Community 1

9. After discussing the leading health indicators with a class, which condition if stated by the class as one of these indicators suggests that the class has understood the information? A) Cardiac disease B) Mental health C) Sedentary lifestyle D) Maternal health care

Ans: B Feedback: Mental health is a leading health indicator. Other leading health indicators include physical activity, overweight and obesity, tobacco use, substance use, responsible sexual behavior, injury and violence, environmental quality, immunization, and access to health care.

6. The nurse is working with a community of solution. Which of the following would the nurse expect to find? A) A health problem affecting the group B) Common goal binding members together C) Sharing of a similar goal D) Locational boundaries

Ans: A Feedback: A community of solution involves a group of people coming together to solve a problem that affects them. A common-interest community involves a collection of people widely scattered geographically who have an interest or goal that binds the members together. A geographical community is one defined by its geographical or locational boundaries.

20. After teaching a group of students about the various types of epidemiologic research studies that can be done, the instructor determines that the teaching was effective when the students describe a community trial as which of the following? A) A type of experimental study conducted at the community level B) An inexpensive type of analytic research study C) A study that gathers volunteers for the experimental group D) A way to locate health problems in a variety of communities

Ans: A Feedback: A community trial is conducted as an experimental study design with large populations. Some of the community receives a treatment, while the other part does not. This is probably the most expensive type of experimental study. It involves a great number of subjects, the support of the governmental forces as well as the population involved, a large number of staff over a long period of time, and the cost of the intervention itself. When a whole community is involved, individuals are not approached to be volunteers. What makes it a community study is that the entire community is part of the study. The health problem is identified prior to the implementation of the study. The introduction of an intervention in one community with no introduction in a similar community forms the study population, and the health problem being studied is then monitored between the two populations. The health problem has to be identified first in this type of study.

8. Which of the following statements is an accurate description of the characteristic shared by all cultures, culture is integrated? A) A person's culture is an interrelated and interdependent web of ideas and practices. B) In order to describe a person's culture, it is necessary to describe each trait independently. C) Aspects of a person's culture are best described as unrelated to other aspects of the person's culture. D) A person's culture is an assortment of various customs and traits.

Ans: A Feedback: A person's culture is an integrated web of ideas and practices. To understand culture, single traits should not be described independently. As in any system, all parts of a culture are interrelated and interdependent.

22. When employing a population-oriented focus, the community health nurse would do which of the following? A) Assess the groups' relationships looking for a common need. B) Consider the members individually for similarities. C) Focus on the geographical area of the population. D) Promote the groups' dependency for improving health.

Ans: A Feedback: A population-oriented focus requires the assessment of relationships, considering the groups or communities in relationship to the rest of the community to discover common needs or risks for a common health problem. The nurse does not consider the groups or communities separately but rather in context. The population may or may not be delineated by the geographical area. The community health nurse encourages individuals' participation to promote their autonomy rather than permitting dependency.

7. As part of a class presentation, a nursing instructor describes the characteristics shared by all cultures. Which description of culture being tacit indicates that the teaching was successful? A) Culture is mostly unexpressed. B) Cultures do not remain static. C) Culture is a functional and integrated whole. D) Patterns of cultural behavior are acquired.

Ans: A Feedback: Culture is tacit, that is, mostly unexpressed and at the unconscious level. Culture is dynamic, undergoing change and never entirely static. It is integrated and learned.

17. Which of the following would be crucial for the community health nurse to address as the priority when dealing with policy makers about the development of community health programs? A) Research-based best practices B) Population's make up C) Amount of services to be provided D) Scarcity of the available resources

Ans: A Feedback: Decisions for programs or services are often made on the basis of cost-effectiveness or cost-benefit. Therefore, community health nurses must provide policy makers with information about best practices, grounded in research. Although population make up, amount of services to be provided, and scarcity of resources are factors that may need to be considered, the community health nurse must demonstrate evidence-based practice.

5. In their early stages, district nursing was sponsored by which of the following? A) Religious organizations B) Private philanthropy C) Contributions D) Public funding

Ans: A Feedback: Early district nursing services were founded by religious organizations that served as their sponsors. Later sponsorship shifted to private philanthropy. Funding came from contributions and fees charged to clients on an ability-to-pay basis. Finally, visiting nursing began to be supported by public money.

3. While providing care to a community group, a community health nurse provides culturally sensitive care by avoiding which of the following? A) Ethnocentrism B) Ethnorelativism C) Enculturation D) Ethnicity

Ans: A Feedback: Ethnocentrism is the belief or feeling that one's own culture is best causing the person to believe that his or her way of doing things is right and to judge others' methods as inferior, ignorant, or irrational. It blocks effective communication by creating biases and misconceptions. Ethnorelativism is seeing all behavior in a cultural context. Enculturation refers to the process of each person learning his or her culture through socialization with the family or significant group. Ethnicity refers to the group of qualities that mark a person's association with a particular ethnic group (collection of people who have common origins and a shared culture and identity).

