Community Health Final (Fixed)

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The first step in the epidemiologic process is to answer the ________ questions by defining a ___________.

"what"; health outcome

what are some examples of programs provided by local health departments?

-AIDS community care -animal shelter -blood pressure -cancer -dental services -flu shots -health insurances -senior health -substance abuse -TB -workplace health information -west nile virus -mental health -cholesterol screening

What are some examples of environmental factors?

-Climate (e.g., temp., rainfall) -Plant and animal life (e.g., agents or reservoirs or habitats for agents) -Human population distribution (e.g., crowding, social support) -Socioeconomic factors (e.g., education, resources, access to care) -Working conditions (e.g., levels of stress, noise, satisfaction)

What are some examples of hosts?

-Genetic susceptibility -Immutable characteristics (e.g., age, sex) -Acquired characteristics (e.g., immunological status) -Lifestyle factors (e.g., diet and exercise)

What are some vaccine-preventable diseases?

-Routine childhood immunization schedule -measles -rubella -pertussis -influenza

What are some typical programs in a state health department?

-epidemiology, environmental and occupational health -communicable disease services -cancer epidemiology services -consumer, environmental and occupational health services -family health services -HIV/AIDS services -Budget and finances -information technology -public health and environmental labs

Discuss issues related to obtaining and maintaining appropriate levels of immunization against vaccine-preventable diseases.

-ethnic groups -religious beliefs -low-income -no transportation -minority groups

What are some examples of agents?

-infectious agents (e.g., bacteria, viruses, fungi, parasites) -Chemical agents (e.g., heavy metals, toxic chemicals, pesticides) -Physical agents (e.g., radiation, heat, cold, machinery)

Name the public health core functions.

1. Assessment 2. Policy development 3. Assurance

What are the goals and means of practice in the community assessment?

1. Community Health 2. Healthy people 2020 3. Community partnerships 4. Strategies to improve community health

What are the steps of a community focused nursing process?

1. Community assessment 2. Community nursing diagnosis 3. Planning for community health 4. Implementing in the community 5. Evaluating community health interventions

What are the Nursing Section purposes?

1. Define nursing issues for public health care and disaster health care 2. Exchange scientific and professional information relevant to the practice of disaster nursing 3. Encourage collaborative efforts enhancing and expanding the field of nursing disaster research 4. Encourage collaboration with other nursing organizations 5. Inform and advise WADEM of matters related to disaster nursing

What are the 4 steps to assessing community health?

1. Gathering relevant existing data and generating missing data. 2. Developing a composite database. 3. Interpreting the composite database to identify community problems and strengths. 4. Analyzing the problem

What are the 4 goals to control communicable disease through a multisystem approach and give examples of each.

1. Improve host resistance to infectious agents and other environmental hazards. (ex. hygiene, nutrition, and physical fitness) 2. Improve safety of the environment. (ex. Sanitation, clean water and air) 3. Improve public health systems (ex. increased access to health care) 4. Facilitate social and political change to ensure better health for all people. (individual, organizational, and community action, legislation)

What are the six characteristics of an infectious agent?

1. Infectivity 2. Pathogenicity 3. Virulence 4. Toxicity 5. Invasiveness 6. Antigenicity.

What are the 4 methods of generating direct data?

1. Informant interviews 2. Focus groups. 3. Participant observation 4. Windshield surveys

Epidemiology is the study of populations in order to: 1. ___________ of the population. 2. Understand the _________ and disease in communities 3. _____________interventions to prevent disease and maintain health.

1. Monitor the health of the population 2. Understand the determinants of health and disease in communities 3. Investigate and evaluate interventions to prevent disease and maintain health.

What are the 10 basic data elements of surveillance?

1. Mortality registration 2. Morbidity reporting 3. Epidemic reporting 4. Epidemic field investigation 5. Laboratory reporting 6. Individual case investigation 7. Surveys 8. Utilization of biological agents and drugs 9. Distribution of animal reservoirs and vectors 10. Demographic and environmental data

What is a community?

1. Open system (metro area) 2. with boundaries (NAU) 3. People have a common purpose (students)

Disaster managment includes four stages, what are they?

1. Prevention (mitigation) 2. Preparedness 3. Response 4. Recovery

What are the factors that can influence the emergence of new infectious diseases?

1. Societal events (economic impoverishment) 2. Health care (new medical devices) 3. Food production (Globalization of food supplies) 4. Human Behavior (sexual behavior) 5. Environmental (deforestation) 6. Public Health (lack of trained personnel) 7. Microbial adaptation (changes in virulence and toxin production)

What are a few clincial and epidemiological features of smallpox?

1. Sudden onset of fever, prostration, severe body aches, and occasional abdominal pain and vomiting, as in influenza 2. Clear-cute prodromal illness, rash follows 2-4 days after fever begins decreasing 3. Progression is macular, papular, vesicular, and pustular, follwed by crusted scabs that fall off after 3-4 weeks if client survives 4. Rash is "centripetal" with lesions most abundant on the face and extremities 5. Lesions are all at the same stage in all areas 6. Vesicles are deep-seataed and do not collapse on puncture; pitting and scarring are common.

What are the 17 Interventions of the Intervention Wheel?

1. Surveillance 2. Disease and other health event investigation 3. Outreach 4. Screening 5. Case finding 6. Referral and follow-up 7. Case management 8. Delegated functions 9. Health teaching 10. Counseling 11. Consultation 12. Collaboration 13. Coalition building 14. Community organizing 15. Advocacy 16. Social marketing 17. Policy development 18. Policy enforcement

What are the six infectious agents that are considered highest of concern for bioterrorism?

1. anthrax (Bacillus anthracis) 2. plague (Yersinia pestis) 3. smallpox (variola major) 4. botulism (Clostridium botulinum) 5. tularemia (Francisella tularensis) 6. selected hemorrhagic viruses (filoviruses such as Ebola and Marburg; arenaviruses such as Lassa fever, Junin virus, and related viruses)

Anthrax disease many manifest in one of three syndromes:......

1. cutaneous 2. gastrointestinal 3. respiratory or inhalational

What are some ways to collect community assessment data?

1. data collection and interpretation 2. data gathering 3. data generation 4. collection of reported data (secondary analysis)

Healthy people has established benchmarks and monitored progress over time in order to:

1. encourage collaboratios across sectors 2. Guide individuals toward making informed health decisions 3. Measure the impact of prevent activities

This model identifies and defines _______ public health interventions

The ___________ provide a framework commonly used in public health practice.

3 levels of prevention.

A community-level intervention designed to increase the sense of belonging among older community residents at risk for social isolation was implemented by opening a senior center every other Wednesday at a local church that provided lunch and social programs. At the end of 6 months, the attendees were surveyed to determine their experience with the program, barriers to attendance, expansion of their social networks, and involvement in other community activities. This survey allowed the community health nurse to _______ the program and design program improvements. A) Evaluate the effectiveness of. B) Assess the expansion needs of. C) Identify problems with D) Implement the expansion of.

A community-oriented nurse conducts home visits to new parents to assess the health status of the infant, the parent-child relationship, the parents' knowledge regarding the care of the infant, and the need for health department and social services referrals to support the needs of the new parents and the infant. This can best be described as an example of: A) Clinical community health practice. B) Community-based practice. C) Population-focused practice. D) Public health nursing.

A community-oriented nurse has identified obesity as a problem in the middle school. The next step in a population-focused practice is to make information available about the health of the middle school students. This describes the core public health function of: A) Assessment. B) Assurance. C) Policy development. D) Research.

