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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.

A screening for diabetes revealed 20 previously diagnosed diabetics and 10 probable new cases, which were later confirmed, for a total of 30 cases. This is called: a. Prevalence b. Incidence c. Attack d. Morbidity

ANS: A Prevalence is the measure of existing disease in a population at a particular time.

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.

Immunization for measles is an example of: 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.

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.

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.

An example of tertiary prevention is: a. Rehabilitative job training b. Parenting education c. Testicular self-examination d. Family counseling

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

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.

The term evidence-based was first used in: a. Canada b. Great Britain c. The United States d. Australia

ANS: A The term evidence-based was first attributed to Gordon Gyatt, a Canadian physician at McMaster University in 1992.

When a nurse examines birth and death certificates during an epidemiologic investigation, what data category is being used? a. Routinely collected data b. Data collected for other purposes but useful for epidemiologic research c. Original data collected for specific epidemiologic studies d. Surveillance data

ANS: A These are examples of data collected routinely.

A nurse makes clinical judgments based upon trial and error and past clinical experiences. What problem can result from using these data sources in clinical decision making? a. Not all sources of information are reliable. b. Authority always leads to faulty decision making. c. Ethical knowledge is not taken into account. d. Trial and error has lead to poor outcomes.

ANS: A Using the sources of knowledge listed in the other options does not consistently produce desired outcomes.

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.

Which are barriers to implementation of evidence-based practice? Select all that apply. a. Lack of available time b. Inferior quality of available research c. Unwillingness of organizations to fund research d. Inability to understand the evidence

ANS: A, B, C, D All of these are barriers to evidence-based practice.

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

Nurses incorporate epidemiology into their practice and function in epidemiologic roles through (select all that apply): a. Policy making and enforcement b. Collection, reporting, analysis, and interpretation of data c. Environmental risk communication d. Documentation on patient charts and records

ANS: B, C, D The 2nd, 3rd, and 4th options are examples of the use of epidemiology in practice. The first option does not apply to epidemiology.

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.

Vocational rehabilitation of a person with a neuromuscular disease is an example of: a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Health promotion

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.

To understand the causes of health and disease, epidemiology studies: a. Individuals b. Families c. Groups d. Populations

ANS: D Epidemiology monitors health of populations, understands determinants of health and disease in communities, and investigates and evaluates interventions to prevent disease and maintain health.

A nurse working in a community setting should apply evidence-based practice methods that are described by: a. Randomized clinical trials b. Qualitative studies c. Quantitative studies d. Multiple research methods

ANS: D Evidence from multiple research methods has the potential to enrich the application of evidence and improve nursing practice.

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.

Which would be considered a serious epidemic of influenza? a. 50 cases b. 100 cases c. 500 cases d. Unable to determine

ANS: D One cannot tell the degree of seriousness without a denominator, which represents the total population.

A nurse is grading the strength of evidence when critiquing a research study. Which domains will the nurse need to consider? a. Randomness, sample size, and blinding b. Selection, variables, and description c. Nursing, medicine, and physiology d. Quality, quantity, and consistency

ANS: D Quality, quantity, and consistency are the three domains for evaluating systems.

A nurse providing care in the 1970s would have used which process as the guide for making clinical decisions? a. Evidence-based nursing practice b. The science of medicine c. Evidenced-based medicine d. Research utilization

ANS: D Research utilization projects in the 1970s provided a guide to clinical practice.

An example of secondary prevention is: a. Rehabilitation b. Avoidance of high-risk behaviors c. Immunization d. Mammogram

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

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 interaction between an agent, a host, and the environment is called: a. Natural history of disease b. Risk c. Web of causality d. The epidemiologic triangle

ANS: D The epidemiologic triangle consists of the interaction between an agent, a host, and the environment.

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.

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.

An epidemiologist wanting to know what caused severe diarrhea and vomiting in several people at a local banquet would be using: a. Descriptive epidemiology b. Analytic epidemiology c. Distribution d. Determinants

ANS: B Analytic epidemiology is directed toward understanding the etiology 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.

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.

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.

Which statement is true about mortality rates? Mortality rates: a. Are informative only for fatal diseases b. Provide information about existing disease in the population c. Are calculated using a population estimate at year-end d. Reveal the risk of getting a particular disease

ANS: A Mortality rates are informative only for fatal diseases and do not provide direct information about the level of existing disease or the risk of getting a particular disease.

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.

As a result of an outbreak of influenza in a community, a nurse encourages members of the community to receive the influenza vaccine. Which level of prevention is being used? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Multifactorial prevention

ANS: A Nurses are involved in epidemiologic surveillance by monitoring the potential for disease outbreaks. Primary prevention refers to interventions aimed at preventing the occurrence of disease, injury, or disability.

