaction of the characteristics of the host, agent, and environment C) Study of the distribution and determinants of states of health and illness in human populations D) Epidemiologic model that strongly emphasizes the concept of multiple causation while de-emphasizing the role of agents in explaining illness

D) Specific.

7.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? A) Adjusted B) Incidence C) Prevalence D) Specific

ANS: C The epidemiologic triangle consists of an agent (chemical), host (community consisting of several variants), and environment (air, water, soil, etc.).

8. Which example contains the components necessary to form an epidemiologic triangle? a. Pesticides, water, food b. Lead, mercury, soil c. Trichloroethylene, water, infants d. Children under 12, elderly, temperature

B) Cause-specific mortality rate

8.. 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? A) Age-specific mortality rate B) Cause-specific mortality rate C) Case fatality rate D) Crude mortality rate

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

8.Which most accurately defines ìrateî? A) Course of a disease or condition from the onset to resolution B) Primary measurement used to describe either the occurrence or the existence of a specific state of health or illness C) Probability or likelihood that a disease or illness will occur in a group of people who presently do not have the problem D) Characteristic or event that has been shown to increase the probability that a specific disease or illness will develop

ANS: C All citizens can engage in minimizing their impact on the environment by reducing, reusing, and recycling. Although it would be nice to replace all appliances for energy-efficient newer models, most people can't afford that—furthermore, it is an environmental issue to discard the used models. Similarly, downsizing to a smaller living space could help the environment, because the nurse would use less energy, but again, not everyone can afford all the expenses involved in moving. On the other hand, all persons can reduce, reuse, and recycle the individual products they currently consume.

9. A nurse wants to help keep the community environment safe. Which of the following is the most appropriate action for the nurse to take? a. Conserve water by bathing less often. b. Downsize to a smaller living space. c. Reduce, reuse, and recycle. d. Replace all his appliances with new energy-efficient ones.

ANS: A Point sources of pollution are identifiable sources of air pollution, such as a smoke stack.

9. An example of a point source of air pollution is: a. A smoke stack b. The number of cars and trucks c. How much fossil fuel is consumed in a community d. Ground ozone levels

B) 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

9.Which correctly defines sensitivity? A) The ratio of the incidence rate in the exposed group to the incidence rate in the nonexposed group B) 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 C) Variations measured in hours, days, weeks, or months and commonly used to quantify outbreaks of infectious disease D) Ability of a test to correctly identify people who do not have a health problem or the probability of testing negative if the health problem is truly absent

B) John Graunt

9.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? A) William Farr B) John Graunt C) Florence Nightingale D) John Snow

20. A PHN is looking at creating a plan to address the high rate of uncontrolled hypertension in a community. List the following steps in the order in which the nurse should perform them (1-4). _____ 1. Evaluate the community to see what social determinants of health need to be addressed and what is lacking within the community. _____ 2. Review the program outcomes with evaluations from participants and local care providers to determine the effectiveness of the program. _____ 3. Start planning a community wide health fair with representatives from local primary-care providers, fitness centers, and local produce vendors. _____ 4. Have printed material and educational information available for community participants to take home and use after the fair.

: 1, 4, 2, 3 Feedback: First, the nurse should perform a community assessment to see what social determinants of health need to be addressed and to see what is lacking within the community. Next, the nurse should formulate a nursing diagnosis and create a plan to address the needs of the community. This can be done by planning a community wide health fair with representatives from local primary-care providers, fitness centers, and local produce vendors. Next, the nurse implements the plan and tries to anticipate the needs of the participants after the fair by having printed materials and educational information available for people to take home and use after the fair. Finally, the nurse evaluates the effectiveness of the program and modifies the plan as needed. Objective: 7. Discuss solutions to decreasing health disparity caused by social determinant of health, specifically how nurses can be part of the solution. p. 174 Heading: Nurses Are Part of the Solution Integrated Processes: Nursing Process Client Need: Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Perfusion

2. Which of the following is the definition of health disparity? A. A difference in health outcomes B. An unequal and unjust difference in health outcomes C. A social factor that impacts health outcomes and contributes to disparity D. Access to health care for everyone without financial hardship

: A Objective: 1. Compare and contrast the concepts of health disparity, inequity, and inequality. pp. 158-160 Heading: Definitions Integrated Processes: N/A Client Need: Client Need: Health Promotion and Maintenance Cognitive Level: Comprehension [Understanding] Concept: Promoting Health Difficulty: Moderate Feedback A A health disparity is simply a difference in health outcomes. B A health disparity is simply a difference in health outcomes

11. A nurse is working in a community center and notices a high rate of obesity in its members. The nurse suspects that poor access to fresh fruits and vegetables may be partially responsible. What should the nurse do first when formulating a plan? A. Assess the social determinants in the community. B. Implement a plan to increase access to fresh produce. C. Outline the steps needed to address the disparity. D. Formulate a community diagnosis.