A factor that strongly influences the success of a primary health care system is: A) Participation of the community members in the design, implementation, and evaluation of the initiative. B) Assurance of access to care for every woman and child from pregnancy through childhood. C) Each entity's sense of urgency regarding the evaluation of indicators. D) Cure orientation of the private sector of health care delivery in the United States.

A nurse planning a smoking cessation clinic for adolescents in the local middle schools and high schools is providing: A) Community-oriented care. B) Community-based care. C) Secondary care. D) Tertiary care.

A nursing diagnosis of Increased risk for delayed development, injury, and disease because of inadequate parenting by a primary parent experiencing depression would most likely indicate that the nursing process is being applied at the _______ level of practice and the _______ level of prevention. A) Individual/family + secondary. B) Community + primary. C) Community + secondary. D) Individual/family + primary.

A rural community health nurse has made sure that male and female lay advisors are involved in the health department's migrant worker outreach program. The nurse believes this intervention strategy is important because the nurse knows that such individuals can be: A) People who are influential in approving or vetoing new ideas. B) Medical professionals within the migrant community. C) Natural healers within their community. D) Translators to help overcome language barriers.

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.

A shift in general approach from a more reactionary, acute care orientation toward a proactive, primary prevention orientation is necessary to achieve not only a more cost-effective but also a more equitable health care system in the United States. From a public health perspective, this strategy is necessary to avoid the need for other less desirable approaches that may compromise access and quality such as: A) Rationing of health care. B) Secondary prevention. C) Managed care expansion. D) Regulatory program mandates.

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 two years. Appropriate intervention by the nurse would be to: A) Arrange to have the client referred for medical evaluation for pelvic inflammatory disease (PID) and appropriate intervention and treatment. B) Contact the health department to confirm the spouse's diagnosis of Chlamydia infection to determine the client's exposure, give the client antibiotics, and have her return to the clinic if symptoms worsen. C) Provide sexually transmitted disease (STD) prevention and treatment education and refer the client to the health department for STD screening for gonorrhea and/or Chlamydia infection. D) Supply the client with nonsteroidal antiinflammatory drugs and caution her to call the after-hours call doctor if her symptoms worsen.

Although the definitions of evidence-based practice (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.

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.

Before 1950, the major portion of U.S. health care was funded by out-of-pocket payments by consumers. In the 1950s, a shift was seen to third-party reimbursement, and that trend continues today. Recent trends of third-party reimbursement indicate that the highest portion of third-party health care financing is being carried by: A) Combined public sources. B) Consumer premiums. C) Medicare. D) Private health insurers.

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.

If the community is where nurses practice and apply the nursing process, and the community is the client in that practice, then nurses will want to analyze and synthesize information about: A) Boundaries, parts, and dynamic processes of the client community. B) Community health status and structure. C) Community problems and problem correlates. D) Role of the nurse and lay advisors in the community partnership.

Primary health care differs from primary care in which of the following ways? A) Primary health care encourages community participation. B) Primary health care focuses on prevention and cure. C) Primary health care is defined more narrowly. D) Primary health care is the primary method of health care delivery in the United States.

Public health nurses are challenged to respond to public health-related trends of the twenty-first century, which include: A) Racial, ethnic, and economic health disparities; rise of drug-resistant pathogens; unequal access to health care; and violence. B) Violence, availability of health care for all, and increasing life expectancy. C) Health disparities, access issues, and adequate mental health program funding. D) Rise of drug-resistant organisms, increased life expectancy, societal violence, and more effective disease surveillance.

Public health nursing practice is guided by the community's priorities as identified by community: A) Assessment. B) Diagnosis. C) Interventions. D) Planning.

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.

The clients most at risk of reactivation of latent infections of tuberculosis (TB) are: A) Immunocompromised persons, substance abusers, and those with diabetes. B) Individuals previously treated for TB. C) Long-term cigarette smokers. D) Persons with new-onset asthma or emphysema.

The community practice nurse is preparing to initiate a community partnership with a neighborhood watch association to address teenager street vandalism. The nurse is evaluating the community health dimension of process and seeks to determine the community's: A) Commitment to prioritizing and solving health problems. B) Crime rate and school absenteeism rate. C) Educational level. D) Local client-to-provider ratio.

The federal-state-local partnership teams with other organizations to develop and implement responses to identified public health concerns because: A) Community health is a shared responsibility. B) Health objectives are defined nationally. C) Population health is the responsibility of the government. D) Public health trends focus on bioterrorism.

The public health nurse applies knowledge in working with a local school board coalition to develop a helmet safety campaign in the middle and high schools. This best exemplifies which aspect of public health? A) Core competency. B) Core function. C) Nursing role. D) Standard of practice.

The state public health agency has received multiple complaints regarding the availability of elder transportation services to a specific county senior center. The state agency assigns a public health nurse to work with the community to evaluate its program for elder transportation services to publicly sponsored eldercare programs. The public health core function applied is: A) Assurance. B) Policy development. C) Primary prevention. D) Public transportation.

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.

When a nurse evaluates the completeness and accuracy of information made available to community residents regarding the impact of rezoning of land parcels for industrial use, the nurse can best be described as: A) Advocating for ethical choices. B) Communicating risk. C) Controlling environmental damage. D) Volunteering for service on state boards.

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.

When confirmed cases of the mumps, a vaccine-preventable disease, emerged on college campuses in fall 2006, public health nurses conducted outreach at campuses and collaborated with student health officials to increase the number of students with full immunization compliance. This is an example of: A) Community-level practice. B) Family-level practice. C) Individual-level practice. D) Systems-level practice.

What is the definition of Primary health care:

A combination of primary care and public health care made universally accessible to individuals and families in a community, with their full participation, and provided at a cost that the community and country can afford.

What is an example of policy development.

A director of public health for the state of oregon, she moblized efforts to develop statewide goals for Healthy People 2000 as well as to update Oregon's disease reporting laws.

What is the definition of health.

A state of complete physical, mental, and social well-being; not merely the absence of disease or infirmity.

Which of the following are the best argument(s) for supporting community-as-client nursing (select all that apply)? A) Change for the benefit of the community-client must often occur at several levels. B) Changes in the health of individuals will affect the health of their communities. C) The idea of providing health-related care within the community is not new. D) The impact of the environment on health has long been established. E) Direct hands-on nursing care delivered to individuals or families in community settings is important.

A,B,C,D

Factors related to the determinants of health identified in Healthy People 2020 include which of the following (select all that apply)? A) Education and literacy. B) Genetic endowment. C) Gender. D) Culture. E) Social status.

A,B,C,D,E

The role of the nurse who wants to become more active in environmental health could include which of the following (select all that apply)? A) Assessing farmworkers for pesticide exposure and providing pesticide risk education. B) Conducting epidemiologic investigations as a public health nurse. C) Developing corporate policy to protect workers from unsafe levels of toxic agents. D) Organizing the local community to encourage landlords to remove lead-based paint. E) Working as a skilled risk communicator for a local chemical manufacturer.

A,B,C,D,E

The Quad Council of Public Health Nursing identified eight principles that distinguish the public health nursing specialty from other nursing specialties, including which of the following (select all that apply)? A) Collaboration with other professions, organizations, and entities. B) Optimal use of available resources. C) Population-based unit of care. D) Primary obligation to work for the good of individuals and families. E) Engagement with clients as an equal partner.

A,B,C,E

A community health nurse is revising the agency's nursing protocols to incorporate current evidence-based practice (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.

A,B,D,E

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.

