Community Test 4

HIV transmission can occur through: a. Exposure to blood b. Insect bites c. Sharing of school supplies d. Toilets

ANS: A HIV can be transmitted through exposure to blood.

Which type of hepatitis would likely be found where sanitation is inadequate? a. A b. B c. C d. D

ANS: A Hepatitis A would likely be found where sanitation is inadequate.

Teaching a client with gonorrhea how to prevent reinfection and further spread is an example of _____ prevention. a. Primary b. Secondary c. Tertiary d. Primary health care

ANS: B Secondary prevention focuses on early detection and prompt treatment of disease, injury, or disability.

Which elements of surveillance does a nurse use? Select all that apply. a. Mortality registration b. Epidemic field investigation c. Laboratory reporting d. Individual case investigation

ANS: A, B, C, D There are 10 basic elements of surveillance. Mortality registration, epidemic field investigation, laboratory reporting, and individual case investigation are among them

10. Morbidity data can most easily be located in which of the following sources? (Select all that apply.) a. Environmental surveys b. Hospital discharge reports c. Medical examiners' reports d. Specialized disease registries e. Vital statistics sources

ANS: A, B, D Mortality data can be found in data sources containing vital statistics, which typically include death certificates and coroner/medical examiner reports, and birth certificates. Morbidity data are typically found in reports of notifiable disease; laboratory reports; hospital discharge reports; billing data; outpatient health care data; specialized disease registries; injury surveillance systems; environmental surveys; and sentinel surveillance systems.

In comparison with HIV infection in adults, HIV infection in infants and children: a. Has the same signs and symptoms b. Has a shorter incubation period c. Has a longer survival period d. Is detected by using the same tests

ANS: B HIV infection in infants and children has a shorter incubation period.

Immunity is a characteristic of the: a. Agent factor b. Host factor c. Environmental factor d. Epidemiologic triad

ANS: B Immunity refers to species-determined resistance to an infectious agent.

A nurse is working in a health department when a patient arrives who has been traveling to South America and has been diagnosed with malaria. The nurse knows: a. The Morbidity and Mortality Weekly Report should be consulted to investigate the rate of malaria in the United States. b. This is a disease that must be reported to the state health department. c. The nurse should take precautions to wear a mask and gown to avoid exposure. d. The patient is very ill and should be sent to the hospital immediately.

ANS: B Malaria is on the list of infectious diseases notifiable at the national level.

Which situation describes the role of a nurse being involved in surveillance? a. Educating clients about influenza immunizations b. Collecting information about occurrence of measles c. Evaluating the effectiveness of a HIV/AIDS prevention program d. Advocating for changes in the national disease reporting requirements

ANS: B Nurses are frequently involved in surveillance by collecting data, making diagnoses, investigating and reporting cases, and providing information to the general public.

Rabies post-exposure immunization is an example of which of the following levels of prevention with regard to infectious disease interventions? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Assessment

ANS: B Secondary prevention focuses on early detection and prompt treatment of disease, injury, or disability.

Which part of the immunological system suffers the greatest damage as a result of HIV infection? a. Dendrite cells b. CD4+ T-lymphocytes c. Macrophages d. Monocytes

ANS: B The count drops when the virus is most plentiful in the body.

The time interval between invasion by an infectious agent and the first appearance of signs and symptoms of the disease is called: a. Communicable period b. Incubation period c. Infectiousness d. Pathologic reaction

ANS: B The incubation period is the time interval between invasion by an infectious agent and the first appearance of signs and symptoms.

When one case of smallpox occurs in a population in which it was considered to be previously eliminated, it is called: a. Endemic b. An epidemic c. Pandemic d. Infectivity

ANS: B The occurrence of one case of smallpox in a population in which it was considered to be previously eliminated is an epidemic.

A nurse utilizes the provisions created by the Ryan White Comprehensive AIDS Resource Emergency Act when performing which intervention? a. Increasing AIDS awareness in the community b. Determining available health care services for HIV-infected individuals c. Preventing the transmission of AIDS to children from their mothers d. Allowing persons in the final stages of HIV to die with dignity

ANS: B This act provides services including emergency services, services for early intervention and care, and drug reimbursement programs for HIV-infected individuals.

A public health nurse understands that the emergence of new infectious diseases is influenced by the: a. Increased availability of immunizations b. Globalization of food supplies c. Decreased use of child care facilities d. Creation of sanitation systems in third world countries

ANS: B This is one of the many factors that can influence the emergence of infectious diseases.

What information would be appropriate for a nurse to share when educating IV drug users about sharing equipment? a. Tell the clients to throw away their equipment after one use. b. Educate the clients on using full-strength bleach on their drug paraphernalia for 30 seconds. c. Report illegal activities to the authorities and confiscate the needles and syringes. d. Give out needles and syringes to whoever wants them.

ANS: B Using bleach on the needles and syringes is a way to decrease cross contamination.

An example of a vector is: a. Contaminated water b. A tick c. A dirty needle d. An infected person

ANS: B Vectors transmit the infectious agent by biting or depositing the infective material near the host.

West Nile Virus is an example of which of the following types of illness? a. Foodborne b. Vectorborne c. Waterborne d. Zoonoses

ANS: B West Nile virus is carried by a mosquito, which is a vector.

7. The most common sources of surveillance data are databases maintained by the federal agencies, state health departments, and other organizations with an interest in understanding a specific disease or event. The National Program of Cancer Registries contains morbidity data for the types of cancer found in a state as well as: a. key centers for the specialized treatment of certain cancers. b. links to National Institutes of Health cancer research projects currently being conducted. c. locations of cancer risks and health problems within the state. d. major genetic determinants of cancer by age and sex.

ANS: C A good example of a process in place to collect morbidity data is the National Program of Cancer Registries. This program provides for monitoring the types of cancer found in a state and the locations of the cancer risks and health problems in the state.

6. One of the unique advantages of using data reporting such as a spatial map to analyze and present data is that such a tool provides a graphical way of determining: a. characteristics of the population. b. potential hypothesis. c. priority prevention target areas. d. trends for the spread of the disease.