: A Objective: 6. Define and explain the role of social determinants of health in contributing to health disparities. p. 166 Heading: Social Determinants of Health, Health Disparity, and Social Justice Integrated Processes: Nursing Process Client Need: Client Need: Health Promotion and Maintenance Cognitive Level: Analysis [Analyzing] Concept: Nutrition

15. During a lecture on health disparities, a student asks the instructor how communities with great access to health care can still have poor health outcomes. How should the instructor respond? A. Social determinants of health determine how people respond to health threats and how they access preventative care. B. The student is incorrect. Communities with good access to care have good health outcomes. C. This phenomenon only occurs in communities where the quality of health care is poor. D. Members of these communities only have access to primary-care providers, which reduces the quality of care they receive.

: A Objective: 7. Discuss solutions to decreasing health disparity caused by social determinant of health, specifically how nurses can be part of the solution. pp. 170-172 Heading: Solutions to Health Disparities > Paradigm Shift Integrated Processes: Teaching/Learning Client Need: Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Promoting Health

5. Which of the following programs has been designed to work toward optimal health for all Americans? A. Racial and Ethnic Approaches to Health (REACH) B. Universal Health Care C. Healthy People D. EURO Health for All

: C Objective: 3. Describe the role of Healthy People 2010 in eliminating health disparities. p. 161 Heading: Magnitude of the Problem > Goal to Eliminate Health Disparities Integrated Processes: N/A Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Promoting Health

14. A research nurse is looking for funding to study health disparities in a community—an ethnically and economically diverse inner city neighborhood. The nurse is trying to apply evidence from controlled studies to see how they correlate in the real world. What type of study is the nurse designing? A. Translational B. Causation C. Correlation D. Observational

: A Objective: 7. Discuss solutions to decreasing health disparity caused by social determinants of health, specifically how nurses can be part of the solution. pp. 170-172 Heading: Solutions to Health Disparities > Paradigm Shift Integrated Processes: Nursing Process Client Need: Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Diversity

19. A public health nurse (PHN) is performing a community assessment in order to reduce the childhood obesity rate in a community. What social determinants of health should the PHN examine? Select all that apply. A. Location of primary health providers B. Nutrition and physical education classes in the public schools C. Housing security D. Presence of sidewalks within the community E. Access to fresh produce

: A, B, D, E Objective: 7. Discuss solutions to decreasing health disparity caused by social determinants of health, specifically how nurses can be part of the solution. pp. 166-167 Heading: Social Determinants of Health, Health Disparity, and Social Justice > International Recognition of Social Determinants of Health Integrated Processes: Nursing Process Client Need: Client Need: Health Promotion and Maintenance Cognitive Level: Analysis [Analyzing] Concept: Nutrition

1. A nurse is studying the increased infant mortality rate at a local hospital in a largely African American community. The nurse notes that there are very few options for prenatal care in the community and recognizes that this is an example of: A. Health disparity B. Health inequity C. Health injustice D. Social determinant of health

: B A A health disparity is simply a difference in health outcomes

9. Researchers have found that investment in which of the following would have had a greater effect on health disparities than the investment in new medical technology? A. Improving quality of health care B. Increasing access to education for everyone C. Implementing universal health care D. Decreasing crime rate

: B Objective: 5. List reasons why even after 10 years health disparities have not decreased in the United States pp. 165-166 Heading: Magnitude of the Problem > Health Disparities Have Not Been Solved Integrated Processes: N/A Client Need: Client Need: Health Promotion and Maintenance Cognitive Level: Comprehension [Understanding] Concept: Evidence-Based Practice

12. A nurse is performing an assessment of a very economically diverse community and realizes that while comparing income to health outcomes, the nurse must be careful to: A. Compare only the outcomes of the richest community members to the outcomes of the poorest community members. B. Recognize that income and outcomes exist on a scale, and look across the entire spectrum. C. Evaluate only the poorest health outcomes and where they land on the income spectrum. D. Evaluate only the poorest community members and their health outcomes.

: B Objective: 6. Define and explain the role of social determinants of health in contributing to health disparities. pp. 166-167 Heading: Social Determinants of Health, Health Disparity, and Social Justice > International Recognition of Social Determinants of Health Integrated Processes: Nursing Process Client Need: Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Diversity

16. A nurse is counseling a young man with obesity and diabetes. The nurse explains that in addition to direct medical costs, indirect costs will likely include: A. Costs of medication B. Lost wages and loss of employment productivity C. Decreased lifespan D. Increased costs of health insurance

: B Objective: 7. Discuss solutions to decreasing health disparity caused by social determinant of health, specifically how nurses can be part of the solution. pp. 160-161 Heading: Magnitude of the Problem Integrated Processes: Teaching/Learning Client Need: Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Promoting Health

18. A nurse administrator is teaching staff about populations at risk for poor health outcomes in an attempt to decrease health inequities in the hospital. Which of the following groups does the nurse administrator mention are at higher risk for poor health outcomes related to health disparities? Select all that apply. A. People who carry private health insurance B. Families receiving public assistance C. African Americans D. Native Americans E. The middle class

: B, C, D Objective: 2. Discuss the magnitude of health disparities both in the United States and internationally. pp. 157-158 Heading: Introduction Integrated Processes: Teaching/Learning Client Need: Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Promoting Health

17. A nurse is organizing a round table presentation at a conference. The nurse asks the other participants for suggestions on actions that nurses can take to reduce national health disparities. Which of the following suggestions are known to be effective measures for the reduction of health disparities? Select all that apply. A. Volunteer with an international organization that supports building infrastructure in underdeveloped areas. B. Support initiatives that increase physical education classes and healthy school meals. C. Design and create research studies that address inequities and support vulnerable populations. D. Discuss social and health disparity information with coworkers to promote awareness. E. Act as advocates for patients, families, and communities in reducing inequities.