A,B,D,E

The factors that are frequently cited as having caused the increases in total and per capita health care spending in the United States are well exemplified by which of following health care events (select all that apply)? A) Development of the drug sildenafil (Viagra). B) Increase in hip and knee replacement surgeries. C) Increased incidence of ischemic heart disease. D) Mandated two-day maternity hospital stays. E) Medicare Part D prescription drug plan.

A,B.C.D.E

The American health care system will continue to evolve and change. Which of the following groupings of health care trends will have the greatest influence on the health care transformation process at the present time? Select all that apply. A) Aging of the population, globalization, and medical technology advances. B) Funding levels, political structure, and professional licensure requirements. C) Longevity, population diversity, and funding sources. D) Managed care, workforce shortages, and level of education of the population.

A,C

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 most important features of the Affordable Health Care for America Act of 2010 that the community-oriented nurse needs to understand to provide resource information to clients are that the Act: A) Transforms the health care system from a sick care system to health care system. B) Uses piecemeal approach to strengthen the safety net. C) Replaces the rational equitable health care system. D) Provides insurance reform. E) Increases access to affordable health care insurance.

A,D,E

________ is the purposeful, ongoing search for new cases of disease by public health personnel, through personal or telephone contacts or the review of laboratory reports or hospital or clinic records.

Active surveillance

What is the definition of health promotion.

Activities that have as their goal the development of human attitudes and behaviors that maintain or enhance well-being.

What is the definition of disease prevention.

Activities that have as their goal the protection of people from becoming ill because of actual or potential health threats.

The yellow wedge includes which interventions?

Advocacy Social Marketing Policy development and enforcement

___________The technical aspects of formulating and stating one's views in relation to other person's views.

Articulateness

____________ focuses on the responsibility of public health agencies to make certain that activities have been appropriately carried out to meet public health goals and plans.

Assurance

_____________ also includes the development of partnerships between public and private agencies to make sure that needed services are available and that assessing the quality of the activities is carried out.

Assurance

__________ is the clear and realistic view of one's own and other persons community components, identities, and positions on issues.

Awareness of self and others and clarity of situational definitions

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.

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.

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.

A college health nurse is working with students, faculty, and staff to improve environmental air quality. To address the primary cause of air pollution on campus, the nurse plans a precautionary intervention. Which of the following interventions best demonstrates an appropriate approach? A) Encourage the use of electric cars and scooters on campus. B) Increase the use of bicycles, foot-powered scooters, rollerblades, and walking as the primary mode of transportation on campus. C) Make the entire campus a no-smoking zone. D) Establish a policy to reduce electricity consumption in university buildings by raising the thermostat to 78 degrees in the summer and lowering the thermostat to 70 degrees in the winter.

A community health nurse manager has integrated exposure history elements into the assessment practices of the health department that are relevant to the urban industrial community served. This strategy indicates that the nurse manager is aware of the relationship between: A) Community strengths and weaknesses. B) Environment and human health/disease. C) Toxicology studies conducted by the Environmental Protection Agency and the environment. D) Federal and state environmental regulations.

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 evidence-based practice (EBP). C) Secondary prevention using EBP. D) Tertiary prevention using EBP.

A community-oriented nurse seeks to implement evidence-based practice (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.

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.

A nurse is concerned about the accuracy of the purified protein derivative (tuberculin) test in screening individuals with tuberculosis exposure for followup chest radiography. The nurse's concern is related to which aspect of the test's validity? A) Reliability. B) Sensitivity. C) Specificity. D) Variability.

A nurse practitioner is seeking support from a community health and hospital system to open a nurse-managed and nurse-staffed clinic. The nurse provides data demonstrating the role of the clinic in reducing nonurgent emergency department visits and in improving access to services for clients with chronic illness, management of caseloads, and service flow, as well as data showing proposed input and output parameters. This best demonstrates application of the techniques of: A) Business cycle modeling. B) Cost-effectiveness analysis. C) Cost-benefit analysis. D) Indirect reimbursement methods.

A nurse questions whether a particular activity in her job description is within a nurse's scope of practice. The nurse would look to which government jurisdiction/agency within the public health system to seek clarification? A) Federal system B) State system C) U.S. Department of Labor D) U.S. Department of Health and Human Services

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.

A public health nurse in the local health department assists the community in identifying the health need priorities and the services that can best meet these needs in a cost-effective manner. This is an example of the tertiary prevention public health nursing function of: A) Case finding. B) Case management. C) Collaboration. D) Provision of direct services.

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.

Community-oriented nurses use evidence-based practice (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.

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.

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.

Nurses should consider opportunities for population-focused practice that result from the rapid transformation of health care delivery from a medical model to a health promotion/disease prevention model. An example of such opportunity is: A) Operator of a nurse practitioner-run urgent care center in a major retail location. B) Director of clinical services spanning inpatient and community-based settings that provide a wide range of services to the populations seen by the system. C) Clinical director of a home health agency. D) School nurse position in the local high school.

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.

The Superfund Amendments and Reauthorization Act (SARA) increased the involvement of the states and their citizens in the cleanup of toxic waste sites and stressed the importance of permanent remedies and innovative treatment technologies. Another important aspect of this federal legislation was that it: A) Provided for the appointment of state emergency response commissions. B) Increased focus on the human health problems related to hazardous waste sites. C) Established a new safety standard of reasonable certainty of no harm that is to be applied to all pesticides used on food. D) Reduced the amount of pollution by mandating cost-effective changes in production, operation, and raw materials use.

The U.S. public health system is operated at three distinct levels with collaboration and interface across all levels. The agency that assumes the responsibility for improving health by expanding access to primary care for low-income, uninsured, or rural individuals is: A) Agency for Healthcare Research and Quality. B) Health Resources and Services Administration. C) Local health department. D) State department of health.

The community planning board's evaluation of a community intervention (child immunization campaign) carried out by the health department determined that some progress was made toward the desired outcome (target rate of childhood immunization), but the degree of progress achieved was not sufficient to offset the initial effort in terms of cost and time to launch the campaign. The community determined that the rate gain was not adequate when compared with that achieved through similar initiatives in other communities, which obtained better results by using more efficient strategies. The budget for this program was cut. This community decision best exemplifies which statement about evaluation? A) Evaluation should start in the planning phase of the nursing process. B) Evaluation can have unintended consequences. C) Effectiveness is the only true measure of worthiness. D) The power to design, judge, or institute change is important.

The monitoring and public reporting of air quality in a local community to assist individuals with asthma or other respiratory conditions best illustrates the application of: A) Compliance and enforcement. B) Environmental epidemiology. C) Secondary prevention. D) Toxicology.

The public health nurse ensures that a local community coalition for improving school lunches takes the time to listen to each stakeholder's view, develops a common validated language for discussing the initiative, and shares the credit for the success of the initiative. The public health nurse is adhering to the principles of: A) Collaboration. B) Partnership. C) Public health care. D) Public health nursing.

The public health nurse serves as a bridge between at-risk populations and the community's health care resources. This role is based on the nurse's responsibility to: A) Collect and analyze data on public health programs. B) Ensure that all populations have access to affordable, quality health care. C) Monitor and assess critical health status indicators. D) Provide evidence-based use of resources.

There is strong evidence to suggest that poverty can be directly related to poor health outcomes. Poorer health outcomes lead to reduced educational outcomes for children, poor nutrition, low productivity in the adult workforce, and unstable economic growth in the population, community, and nation. These concepts reflect the human capital approach of the branch of economics known as: A) Effectiveness and efficiency. B) Macroeconomics. C) Microeconomics. D) Supply and demand.

When a public health nurse 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.

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.