ANS: C A spatial map is a data-reporting tool that graphically presents the distribution of an event/outbreak in such a way that priority prevention target areas can easily be identified, because it shows graphically what is happening and where it is happening.

Although infectious disease epidemics are still the major cause of death worldwide, they have subsided in the United States because of improvements in nutrition and sanitation, the discovery of antibiotics, and the development of vaccines. Infectious diseases have not vanished, however, and remain a continuing cause of concern. Healthy People 2020 has a number of objectives aimed at reducing these illnesses because of the morbidity, mortality, and costs associated with infectious diseases. One such costly disease trend related to an increase in the performance of invasive diagnostic and surgical procedures, the use of broad-spectrum antibiotics, and treatment with immunosuppressive drugs is the rise of: a. Escherichia coli 0157:H7. b. multisyndrome effect. c. health care-associated infections. d. severe acute respiratory syndrome.

ANS: C Although infectious diseases may not be the leading cause of death in the United States at the beginning of the twenty-first century, they continue to present varied, multiple, and complex challenges to all health care providers. One trend in the United States is the rise of health care-associated infections. Pennsylvania, the first state in the country to examine the costs of these infections, reported that health care-associated infections led to $2 billion in additional hospital charges and at least 1500 preventable deaths in 2004. Health care-associated infections are acquired during hospitalization or develop within a hospital setting and were previously known as nosocomial or hospital-acquired infections. The performance of invasive diagnostic and surgical procedures, the use of broad-spectrum antibiotics, and treatment with immunosuppressive drugs, along with the original underlying illness, leave hospitalized clients particularly vulnerable to infection by virulent agents carried by other clients and indigenous hospital flora transmitted by health care staff. Cognitive Level: Application Associated Chapter Objective: 1 REF: p. 314

A nurse is providing information to a local newspaper about the presence of infectious diseases in the United States. Which statement by the nurse is accurate? a. It is the goal of the World Health Organization to prevent the transmission of the plague by avoiding direct contact with inflicted individuals. b. Rabies is easily spread by contact with animals. c. Polio has been eliminated in the United States since 1994. d. The onset of tularemia is characterized by a distinct skin lesion often called a bulls-eye lesion.

ANS: C The plague is a vector-borne disease and cannot be spread by direct contact with inflicted individuals. Rabies is a rare event because of the widespread vaccination of dogs in the 1950s. The Americas were certified as polio free in 1994. The onset of Lymes disease is characterized by a bulls-eye lesion.

Requirements for disease reporting in the United States are mandated by: a. The Centers for Disease Control and Prevention (CDC) b. Federal laws c. State laws and regulations d. The World Health Organization (WHO)

ANS: C Requirements for disease reporting in the United States are mandated by state laws and regulations.

The nurse teaches food handlers to wash utensils after contact with raw meat. This prevention focuses on the: a. Agent b. Host c. Environment d. Food handler

ANS: C Teaching food handlers to wash utensils after contact with raw meat is a prevention that focuses on the environment.

The nurse teaches the family of an AIDS client about managing symptomatic illness by preventing deteriorating conditions, such as diarrhea, skin breakdown, and inadequate nutrition. This nursing intervention is an example of _____ prevention. a. Primary b. Secondary c. Tertiary d. Primary health care

ANS: C Tertiary prevention includes those interventions aimed at disability limitation and rehabilitation from disease, injury, or disability.

The nurse provides footwear and gloves to leprosy clients to prevent trauma to their insensitive and deformed hands and feet. This is an example of ____ prevention. a. A primary level of b. A secondary level of c. A tertiary level of d. Primary health care

ANS: C Tertiary prevention reduces complications through treatment and rehabilitation.

The most chronic bloodborne infection in the United States is: a. Hepatitis A b. Hepatitis B c. Hepatitis C d. HIV

ANS: C The most chronic bloodborne infection in the United States is hepatitis C.

What was the purpose of the CDC creating the first list of standard case definitions for notifiable diseases? a. Some diseases were underreported and others were overreported. b. There was no central office to collect data. c. Some people refused to notify officials when diseases were seen. d. No one knew where to report the information that was collected.

a. Some diseases were underreported and others were overreported.

A person has returned from overseas and it is determined that he has Q fever. Which of the following must occur? a. This is not a disease that is on the notifiable list; nothing need be reported. b. The case must be reported to the state and local health departments. c. The patient must be isolated immediately. d. The patient will probably die, so it is not reportable.

b. The case must be reported to the state and local health departments

A nurse is conducting disease surveillance. Which of the following describes the rationale for this action? a. To eradicate a disease before it starts b. To establish a baseline rate of disease occurrence and patterns of spread c. To target populations for triage d. To reduce the incidence of heart disease in a community

b. To establish a baseline rate of disease occurrence and patterns of spread

Which problem does a health department usually have the legal authority to investigate? a. Pandemics b. Unusual clusters of illness c. World trends of disease d. Cases of the common cold and pneumonia

b. Unusual clusters of illness

A hospital is using surveillance. Which of the following describes the rationale for this action? a. To protect the public against isolated patients b. To eliminate pathogens from the environment c. To improve quality of care and outcomes d. To decrease the incidence of ventilator-acquired pneumonia

c. To improve quality of care and outcomes

What does each state do with the information that it receives about notifiable diseases? a. Uses the information for surveillance purposes b. Reports the information to the local branch of the World Health Organization (WHO) c. Transmits the data electronically, weekly, to the Centers for Disease Control and Prevention (CDC) d. Does nothing with the information

c. Transmits the data electronically, weekly, to the Centers for Disease Control and Prevention (CDC)

An example of HIV transmission is: a. Having contact with a HIV-positive individual who is coughing b. An infant receiving breast milk from a HIV-positive mother c. Receiving a mosquito bite while in Africa d. Being near a HIV-positive individual who is sneezing

ANS: B HIV can be transmitted through breast milk.

A client diagnosed with human papillomavirus (HPV) infection states, "I'm not concerned, I know the warts disappear after a while." The nurse should counsel the client regarding which of the following? Select all that apply. A. Link between HPV and cervical cancer. B. Status of HPV infection as a reportable disease. C. Need to eliminate the warts. D. Serious complications of HPV infection for men. E. Lack of cure for HPV infection.