: B, C, D, E Objective: 7. Discuss solutions to decreasing health disparity caused by social determinant of health, specifically how nurses can be part of the solution. p. 174 Heading: Nurses Are Part of the Solution Integrated Processes: Teaching/Learning Client Need: Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Critical Thinking

6. Which of the following statements about Healthy People is correct? A. Healthy People 2010 was successful in reaching its goal of ending health disparities. B. Healthy People 2010 focused on climate change as one of the key factors contributing to health inequities. C. The goal of Healthy People 2020 was expanded to include improving the health of all ages and groups, and to eliminate all health disparities and inequities. D. The goal of Healthy People 2010 was to reduce health disparities and inequity.

: C Objective: 3. Describe the role of Healthy People 2010 in eliminating health disparities. p. 161 Heading: Magnitude of the Problem > Goal to Eliminate Health Disparities Integrated Processes: N/A Client Need: Client Need: Health Promotion and Maintenance Cognitive Level: Comprehension [Understanding] Concept: Promoting Health

7. A nurse manager has been working in a community health center for many years. In the recent months, the nurse manager has noticed a dramatic increase in the number of Hispanic clients coming in to the center with uncontrolled diabetes. Which of the following is the best way to address the situation? A. Speak with local providers about decreasing the length of time between follow-up visits. B. Involve pharmacists in counseling newly diagnosed patients about their insulin regimen. C. Perform a community assessment to determine why community members aren't properly caring for themselves. D. Develop several educational handouts about managing diabetes and have them translated into Spanish.

: C Objective: 4. Identify different actions nurses can take to alleviate health disparities within the health-care system. p. 174 Heading: A World Without Health Disparities Integrated Processes: Nursing Process Client Need: Client Need: Health Promotion and Maintenance Cognitive Level: Analysis [Analyzing] Concept: Nursing Roles

13. A nurse is looking at reasons why members of a community are more likely to die from heart disease. The nurse finds several studies that suggest that social factors, such as ____, are more important than behavioral choices. A. Smoking B. High-fat or high-sugar diets C. Poverty D. Lack of exercise

: C Objective: 6. Define and explain the role of social determinants of health in contributing to health disparities. pp. 166-167 Heading: Social Determinants of Health, Health Disparity, and Social Justice > International Recognition of Social Determinants of Health Integrated Processes: Nursing Process Client Need: Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Perfusion

4. In a study performed by the Center for Economic and Political Studies, researchers found that between 2003 and 2006 the cost of health inequalities in the United States was approximately: A. $1 million B. $100 million C. $1 billion D. $1 trillion

: D Objective: 2. Discuss the magnitude of health disparities both in the United States and internationally. pp. 160-161 Heading: Magnitude of the Problem Integrated Processes: N/A Client Need: Health Promotion and Maintenance Cognitive Level: Knowledge [Remembering] Concept: Promoting Health

3. In many countries, which factors decrease infant mortality rate? A. Income B. Education level C. Neither 1 nor 2 D. Both 1 and 2

: D Objective: 2. Discuss the magnitude of health disparities both in the United States and internationally. pp. 168-169 Heading: Social Determinants of Health, Health Disparity, and Social Justice > Role of Income and Education Integrated Processes: N/A Client Need: Client Need: Health Promotion and Maintenance Cognitive Level: Knowledge [Remembering] Concept: Evidence-Based Practice Difficulty: Moderate Feedback A Both increased income and increased education are known to decrease infant mortality rate. B Both increased income and increased education are known to decrease infant mortality rate. C Both increased income and increased education are known to decrease infant mortality rate. D Both increased income and increased education are known to decrease infant mortality rate. PTS: 1 CON: Evidence-Based Practice

8. A nurse educator is preparing a lesson on the issues surrounding the Affordable Care Act and universal health care. In 2005, which organization passed a resolution that states that every person should be able to access health-care services regardless of economic status? A. The Supreme Court B. The World Health Organization C. The United Nations D. The World Health Assembly

: D Objective: 4. Identify different actions nurses can take to alleviate health disparities within the health-care system. pp. 161-165 Heading: Magnitude of the Problem > Reflection of Health Disparities in Health Outcomes Integrated Processes: Teaching/Learning Client Need: Client Need: Health Promotion and Maintenance Cognitive Level: Comprehension [Understanding] Concept: Promoting Health Difficulty: Easy Feedback A The Supreme Court does not pass regulations. It did, however, uphold that the measures included in the Affordable Care Act (which is not universal health care) are constitutional. B The World Health Assembly, not the World Health Organization, passed a resolution in 2005 that stated that every person should be able to access health-care services regardless of economic status. C The World Health Assembly, not the United Nations, passed a resolution in 2005 that stated that every person should be able to access health-care services regardless of economic status. D The World Health Assembly passed a resolution in 2005 that stated that every person should be able to access health-care services regardless of economic status. PTS: 1 CON: Promoting Health

10. A nurse is teaching an in-service for new nurses on the importance of cultural sensitivity when caring for patients. Which of the following statements is incorrect? A. The ethnic diversity of health-care staff plays little role in the reduction of health-care inequalities. B. Translators should always be used when a patient does not speak English as a primary language. C. Nurses and other health-care workers may often display discriminatory behavior without realizing it. D. Nurses must always work as patient advocates to make sure that the patient is receiving culturally sensitive care.