ANS: A A rate is a measure of the frequency of a health event in a defined population in a specified period of time. A rate is a ratio but not a proportion, because the denominator is a function of both the population size and the dimension of time, whereas the numerator is the number of events. Rates relate to change: moving from one state of being to another, such as from illness to health or from life to death. In this example, seven child deaths divided by the total number of children age 15 years and younger in the population (which is 84,000) = 0.0000833 1000 = 0.0833/1000. Cognitive Level: Application Associated Chapter Objective: 5 REF: p. 262

1. Today, an evidence-based nursing practice can best be defined as which of the following? a. Approach to the integration of the best research available, nursing expertise, and the preferences/values of the clients served b. Concept developed by acute care nurses to ensure the quality of care of hospitalized clients and to challenge managed care decisions c. Concept developed in the early twentieth century to help nurses document the scientific basis of their nursing practice d. Framework supporting the use of traditional research as the only basis for making clinical decisions in practice

ANS: A Evidence-based practice (EBP) was originally adopted by physicians as the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual clients. Evidence-based public health is a public health endeavor in which there is informed, explicit, and judicious use of evidence that has been derived using any of a variety of scientific and social science research and evaluation methods. In 2005, Sigma Theta Tau International defined evidence-based nursing as an integration of the best evidence available, nursing expertise, and the values and preferences of the individuals, families, and communities who are served. External evidence includes research and other evidence while internal evidence includes the nurse's clinical experiences and client's preferences

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

The World Health Organization (WHO) developed the Five Keys to Safer Food campaign in 2001 to address the problem of foodborne and waterborne diarrheal diseases worldwide. This campaign emphasizes which of the following practices? a. Keep clean, separate raw and cooked, cook thoroughly b. Never use raw, always cook, buy better c. Wash, cut, cook, and throw away d. Wash, cover, and always refrigerate

ANS: A Protecting the nation's food supply from contamination by virulent microbes is a multifaceted issue that is and will continue to be incredibly costly, controversial, and time-consuming to address. The specter of terrorist threats to the food supply adds an additional layer of complexity. However, much foodborne illness, regardless of the causal agent, can be easily prevented through simple changes in food preparation, handling, and storage. WHO estimates that 2.2 million people, most of them children, die annually from foodborne and waterborne diarrheal diseases in less-developed countries. In 2001, WHO initiated a new campaign entitled Five Keys to Safer Food, a simplified version of an earlier campaign that includes the following elements: keep clean, separate raw and cooked, cook thoroughly, keep food at safe temperatures, and use safe water and raw materials. Cognitive Level: Application Associated Chapter Objective: 3 & 9 REF: p. 307

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 nurse uses clinical experience and client preference to guide clinical decision making when using: a. Evidence-based practice b. Internal evidence c. Research utilization d. External evidence

ANS: B Internal evidence refers to the use of the nurses clinical experiences and the clients preferences.

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

6. Although the definitions of EBP in the literature vary widely, their common thread across all health care disciplines is: a. application of the best available evidence to improve practice. b. definition of what counts as evidence. c. reliance on principles of pathophysiology. d. method of transforming research into practice.

ANS: A The definition of EBP has evolved over the years and across health professions. The current understanding of EBP has identified this term as an approach to integrating all health professions. The underlying principle is that high-quality care is based on evidence rather than on tradition or intuition. Although definitions of EBP vary widely in the literature, the common thread across disciplines is the application of the best available evidence to improve practice.

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 study that uses information on current health status, personal characteristics, and potential risk factors or exposures all at once is called: a. Cross-sectional b. Ecological c. Case-control d. Cohort

ANS: A A cross-sectional study collects information on current health status, personal characteristics, and potential risk factors or exposures all at once.

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.

When looking at evidence-based practice to support the methods used to facilitate smoking cessation, which type of evidence would be the best for the nurse to examine? a. Scientific literature found in systematic reviews b. Double-blind randomized controlled trial c. Quasi-experimental studies d. Expert opinion

ANS: A Because it is difficult to find or perform randomized controlled trials in the community, other types of evidence have been highlighted as the best evidence in public health literature upon which to base evidence-based public health (EBPH) practice; scientific literature found in systematic reviews is one type that is recommended. Although randomized controlled trials are the highest level of evidence, it would not be possible to implement this type of study when studying smoking cessation.

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.

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.

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.

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.

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.

John Snow is called the father of epidemiology because of his work with: a. Cholera b. Malaria c. Polio d. Germ theory

ANS: A John Snow investigated the spread of cholera in the mid-nineteenth century.

Which is an example of an epidemic? a. Bird flu in China b. Adult obesity in the United States c. An isolated case of smallpox in Africa d. The nursing shortage in the United States

ANS: B It is estimated that 30% of the adults in the United States are obese. According to the CDC, this is an epidemic.

10. A community health nurse is revising the agency's nursing protocols to incorporate current EBP clinical practice guidelines. Common barriers to EBP implementation that could be faced include which of the following? (Select all that apply.) a. Disempowerment of nurses in their ability to make clinical decisions b. Experienced nurses' challenging of the need to change long-accepted practices c. Lack of knowledge of how to conduct a systematic review of the research literature d. Unwillingness of clients to accept changes in familiar agency programs e. Urban agency setting with restricted computer resources

ANS: A, B, D, E Barriers to adopting EBP in the community setting can include miscommunication among nursing leaders about the implementation process; inferior quality of available research or other types of evidence; inability to assess and use evidence; unwillingness of organizations to fund research and make decisions based on research or other evidence; the nurse's ability to make clinical decisions; and certain realities of the practice setting, such as lack of resources for implementation in the setting (time, funding, computer resources, and knowledge), reluctance to accept findings, and resistance to changing long-standing practices. The use of EBP clinical guidelines is one way for nurses to provide evidence-based nursing care in an efficient manner. Clinical practice guidelines usually are developed by groups of experts in the field who have reviewed the evidence (systematic review) and made recommendations based on the best available evidence.