A, C, E The complications of HPV infection are especially serious for women. The link between HPV infection and cervical cancer has been established, and this cancer is associated with specific types of the virus. HPV infection is exacerbated during pregnancy and immune-related disorders, a fetus may become infected, and there is no cure. Although the warts will disappear over time, the goal is to eliminate the warts through surgical removal and other treatments to prevent skin-to-skin contact with them.Cognitive Level: Synthesis Associated Chapter Objective: 2, 3, 5, & 6Page Reference: 325-326

Community health nurses conducting health education among populations vulnerable to HIV infection should explain the natural history of the infection, including the fact that HIV infection may go undetected during the primary infection stage because: A. Antibody test results are typically negative. B. Antibody production by the immune system increases. C. Incubation period is prolonged. D. Symptoms include myalgias, sore throats, and rash.

A. Antibody test results are typically negative. Individuals may experience flu-like symptoms such as lymphadenopathy, myalgias, sore throat, lethargy, rash, and fever during the primary stage of HIV infection. Results of an antibody test during this phase are usually negative, so the illness often is not recognized as HIV infection. After a variable period of time, commonly 6 weeks to 3 months, HIV antibodies appear in the blood and can be used to confirm the presence of HIV infection.Cognitive Level: AnalysisAssociated Chapter Objective: 1Page Reference: 317-318

3. The nurse epidemiologist in a local health district receives a report from a local pediatrician that a case of chickenpox has been diagnosed in a second grader at one of the local elementary schools. The nurse proceeds to contact the school to determine whether or not any other children are absent for illness or were recently seen by the school nurse. Other area pediatricians are also contacted to determine whether or not any other cases have been identified. The nurse works with the school to notify parents about what signs and symptoms they should look for and how to manage a child with such symptoms. This is an example of which type of surveillance? a. Active b. Passive c. Sentinel d. Special

ANS: A In an active system of surveillance, the PHN, as an employee of the health department, may begin a search for cases through contacts with the local health providers and health care agencies. The nurse names the disease or event and gathers data about existing cases to try to determine the magnitude of the problem.

A school nurse notes that 60 children have missed days of high school because of pertussis this past year and this rate has been relatively constant for the past 5 years. The nurse plans to work with the community to increase awareness of the seriousness of this disease for children younger than 6 months of age and to raise and maintain the immunization rates, because in this community the pertussis is: a. endemic. b. epidemic. c. pandemic. d. sporadic.

ANS: A Pertussis (whooping cough) is caused by the bacterium Bordetella pertussis. It is highly contagious and is considered endemic in the United States. Endemic means that the disease is constantly present within a geographic area or population. Vaccination against pertussis, delivered in combination with diphtheria and tetanus vaccination, is a part of the routine childhood immunization schedule. The increase in adolescent and adult pertussis is alarming not because of the increased morbidity—cases are mild or inapparent in these groups—but because these individuals serve as a reservoir of infection for infants, especially those younger than 6 months of age, who are the most vulnerable to pertussis and the most likely to suffer complications resulting in hospitalization and death. Cognitive Level: Synthesis Associated Chapter Objective: 1, 8 REF: pp. 291-292

4. The public health nurse is concerned about a possible multi-state outbreak of a foodborne illness. What resource will the nurse consult? a. PulseNet b. Healthy People 2020 c. CDC Yellow Book d. National Healthcare Safety Network

ANS: A The Foodborne Diseases Active Surveillance Network (FoodNet) is a CDC sentinel surveillance system targeting 10 sites across the country and collecting information from laboratories on disease caused by 9 enteric pathogens transmitted commonly through food. This is the resource the nurse would consult if worried about a multi-state outbreak. Cognitive Level: Apply Associated Chapter Objective: 3

A nurse is presenting information to the county health department about potential bioterrorism threats. Which of the agents would the nurse discuss in this presentation? a. Smallpox b. West Nile Virus c. Severe acute respiratory syndrome (SARS) d. Novel influenza A H1N1

ANS: A Susceptibility to smallpox is 100% in the unvaccinated and fatality rate is estimated at 20% to 40% or higher. The agents of highest concern are anthrax, plague, smallpox, botulism, tularemia, and selected hemorrhagic viruses.

The nurse counsels a client to have the enzyme-linked immunosorbent assay (EIA) test in order to: a. Indicate the presence of the antibody to HIV. b. Reveal whether or not the client has AIDS. c. Isolate the HIV virus. d. Confirm HIV after having a positive Western blot.

ANS: A The EIA is used to indicate the presence of the antibody to HIV.

An American takes a long-awaited vacation in sunny Mexico, spending days on the beach eating fresh raspberries from a nearby vendor and drinking bottled water. The tourist may be altering: a. agent-host-environment interaction. b. circadian rhythms. c. herd immunity. d. host resistance.

ANS: A The balance among agent, host, and environment is often precarious and may be unintentionally disrupted. Changes in the characteristics of any of these factors may result in disease transmission. Many travelers are at risk for foodborne and waterborne diseases and should be careful to eat only thoroughly cooked foods prepared under reasonable hygienic conditions. Eating foods purchased from street vendors may not be wise. Fruits that can be peeled immediately before eating, such as bananas, are less likely to be a source of infection. Dairy products should be pasteurized and appropriately refrigerated. Only potable water (safe to drink) should be consumed, such as boiled water or bottled water. Other diarrheal diseases may not be related to viral or bacterial infective agents and may be the result of stress, fatigue, schedule changes, and consumption of unfamiliar foods. Cognitive Level: Application Associated Chapter Objective: 2 & 9 REF: p. 290

4. The first step in initiating a surveillance strategy is to confirm the: a. existence of the event. b. magnitude of the problem. c. source of the outbreak. d. tentative hypothesis.

ANS: A The first step in conducting an investigation is to confirm that an occurrence/outbreak actually exists and that a supposed event is not a false alarm. The investigator must find out the nature, location, and severity of the problem. Only the investigator can make this determination. The investigator can then verify the diagnosis and develop a case definition to determine the magnitude of the problem.