:A Objective: 4. Identify different actions nurses can take to alleviate health disparities within the health-care system. p. 165 Heading: Magnitude of the Problem > Actions to Reduce Health Disparities Integrated Processes: Teaching/Learning Client Need: Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Ethics

Which of the following actions represents the use of secondary prevention to reduce environmental health risks? a. Collecting blood specimens from preschool children to check for lead levels b. Meeting with local government officials to request that the city clean up a hazardous vacant lot c. Referring a child with toxic lead levels to a neurologist d. Teaching parents of a 2-year-old about the dangers of lead-based paint in older homes

A city has announced its plans to build a city dump near a community of poor and predominantly African American citizens. Which of the following principles would the nurse be using when vocalizing opposition for this plan? a. Environmental justice b. Environmental epidemiology c. Tertiary prevention d. Risk communication

A Environmental justice is the goal of campaigns seeking to improve the unequal burden of environmental risks borne by impoverished and minority communities.

A community citizen reports to the public health nurse that the city water in one neighborhood has had an unusual taste for the past few months. Which of the following actions should the nurse take first? a. Check the most recent consumer confidence report. b. Consult the Centers for Disease Control and Prevention. c. Notify the Environmental Protection Agency (EPA). d. Place a call to the poison control center.

A The consumer confidence report (also known as the right-to-know report) reports the condition of drinking water. Because this is only one citizen, whose sense of taste may be affected by many conditions, it would not be appropriate to overreact by calling in governmental agencies first. Even so, in case one needed to contact an authority, it would be appropriate to start with local governmental agencies such as the city water department rather than federal agencies

ANS: A The consumer confidence report (also known as the right-to-know report) reports the condition of drinking water. Because this is only one citizen, whose sense of taste may be affected by many conditions, it would not be appropriate to overreact by calling in governmental agencies first. Even so, in case one needed to contact an authority, it would be appropriate to start with local governmental agencies such as the city water department rather than federal agencies.

ANS: B Conducting a windshield survey is a useful first step to understanding potential environmental health risks. This provides first-hand information about the community and areas of concern that must be investigated.

A nurse is assessing potential environmental health risks in the community. Which of the following would be the first step that the nurse should take? a. Conduct health risk assessments of randomly selected individuals b. Perform a windshield survey c. Review facility permits and consumer confidence reports d. Survey community members

ANS: C An exposure history should identify current and past exposures, have a preliminary goal of reducing or eliminating current exposures, and have a long-term goal of reducing adverse health effects. The "I PREPARE" mnemonic consigns the important questions to categories that can be easily remembered. Asking about previous employment helps to answer the "P" of past work.

A nurse is completing a basic health assessment. Which of the following questions should be asked by an environmentally aware nurse? a. "Is anyone else in your family having these symptoms?" b. "Can you tell me about your house or apartment?" c. "What jobs have you held longest?" d. "Where do you live?"

ANS: C Giving immunizations is an intervention that will increase the number of people who will be vaccinated. Intervention includes coordinating medical, nursing, and public health actions to meet the client's needs.

A nurse practitioner has established a mobile clinic to vaccinate noninstitutionalized adults against influenza. Which of the following phases of the nursing process is being implemented? a. Assessment b. Planning c. Intervention d. Evaluation

ANS: B, D Sharing all the data would be overwhelming, and much of the data might not be relevant. Using epidemiological statistics would not be meaningful to those without the education or experience to be able to draw an appropriate conclusion. Instead, the correct information must be given in a language the audience—namely, those at risk or worried about the risk—can understand. Use the communication channels the neighborhood residents use and meet at a common meeting place for the community. It is wasteful of resources to advertise in media throughout a wider region or to meet at a central regional facility when only community residents will be interested or involved.

A nurse wants to use the principles of risk and outrage to improve an environmental hazard in the community. To accomplish this, which of the following actions would be taken by the nurse? (Select all that apply.) a. Advertise in the media throughout the entire surrounding area. b. Communicate the correct information in a timely fashion. c. Share all the data found on the community assessment. d. Talk to those affected or those worried about the situation.

ANS: C Employees have the right to know about hazardous chemicals with which they work. Employers must maintain a list of all hazardous chemicals used on the premises, along with a material safety data sheet that addresses health risks related to these chemicals, as well as information about safe use and handling.

A nurse who works at the local hospital asks a public health nurse what might be causing her hands to become very sore and sensitive. Which of the following statements would be the most appropriate response by the public health nurse? a. "Ask the staff in employee health if there have been any other complaints." b. "Call the local health department about any recent problems at the hospital." c. "Check the material safety data sheet on any chemicals you have used recently." d. "See the nurse's health care provider for a complete work-up."