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

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 state public health region reported 39 cases of meningitis in children 15 years of age and younger to date this year. Seven of those children died. The total population of the region is 780,000, of whom 84,000 are children age 15 years old and younger. Only four cases of meningitis were reported in the public health region during the previous year. No other public health region in the state has an incidence of meningitis that is higher than expected for that region. Based on the information given, the relative frequency of meningitis in the region at this time can best be described as: a. endemic. b. epidemic. c. pandemic. d. sporadic.

ANS: B An epidemic occurs when the rate of disease, injury, or other condition exceeds the usual (endemic) level of that condition. Cognitive Level: Application Associated Chapter Objective: 1 REF: p. 259

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. Community-oriented nurses use EBP most effectively when they: a. base care on nationally accepted clinical guidelines, informing clients and community groups that the accepted standards of care need to be universally applied. b. base care on nationally accepted clinical guidelines, involve clients in individual care decisions, and include community input when applying evidence in practice. c. make client care decisions using the latest nursing research findings. d. work with physicians to design client care guidelines for community clinics.

ANS: B EBP uses interventions based on the best available evidence from a variety of sources, including research studies, evidence from nursing experiences and expertise, and evidence from community leaders. EBP also addresses client preferences and values, including clients in decisions, and focuses on developing true partnerships in which power and decision making are shared between health care providers and the community to make culturally and financially appropriate interventions.

A business executive develops flu-like symptoms 1 day after returning by air from a trans-Atlantic 2-day conference that involved lengthy meetings into the evening. The scenario best illustrates the interaction of: a. host and agent. b. host, agent, and environment. c. risk and causality. d. morbidity and disease.

ANS: B Epidemiologists understand that disease results from complex relationships among causal agents, susceptible persons, and environmental factors. These three elements—agent, host, and environment—are called the epidemiologic triangle. Changes in one of the elements of the triangle can influence the occurrence of disease by decreasing or increasing a person's risk of disease. Cognitive Level: Application Associated Chapter Objective: 3 REF: p. 266

A public health nurse would like to incorporate evidence-based practice into the clinical practice at the health department. According to Melnyk and Fineout-Overholt et al., the first step in this process is: a. Integrating the evidence with clinical expertise b. Cultivating a spirit of inquiry c. Asking clinical questions d. Searching for the best evidence

ANS: B According to Melnyk and Fineout-Overholt et al., the first step is step 0: cultivating a spirit of inquiry.

3. A community-oriented nurse seeks to implement EBP in the community clinic's programs. The best model for the nurse to apply is: a. action research and review. b. community development. c. community research utilization. d. EBP

ANS: B Nurses have an important role to play in developing and using clinical guidelines for community practices. The use of a community development model will ensure that the community's perspective is included. Nurses active in the EBP movement should devote attention to understanding how best to incorporate clinical practice guidelines into a community-oriented practice. Nurses must use caution in adopting EBP in a prescriptive manner in different community environments. When EBP is applied at the community level, best evidence may point to a solution that is not sensitive to cultural issues or distinctions and thus may not be acceptable to the community. Ethical practice in communities requires attention to community differences

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

8. When a public health nurse (PHN) uses evidence-based interventions to evaluate the effectiveness, accessibility, and quality of population-based services within the community, the nurse is addressing the core public health function of: a. assessment. b. assurance. c. policy development. d. research

ANS: B The core public health functions of assessment, assurance, and policy development can be addressed through EBP interventions. The core function of assurance can be carried out by monitoring health status to identify community health problems, enforcing laws and regulations that protect health and ensure safety, ensuring the provision of health care that is otherwise unavailable, ensuring a competent public health and personal health workforce, and utilizing EBP to evaluate effectiveness. To successfully implement an EBP, nurses must be knowledgeable about the research and current evidence; have the ability to interpret the meaning of the evidence; be willing to change personal viewpoints about quality and credibility of evidence; and the practice environment must be willing to embrace EBP.

A nurse is concerned about the accuracy of the purified protein derivative (tuberculin) test in screening individuals with tuberculosis exposure for follow-up chest radiography. The nurse's concern is related to which aspect of the test's validity? a. Reliability b. Sensitivity c. Specificity d. Variability

ANS: B The validity of a screening test is measured by its sensitivity and specificity. Sensitivity quantifies how accurately the test identifies those individuals with the condition or trait of interest. Sensitivity is calculated as the proportion of persons with the disease that the test correctly identifies as having the disease (true positives). High sensitivity is needed when early treatment is important and when the identification of every case is important. Accurate identification is cost-effective and timely. Cognitive Level: Analysis Associated Chapter Objective: 8 & 11 REF: pp. 271-272

4. A community-oriented nurse introduces a community partnership group to the Healthy People 2020 information access objective to use electronic personal health management tools. This is an example of: a. meta-analysis of research evidence. b. primary prevention using EBP. c. secondary prevention using EBP. d. tertiary prevention using EBP.

ANS: B Using resources such as the Healthy People 2020 information access objectives, nurses can identify evidence-based prevention strategies to implement at the community level in their nursing practice and improve clients' understanding of EBP by fostering access to these electronic personal health tools.

9. Randomized controlled trials are often inappropriate for evaluating many public health interventions. The most common approach to establishing evidence in public health is the use of: a. blinded studies. b. case-control studies. c. expert opinion. d. research synthesis

ANS: B What counts as evidence has been argued in the public health literature. Randomized controlled trials, the gold standard in other areas of EBP, are often inappropriate for evaluating public health interventions because subjects cannot be randomly assigned to treatment and control groups. In public health, a case-control study is most appropriate.