Public health nursing specialists are interested in which of the following topic(s)? Select all that apply. A) Educational materials for individuals with HIV/AIDS. B) Evaluation of an outreach program for at-risk pregnant teenagers. C) Community subpopulations with high rates of type 2 diabetes. D) New technologies to monitor diabetes. E) Prevalence of hypertension among various age, race, and gender groups.

B, C, E

What are the 3 main characteristics of a successful partnership?

Being informed flexibility negotiation

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.

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) 1998 = 2/100,000; 1999 = 3/100,000; 2000 = 1/100,000 B) 1998 = 4/100,000; 1999 = 8/100,000; 2000 = 6/100,000 C) 1998 = 12/100,000; 1999 = 8/100,000; 2000 = 31/100,000 D) 1998 = 16/100,000; 1999 = 24/100,000; 2000 = 9/100,000

A nurse has been newly appointed as commissioner of the state health department services. The programs the nurse will oversee will most likely include: A) Administration of Medicare reimbursement rates and eligibility determination. B) Programs involving citizens in the local community, including sanitation and communicable disease contact tracing. C) Disaster response, health care financing and administration of programs such as Medicaid, and establishment of health codes. D) Monitoring of drugs and over-the-counter products available for sale and use by consumers.

A registered nurse is seeking a position as a public health nurse. In reviewing the job description the nurse would expect to find a description of a position that focused on functions such as: A) Monitoring pregnant teenagers for symptoms of complications of pregnancy. B) Offering free hypertension screening and treatment referral at local health fairs to low-income, uninsured, community members. C) Partnering with local seasonal farmworkers to design a program aimed at preventing illness and injury, and advocating for this population with local political and community leaders. D) Preventing injury among a population of elderly residents in an assisted living facility and treating residents' chronic illnesses.

A rural public health nurse is in the first phase of a community assessment to determine the community health status characteristics of the local county. This initial data gathering should most likely begin with which agency? A) County public health department. B) National Centers for Disease Control and Prevention. C) State vital statistics bureau. D) U.S. Census Bureau.

A small business employer desires to control company benefit expenditures by turning health care decision-making control over to the employees. The insurance reform mechanism that best addresses the shifting of responsibility, knowledge, and decision-making involvement to the individual receiving the care is: A) Health spending account. B) Managed care. C) Medical savings account (MSA). D) Prospective payment.

After consulting with the health department director, a public health nurse collaborates with a housing advocate service and legal counsel on behalf of the nurse's clients who live in substandard housing under fear of eviction. The nurse is applying the _______ component of the nursing process to a _______ level of practice. A) Evaluation + systems. B) Assessment + community. C) Implementation + systems. D) Diagnosis + community.

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) Hospital acquired infections. D) Severe acute respiratory syndrome.

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.

Collaboration is an intervention that would be located where in the Intervention Wheel? A) Red wedge at the individual/family level of practice. B) Blue wedge at the community level of practice. C) Orange wedge at the community level of practice. D) Green wedge at the systems level of practice.

Examples of the application of evidence-based practice (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.

If the two major goals of Healthy People 2020 are to be achieved, collaboration is essential for public health nursing practice, and collaboration with existing groups at the local level is encouraged for which of the following reasons? A) The federal government is ultimately responsible for the health status of the nation. B) The public demands that the government protect the people. C) Public health departments do not have the resources to accomplish these goals independently. D) State health agencies must take a universal approach to achieving objectives.

In evaluation of a program to prevent teen pregnancy, analysis of the net direct and indirect costs, the improvements in the community attributable to the program (such as lower high school dropout rates), and the costs that would result if the program were not implemented (such as the cost of care for low-birth-weight infants) is an example of which of the following? A) Cost-benefit analysis. B) Cost-efficiency analysis. C) Cost-effectiveness analysis. D) Economic growth predictions.

Rapid changes in public health are providing a challenge to public health nurses because there is neither time nor staff to provide nurses with the on-the-job training needed to acquire the core public health competencies required of the public health nurse. This resulted in revisions to the American Nurses Association (ANA)'s Scope and Standards of Public Health Nursing Practice in 2005 that established: A) Core public health functions as the competency framework. B) Minnesota Department of Health's intervention wheel as the practice competencies. C) Standards for baccalaureate- and master's-prepared public health nurses. D) Quad Council principles as the primary framework for practice.

State public health agency responsibilities include: A) Conducting community health assessments. B) Enforcing public health codes. C) Monitoring health status. D) Providing expertise that facilitates evidence-based practice.

The 1989 changes to Medicaid Title XIX required states to provide care for children younger than age 6 years and pregnant women with incomes less than 133% of the federal poverty level. These changes also ensured adequate access to qualified providers by: A) Adding coverage for the medically indigent. B) Reimbursing the costs of early periodic screening, diagnosis, and treatment for those younger than age 21 years. C) Reimbursing for treatment by pediatric and family nurse practitioners. D) Reimbursing for skilled and intermediate nursing home care.

The goal of the primary health care system is to achieve the objective "Health for All in the 21st Century," set forth by the World Health Organization (WHO). The major barrier to achieving this objective in the United States is that: A) Global indicators are not applicable to the United States. B) Healthy People 2020 is not consistent with the Declaration of Alma-Ata. C) Primary health care is not the primary delivery method for health care in the United States. D) The U.S public health system is not structured to provide primary health care.

The impact of the baby boomer generation on the future of health care can best be described as: A) Decrease in demand because they are a healthier group of older adults. B) Decrease in demand because they are less likely to use preventive care. C) Increase in demand because of increased life expectancy. D) Increase in demand because rates of acute health problems.

The local nurse-managed clinic/center initiative is providing community-based primary and preventive care as well as specialty care, community screenings, local health assessments, health education, and health care coordination, targeted to medically uninsured individuals regardless of ability to pay. This initiative best describes a system of: A) Managed care. B) Primary care. C) Primary health care. D) Private health care.

The major factor that drives the current discussions about a Medicare shortfall in the middle of the twenty-first century is: A) Diversity of the U.S. health care workforce. B) Longevity of the U.S. population. C) Percentage of elderly in the U.S. population. D) Percentage of foreign-born in the U.S. population.

The most important aspect of the nursing community assessment phase can best be described as: A) Analyzing and synthesizing data. B) Collecting and gathering data. C) Formulating a community nursing diagnosis. D) Identifying problem correlates.

The role and goals of the community health nursing practice can best be described as: A) Community-based interventions aimed at promoting, preserving, and maintaining the health of populations residing in institutional facilities such as nursing homes. B) Education of nurses and other staff working in community-based and community-oriented settings to improve the overall effectiveness of their programs to meet client needs. C) Population-level strategies aimed at promoting, preserving, and maintaining the health of populations through the delivery of personal health care services to individuals, families, and groups in an effort to improve the health of the community as a whole. D) Activities targeted at improving the health status of clients served by community-based health service agencies such as hospice and home health agencies.

The three components of the Intervention Wheel are: A) Communities, systems, and individuals/families. B) Interventions, color wedges, and levels of practice. C) Population base, levels of practice, and public health interventions. D) Populations at risk, populations of interest, and levels of practice.

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.

Which action by the community-oriented nurse best illustrates a partnership for health? A) Assisting a school nurse in conducting vision screening of elementary school children. B) Developing a volunteer program for teaching parenting skills. C) Helping a group of citizens concerned about potential environmental hazards collect relevant health data and develop needed interventions. D) Informing a neighborhood council that smoking is its major community health problem.

Which of the following article titles include(s) an example of epidemiologic distribution and determinants (select all that apply)? 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

What are CBRNE threats?