ANS: C, D The nurse's role is to understand the roles of each respective agency and organization, know the public health laws, and work with the community to coordinate services to address the community's needs. Other needed interventions include organizing a blood-lead screening program through the local health department, educating local health providers to encourage them to systematically test children for lead poisoning, and working with local landlords to improve the condition of their housing stock.

A public health nurse is assisting the community in dealing with the effects of lead paint poisoning. Which of the following activities would the nurse most likely complete? (Select all that apply.) a. Administering medications to those with signs of lead poisoning b. Assessing community members for any health problems c. Setting up a blood screening program with the local health department d. Encouraging local landlords to improve the condition of their housing

ANS: B Chemicals are grouped so it's possible to understand the actions and risks associated with each group.

A public health nurse is working with a migrant farm worker who has experienced an exposure to a pesticide. When researching pesticides, the nurse looks at the "family" of the chemical. What similarities are found among chemicals that have been placed in the same family? a. Route of entry into the body b. Actions and associated risks c. Effects that they have on the body d. Potency and toxicity

Which of the following are the major sources of air pollution in the United States? (Select all that apply.) a. Burning of fossil fuels b. Waste incineration c. Wood burning fireplaces d. Motor vehicles

A, B, D

Which of the following actions would a nurse take when serving as an advocate for the community? (Select all that apply.) a. Asking questions related to health implications at policy meetings b. Calling the local health department to report problems at the hospital c. Serving as a source of information at public meetings d. Volunteering to serve on health-related committees

A, C, D

ANS: D An example of an environmental standard is an acceptable level of emissions or a maximum contaminant level allowed.

An acceptable level of emissions or a maximum contaminant level allowed is an example of which environmental protection strategy? a. Controlling pollution b. Waste minimization c. Land use planning d. Environmental standard

ANS: C Education is a primary preventive strategy. When examining the sources of environmental health risks in communities and planning intervention strategies, it is important to apply the basic principles of disease prevention.

An occupational health nurse at a local factory is using primary prevention strategies to reduce the environmental health risks among the employees. Which of the following activities would the nurse most likely implement? a. Checking radiation detectors to monitor for unsafe levels of radiation exposure b. Irrigating the eyes of an employee who has had a chemical splash to the face c. Teaching new employees who will work outdoors about the signs and symptoms of heat-related illness d. Using spirometry to rule out obstructive or restrictive lung disease for workers who will be wearing mask respirators

Which of the following best describes the purpose of local health departments making unannounced inspections of local restaurants? a. To enforce local laws and regulations b. To ensure compliance c. To provide oversight to potential exposure d. To monitor employee safety

Which of the following statements about children and environmental hazards is correct? a. The prevalence of autism is directly related to the increase in environmental toxins. b. Children are more susceptible to environmental toxins because of their smaller size. c. The incidence of asthma among children has been decreasing. d. Children are more susceptible to cancer if they have a family history of the disease.

A nurse wants to find information about environmental threats that are present in the community. Which of the following would be the best source of data for the nurse? a. Cumulative Index of Nursing and Allied Health (CINAHL) database b. National Library of Medicine c. State health department d. Closest local library

B The NLM website provides access to medical databases such as PubMed and GratefulMed, which can be searched for possible environmental linkages to illnesses using key terms.

B, D

A nurse is completing a basic health assessment. Which of the following questions should be asked by an environmentally aware nurse? a. "Is anyone else in your family having these symptoms?" b. "How many people live in your home?" c. "What jobs have you held longest?" d. "Where did you live 10 years ago?"

A nurse practitioner has established a mobile clinic to vaccinate adults against influenza. Which of the following phases of the nursing process is being implemented? a. Assessment b. Planning c. Intervention d. Evaluation

A nurse wants to help keep the community environment safe. Which of the following is the most appropriate action for the nurse to take? a. Conserve water by bathing less often. b. Downsize to a smaller living space. c. Reduce, reuse, and recycle. d. Replace all his appliances with new energy-efficient one

C, D

A high school student considering a job in the restaurant industry after graduation asks a nurse about workplace safety issues. Which of the following acts would the nurse most likely discuss with the student? a. Chemical Safety Information, Site Security, and Fuels Regulatory Act b. Comprehensive Environmental Response, Compensation, and Liability Act c. Food Quality Protection Act d. Occupational Safety and Health Act

The nurse is examining blood lead levels in school-age children 1 year after a community-wide education intervention. Which of the following phases of the nursing process is being implemented? a. Assessment b. Diagnosis c. Intervention d. Evaluation

D In this instance, the nurse is evaluating the results of the intervention to determine whether goals were reached.

A nurse wants to have a better understanding of the physiological effects of selected chemicals. Which of the following individuals would provide the most useful information to the nurse? a. Chemist b. Epidemiologist c. Pharmacist d. Toxicologist

D Toxicology is the basic science that studies the health effects associated with chemical exposures.

ANS: B Chemical, biological, and radiological pollutants are often found in the air we breathe, the water we drink, and the products we use.