When a situation exists in which there is potential contact with blood or body fluids, health care workers must always perform hand hygiene and wear gloves, masks, protective clothing, and other indicated personal protective barriers. The underlying reason for requiring these practices, known as universal precautions, is that: a. blood and body fluids of all clients need to be handled as if they were infected. b. effective infection control surveillance programs are in place. c. health care settings are reservoirs of infection. d. health care workers do not effectively use hand hygiene.

ANS: A The practice of universal precautions is a policy relevant for all health care settings. In 1985, in response to concern regarding the transmission of HIV infection during health care procedures, the Centers for Disease Control and Prevention recommended implementation of a universal precautions policy in all health care settings. This policy requires that all blood and body fluids from all clients be handled as if they were infected with HIV or other blood-borne pathogens. Cognitive Level: Analysis Associated Chapter Objective: 10 REF: p. 314

A nurse is providing education to a mother about the importance of having her infant immunized for measles, mumps, and rubella. This immunization will provide what type of immunity? a. Active b. Passive c. Natural d. Acquired

ANS: A Active immunity refers to the immunization of an individual by administration of an antigen (infectious agent or vaccine) and is usually characterized by the presence of an antibody produced by the individual host.

A nurse examining a child in the early stages of HIV infection would expect to see: a. Failure to thrive and developmental delays b. Kaposis sarcoma and developmental delays c. Toxoplasmosis and oral candidiasis d. Fatigue and shortness of breath

ANS: A Early symptoms of pediatric HIV infection include failure to thrive and developmental delays.

What is the best method for preventing hospital-acquired infections? a. Perform good hand washing before and after approaching every patient. b. Prevention is almost impossible due to the high infection rates in hospitals. c. Isolate every patient having surgery. d. Use contact isolation for every patient at risk.

ANS: A Hand washing is the best way to prevent infection.

A nurse is uncomfortable discussing such topics as sexual behavior and sexual orientation when counseling clients. By avoiding this topic with clients: a. Potential risks and risky behaviors will not be identified. b. Transmission of sexually transmitted diseases will decrease. c. Clients will be reluctant to return to care providers. d. The nurse will be violating the laws in most states.

ANS: A It is important that nurses be able to discuss these topics to help prevent and control STDs. Without discussion of these topics, it is possible that clients will not be aware that they have an STD and may transmit it to others.

A nurse is assisting an employer who has hired an individual who has been recently diagnosed with HIV. Which intervention would be most appropriate for the nurse to implement? a. Educate about how to reduce the risk of breaching the employees confidentiality. b. Explain how to inform co-workers about avoiding HIV transmission. c. Facilitate obtaining medical insurance coverage for the HIV-infected employee. d. Describe the early signs and symptoms of HIV infection.

ANS: A Nurses frequently work in the education role, and employers may need assistance in dealing with HIV-infected employees.

A public health nurse is reviewing Healthy People 2020 to determine where to prioritize programming for the county health department. Based on Healthy People 2020, the nurse decides to implement programming to: a. Reduce the rate of HIV transmission among adults and adolescents. b. Eliminate STDs from developed countries. c. Reduce deaths from gonorrhea. d. Increase awareness about HIV in lesbian females.

ANS: A One of the Healthy People 2020 objectives is reducing the number of cases of HIV infection among adults and adolescents.

Pelvic inflammatory disease (PID) is a common complication of: a. Gonorrhea b. Syphilis c. Chancroid d. Herpes

ANS: A PID is a common complication of gonorrhea.

Adoption of universal precautions by health care workers is an example of: a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Specific protection

ANS: A Primary prevention refers to those interventions aimed at preventing the occurrence of disease, injury, or disability.

Screening blood products and donor organs and tissue for hepatitis C infection is: a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Health promotion

ANS: A Primary prevention refers to those interventions aimed at preventing the occurrence of disease, injury, or disability.

An example of a vertical transmission of a disease is through: a. Breast milk b. Sexual transmission c. Mosquitoes d. Contaminated food

ANS: A Vertical transmission is the passing of infection from parent to offspring via sperm, placenta, milk, or contact in the vaginal canal at birth.

Emerging infectious diseases may arise as a result of factors operating singly or in combination, and these factors may include which of the following? (Select all that apply.) a. Environmental changes b. Host behavior c. Improved surveillance d. Microbial adaptation e. Public health infrastructure deterioration

ANS: A, B, D, E Emerging infectious diseases are those for which the incidence has actually increased over the past several decades or has the potential to increase in the near future, and these include both new and known infectious diseases. New viruses may appear as a result of microbial adaptation, activities and behaviors of human hosts, and environmental changes. Relevant environmental changes include such things as weather changes, deforestation, urbanization, and industrialization. Human activities and behaviors that influence the spread of these diseases include increased use of daycare centers, illegal drug use, changing sexual behavior, use of modern modes of transportation, use of air conditioning, immigration, and global travel. Cognitive Level: Analysis Associated Chapter Objective: 6 REF: pp. 293-295

.3. The nurse educates a group of students that which persons would be most at risk of reactivation of latent infections of tuberculosis (TB)? (Select all that apply.) a. Immunocompromised b. Substance abusers c. Individuals previously treated for TB d. Long-term cigarette smokers e. Diabetics

ANS: A, B, E Reactivation of latent TB infections later in life is common, and the incidence rises in immunocompromised persons, substance abusers, underweight and undernourished individuals, and those with diabetes, silicosis, or gastrectomy. Cognitive Level: Understand Associated Chapter Objective: 3

The nurse is counseling a female who has recently tested positive for HIV. The nurse educates her that she is responsible to (select all that apply): a. Have regular medical evaluations and follow-ups. b. Donate blood, plasma, body organs, or sperm. c. Inform health care providers about the HIV infection. d. Consider the risk of perinatal transmission.

ANS: A, C, D A person who is infected with HIV should have regular medical evaluations and follow-up appointments; not donate blood, plasma, body organs, or sperm; inform health care providers about the HIV infection; and consider the risk of perinatal transmission and follow-up with contraceptive use.