C-chemical B-biological R-Radiological N-Nuclear E-Explosive

_____locates individuals and families with identified risk factors and connects them with resources.

Case finding

_________optimizes self-care capabilities of individuals and families and the capacity of systems and communities to coordinate and provide services.

Case management

______ promotes and develops alliances among organizations or constituencies for a common purpose.

Coalition building

_______ commits two or more persons or organizations to achieve a common goal through enhancing the capacity of one or more of the members to promote and protect health.

Collaboration

The orange wedge includes which interventions?

Collaboration Community organization building

_________is one of three core functions of PHN and is the process of critically thinking about the community.

Community Assessment

_______ helps community groups to identify common problems or goals, mobilize resources, and develop and implement strategies for reaching the goals they collectively have set.

Community organizing

___________ is necessary because when there is a __________, lay community members have a vested interest in the success of efforts to improve the health of their community.

Community partnerships; community partnerships

__________changes community norms, community attitudes, commnity awareness, community practices, and community behaviors.

Community-level practice

_______ seeks information and generates optional solutions to perceived problems or issues through interactive problem solving with a community, system, family, or individual.

Consultation

_________ establishes an interpersonal relationship with a community, system, family, or individual intended to increase or enhance their capacity for self-care and coping.

Counseling

Ethnicity represents the identifying characteristics of ________, such as race, religion, or national origin and affects beliefs, behaviors, and access to resources.

Culture

__________ is a set of beliefs, values, and assumptions about life that are widely heald among a group of people and that are transmitted intergenerationaly. This develops over time and is resistant to change.

Culture

The incidence proportion is also referred to as the __________(and erroneously simply as the incidence rate) because it reflects the cumulative effect of the incidence rate over the time period, whether it is a month, a year, or several years.

Cumulative incidence rate

A community-oriented nurse leader is working with a community partnership to improve access to services for the underserved by planning an expansion of the local community health clinic. This nursing intervention strategy is focused on which of the following community health dimensions? A) Environment. B) Health status. C) Process. D) Structure.

A nurse identifies higher-than-normal levels of lead when screening a 3-year-old child. The nurse works with the local health department to put together a team to address the environmental issues responsible for the child's abnormal lead level. Team members should include the following specialists: A) Epidemiologist, pediatric specialist, and sanitarian. B) Laboratory specialist, contractor whose bid for lead reduction work is the lowest, and public health lead reduction specialist. C) Public health sanitarian, pediatric generalist, and plumbing inspector. D) Specially trained housing inspector, pediatric specialist, lead-based paint intervention team, and laboratory specialists to test the child's home and the surrounding neighborhood.

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.

A public health nurse leader is encountering barriers when trying to shift the public health agency's efforts to a population-focused practice. The reasons peers are not supportive of the proposed shift to a population focus are most likely related to: A) Agency colleagues' push for nurses to focus on population initiatives. B) Costs associated with staff training and revision of documents. C) Lack of support from the agency's funding sources. D) Opinions that nursing should focus on the provision of direct client care and services.

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.

An occupational health nurse practitioner's physical assessment of a factory worker identifies an acute-onset pruritic dermatitis extending over the face, hands, neck, and forearms. The nurse's priorities should be to: A) Contact factory senior management, educate workers about their exposure, and clean the area. B) Contact the Occupational Safety and Health Administration immediately and remove the offending chemical in the work environment. C) Immediately evacuate the worker's nearby workspace and treat the worker and other exposed workers. D) Treat the client and obtain a comprehensive exposure history; if an onsite environmental exposure is suspected as the cause, screen other at-risk workers and ensure that the environmental risk is identified and eliminated.

Campaigns to decrease the inequitable burden of environmental risks on the poor and people of color in the United States strive to apply the ethical principle of: A) Societal justice. B) Nonmaleficence. C) Compliance and enforcement of the Environmental Protection Agency Regulatory Act. D) Environmental justice.

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) Even-related clusters. C) Point epidemic. D) Secular trends.

In 1988 the Institute of Medicine (IOM) published a report on the future of public health and its mission that defined public health as: A) What public-private partnerships do to treat vulnerable populations. B) What the government does to ensure that vital programs are in place. C) What the U.S. Public Health Service does to prevent disease, promote health, and deliver services. D) What society does collectively to ensure the conditions in which people can be healthy.

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.

Of the four major factors that affect health-personal behavior/lifestyle, environmental factors (physical, social, economic), human biology, and the health care system-medical services are said to have the least effect. Yet the U.S. health care system remains reactionary, with high-cost, high-technology, and disease-specific "sickness care." These statements support the public health goal of: A) Expanding managed care for the underserved. B) Expanding secondary prevention in the schools. C) Increasing tertiary prevention in skilled nursing facilities. D) Preserving and maximizing human capital.

Promotion of the creation of immunization registries that combine immunization information from different sources into a single electronic record to provide official immunization records for schools, daycare centers, health departments, and clinics is a goal of: A) Community-level practice. B) Family-level practice. C) Individual-level practice. D) Systems-level practice.

The intervention used to influence the knowledge, attitudes, values, beliefs, behaviors, and practices of the population of interest is referred to as: A) Advocacy. B) Coalition building. C) Consultation. D) Social marketing.

When applying the nursing process to environmental health, the nurse would: A) Conduct an assessment focused on the client's presenting problem. B) Coordinate interventions with the primary care provider of record. C) Examine criteria that are limited to the client's immediate responses. D) Include outcome measures that involve mitigation and elimination of the contributing factors.

Which community attribute is an indicator of a community's health status? A) Mean educational level. B) Location of health facilities within the community. C) Ratio of police to citizens. D) Suicide rate.

________is the process of obtaining existing, readily available data.

Data gathering

__________ are direct care tasks a registered professional nurse carries out under the authority of a health care practioner as allowed by law.

Delegated functions

_____________systematically gathers and analyzes data regarding threats to the health of populations, ascertains the source of the threat, identifies cases and others at risk, and determines control measures.

Disease and other health event investigation

_________ is responsible for developing and coordinating emergency response plans within their defined area, whether local, state, federal, or tribal.

Emergency management

_______refers to the constant presence of a disease within a geographic area or a population.

Endemic

________ has been defined as "the study of the occurrence and distribution of health-related states or events in specified populations, including the study of the determinants influencing such states, and the application of this knowledge to control the health problems.

Epidemiology

_________ is removing a disease worldwide by ending all transmission of infection through the complete extermination of the infectious agent.

Eradication

__________ is the shared feeling of peoplehood among a group of individuals. This reflects membership in a cultural group and is based on individuals sharing similar cultural patterns (e.g., faimly structures, beliefs, and dietary habits).

Ethnicity

______ is a state of complex physical, mental and social well-being, and not merely the absence of disease or infirmity, is a fundamental human right and the attainment of the highest possible level of health is a most important world-wide social goal.

Health

______ is the core concept in nursing and epidemiology.

Health

The _____________ at the national level recognizes the need to work collectively, in community partnerships, to bring about the changes that necessary to fulfill this vision.

Health People 2020

The _______is the agency most heavily involved with the health and welfare concerns of U.S. Citizens.

Health and Human services (HHS)

What are some functions of a state health department?

Health care financing and administration for programs such as Medicaid, providing mental health and professional eduction, establishing health codes, licensing facilities and personnel, and regulating the insurance industry

________communicates facts, ideas, and skills that change knowledge, attitudes, values, beliefs, behaviors, and practices of individuals, families, systems, and/or communities.

Health teaching

The blue wedge includes which interventions?

Health teaching counseling consultation

Disaster incidents have an effect on almost every _________________ objective.