Environmental health is important to nurses because chemical, biological, and radiological materials are: a. A major cause of global warming b. Often found in the air, water, and products we use c. Frequently linked to the development of chronic illnesses d. Products that nurses work with on a daily basis

ANS: C Epidemiology studies the incidence and prevalence of disease, helping nurses understand the strength of the association between exposure and health effects.

Epidemiology: a. Is a science that studies the poisonous effects of chemicals b. Explains the association between learning disabilities and exposure to lead-based paint at the cellular level c. Helps nurses understand the strength of the association between exposure and health effects d. Is a method for tracking the prevalence of a disease

ANS: D In this instance, the nurse is evaluating the results of the intervention to determine whether goals were reached. If you chose assessment, understand that this would have been done earlier in the process because assessment was needed to determine that a problem existed and that interventions were needed.

ANS: A Secondary prevention refers to actions such as surveillance and screening, which are undertaken so that problems may be detected at early stages.

ANS: A, B, D Motor vehicles are the greatest single source of air pollution in the United States. The burning of fossil fuels (diesel, industrial boilers, and power plants) and waste incineration are two other major contributors.

Which of the following are the major sources of air pollution in the United States? (Select all that apply.) a. Burning of fossil fuels b. Waste incineration c. Industrial plants d. Motor vehicles

ANS: B Ensuring compliance refers to the process of making certain that permitting requirements are met. Although this activity may be seen as a type of monitoring, the question asks for the purpose, which is to ensure compliance. Enforcement involves penalties such as fines or facility closure.

Which of the following best describes the purpose of local health departments making unannounced inspections of local restaurants? a. To enforce local laws and regulations b. To ensure compliance c. To provide exposure to oversight d. To monitor employee safety

ANS: B Because of the smaller size of children, they are exposed to higher doses of pesticide residues in the foods they eat and drink. Autism has increased 1000% since the mid-1980s. However, there is not a direct link to environmental toxins discussed in the text. The prevalence of asthma is at an all time high. Only about 5% of all cancers are strongly associated with heredity.

Which of the following statements about children and environmental hazards is correct? a. The prevalence of autism is directly related to the increase in environmental toxins. b. Children are more susceptible to environmental toxins because of their smaller size. c. The prevalence of asthma among children has been decreasing. d. Children are more susceptible to cancer if they have a family history of the disease.

ANS: A, C, D The organization and approach to environmental protection vary somewhat among states, but the common essential strategies of prevention and control via the permitting process, establishment of environmental standards, and monitoring, as well as compliance and enforcement, are found in every state.

Which of the following strategies would a nurse expect to be implemented by a typical state environmental agency? (Select all that apply.) a. Acting, through unannounced inspections, to ensure compliance b. Writing permits that help limit toxic hazards c. Monitoring hazardous substances to uphold established standards d. Obtaining and analyzing samples to confirm compliance

The nurse is asking a client with arthritis questions to collect information. Which questions asked by the nurse are closed-ended questions? Select all that apply. One, some, or all responses may be correct. a) "Are you having pain?" b) "Tell me how your pain has been." c) "Describe how your husband is helping you at home." d) "Do you think the medication is helping you get pain relief?" e) "Give me an example of a method that helps you get pain relief at home."

a) "Are you having pain?" d) "Do you think the medication is helping you get pain relief?"

Which statement by the nurse reflects understanding of therapeutic communication with a client experiencing domestic violence? Select all that apply. One, some, or all responses may be correct a) "Tell me about your struggles." b) "Everything is going to be okay." c) "Get out of the house right away." d) "You'll feel better after you leave." e) "Why do you stay when he hits you?" f) "Why did you return to him after the abuse?"

a) "Tell me about your struggles."

Which nurse statement reflects positive cultural sensitivity to help reduce potential health disparities? a) "Which type of food do you usually eat at home?" b) "You need to ask your family to bring food of your choice." c) "The hospital staff will not be able cook food with your requirements." d) "You need to eat the food that the hospital provides."

a) "Which type of food do you usually eat at home?"

Which factor that influences the spread of sexually transmitted infections (STIs) would the nurse include in a teaching session? Select all that apply. One, some, or all responses may be correct. a) Age b) Drug abuse c) Lack of education d) Multiple sex partners e) Absent or subtle symptoms f) Limited access to health care

a) Age b) Drug abuse c) Lack of education d) Multiple sex partners e) Absent or subtle symptoms f) Limited access to health care

The nurse is instructing a community group regarding risk factors for coronary artery disease. Which risk factor cannot be modified? a) Heredity b) Hypertension c) Cigarette smoking d) Diabetes mellitus

a) Heredity

Which risk factor increases a client's risk for infection in the community? Select all that apply. One, some, or all responses may be correct. a) Lifestyle b) Occupation c) Chronic diseases d) Frequent traveling e) Diagnostic procedures

a) Lifestyle b) Occupation d) Frequent traveling

Which risk of adolescent pregnancy would the community nurse teach? a) Risk for premature birth b) Risk for having a large baby c) Risk for chromosomal defects d) Risk for increased weight gain

a) Risk for premature birth

Which information would the nurse obtain in a health history for a sexually active 16-year-old to determine the client's risk for sexually transmitted infections (STIs)? Select all that apply. One, some, or all responses may be correct. a) Sexual practices b) Barrier protection use c) Gender of sexual partners d) Number of sexual partners e) Use of illicit drugs before sex

a) Sexual practices b) Barrier protection use c) Gender of sexual partners d) Number of sexual partners e) Use of illicit drugs before sex