A woman comes to the community health center complaining of increasing lower abdominal pain, fever, and abnormal menses for several months. During the assessment, the client indicates that she is aware that her husband has had multiple sex partners in the past 2 years. Which interventions by the nurse are most appropriate? (Select all that apply.) a. Provide comprehensive STD screening. b. Call the health department to inquire about the spouse. c. Educate the client on ceftriaxone and azythromycin. d. Instruct the client on safer sex practices. e. Perform a serum pregnancy test.

ANS: A, C, D, E Gonorrhea and chlamydia are the two most common STDs today. The CDC guidelines are to treat both infections at the same time with ceftriaxone and azithromycin. However, the patient needs comprehensive STD screening. The client also needs a pregnancy test as STDs can lead to fetal effects (abnormal menses does not rule out a pregnancy). The nurse would educate the client on safer sex practices. Cognitive Level: Apply Associated Chapter Objective: 5

In an effort to address West Nile virus, a community increased livestock immunization, began a vector control program, and initiated a community campaign to eliminate standing water reservoirs. This best exemplifies communicable disease control through: a. health education. b. multisystem approach. c. improved public health infrastructure. d. reduction of environmental hazards.

ANS: B Communicable diseases represent an imbalance in the usually harmonious relationship between the human host and the environment. This state of imbalance provides the infectious agent an opportunity to cause illness and death in the human population. Given the many factors that can disrupt the agent-host-environment relationship, a multisystem approach to the control of communicable diseases must be developed. Cognitive Level: Analysis Associated Chapter Objective: 3, 4, & 6 REF: p. 297

2. A PHN uses the state health department's reportable disease system to complete a community assessment of a rural county with issues of access to primary care services. This can best be described as what type of surveillance system? a. Active b. Passive c. Sentinel d. Special

ANS: B In a passive system of surveillance, health care providers, agencies, or laboratories send case reports to local health departments. The case reports are summarized and forwarded to the state health department, national governmental agency, or organization responsible for monitoring the problem, or to an international organization like the World Health Organization. This system can then be used to derive disease-specific demographic, geographic, and seasonal trends for reported events. These data are useful to a PHN conducting a community assessment or mobilizing for action through planning and partnerships (MAPPS) on a defined community.

A 6-year-old is brought to the emergency department with a full-body rash and fever. During the nursing assessment, which of the following findings would be most relevant to recognizing the case as potential smallpox rather than varicella? a. Fever has responded to acetaminophen, and the child is playful when temperature is not elevated. b. Fever of 101°F was present for several days before the rash appeared. c. Low-grade fever (100°F or less) has been present ever since the rash became obvious. d. Rash is primarily on the trunk of the body.

ANS: B Smallpox is associated with a sudden onset of fever, severe body aches, and occasional abdominal pain and vomiting, as in influenza. The rash, which is centrifugal with same-stage lesions in all areas but most abundant on the face and extremities, follows 2-4 days after the fever begins decreasing. With chickenpox, the rash is centripetal, with lesions most abundant on the trunk or in areas covered by clothing; the rash is present at the onset of symptoms, such as a slight fever with mild constitutional symptoms, and can appear as multiple crops of lesions at various stages of development (maculopapular lesions, vesicular lesions, or granular scabs). Cognitive Level: Application Associated Chapter Objective: 3 & 7 REF: p. 299

An example of an agent is: a. Host resistance b. Virus c. Infectiousness d. Bug bite

ANS: B An agent is described by its ability to cause disease and the nature and the severity of the disease.

Food intoxication is caused by: a. Toxins produced by bacterial growth and chemical contaminants b. Bacterial, viral, or parasitic invasion of food c. Overcooking of meat and produce d. Adding too many spices or ingredients to food

ANS: B Food intoxication is caused by bacterial, viral, or parasitic invasion of food.

A nurse practitioner reports a case of gonorrhea to the local health department. Which type of surveillance system is being used? a. Active b. Passive c. Sentinel d. Special

b. Passive

A local health department in the Midwest reports cases of certain diseases to the state health department for inclusion in the National Notifiable Diseases Surveillance System (NNDSS). From the perspective of community-level disease monitoring, which of the following 3-year trends in incidence rates for hepatitis A would be of local, state, and national interest? a. 2012 = 2/100,000; 2013 = 3/100,000; 2014 = 1/100,000 b. 2012 = 4/100,000; 2013 = 8/100,000; 2014 = 6/100,000 c. 2012 = 12/100,000; 2013 = 8/100,000; 2014 = 31/100,000 d. 2012 = 16/100,000; 2013 = 24/100,000; 2014 = 9/100,000

ANS: C In this community's report, the incidence of hepatitis A in 2014 was more than double the incidence in 2012. At the community level, a disease may occur in endemic, epidemic, or pandemic proportions. An epidemic is the occurrence of disease in a community or region at a rate in excess of normal expectations. Although people tend to associate large numbers of cases with epidemics, even one case can be termed an epidemic if the disease is considered to have been previously eliminated. Cognitive Level: Synthesis Associated Chapter Objective: 3 & 5 REF: pp. 291-292

5. During an investigation, the problem has been identified and the initial magnitude of this issue has been delineated. What action will the nurse take next? a. Check the state reportable disease list. b. Develop a tentative hypothesis. c. Initiate appropriate control measures. d. Seek additional cases.

ANS: C Once an event/outbreak has been identified, confirmed, and initially defined, early and continuously changing control measures should be initiated to contain the event and minimize further impact on the public. Then, the investigation can proceed and the proper authorities can be notified or asked for assistance and further consultation.

An example of secondary prevention of infectious disease is: a. malaria chemoprophylaxis. b. Pneumocystis carinii pneumonia chemoprophylaxis for people with AIDS. c. quarantine. d. restaurant inspections.