Healthy People 2020

______provides science-based, 10 year national objectives for improving the health of all americans.

Healthy People documents

_______ is needed when early treatment is important and when identification of every case is important.

High sensitivity

___________ is needed when rescreening is impractical and when reduction of false positives is important.

High specificity

_________ is the person-to-person spread of infection through one or more of the following four routes: direct/indirect contact, common vehicle, airborne, or vector-borne.

Horizontal transmission

_____ quantifies the rate of development of new cases in a population at risk, whereas an _______ indicates the proportion of the population at risk who experience the event over some period of time, for example, the proportion of the population who develop influenza during a given year.

Incidence rate; incidence proportion

What is an example of the public health core function, Assessment?

Includes activities that involve collecting, analyzing, and disseminating information on both the health status and the health-related aspects of ocmmunity or a specific population. This also includes an ongoing effort to monitor the health status of the community or population and the services provided. Excellent examples at the national level are the efforts of the USDHHS to organize the goal setting, data collecting and analysis, and monitoring necessary to develop the series of publications describing the health status and health-related aspects of the U.S. population.

_______changes knowledge, atttitudes, beliefs, practices, and behaviors of individuals.

Individual-level practice

What does the Nursing Section of WADEM serve?

It serves to welcome and represent nurses from all countries with an intent and desire to strengthen and improve the practice and knowledge of disaster nursing.

Community partnership is a basic focus of such population-centered approaches as ......

Moblizing for action through planning and partnerships (MAPP)

_______ refers to events and factors related to or caused by disease or disability.

Morbidity

The NNDSS data are collated and published weekly in the __________.

Morbidity and Mortality Weekly Report (MMWR)

_______refers to events and factors related to death.

Mortality

The _______ is the world's premier medical research organization.

National Institutes of Health (NIH)

What is the definition of public health:

Organized community and multidisciplinary efforts, based on epidemiology, aimed at preventing disease and promoting health. (What we, as a society, do collectively to assure the condition in which people can be healthy.)

________locates populations of interest or populations at risk and provides information about the nature of the concern, what can be done about it, and how services can be obtained.

Outreach

___________ is the more common form used by most local and state health departments.

Passive surveillance

Then state and local emergency planners ensure ____________, to provide prophylaxis is the entire population within 48 hours.

Points of Dispensing (POD)

_____________in the public arena seeks to build constituencies that can help bring about change in the public policy.

Policy Development

______ places health issues on decision-makers' agendas, acquires a plan of resolution, and determines needed resources.

Policy development

_____ compels others to comply with the laws, rules, regulations, ordinances, and policies created in conjunction with policy development.

Policy enforcement

______ promotes health and protects against threats to health.

Primary prevention

The U.S. ________ is a major component of the HHS.

Public Health Service (PHS)

______ has been described as a system and social enterprise; a profession; a collection of methods, knowledge, and techniques; governmental health services, especially medical care for the poor and undeserved; and the health status of the public.

Public health

The ______is mandated through laws that are developed at the national, state, or local level.

Public health system

__________ is primarily a social classification that relies on physical markers such as skin color to identify group membership.

Race

What is the definition disparities.

Racial or ehtnic differences in the quality of health care, not based on access or clinical needs, preferences, or appropriateness of an intervention

_________assists individuals, families, groups, organizations, and/or communities to identify and access necessary resources in order to prevent or resolve problems or concerns.

Referral and follow-up

The green wedge includes which interventions?

Referral and follow-up Case management Delegated functions

Define Assessment.

Refers to systematically collecting data n the population, monitoring the populations health status and making information available about the health of the community.

Define Policy Development.

Refers to the need to provide leadership in developing policies that support the health of the population, including the use of the scientific knowledge base in making decisions about policy.

Define Assurance.

Refers to the role of the public health in ensuring that essential community-oriented health services are available, which may include providing essential personal health services for those who would otherwise not recieve them. This also refers to making sure that a competent public health and personal health care workforce is available.

_____ refers to the probability that an event will occur within a specified time period

Risk

_____ detects and treats problems in their early stages. It keeps problems from causing serious or long-term effects or from affecting others.

Secondary prevention

_______quantifies how accurately the test identifies those with the condition or trait.

Sensitivity

___________ has been indentified as one of the leading candidate agents for bioterrorism.

Smallpox

______ is the branch of epidemiology that studies the social distribution and social determinants of health and disease.

Social epidemiology

______ uses commercial marketing principles and technologies for programs designed to influence the knowledge, attitudes, values, beliefs, behaviors, and practice of the population of interest.

Social marketing

______ indicates how accurately the test identifies those without the condition or trait.

Specificity

In addition to standing ready for disaster prevention or response, ____________ have other equally important functions.

State health departments

_________, on a voluntary basis, report cases of slected disease to the CDC through the National Notifiable Diseases Surveillance System (NNDSS).

State health departments

________ collaborate with the CDC to determine which diseases should be nationally notifiable.

State public health officials

__________ gathers the "who, when, where, and what"; these elements are then used to answer "why."

Surveillance

_________describes and monitors health events through ongoing and systematic collection, analysis, and interpretation of health data for the purpose of planning, implementing, and evaluating public health interventions.

Surveillance

_____involves the systematic collection, analysis, and interpretation of data related to the occurrence of disease and the health status of a given population.

Surveillance

The red wedge includes which interventions?

Surveillance Disease and health event investigation Outreach screening

_______ changes organizations, policies, laws, and power structures within communities.

Systems-level practice

________ limits further negative effects from a problem. It keeps existing problems from getting worse.

Tertiary prevention

What is the FEMA?

The Federal Emergency Management Agency is a coordination entitity responsible for creating a comprehensive, all-hazard plan that incorporates scenarios that illustrate plausible major incidents that may affect their community.

The _____ serves as a national focus for efforts to assure the delivery of health care to residents of medically under served areas and to persons with special health care needs.

The Health Resources and Services Administration (HRSA)

What is are examples of EBP in public health nursing?

The intervention wheel and it's 17 interventions; Health Care Reform also supports EBP.

What is the Public Health Security and Bioterrorism Preparedness and Response Act of 2002?

This addressed the need to enhance public health and health care readiness and community health care infrastructures.It reaffirmed the public health department role on the front line of disaster prevention, preparedness, response, and recovery, to include a national need for "...emergency-ready public health and healthcare services in every community."

________is the basic science applied to understanding the health effects associated with chemical exposures.

Toxicology

______ are one of the most effective methods of preventing and controlling communicable diseases.

Vaccines

___________ are one of the most effective methods of preventing and controlling communicable diseases.

Vaccines

______in a screening test is measured by sensitivity and specificity.

Validity

3 major sources of error can affect the reliability of measurement: -_______inherent in the trait being measured -________, which can be divided into intraobserver reliability and inter-observer reliability -______________, which includes the internal consistency of the instrument and the stability of the instrument over time

Variation Observer variation Inconsistency in the instrument

_________are the motorized quivalent of simple observation. They involve the generation of data that helps to define the community, the trends, stability, and changes that all serve to define the health of the community.

Windshield surveys

What are the 3 components of the intervention wheel

a population basis three levels of practice 17 interventions

a,b,d,e

_________ is the resistance acquired by a host as a result of previous natural exposure to an infectious agent.

acquired immunity

_______ refers to the immunization of an individual by administration of an antigen and is usually characterized by the presence of an antibody produced by the individual host.

active immunization

Surveillance systems are often classified as either ______ or _______.

active or passive

Most changes must aim at improving community health through ________between community residents and health workers from a variety of disciplines.

active partnerships

Coalition building builds linkages, solves problems, and/or enhances local leadership to .....

address health concerns.