Which characteristic can be observed in abusive parents? Select all that apply. One, some, or all responses may be correct. a) Social isolation b) Poor coping skills c) Family authoritarianism d) Feeling of no control over life e) Inability to seek help from others f) Expects child to satisfy needs for love

a) Social isolation b) Poor coping skills c) Family authoritarianism d) Feeling of no control over life e) Inability to seek help from others f) Expects child to satisfy needs for love

Which topic is most important for the nurse to teach in a community health promotion class for middle-aged adults? a) Tobacco cessation b) Infection prevention c) Alcohol abstinence d) Pain management

a) Tobacco cessation

Which instruction would the nurse provide to a group of parents with small children to promote safety and prevent injury? Select all that apply. One, some, or all responses may be correct. a) Turn pot handles away from edges. b) Install smoke detectors in the house. c) Lock medication away in a safe place. d) Place child safety latches on cabinets. e) Verify water temperature before baths.

a) Turn pot handles away from edges. b) Install smoke detectors in the house. c) Lock medication away in a safe place. d) Place child safety latches on cabinets. e) Verify water temperature before baths.

The nurse is teaching first aid to a group of community members. A participant asks which first aid should be administered, after calling 911, to a person who suffers extensive burns. Which response by the nurse is appropriate? a) "Apply ice to burned areas because this decreases pain." b) "Cover the burned areas with a bed sheet because this provides protection." c) "Do nothing because attempting to treat the burned areas may cause further damage." d) "Use first aid cream to burned areas because this prevents infection and decreases pain."

b) "Cover the burned areas with a bed sheet because this provides protection."

The nurse has instructed the client about effective ways of reducing burn injury. Which statement made by the client shows ineffective learning? a) "I will refrain from smoking when lying in bed." b) "I will set the bathing water temperature below 160°F (71°C)." c) "I will use a potholder when taking the food from an oven." d) "I will keep the screens and doors closed on the front of any fireplace."

b) "I will set the bathing water temperature below 160°F (71°C)."

Which activity by the community nurse is an illness prevention strategy? a) Encouraging the client to exercise daily b) Arranging an immunization program for chicken pox c) Teaching the community about stress management d) Teaching the client about maintaining a nutritious diet

b) Arranging an immunization program for chicken pox

Which environmental emergency requires the nurse to administer priority emergency abdominal and chest thrusts to clear a client's airway obstruction? a) Frostbite b) Drowning c) Hypothermia d) Lightening injury

b) Drowning

The community nurse is assessing an older adult client who lives alone at home. The nurse finds that the client refrains from physical activity for fear of falling when walking. Which intervention(s) by the nurse are beneficial to promote a healthy lifestyle? Select all that apply. One, some, or all responses may be correct. a) Instruct the client to apply bedside rails. b) Encourage the client to wear nonskid shoes. c) Suggest that the client use an assistive device. d) Ask the client to install handrails in the bathroom. e) Help the client rearrange furniture in the house

b) Encourage the client to wear nonskid shoes. c) Suggest that the client use an assistive device. e) Help the client rearrange furniture in the house

The nurse is teaching campfire safety to a group of community members and includes information about what to do if a person catches on fire. The nurse teaches the most effective method for putting out the flames. Which information from the group members indicates successful learning? a)Wrap hand with towel and slap at the flames. b) Instruct the victim to roll on the ground. c) Pour cold liquid over the flames. d) Remove the victim's burning clothes.

b) Instruct the victim to roll on the ground.

A 16-year-old high school student comes to a community health center because of the fear of having contracted herpes. The teenager is upset and shares this information with the community health center nurse. Which response would the nurse provide? a) "Let me get a brief health history now." b) "Try not to worry until you know whether you have herpes." c) "You sound worried. Let me make arrangements to have you examined." d) "Herpes has received too much attention in the media; let's be realistic."

c) "You sound worried. Let me make arrangements to have you examined."

Which clients are ideal candidates for interpreter service to prevent contributing health disparities? Select all that apply. One, some, or all responses may be correct. a) An English-speaking client with a speech disorder b) An African American client with a hearing impairment c) A non-English-speaking client in the emergency department d) A Spanish-speaking client ready to be discharged from the facility e) An Indian American who does not speak the language used at the facility

c) A non-English-speaking client in the emergency department d) A Spanish-speaking client ready to be discharged from the facility e) An Indian American who does not speak the language used at the facility

The nurse speaking in support of the best interest of a vulnerable client reflects which nursing duty? a) Caring b) Veracity c) Advocacy d) Confidentiality

c) Advocacy

Which is the most highly sensitive time within the developing embryo for the risk of malformation related to environmental teratogens? a) Heart at 32 weeks' gestation b) Cleft lip at 18 weeks' gestation c) Cleft palate at 8 weeks' gestation d) Upper limbs at 24 weeks' gestation

c) Cleft palate at 8 weeks' gestation

Which role is the nurse expected to have in a community-based nursing practice if there is a sudden spread of malaria? a) Educator b) Collaborator c) Epidemiologist d) Client advocate

c) Epidemiologist

The nurse in an emergency department is assessing a young child with a head injury. The child is accompanied by a parent. Which observation would prompt the nurse to assess the child for abuse? a) The child has Mongolian spots on the back. b) The child belongs to a single-parent family. c) The child has received care for injuries twice earlier. d) The child and parent narrate the same story about the injury.

c) The child has received care for injuries twice earlier.