When the association between maternal alcohol use and low birth weight is being studied, the nurse investigator's failure to consider the variable of smoking could introduce bias into the observed association, because smoking has a correlation with both factors. This effect could best be described as: a. causality. b. confounding. c. information bias. d. selection bias.

ANS: B When looking for the existence of statistical association between some factor and a health outcome, the investigator must consider the three general categories of bias. Bias is a systematic error resulting from study design, study execution, or confounding. Bias resulting from the relationship of the outcome and the study factor with some third factor not accounted for in the study design is called confounding. In practice, one can often identify potentially confounding variables and adjust for them in analysis. Cognitive Level: Analysis Associated Chapter Objective: 9, 10 & 11 REF: pp. 280-281

What information will a nurse find when reading a systematic review? a. Results of randomized controlled trials b. A description of the methods used to search for evidence c. Data compiled on a particular question d. An in-depth review of the literature completed by one person

ANS: B A systematic review is usually done by more than one person and describes the methods used to search for the evidence. It is a method of identifying, appraising, and synthesizing research evidence to evaluate and interpret all available research relevant to a particular research question.

Which is an example of an agent in the epidemiologic triangle? a. Human population distribution b. Salmonella c. Genetic susceptibility d. Climate

ANS: B An agent includes infectious organisms.

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.

An outbreak of a gastrointestinal illness from a food-borne pathogen is an example of a(n): a. Attack rate b. Point epidemic c. Secular trend d. Event-related cluster

ANS: B One temporal and spatial pattern of disease distribution is the point epidemic. A point epidemic is most clearly seen when the frequency of cases is plotted against time. The sharp peak characteristic of such graphs indicates a concentration of cases in some short interval of time.

The probability an event will occur within a specified period of time is called: a. Rate b. Risk c. Epidemiology d. Epidemic

ANS: B Risk is the probability an event will occur within a specified period of time.

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.

Screening for hearing defects is an example of: a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Health promotion

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

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.

In which situation does the nurse need to be aware of the potential for selection bias? a. Determining the population to be studied b. Considering how the participants will enter the study c. Studying cause and effect relationships d. Documenting results of the study

ANS: B Selection bias is attributable to the way subjects enter a study. It has to do with selection procedures and the population from which subjects are drawn.

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.

Which type of research is defined as the gold standard of evidence in evidence-based practice? a. Clinical expertise b. Randomized controlled trials c. Case studies d. Systematic review

ANS: B The double blind randomized controlled trial generally provides the highest level of evidence followed by other randomized controlled trials.

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.

The most important predictor of overall mortality is: a. Race b. Age c. Gender d. Income

ANS: B The mortality curve by age drops sharply during and after the first year of life to a low point in childhood, then begins to increase through adolescence and young adulthood and then increases sharply through middle and older ages.

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.

Epidemiologic studies of diseases conducted by nurses during the twentieth century were influenced by the (select all that apply): a. Increasing rate of poverty b. Declining child mortality rates c. Overcrowding in major cities d. Development of new vaccinations

ANS: B, D Factors contributing to the development and application of epidemiologic methods in the twentieth century were: improved nutrition, new vaccines, better sanitation, the advent of antibiotics and chemotherapies, and declining infant and child mortality and birth rates. A rise in the standard of living occurred for many following the Great Depression and World War II.

ANS: C A proportion is a type of ratio in which the denominator includes the numerator. The prevalence proportion is a measure of existing disease in a population at a particular time and is calculated by dividing the number of existing cases by the current targeted population. In this example, 39 cases divided by the total number of children age 15 years and younger in the population (which is 84,000 children) = 0.0004642 100,000 = 46.42/100,000. Cognitive Level: Application Associated Chapter Objective: 5 REF: p. 262

7. Examples of the application of EBP to improve public health nursing can be found in research projects designed to test the effectiveness of public health nursing interventions related to the core functions and essential services of public health. These projects are associated with: a. Agency on Healthcare Research and Quality. b. Cochrane Database of Systematic Reviews. c. the Intervention Wheel. d. U.S. Preventive Services Task Force.

ANS: C A systematic review of the literature was conducted on three levels of practice and 17 interventions identified in the Intervention Wheel. The sources were rated by members of a practitioner panel and consensus was achieved on the outcomes of the review. These findings were field tested and subsequently critiqued by a national panel of experts providing examined evidence for the use of the model and its relationship to the core functions and essential services of public health.

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

Which of the following article titles include(s) an example of epidemiologic distribution and determinants? a. Can Operating Room Nurses Measurably Reduce Patient Anxiety? b. Characteristics of Patients Newly Diagnosed with Tuberculosis c. Comparison of Postinsecticide Exposure Incidence of Atopic Dermatitis in Migrant Farmworkers and Land-Owning Farmers in Southwestern Utah d. Postpartum Nurses' Reaction to Rotating Shifts Compared with Assigned Stable Shift

ANS: C Epidemiology investigates the distribution (patterns) and the determinants (factors such as exposure, characteristics, and behaviors) of health events in a population. Distribution addresses "Who, what, where, when, and why?" and determinants address "How did the health event occur?" and "Why are some affected more than others?" Cognitive Level: Analysis Associated Chapter Objective: 1 REF: p. 258

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. When nurses work with communities, "best practices"—the application of the best available evidence to improve practice—must also be: a. accessible and diverse. b. competent and compliant. c. culturally and financially appropriate. d. reasonable and deliverable in a timely fashion.