_________pleads someone's cause or acts on someone's behalf, with a focus on developing the capacity of the community, system, individual, or family to plead their own cause or act on their own behalf.

advocacy

As an _______, the public health nurse collects, monitors, and analyzes data and works with the client to identify and prioritize needed services, whether the client is an individual, a family, a community, or a population.

advocate

What are the 3 elements of the epidemiologic triangle?

agent, host and environment

An _______ is a collection of individuals who have in common one or more personal or environmental characteristics.

aggregate

______focuses on investigations of causes and associations.

analytic epidemiology

What are the categories of public health workforce competencies?

analytic/assessment policy development/program planning communication cultural competency community dimensions of practice basic public health sciences financial planning and management leadership and systems thinking

Delegated functions also includes......

any direct care tasks a registered professional nurse entrusts to other appropriate personnel to perform.

What are the 3 public health core functions?

assessment, policy development, assurance

Another measure of morbidity, often used in infectious disease investigations, is the _______.

attack rate

What are some things to look for during a windshield survey?

boundaries, demographics, amentities and open spaces, transportation, safety, commerical buildings, government offices, health services, schools, residential areas, religious facilities, communication, environment, any other pertinent observations

______ is usually a proportion: the proportion of persons diagnosed with a particular disorder that dies within a specified time period.

case fatality rate (CFR)

All interventions, except for which 3 are applicable at all three levels of practice?

case finding, coalition building, and community organizing

__________ is another major role for public health nurses. They assist clients in identifying the services they need the most at the least cost. They also assist communities and populations in identifying and linking with services that will increase the overall population health status.

case manager

Epidemiologists understand that disease results from complex relationships among......

causal agents, susceptible persons, and environmental factors.

Content-focused roles often are considered _______ roles, whereas process roles are called _______roles.

change agent; change partner

__________ is the affective and cognitive attachment to a community "that is worthy of substantial effort to sustain and enhance

commitment

___________ refers to transportation of the infectious agent from an infected host to a susceptible host via food, water, milk, blood, serum, saliva, or plasma.

common vehicle

______ diseases are preventable.

communicable

Interventions at the secondary level of prevention may occur in ______ as well as within primary and secondary levels of health care services.

community settings

This model encompasses three levels of practice which are?

community, systems, and individual/family

The goal of _________ is to increase the knowledge and attitude of the entire community about the importance of immunization and the consequences of not being immunized.

community-level practice

The federal government looks to the Division of Nursing to provide the _______ and _________ for administering nurse education legislation, interpreting trends and needs of the nursing component of the nations health care delivery system, and maintain a liason with the nursing community.

competence and expertise

What are some ways nurses can serve in the state health departments?

consultants, direct service providers, researchers, teachers, supervisors, program development, planning, and evaluation of health programs

______is the process of developing data that do not already exist through interaction with community members or groups.

data generation

_________ seeks to describe the occurence of a disease in terms of person, place, and time.

descriptive epidemiology

The how and why, or _______ of health events, are those factors, exposures, characteristics, behaviors, and contexts that determine (or influence) the patterns.

determinants

Tertiary prevention includes interventions aimed at _____________ and ___________ from disease, injury, or disability.

disability limitation and rehabilitation

A __________ is any natural or human-made incident that causes disruption, destruction, and/or devastation requiring external assistance.

disaster

Changes in the characteristics of any of these three (agent, host, environment) may result in ___________.

disease transmission

The public health nurse is an ________, teaching to the level of the client so that information received is information that can be used. The PHN identifies community needs and develops and implements educational activities aimed at changing behaviors over time.

educator

At the community-level practice, PHN's work with health ________ on public awareness campaigns.

educators

__________is the accurate transmission of information based on the development of common meaning among the communicators

effective communication

The Public health service (PHS) consists of _____ agencies.

eight

The goal of _______ is to remove disease from a large geographic area such as a country or region of the world.

elimination

Counseling engages the community, system, family, or individual at an ________ level.

emotional

In the language of community ________ advocates, community participants must have an active role in the change process.

empowerment

Pertussis is _________ in the US

endemic

Community-level practice is directed toward _________ within the community or occasionally toward populations at risk or populations of interest.

entire populations

For example, one case of polio, a disease considered eliminated from the US, would be considered a ________.

epidemic

There is no specific threshold of incidence that indicates the existence of an _________.

epidemic

________refers to the occurrence of disease in a community or region in excess of normal expectancy.

epidemic

HIV disease is both _______ and ______, as the number of cases continues to grow across various regions of the world as well as in the US.

epidemic and pandemic

An ________ occurs when the rate of disease, injury, or other condition exceeds the usual (________) level of that condition.

epidemic; endemic

Simply defined, ____ is the appraisal of the effects of some organized activity or program.

evaluation

Every state has a board of ___________.

examiners of nurses

attack rates are often specific to an ________ or _______ specific attack rates.

exposure; food

Individual-level practice is directed at individuals, alone or as part of a ________.

family, class or group

Mortality rates are informative only for ______ and do not provide direct information about either the level of existing disease in the population or the risk of contracting any particular disease.

fatal diseases

The public health system is organized into many levels in the _______,______,______systems.

federal, state, local

What are some special or selected services that public health nurses display at the local health departments?

follow up of contacts in cases of TB or other diseases, child immunization clinics, delivering services to families in certain geographic areas.

Many infants and toddlers, the group most vulnerable to these potentially severe diseases, do not receive scheduled immunizations despite the availability of ________.

free vaccines

A ____________ systematically collects, organizes, and analyzes current, accurate, and complete data for a defined disease condition.

good surveillance system

The focus of systems-level practice is on the systems that impact ________, do directly on individuals and communities.

health

The HHS is charged with regulating ________ and overseeing the health status of Americans.

health care

At the local level, _________ provide care that is mandated by state and federal regulations

health departments

The first level of prevention includes broad efforts such as .....?

health promotion, environmental protection, and specific protection.

_________ are the mainstay of secondary prevention.

health screening

Disaster kits should be made for the ______, _____, and_____.

home, workplace, and car

Most factors that cause the emergence of infectious diseases are influenced by ________.

human activities and behavior

Communicable diseases represent an imbalance in the harmonious relationship between the _____________ and the ___________.

human host; environment

The burden of infectious diseases is high in both _____ and _______ terms.

human; economic

________the fifth phase of the nursing process, involves the work and activities aimed at achieving the goals and objectives.

implementation

Infectious disease surveillance ______and______data from a variety of sources.

incorporates and analyzes.

Changes in one of the elements of the triangle can influence the occurrence of disease by ________ or _____ a person's risk for disease.

increasing or decreasing

Case finding is the ___________ level of surveillance, disease and other health event investigation, outreach, and screening.

individual

Community organizing and coalition building cannot occur at the _______level.

individual

Teaching effective refusal skills to groups of adolscents is an example of ________ level and _______ prevention strategy practice.

individual/family level secondary prevention

Effective intervention measures at the ______ and ______ levels must be aimed at breaking the chain linking the agent, host and environment.

individual; community

What are the 3 factors that make up the epidemiologic triangle.

infectious agent, host, and environment

From a health care standpoint the disaster event type and timing predict subsequent ______ and _________.

injuries and illnesses

The parts of a community are ________, and their function is to meet a wide variety of collective needs.

interdependent

_______are the strategies used to meet the objectives, the ways change will be effected, and the ways the problem cycle will be broken.

intervention activities

The intervention wheel depicts how public health improve population health through _________ with communities, the individuals and families that comprise communities, and the systems that impact the health of communities.

interventions

What makes public health nursing a specialty?

it has a distinct focus and scope of practice and it requires a special knowledge base.