ANS: C Secondary prevention interventions related to infectious disease prevent the spread of disease. Primary prevention interventions prevent the occurrence of disease, and tertiary prevention interventions reduce the complications and disabilities of disease through treatment and rehabilitation. Secondary prevention activities center on rapid identification of potential contacts of a reported case. Contacts may be identified as new cases and treated or classified as possibly exposed and given appropriate prophylaxis. Public health laws also assist in secondary prevention because they require investigation of certain disease cases and initiation of preventive measures for individuals affected by a reported case or outbreak of communicable disease. These interventions can include quarantine and can be applied to the entire community if the exposure potential is deemed great enough, as could happen with an outbreak of smallpox or epidemic influenza. Cognitive Level: Analysis Associated Chapter Objective: 3 REF: p. 297

1. Disease surveillance, a critical role function for the public health nurse (PHN), can best be defined as the ongoing, systematic collection, analysis, interpretation, and dissemination of specific health data relevant to public health. The nurse's knowledge and understanding of surveillance systems is critical to: a. detecting epidemics and pandemics. b. facilitating planning and policy changes. c. improving the quality and usefulness of the data collected. d. understanding the relationship between epidemiologic principles.

ANS: C Surveillance is a critical role for the nurses practicing in the community. A comprehensive understanding and knowledge of surveillance systems and how they work will help nurses improve the quality and the usefulness of the data collected for the purpose of making decisions about needed community services, community actions, and public health programming.

8. Collaboration among local, state, and federal agencies; health care providers, agencies, and organizations; and other community-based services that address issues of safety and welfare in a community is critical to the success of a quality surveillance program. The public health practice domain that best describes the ability to collaborate effectively is: a. communication. b. analytical assessment skills. c. community dimensions of practice. d. policy and program development.

ANS: C The Core Competencies for public health are divided into eight practice domains: analytical assessment skills, policy/program development, communication, cultural competency, community dimensions of practice, basic public health sciences, financial planning/management, and leadership. The practice domain for community dimensions of practice addresses the establishment and maintenance of links during an investigation; collaboration with partners; and development, implementation, and evaluation of an assessment to define a problem.

A person has syphilis with signs and symptoms of rash, sore throat, and muscle and joint pain. This person is experiencing which stage of syphilis? a. Congenital b. Primary c. Secondary d. Tertiary

ANS: C A person with signs and symptoms of a rash, sore throat, and muscle/joint pain is experiencing the secondary stage of syphilis.

When working with a client who is HIV positive, the nurse serves as an educator, teaching about the modes of transmission, and serves as a(n): a. Advocate, lobbying for AIDS research b. Counselor, discussing implications of future sexual activity c. Role model, providing supportive care d. Policy maker, addressing laws governing privacy rights of HIV-positive persons

ANS: C Nurses must be role models because many HIV-positive patients are stigmatized.

Which information is important for the nurse to know about preventing and controlling parasitic infections? a. The medication to prescribe to treat these infections b. The nature and symptoms of all parasitic illnesses c. What specimens to collect and how and when to collect them d. Public policy about parasitic infections

ANS: C Nurses need to be cognizant about what specimens to collect, how and when to collect, and what laboratory techniques to use.

The most common vector-borne disease in the United States is: a. Malaria b. Yellow fever c. Lyme disease d. Rocky Mountain spotted fever

ANS: C Over 15,000 cases of Lyme disease are reported per year. Malaria is most common worldwide.

A community health nurse visits a homeless shelter that has several clients with tuberculosis who are taking antimicrobial drugs. Supervised drug administration may be done on a daily basis with persons with poor adherence because: a. This type of client does not care about his or her health. b. Homeless people have no access to medications. c. Poor adherence can result in drug resistance. d. The antimicrobials are so powerful, clients must be observed for reactions.

ANS: C Poor adherence has lead to antibiotic resistant strains.

Which strategy would be the most appropriate for a public health nurse to use to increase the immunization coverage of infants and toddlers? a. Read the Mortality and Morbidity Weekly Report to learn about vaccinations. b. Require that children have all their immunizations before going to public school. c. Track children known to be at risk for underimmunization. d. Lead teams of health care workers to enforce laws related to immunizations.

ANS: C This is a function of public health nurses who work in health departments where immunizations are given and tracked.

A community health nurse investigates an outbreak of pinworm at a local day care center. What suggestions would the nurse give to the day care workers? a. Close the day care until all surfaces are cleaned. b. No action is necessary because it is easily treated with oral vermicides. c. Using good hand washing is important to prevent the transmission. d. Every child in the day care should be treated because they all are probably infected.

ANS: C Transmission is through the fecal-oral route, so good hand washing after toileting is essential.

An example of a bacterial STD is: a. Trichomonas b. HIV c. Syphilis d. Genital warts

ANS: C Trichomonas, HIV, and genital warts are caused by viruses.

9. Disease and event surveillance systems exist to help improve the health of the public through the systematic and ongoing collection, distribution, and use of health-related data. A PHN utilizes the data in available surveillance systems to make a presentation to a community planning committee that is interested in the problem of childhood obesity. This use of the data for facilitating community planning is a good example of helping the community to: a. avert a health care epidemic. b. evaluate prevention and control measures. c. identify cases for fact finding. d. manage endemic health problems.

ANS: D A nurse can contribute to surveillance systems and can best use the data collected through such systems to help manage endemic health problems and those that are emerging, such as evolving infectious diseases and bioterrorist (human-created) health problems.

A nurse is working in a public health center. A patient who has been newly diagnosed as HIV positive comes for counseling. By law, what must the nurse do? a. Give antiviral medications to the patient. b. Ask the person to name all of his or her sexual contacts. c. Refer the patient to the social worker as someone possibly needing case management. d. Report the HIV-infected person to the state health department.

ANS: D It is mandatory to report HIV cases in all states. The information is then sent to the Centers for Disease Control and Prevention (CDC). Some states report HIV infections either by name or by code.

When caring for a client with methicillin-resistant S. aureus (MRSA), the community health nurse should know: a. Persons with MRSA usually have a chronic illness. b. MRSA is a hospital-acquired infection and not often seen in the community. c. VRE (vancomycin-resistant Staphylococcus aureus) follows MRSA. d. MRSA is becoming more common in the community.

ANS: D MRSA is being seen more and more in the community with outbreaks frequently associated with school athletic programs and prison populations.