ANS: C Nurses in community-oriented practice need to identify culturally and financially appropriate interventions when implementing EBP in work with communities. The use of evidence to determine appropriate interventions that are both culturally sensitive and cost-effective is a necessity to ensure acceptance by the community and appropriate allocation of limited resources.

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

A nurse teaches an asthmatic client to recognize and avoid exposure to asthma triggers and assists the client's family in implementing specific protection strategies in the home, such as removing carpets and avoiding pets. This nurse's activities can best be described as: a. comprehensive assessment. b. primary prevention. c. secondary prevention. d. treatment intervention.

ANS: C Secondary prevention refers to interventions that promote health and prevent complications of an existing disease, injury, or disability. A prevention intervention at this level is aimed at individuals and groups who have been diagnosed with a disease and have discernible pathology (state of prepathogenesis). Cognitive Level: Analysis Associated Chapter Objective: 4 & 11 REF: p. 269

. The type of epidemiologic study that is used to describe a group of persons enrolled in a study who share some characteristic of interest and who are followed over a period of time to observe some health outcome is a(n): a. Case control study b. Cross-sectional study c. Cohort study d. Experimental study

ANS: C A cohort study is the type of epidemiologic study that is used to describe a group of persons enrolled in a study who share some characteristic of interest and who are followed over a period of time to observe some health outcome.

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.

A summary of the research evidence that relates to a specific question and to the effects of an intervention is: a. Evidence-based practice b. Action research c. Systematic review d. Best practices

ANS: C A systematic review is a summary of the research evidence that relates to a specific question and to the effects of an intervention.

It would be important for a nurse researcher to use blinding when: a. The sample size is small b. The outcomes must be accurately measured c. Using a control group d. Studying the attrition rate

ANS: C Blinding refers to a procedure where the researcher or evaluator does not know which participants are in the experimental or control group.

Evidence-based public health is: a. An integration of the best available nursing expertise b. Derived from community principles to fit the area where it is practiced c. A health endeavor that makes informed use of evidence d. Comprised of only public health records

ANS: C Evidence-based public health is a health endeavor that makes informed use of evidence.

When studying chronic disease, the multifactorial etiology of illness is considered. What does this imply? a. Genetics and molecular structure of disease is paramount. b. Single organisms that cause a disease, such as cholera, must be studied in more detail. c. Focus should be on the factors or combinations and levels of factors contributing to disease. d. The recent rise in infectious disease is the main focus.

ANS: C Multifactorial etiology implies a focus on combinations and levels of factors.

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.

The proportion of persons with positive test results who actually have a disease, interpreted as the probability that an individual with a positive test result has the disease, is the: a. Sensitivity b. Specificity c. Positive predictive value d. Negative predictive value

ANS: C Positive predictive value refers to the proportion of persons with positive test results who actually have the disease, interpreted as the probability that an individual with a positive test result has the disease.

An example of primary prevention is: a. Pap smear b. Blood pressure screening c. Diet and exercise d. Physical therapy

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

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.

A nurse is told that a screening test has high specificity. This means that the test: a. Provides precise and consistent readings b. Accurately identifies those with the condition or trait c. Accurately identifies those without the trait d. Has a high level of false positives

ANS: C Specificity refers to the test accurately identifying those without the trait.

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.

A public health nurse uses a published systematic review to determine which exercises should be incorporated into a newly developed older adult exercise program. Which resource would most likely contain this information? a. Evidence-Based Practice for Public Health Project b. PubMed c. Cochrane Public Health Group (PHRG) d. Task Force on Community Preventive Services

ANS: C The PHRG works with contributors to produce and publish Cochrane reviews of the effects of population-level public health interventions. The PHRG undertakes systematic reviews of the effects of public health interventions to improve health and other outcomes at the population level, not those targeted at individuals.

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.

Public health professionals refer to three levels of prevention as tied to specific stages in the: a. Epidemiologic triangle b. Web of causation c. Natural history of disease d. Surveillance process

ANS: C The natural history of disease is the course of the disease process from onset to resolution. The three levels of prevention provide a framework commonly used in public health practice to depict this process.

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.

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.

Voters have recently decided to have fluoride added to the city water system. Epidemiologists wanting to study the effect of fluoride on dental caries would be conducting a(n): a. Ecological study b. Double-blind study c. Community trial d. Screening

ANS: C This is similar to clinical trials, but the issue is often health promotion and disease prevention rather than treatment of existing disease.

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.

Case fatality from breast cancer has decreased in recent years, although the incidence of breast cancer has increased. Descriptive epidemiology would use the component of time to explain this change in terms of: a. cyclical patterns. b. event-related clusters. c. point epidemic. d. secular trends.

ANS: D In descriptive epidemiology, the components of person, place, and time are used to describe increases or decreases in the frequency of diseases over time. Temporal or spatial patterns that influence long-term changes in morbidity or mortality rates are known as secular trends and may reflect changes in social behavior or practices. Some aspects to be considered are the effects of improved diagnostic capability and changes in survival (case fatality) rather than changes in incidence. The trends in breast cancer have led to a mortality curve that is flatter than the incidence curve. This leads to uncertainty in determining the actual increase in incidence rate, because improved diagnostic capability may explain some but not all of the increase observed. Another area of consideration is changes in case definition or coding of disease in the International Classification of Diseases, because both can produce an artificial change in mortality rates. Cognitive Level: Synthesis Associated Chapter Objective: 5 & 6 REF: p. 275

John Snow played a critical role in the development of modern disease surveillance when he: a. devised a more statistically valid method of analyzing epidemiologic data. b. discovered causal agents for anthrax, tuberculosis, and cholera. c. tracked the incidence of tuberculosis in the tenements of New York City. d. used geographic mapping to demonstrate the connection between water supply and cholera.