Policy development results in what?

laws, rules, regulations, ordinances, and polices

A key concept in epidemiology is that of the ___________; based on the stages in the natural history of disease.

levels of prevention

State systems also have an imporant role in direct assistance to ________, including ongoing assessment of health needs.

local health departments

At the ________, health departments provide care that is mandated by the ______ and _______regulations.

local level; state; federal

All-hazards __________ (________) is an emergency management term for reducing risks to people and property from natural hazards before they occur.

mitigation (prevention)

______ are key epidemiologic indicators of interest to nurses.

mortality rates

Effective control of communicable disease requires the use of a ________ focusing on enhancing host resistance, improving safety of the environment, improving public health systems, and facilitating social and political changes to ensure health for all people.

multisystem approach

The _________ is the course of the disease process from onset to resolution.

natural history of disease

________ refers to species-determined, innate resistance to an infectious agent.

natural immunity

In toxicology, only the _____ effects of chemical exposures are studied.

negative

In other words, the proportion of persons whom the test correctly identifies as ________ for the disease (________).

negative (true negatives)

A ________ is one for which regular, frequent, and timely information regarding individual cases is considered necessary for the prevention and control of the disease.

notifiable disease

A component of the Health Resources and Services Administration (HRSA), the Bureau of Health Professions, includes separate divisions for ______, medicine, _______, _________, and allied health professions.

nursing; dentistry, public health

At the community-level practice, PHN's perform ________ at schools, senior centers, county fairs, community festivals, and neighborhood laundromats.

outreach

______ refers to an epidemic occurring worldwide and affecting large populations.

pandemic

________ is a concept that is as essential for nurses to know and use as are the concepts of community, community as client, and community health.

partnership

______ refers to immunization through the transfer of a specific antibody from an immunized individual to a non-immunized individual, such as the transfer of antibody from mother to infant or by administration of an antibody-containing preparation.

passive immunization

______is the opposite of the partnership approach in which all are involved in assessing, planning, and implementing needed community changes.

passive participation

Public health nurses play a key role in community preparedness, but they must accomplish the critical elements of _______ and _________ preparedness first.

personal and professional

Disaster disproportionably strikes at-risk individuals, whether their day-to-day risk is ______,______, or ________.

physical, emotional, or economic

Initial signs and symptoms of __________ are non-specific and include myalgia,malaise, fever, chills, sore throat, and headache

plague

The intervention wheel is a model that is......

population based

A _____ or ______ is a collection of individuals who have one or more personal or environmental characteristics in common.

population or aggregate

The intervention wheel provides a graphic illustration of _________

population-based public health practice

__________seeks healthful change for the whole community's benefit.

population-centered practice

In other words, sensitivity represents the proportion of persons with the disease whom the test correctly identifies as _______ (________).

positive (true positives)

_______ is a measure of existing disease in a population at a particular time (i.e. the number of existing cases divided by the current population).

prevalence proportion

_____ can include structural measures, such as protecting building and infrastructure from the forces of wind and water, and non-structural measures, such as land development restrictions.

prevention

Avoiding infection through _________ activities is the most cost-effective public health strategy.

primary prevention

In prevention and control of infectious disease, ___________ seeks to reduce the incidence of disease by preventing occurrence, and this effort is often assisted by the government.

primary prevention

Secondary prevention encompasses interventions designed to increase the ________ that a person with a disease will have that condition diagnosed at a stage wen treatment is likely to result in cure.

probability

The _______, or the likelihod that the means can be implemented, is highest when only the nurse is involved, because the nruse has more control over self-behavior than over the behavior of others.

probablity

_____ is a type of ratio in which the denominator includes the numerator

proportion

________was defined as "what we, as a society, do collectively to assure the condition in which people can be healthy."

public health

The _______ is mandated through laws that are developed at the national, state, or local level.

public health system

Individuals may be of the same ________ but of different _________.

race; culture

______ is a measure of the frequency of a health event in a defined population, usually in a specified period of time.

rate

A rate is a _____, but it is not a ______, because the denominator is a function of both the population size and the dimension of time, whereas the numerator is the number of events.

ratio; proportion

The precision, or ________, of the measure (i.e., its consistency or repeatability) and its validity or accuracy (i.e., whether it really measures what we think it is measuring, and how exact the measurement is ) are important considerations for any measurement.

reliability

Diseases such as polio, diphtheria, pertusses, and measles, which previously occurred in epidemic proportions, are now controlled by __________.

routine childhood immunization

An adequate supply of health care providers for placement in underserved areas is ensured through the NHSC (National Health Service Corps ___________ program and the NHSC _________ programs.

scholarship; and loan repayment

________identifies individuals with unrecognized health risk factors or asymptomatic disease conditions in populations

screening

Tertiary prevention interventions occur most often at .....?

secondary and tertiary levels of care (e.g., specialized clinics, hospitals, rehabilitation centers) but may also occur in community and primary care settings.

The goal of __________ is to prevent the spread of infection and/or disease once it occurs.

secondary prevention

Good disaster preparedness planning involves ________ and _______ with back-up contingencies because (1) plans never exactly fit the disaster as it occurs, and (2) all plans need implementation viability, no matter which key members are present at the time.

simplicity and realism

An example of community-level practice is a __________campaign to promote a community norm that serving alcohol to under-aged youth at high school graduation parties is unacceptable.This is a _________ level ________ prevention strategy.

social marketing community level primary prevention

Services and programs offered by local health departments vary depending on what?

state and local health codes that must be followed. the needs of the community, and available funding and other resources

Requirements for disease reporting in the US are mandated by ______ rather than _______ law and as such, vary slightly from _____to_______.

state; federal; state to state

strategy.social marketing community level primary prevention

Each culture has an organizational ________ that distinguishes it from others and provides the structure for what members of the cultural group determine as appropriate of inappropriate _________.

structure; behavior

Interventions at the primary level of prevention are aimed at individuals and groups who are.....?

susceptible to disease but have no discernible pathology.

Conducting compliance checks to ensure that bars and liquor stores do not serve minors or sell to individuals who supply alcohol to minors is an example of a ________level and ________prevention strategy practice.

systems level secondary prevention

_________ works to reduce complications and disabilities through treatment and rehabilitation.

tertiary prevention

The local health departments have direct responsiblity to who?

the citizens in its community or jurisdiction

Why do they use surveillance data?

to assess and prioritize the health needs of populations, design public health and clinical services to address those needs, and evaluate the effectiveness of public health programs.

The _______ of communicable disease depends on the successful interaction of the infectious agent, the host, and the environment.

transmission

________ is sometimes referred to as "rabbit fever" or "deer fly fever" and is a zoonotic disease caused by the bacterial agent F. tularensis which is carried commonly by wild animals, especially rabiits, as well as muskrats, voles, beavers, some domestic animals, and some ticks, mosquitoes,and flies.

tularemia

The _______, or the likelihood that the activity will help meet the objective and finally resolve the problem.

value

Passive surveillance is relatively inexpensive but is limited by ....

variability and incompleteness in provider reporting practices.

_______ are arthropods such as ticks and mosquitoes or other invertebrates such as snails that transmit the infectious agent by biting or depositing the infective material near the host.

vectors

_______ is the passing of the infection from parent to offspring via sperm, placenta, milk, or contact in the vaginal canal at birth.

vertical transmission

The community must have an adequate ___________ and _________ plan that includes measures to remove those individuals from areas of danger who hesitate to leave.

Community Health Final (Fixed)

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