The case rate of tuberculosis (TB) is highest among which ethnicity in the United States? a. African American b. Native American c. Hispanic d. Asian

ANS: D TB is most often found in Asian Americans, at 25.6 new TB cases per 100,000 people.

The ability of an agent to produce a severe pathologic reaction is known as: a. Antigenicity b. Invasiveness c. Toxicity d. Virulence

ANS: D The ability of an agent to produce a severe pathologic reaction is known as virulence.

The most common reportable infectious disease in the United States is: a. Gonorrhea b. Syphilis c. Herpes d. Chlamydia

ANS: D The most common reportable infectious disease in the United States is Chlamydia.

Which group should receive an injection of prophylactic immune globulin for possible exposure to hepatitis A? a. Persons who have had direct contact with blood b. Those who ate at the same restaurant as the person with hepatitis A c. All health care workers d. All those who had household or sexual contact with persons with hepatitis A

ANS: D Those who have been in close contact with persons who develop hepatitis A should receive immune globulin.

A nurse is assigned to teach clients sexually transmitted disease (STD) prevention information. The nurse updates her teaching plan to incorporate new guidelines from the Centers from Disease Control and Prevention (CDC). She includes which of the following as updated information during her next teaching session? A. Always use spermicides with condoms to reduce the risk of contracting chlamydia or gonorrhea. B. Condoms can be effective in preventing infections transmitted by fluids from mucosal surfaces but are not always effective in preventing infections transmitted by skin-to-skin contact. C. Condoms should not be used during oral sex, because they are not effective in preventing transmission of infection. D. When genital ulcers are present, condoms should be used to prevent the spread of infection.

B. Condoms can be effective in preventing infections transmitted by fluids from mucosal surfaces but are not always effective in preventing infections transmitted by skin-to-skin contact. The lesions of herpes simplex virus 2 (HSV-2) and human papillomavirus (HPV) infection as well as other lesions capable of transmitting STDs can occur on all parts of the male and female genitalia and rectum. Condoms are effective in reducing transmission via body fluids from the penis and vagina. However, lesions not covered by a male or female condom can still transmit infection even with proper condom use.Cognitive Level: AnalysisAssociated Chapter Objective: 5 & 6Page Reference: 322-323, 326, 329, 331

A client comes to the local clinic with acute symptoms of fever, nausea, lack of appetite, malaise, and abdominal discomfort. During the course of the assessment, the nurse determines that the client is a health care aide working at a daycare center. These facts are important because: A. Acute hepatitis B is self-limiting. B. Hepatitis A outbreaks commonly occur in facilities where staff change diapers. C. Hepatitis C is a "silent stalker." D. Individuals with chronic liver disease are at greater risk for hepatitis A.

B. Hepatitis A outbreaks commonly occur in facilities where staff change diapers. Hepatitis A virus is most often transmitted through the fecal-oral route. It remains the most frequently reported vaccine-preventable disease. Outbreaks are common in daycare centers where staff must change diapers, among household and sexual contacts of infected individuals, and among travelers to countries were hepatitis A is endemic.Cognitive Level: AnalysisAssociated Chapter Objective: 2 & 4Page Reference: 326-327

Many behaviors place any individual-regardless of age, gender, ethnicity, or other characteristics-at greater risk for sexually transmitted diseases (STDs). The nurse should include primary prevention interventions in all client encounters through the discussion of: A. Partner notification. B. Safer sex. C. Standard precautions. D. STD testing.

B. Safer sex. Sexual abstinence is the best way to prevent STDs; however, for many people it is not realistic. Therefore, education about how to make sexual behavior safer is critical. Safer sexual behavior includes masturbation, dry kissing, touching, fantasy, and vaginal or oral sex with a condom. Nurses should not base assessments on considerations of age, gender, ethnicity, or any other factor, but should discuss safe sex in all client encounters.Cognitive Level: ApplicationAssociated Chapter Objective: 5 & 6Page Reference: 329, 331, 334

A client newly diagnosed with human papillomavirus (HPV) infection, herpes simplex virus 2 (HSV-2) infection, and syphilis asks, "Okay, so how do I get rid of all this stuff?" In developing a plan of care, the nurse recognizes that it is essential to address: A. Correct use of condoms to prevent transmission of all sexually transmitted diseases (STDs). B. Cures for each of the STDs identified. C. Risk of skin-to-skin contact in transmitting the identified STDs. D. Safety of sexual contact in the absence of lesions.

C. Risk of skin-to-skin contact in transmitting the identified STDs. The client needs to understand which STDs are transmitted by skin-to-skin contact and which are transmitted by body fluids. The client also needs to understand which infections are curable with antibiotics (syphilis) and which are virus infections that are treatable but not curable (HPV, HSV-2 infections). In HSV-2 infection, although the ability to pass the infection is higher when active lesions are present, some individuals can spread the infection even when they are asymptomatic. HPV transmission occurs through direct contact with the warts that result from HPV, but the virus has also been detected in semen, and exposure to the virus through body fluids is also possible. In addition, the challenge of HPV prevention is that condoms do not necessarily prevent infection because warts can grow in areas that are not covered by barriers such as condoms, and skin-to-skin contact may occur.Cognitive Level: SynthesisAssociated Chapter Objective: 4, 5, & 6Page Reference: 322-326, 334

A population-level tertiary prevention intervention typically carried out by nurses caring for those with communicable disease in the community is: A. HIV test results counseling. B. Needle exchange. C. Partner notification. D. Instruction in standard precautions.

D. Instruction in standard precautions. Teaching caregivers about infection control in home care is vital. The nurse treating the client with HIV infection in the home environment should teach caregivers about standard precautions. Some clients, families, friends, and others may have concerns about the transmission of HIV infection. Others who may not have concerns about transmission may fail to take adequate precautions or believe myths that they cannot become infected.Cognitive Level: ApplicationAssociated Chapter Objective: 1, 5 & 6Page Reference: 329, 334

A school nurse is teaching a class of sophomores about the relationship between the risk of sexually transmitted disease (STD) and risk-taking behaviors. A key point to include is: A. All STDs are easily preventable with consistent condom use. B. Once a young woman is pregnant, she is no longer at risk for most STDs. C. STDs are most likely to be transmitted during a student's initial sexual encounter. D. Use of alcohol and drugs makes a student more likely to make decisions that result in exposure to and infection with STDs.