ANS: D John Snow is considered the father of modern epidemiology because of the methods he used in his groundbreaking work to connect the incidence of cholera with the water supply. Snow showed that households receiving water from one water company, whose intake valve was in an area of the river contaminated by sewage, had a much higher rate of cholera than those receiving water from other companies drawing water from less-contaminated parts of the river. Cognitive Level: Comprehension Associated Chapter Objective: 2 REF: pp. 259-260

An example of an attack rate is the: a. Number of cases of cancer recorded at a medical center b. Number of people who died of cholera in India in a given year c. Number of beef cattle inoculated against mad-cow disease on a farm d. Proportion of people becoming ill after eating at a fast-food restaurant

ANS: D Attack rates are often specific to exposures, such as food-specific attack rates.

The factors, exposures, characteristics, and behaviors that determine patterns of disease are described using: a. Descriptive epidemiology b. Analytic epidemiology c. Distribution d. Determinants

ANS: D Determinants may be individual, relational, social, communal, or environmental.

19. Which factors place an individual at high risk for acquiring a sexually transmitted infection (STI)? (Select all that apply.) A) Having multiple sexual partners B) Using a condom during sex C) Having no other STIs D) Having a sexual partner who has had an STI E) Receiving a blood transfusion

Ans: A, D Feedback: Any person is in a high-risk group for STIs if they have multiple sexual partners, do not use a condom during sex, have other STIs, and/or have a sexual partner who has had an STD. Although once a risk for exposure to HIV, blood transfusions no longer place an individual at high risk for acquiring an STI.

13. A client presents with severe diarrhea. The client tells the nurse that she went to a chicken roast at church the previous weekend. The nurse suspects a foodborne illness. Which cause of bacterial foodborne illness should the nurse most suspect in this case? A) Campylobacter B) Listeria monocytogenes C) Salmonella D) Escherichia coli O157:H7

Ans: A Feedback: Campylobacter is the most common cause of bacterial foodborne illness in the United States, and it is an important cause of diarrheal illness throughout the world regardless of people's age. Consumption of contaminated poultry is the most common source of Campylobacter infection, although undercooked meats, ground beef, pork, cheese, eggs, shellfish, unpasteurized milk, and direct exposure to pets and farm animals have been implicated. Other infectious organisms that commonly cause foodborne illnesses include noroviruses, Listeria monocytogenes, nontyphoid Salmonella, and E. coli O157:H7.

6. A client with tuberculosis sneezes in the waiting room and infects several other clients who are sitting on the other side of the room. Which mechanism of transmission is involved in this case? A) Airborne B) Droplet C) Direct contact D) Indirect contact

Ans: A Feedback: Airborne transmission occurs when microorganisms are carried in the air in small particles, called droplet nuclei, at distances that exceed a few feet. Droplet transmission theoretically is a form of contact transmission; the mechanism of transfer of the pathogen to the host is quite distinct from either direct or indirect transmission. Therefore, droplet transmission is considered a separate route of transmission. Droplets are generated from the source person primarily during coughing, sneezing, or talking and are propelled a short distance (<3 feet) through the air and deposited on the conjunctivae, nasal mucosa, or mouth of another person. Direct contact occurs through direct body surface-to-body surface contact and physical transfer of microorganisms between a susceptible host and an infected or colonized person (or animal). Indirect contact involves contact of a susceptible host with a contaminated intermediate inanimate object, called a vehicle, such as a contaminated surgical instrument, needle, toy, soiled clothing, or bed linen.

15. The client reports diarrhea, fever, and abdominal cramps 24 hours following exposure to raw eggs while cooking. An efficient and effective homemade oral rehydration solution is to stir: A) One level teaspoon of salt and eight level teaspoons of sugar into one quart or liter of clean drinking water B) Eight level teaspoons of salt and one level teaspoon of sugar into one quart or liter of clean drinking water C) One level teaspoon of salt and one level teaspoon of sugar into one quart or liter of clean drinking water D) Eight level teaspoons of salt and eight level teaspoons of sugar into one quart or liter of clean drinking water

Ans: A Feedback: An efficient and effective homemade oral rehydration solution is to stir one level teaspoon of salt and eight level teaspoons of sugar into one quart or liter of clean drinking water or water that has been boiled and cooled.

8. Chloroquine-resistant malaria occurs in most of Africa, the Middle East, and Asia and all of the South Pacific islands. This type of disease occurrence is known as: A) Endemic B) Epidemic C) Pandemic D) Outbreak

Ans: A Feedback: An endemic disease, infection, or infectious agent occurs when it becomes prevalent within a population or geographic area. An epidemic or outbreak refers to a significant increase in an infection or infectious disease beyond the expected (endemic) level in a certain population and/or geographic area. A pandemic is an epidemic that generally spreads worldwide. The use of "outbreak" in this text is synonymous with epidemic.

20. A client wants to know the best way to avoid sexually transmitted infections (STIs). The nurse should mention: A) Abstinence B) Monogamous relationship with an infected partner C) Washing the genitals after sex D) Use of latex condoms

Ans: A Feedback: Other than abstinence, a long-term mutually monogamous relationship with a partner who has been tested and is known to be uninfected is the best way to avoid STIs. Sexual partners should talk to each other about their STIs so that preventive action can be taken. Prevention of STI transmission does not include washing the genitals, urinating, or douching after sex. Latex condoms can reduce the risk of transmission but only when used consistently (every time) and correctly.