The nurse is instructing a group of clients in the community about food preparation. Which statement indicates that a client is at an increased risk for contracting botulism? a) "I do not usually brush my teeth after I finish eating a meal." b) "Sometimes I eat grapes before I have a chance to wash them." c) "Utensils that I use to cut up chicken are put into the dishwasher." d) "I save money when I buy the slightly damaged cans of vegetables."

d) "I save money when I buy the slightly damaged cans of vegetables."

Which statement describes the step followed to provide competent care for vulnerable populations? a) "Refrain from giving priority to cultural practices and values of the vulnerable populations." b) "Provide financial and legal advice to the vulnerable people as this may be more important to them." c) "Evaluate the clients' beliefs and values about health in terms of the nurse's own culture, beliefs, and values." d) "Understand the clients' cultural beliefs, values, and practices to determine their specific needs and interventions."

d) "Understand the clients' cultural beliefs, values, and practices to determine their specific needs and interventions."

Which question will the nurse ask to assess a client's potential exposure to inhaled environmental irritants or toxic gases? a) "Do you garden?" b) "Are there ashtrays in your home?" c) "How much water or fluids do you drink daily?" d) "What type of work have you done in the past?"

d) "What type of work have you done in the past?"

Which scenario would contribute to health disparities? a) An English-speaking critical care nurse assesses a Hispanic client in a coma. b) An English-speaking nurse plans the nursing procedures for a black Latino client. c) An English-speaking nurse provides discharge instructions to an English-speaking client who is hard of hearing. d) An English-speaking nurse conducts the admission interview of a Puerto Rican immigrant with limited knowledge of English.

d) An English-speaking nurse conducts the admission interview of a Puerto Rican immigrant with limited knowledge of English.

A client with a history of chemical exposure and environmental toxins is diagnosed with mycosis fungoides (MF), which led to the development of Sézary syndrome. The primary health care provider advised extracorporeal photopheresis. Which would the nurse expect as the diagnosis of the client? a) Actinic keratosis b) Basal cell carcinoma c) Malignant melanoma d) Cutaneous T-cell lymphoma

d) Cutaneous T-cell lymphoma

Which factor increases an adolescent's risk for injury in the community? a) Employment b) Eating disorders c) Sleep deprivation d) Distracted driving

d) Distracted driving

Which guideline is useful for reducing disparity when caring for transgender clients? a) Learning about health care needs of homosexual clients b) Always referring to transgender clients using pronouns of the sex to which they transition c) Always referring to transgender clients using pronouns of the sex with which they were born d) Learning about the treatment options for transgender clients and requirements of follow-up care

d) Learning about the treatment options for transgender clients and requirements of follow-up care

The registered nurse (RN) is organizing a community health care program for administering tetanus vaccinations. Which member of the health care team is most suitable for being delegated the task of administering vaccinations? a) Nursing aide b) Certified technician c) Patient care associate (PCA) d) Licensed practical nurse (LPN)

d) Licensed practical nurse (LPN)

While organizing a community health care program for polio vaccinations, the registered nurse (RN) delegates the task of administering vaccines to members of the health care team. Which health care team member is most suitable to carry out the task? a) Technician b) Patient care associate (PCA) c) Certified nursing aide d) Licensed practical nurse (LPN)

d) Licensed practical nurse (LPN)

A client who does not understand English requires an interpreter. Which action by the student nurse may exacerbate health disparities? a) The student expects the interpreter to act as the client's advocate. b) The student expects the interpreter to have a health care background. c) The student maintains steady eye contact with the client. d) The student talks only to the interpreter about the client

d) The student talks only to the interpreter about the client

Which education would the nurse provide the parents of preschool-aged children regarding injury prevention? a) "Preschool-aged children are more prone to falls than are toddlers." b) "Preschool-aged children are at risk for injury because of their poor gross motor skills." c) "Preschool-aged children are less likely to follow rules, which increases the risk for injury." e) "Preschool-aged children are at risk for head injuries from riding a tricycle or balance bike."

e) "Preschool-aged children are at risk for head injuries from riding a tricycle or balance bike."

A community health care nurse is conducting a survey about homeless children in the community. Which finding helps the nurse distinguish absolute homelessness from relative homelessness? a) The children are under-immunized and at risk for childhood illnesses. c) The children are more likely to drop out of school and become unemployable. d) The children have access to health care only through the emergency department. e) The children do not have a physical shelter and may sleep outdoors or in vehicles.

e) The children do not have a physical shelter and may sleep outdoors or in vehicles.

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