D. Use of alcohol and drugs makes a student more likely to make decisions that result in exposure to and infection with STDs. Drug use is linked to STD transmission because drugs such as alcohol lower inhibitions and impair judgment about engaging in risky behaviors. Addictions to drugs may cause individuals to acquire the drug or money to purchase the drug by performing sexual favors. This increases both the frequency of sexual contacts and the chances of contracting STDs. Adolescents are particularly at risk. Not all STDs are preventable through condom use. The challenge of preventing human papillomavirus (HPV) infection (genital warts) is that condoms do not necessarily prevent infection because warts may grow in areas that barriers such as condoms do not cover and skin-to-skin contact may occur.Cognitive Level: ApplicationAssociated Chapter Objective: 4 & 5Page Reference: 329-332

A nurse is completing a disease investigation. Based on the clinical symptoms presented, it is assumed that the individual has measles. However, there has been no laboratory evidence documenting that this individual has the disease. Which of the following types of cases is the nurse investigating? a. A suspected case b. A confirmed case c. A prolonged case d. An identified case

a. A suspected case

A public health nurse (PHN) is investigating an outbreak of salmonellosis in a community. Which type of surveillance system is being used? a. Active b. Passive c. Sentinel d. Special

a. Active

A nurse is using public surveillance. Which of the following describes the actions involved? (Select all that apply.) a. Estimating the magnitude of an influenza outbreak b. Determining the geographical distribution of gonorrhea cases c. Detecting an epidemic of whooping cough d. Reducing the prevalence of obesity e. Determining the incidence of cardiovascular disease

a. Estimating the magnitude of an influenza outbreak b. Determining the geographical distribution of gonorrhea cases c. Detecting an epidemic of whooping cough

What information is shared among agencies when they collaborate to implement a quality surveillance system? a. How to use algorithms to identify which events should be investigated b. Who is to blame for a disease outbreak c. What shelters will be used and by whom d. How political action will be necessary to ensure public health

a. How to use algorithms to identify which events should be investigated

Which is a feature of public health surveillance? a. Sharing of the results with others b. Defining public health policy c. Evaluating interventions d. Planning national programs

a. Sharing of the results with others

A staff nurse has demonstrated the ability to be competent as a participant in surveillance and investigation activities. Which of the following skills would you expect that nurse to possess? (Select all that apply.) a. The ability to identify appropriate data sources b. The ability to communicate effectively using written reports c. The ability to collaborate with community agencies d. The ability to create a budget e. The ability to interpret laboratory findings

a. The ability to identify appropriate data sources b. The ability to communicate effectively using written reports c. The ability to collaborate with community agencies d. The ability to create a budget

The SARS (severe acute respiratory syndrome) outbreak was an epidemic that spread over several countries. Which of the following terms describes what happened? a. Hyperendemic b. Pandemic c. Mixed outbreak d. Holoendemic

b. Pandemic

A nurse is applying the Minnesota Model of Public Health Interventions: Applications for Public Health Nursing Practice steps of surveillance. Which of the following describes the initial action that the nurse would take? a. Analyze data b. Consider whether surveillance is appropriate to the situation c. Evaluate the impact of the surveillance d. Collect data

b. Consider whether surveillance is appropriate to the situation

3. Which are the objectives of a disease investigation? (Select all that apply.) a. Enhance the knowledge of the nurse working in public health b. Control and prevent disease or death c. Identify factors that contribute to the disease outbreak/event occurrence d. Implement measures to prevent occurrences e. Participate in the core functions of public health

b. Control and prevent disease or death c. Identify factors that contribute to the disease outbreak/event occurrence d. Implement measures to prevent occurrences

A nurse is using surveillance to collect outcome data. What information would most likely be collected? a. Number of clinic services which use evidence-based protocols b. Proportion of the population vaccinated against influenza c. Incidence of breast cancer in the population d. Probability of a bioterrorism attack occurring in the community

c. Incidence of breast cancer in the population

A large amount of data related to hypertension rates is collected in a community. The data is analyzed. Which of the following describes the next step in the surveillance process? a. Collecting data from multiple valid sources b. Evaluating the impact on the surveillance system c. Interpreting the data and disseminating it to decision makers d. Asking political officials to finance a hypertension clinic

c. Interpreting the data and disseminating it to decision makers

A college student goes to the Student Health Center with an extremely swollen neck. The advanced practice nurse determines that he has mumps. His roommate also is experiencing malaise and a sore throat. Which of the following defines these two students? a. Mixed outbreak b. Common source c. Point source d. Propagated outbreak

c. Point source

What occurs during biological terrorism? a. The intentional release of hazardous chemicals into the environment b. Environmental and occupational exposure to biological toxins c. Immunity to toxins related to repeated exposures d. An intentional release of viruses, bacteria, or other toxins

d. An intentional release of viruses, bacteria, or other toxins

A nurse is investigating a potential bioterrorism attack. Which of the following evidence would a nurse find if a bioterrorism attack occurred? a. A large number of cases of influenza b. A case of cholera in a local politician following a trip to India c. Dengue fever in a group of students who just returned from a mission trip d. An unusual illness in a population

d. An unusual illness in a population

What information is included in a case definition? a. The precise point of contact b. Laboratory confirmation c. Source of contamination d. Clinical symptoms

d. Clinical symptoms

A community coalition monitors the increasing obesity rate of children in their schools. Based on this data, they consider a variety of programming options which may possibly help decrease this trend. What was the purpose of conducting this surveillance? a. Protect the children from diseases that affect obese children b. Teach parents that obesity will not be tolerated in this community c. Educate children on surveillance techniques d. Demonstrate that new clinical and effective protocols need to be developed

d. Demonstrate that new clinical and effective protocols need to be developed

A nurse is collecting morbidity data. Which of the following would be the source that the nurse would use? a. Vital statistics reports b. Birth records c. Death certificates d. Specialized disease registries

d. Specialized disease registries