12. A client arrives on the unit, diagnosed with norovirus infection from eating shellfish. The client has been vomiting repeatedly and is now severely dehydrated. Which interventions are likely to be performed for this client? (Select all that apply.) A) Starting an intravenous line for fluid and electrolyte replacement B) Encouraging the client and the client's family to practice good handwashing C) Immediate disinfecting all potentially contaminated objects and surfaces D) Isolating the client until 12 hours after the client has been symptom free E) Administering a vaccination

Ans: A, B, C Feedback: Oral hydrating solutions should be given for attacks of norovirus, and in severe cases intravenous fluid and electrolyte replacement may be necessary. At the first signs of this acute gastroenteritis outbreak, good handwashing, thorough and immediate disinfection with appropriate solutions, and isolation of sick people until 72 hours, not 12 hours, after they are symptom free are critical. There is no vaccine currently for noroviruses.

4. In infectious disease epidemiology, just the presence of an infectious agent is not sufficient to produce an infectious disease. Which host factors determine whether a person is at risk for an infection or an infectious disease? (Select all that apply.) A) Age B) Sex C) Occupation D) Physical and emotional health E) Immune status

Ans: A, B, D, E Feedback: There are several host factors that determine whether a person is at risk for an infection or an infectious disease. These include age, sex, race, physical and emotional health, and immune status. Occupation is not a host factor.

3. Infectious agents are biological agents capable of producing an infection or infectious disease. Which are considered biological agents? (Select all that apply.) A) Fungi B) Fomites C) Bacteria D) Viruses E) Helminths

Ans: A, C, D, E Feedback: Infectious agents are biological agents capable of producing an infection or infectious disease and include bacteria, viruses, rickettsiae, fungi, protozoa, and helminths. Fomites are any substance that adheres to and transmits infectious materials. An infectious disease need not be contagious or communicable.

10. Several levels of public health surveillance are necessary to protect the nation's health. At what level are healthcare providers and health facilities required to report certain infectious diseases? A) Local B) State C) Federal D) International

Ans: B Feedback: Local reporting mechanisms are community specific. At the state level, healthcare providers and health facilities are required to report certain infectious diseases to state health departments. At the federal level, the Department of Health and Human Services (DHHS) is the US public health infrastructure that develops policies to protect the nation's health. The Centers for Disease Control and Prevention (CDC) also is a partner with the World Health Organization (WHO) through the Global Outbreak Alert and Response Network and the WHO Surveillance and Response system, which provide international epidemic alerts and responses.

14. A client arrives at the clinic reporting diarrhea and flu-like symptoms. On questioning, the client tells the nurse about a family gathering she attended recently where she had some smoked seafood. Which foodborne illness should the nurse most suspect in this client? A) Campylobacter B) Listeria monocytogenes C) Salmonella D) Escherichia coli O157:H7

Ans: B Feedback: Nurses and other healthcare providers should suspect listeriosis in high-risk clients with a recent history of eating delicatessen food, soft cheeses, or smoked seafood who become ill with diarrhea and/or flu-like symptoms. Other infectious organisms that commonly cause foodborne illnesses include noroviruses, Listeria monocytogenes, nontyphoid Salmonella, and E. coli O157:H7. Campylobacter is the most common cause of bacterial foodborne illness in the United States, and it is an important cause of diarrheal illness throughout the world regardless of people's age.

2. A student nurse asks if an infectious disease is the same thing as a communicable disease. The nurse explains that an infectious disease is not necessarily a communicable disease. Which must a communicable disease have that an infectious disease does not have to have? (Select all that apply.) A) Pathogenic microorganism B) Portal of exit from the infected person C) Means of transmission D) Portal of entry to a susceptible host E) Organism that harbors the infectious agent

Ans: B, C, D Feedback: An infectious disease in a human host is one caused by the growth of pathogenic microorganisms in the body. For a disease to be communicable, or contagious, there must be a portal of exit from the infected person (or animal), a means of transmission, and a portal of entry to a susceptible host. Thus, an infectious disease need not be contagious, or communicable.

9. Person, place, and time characterize the description of an epidemiologic problem. Using knowledge of outbreak investigations, which occurs with propagated outbreaks? A)Same person or vehicle as the reservoir or means of transmission B) Infection transmitted from person to person over a short period of time C) Generating secondary infections with intervals between peaks that approximate the usual incubation period for the infection D) Generating tertiary infections following exposure to a primary case

Ans: C Feedback: A propagated outbreak is one where the infection is transmitted from person to person over a longer period of time than with a common source outbreak, and it can generate secondary infections with intervals between peaks that approximate the usual incubation period for the infection. A common source outbreak is one that has the same origin. Secondary infections are those that occur within the accepted incubation period following exposure to a primary case.

16. A client reports symptoms of severe abdominal cramps, bloody diarrhea, and vomiting after eating commercially packaged salad. The nurse suspects Escherichia coli O157:H7. The client asks about the average time of resolution of these symptoms. What time frame should the nurse provide? A) 3 to 5 days B) 5 to 7 days C) 7 to 10 days D) 12 to 14 days

Ans: C Feedback: Escherichia coli O157:H7, a deadly toxin-producing bacterium, produces symptoms of severe abdominal cramps, bloody and nonbloody diarrhea, and vomiting that generally resolve within 7 to 10 days.

21. A client presents with several ulcerative sores on his penis that are firm, round, and painless. He also has rough, reddish brown spots on his palms and the bottoms of his feet. He acknowledges that he is sexually active with multiple partners and is inconsistent in his use of a condom. Which sexually transmitted infection should the nurse most suspect in this client? A) Gonorrhea B) Chlamydia C) Syphilis D) Human papillomavirus

Ans: C Feedback: Syphilis is primarily indicated by ulcerative sores occurring mainly on the external genitals, vagina, anus, or in the rectum, although they can occur on the lips or in the mouth. The sore is usually firm, round, and painless. Rashes associated with secondary syphilis appear as rough, red, or reddish brown spots both on the palms of the hands and/or the bottoms of the feet. Infections with Neisseria gonorrhoeae, like those resulting from Chlamydia trachomatis, cause several clinical syndromes including urogenital, pharyngeal, and rectal infections in males and females, and conjunctivitis in adults and neonates. Chlamydia is known as a "silent" infection because most infected people are asymptomatic and lack abnormal physical examination findings. Men who are symptomatic typically have urethritis, with a mucoid or watery urethral discharge and dysuria. A minority of infected men develop epididymitis (with or without symptomatic urethritis), presenting with unilateral testicular pain, tenderness, and swelling. Human papillomavirus infections, if manifest, are primarily indicated by genital warts.

1. The nurse works with a female client who recently developed an infection of Staphylococcus aureus while in the hospital. In this case, S. aureus is which component in the chain of infection? A) Host B) Environmental reservoir C) Agent D) Portal

Ans: C Feedback: The agent, or the microbe that causes the disease, is the "what" of the epidemiologic triangle. The host, or the organism that is harboring the infectious agent, is the "who" of the triangle. The environment, which includes those external factors that cause or allow disease transmission, is the "where" of the triangle. Other necessary elements include a portal of exit from the host, environmental reservoirs, transmission, and a portal of entry to a new host.

5. When an infectious agent enters the host and begins to multiply, an infection occurs. The time between exposure to an infectious agent and the manifestation of symptoms in the host is known as: A) Carrier time B) Colonization C) Incubation period D) Latent period

Ans: C Feedback: The time between exposure to an infectious agent and the manifestation of symptoms in the host is called the incubation period. Asymptomatic people are carriers of a virus and can transmit the virus to others through percutaneous inoculation, exposure to mucous membranes, and sexual contact. When an infectious agent is present and there are no clinical signs of disease, colonization with the infectious agent is said to have occurred, and the infected person is capable of transmitting the agent. The latent period is the stage of a disease during which symptoms are hidden.

17. Which criteria must be met to define a water-associated disease outbreak? A) Two or more people with laboratory-confirmed primary amebic meningoencephalitis B) Two or more cases of chemical poisoning if water quality data indicate contamination by the chemical C) Two or more people having experienced a similar illness after exposure to water D) Epidemiologic evidence implicating drinking water as the probable source of the illness

Ans: C Feedback: Two criteria must be met for an event to be defined as a water-associated disease outbreak. First, two or more people must have experienced a similar illness after exposure to water. Second, epidemiologic evidence must implicate recreational water (not drinking water) or volatilization of water-associated compounds into the air surrounding the water as the probable source of illness. Evidence of primary amebic meningoencephalitis and chemical poisoning are not required for confirmation of a water-associated disease outbreak.

18. A 16-year-old client visits the community health clinic with concerns that she may have a sexually transmitted infection (STI). She asks whether STIs are treatable. STIs that are easily treated and curable include: (Select all that apply.) A) Human papillomavirus B) Herpes simplex C) Chlamydia D) Gonorrhea E) Syphilis

Ans: C, D, E Feedback: Infections caused by bacteria can be treated and usually cured with antibiotics, but those caused by viruses cannot be cured this way. Chlamydia, gonorrhea, syphilis—all bacterial—and trichomoniasis—parasitic are easily treated with antibiotics and cured if diagnosed early. Human papillomavirus and herpes simplex are viral infections that are not treatable.

7. The student-nurse discusses transmission that involves contact of a susceptible host with a vehicle. Based on the chain of infection links, which exemplifies a vehicle? A) Animals B) Insects C) Reptiles D) Water

Ans: D Feedback: Indirect contact involves contact of a susceptible host with a contaminated intermediate inanimate object, called a vehicle, such as a contaminated surgical instrument, needle, toy, soiled clothing, or bed linen. Vehicles also include food, water, and contaminated hands that are not washed. Indirect contact also includes vector transmission. Vectors are animal or insect carriers of infectious agents.

11. Which agency has an electronic surveillance system for the early notification of community-based epidemics? A) Department of Health and Human Services B) Centers for Disease Control and Prevention C) World Health Organization D) Department of Defense

Ans: D Feedback: The Department of Defense (DoD) has an electronic surveillance system for the early notification of community-based epidemics (ESSENCE), which has been in operation since 2001 to detect infectious disease outbreaks. At the federal level, the Department of Health and Human Services (DHHS) is the U.S. public health infrastructure that develops policies to protect the nation's health. The Centers for Disease Control and Prevention (CDC) is a major DHHS agency that protects the nation's health by developing guidelines that promote health and quality of life by preventing and controlling disease, injury, and disability. The CDC is also a partner with the World Health Organization (WHO) through the Global Outbreak Alert and Response Network and the WHO Surveillance and Response system, which provide international epidemic alerts and responses.

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