11. A group of nursing students are studying for an examination on influential nursing leaders involved in the advancement of community health nursing. The students demonstrate that they are prepared for the examination when they identify which person as the first community health nurse in the United States? A) Frances Root B) Mary Robinson C) Mary Seacole D) Reba Thelin

Ans: A Feedback: In the United States, Frances Root was the first community health nurse who was hired by the Women's Branch of the New York Mission in 1877. Mary Robinson was the nurse who cared for William Rathbone's wife and was hired by Rathbone to visit the sick poor in their homes in England. Mary Seacole, the "Black Nightingale," practiced Creole or Afro-Caribbean medicine in Jamaica and helped populations who experienced tropical diseases in Central America, Panama, and the Caribbean. Reba Thelin was a nurse hired by Johns Hopkins Hospital to visit the homes of tuberculosis clients in 1903.

6. When reviewing the trends in communicable diseases for a county, the community health nurse notes that there was an increased incidence of Lyme's disease. The nurse develops a plan for prevention and control integrating the understanding that this disease is most likely transmitted by which mode? A) Vector B) Airborne C) Vehicle-borne D) Direct

Ans: A Feedback: In the United States, vector-borne illnesses have received renewed attention with accumulating information about Lyme's disease, transmitted to humans by a tick vector. Airborne transmission occurs through droplet nuclei, such as sneezing or coughing. Indirect or vehicle-borne transmission occurs when the infectious agent is transported via contaminated inanimate objects such as air, water, or food. Direct transmission occurs via the immediate transfer of infectious agents from a reservoir to a new susceptible host such as through touching, biting, kissing, or sexual intercourse.

22. Which of the following statements about confidentiality, privacy, and discrimination is the most accurate? A) It is permissible for a community health nurse to reveal the name and any other personal health information of a person who has a communicable disease to the public health authorities. B) It is permissible for a community health nurse to tell the contacts of a person who is infected with a communicable disease which disease they have been exposed to and the name of the source. C) It is permissible for any health care provider to report any cases of known or suspected communicable diseases to the news media. D) Only the identity of the index case of a communicable disease needs to be protected.

Ans: A Feedback: It is permissible and necessary for a community health nurse to reveal the name and any other personal health information of a person who has a communicable disease to the public health authorities. It is important that the contacts of a person who is infected with a communicable disease which disease they have been exposed to but is not acceptable for the community health nurse to reveal the identity of the source. It is permissible and often helpful for a community health nurse to involve the news media in informing the public of information about the specific disease including mode of transmission, prevention, and treatment options but not the identity(ies) of the cases. It is important to assure the individual being interviewed that the information will be maintained in a confidential manner, and the goal is care and treatment.

14. A community health nurse is developing health promotion programs for a local community that consists predominantly of African Americans. Which of the following areas would be a priority for health promotion with this group? A) Cardiac health B) Respiratory care C) Mental health D) Skin care

Ans: A Feedback: Leading causes of death for African Americans include heart disease, cancer, and stroke. Heart disease is also a major health problem. Thus programs emphasizing cardiac health would be a priority. African Americans show a lower incidence in suicide and chronic obstructive pulmonary disease. They may experience skin problems such as keloids and melasma. However, all of these conditions would be of lesser importance than cardiac health.

10. After a class discussion about the contributions of Lillian Wald to the advancement of community health nursing, which of the following if stated by the class indicates that the discussion was effective? A) Establishment of family-centered nursing and outreach services in New York City at the turn of the 20th century B) Use of clean and safe nursing care practices to soldiers during the Crimean War in the 1850s C) Assistance to high-risk populations experiencing tropical diseases in Central America and the Caribbean in the late 1800s D) Creation of home nursing services in London, marking the beginning of district nursing in the 1860s

Ans: A Feedback: Lillian Wald worked with immigrant families in the Lower East Side of New York City, providing home visits, a neighborhood center, and general sanitation improvement for families and health care services to children in schools. Florence Nightingale was responsible for providing clean and safe nursing care practices to soldiers during the Crimean War. Mary Seacole helped high-risk populations who experienced tropical diseases in Central America and the Caribbean. William Rathbone was responsible for establishing a visiting nurse service for the sick in London.

14. During which stage of the natural history of a communicable disease would quarantine be most effective? A) Susceptibility stage B) Subclinical disease stage C) Clinical disease stage D) Resolution stage

Ans: A Feedback: Quarantine is the isolation of persons who are susceptible to a communicable disease and have been exposed to that communicable disease until the incubation period of the subclinical disease stage has passed. Quarantining persons during the susceptibility stage itself is not indicated as individuals have not been exposed. The proper action for persons who are in the clinical disease stage and beyond is isolation until the danger of spreading the communicable disease has passed.

16. A community health nurse is looking for data on the use of nursing home services and the common diagnoses of those using these services. Which source of information would be most appropriate for the nurse to investigate? A) National Center for Health Statistics B) Consumer Product Safety Commission C) Environmental Protection Agency D) Cancer disease registries

Ans: A Feedback: The National Center for Health Statistics furnishes valuable health prevalence data from surveys of Americans. Among the information available is the National Nursing Home Survey, which provides information on those who are using these services and the diagnoses and other characteristics. The Consumer Product Safety Commission and Environmental Protection Agency would provide information about environmental issues. Cancer disease registries would provide information specific to the diagnosis of cancer.

1. After discussing the meaning of cultural diversity and its significance for community health nursing, the nursing instructor recognizes that some points need to be clarified when a student makes which of the following comments? A) "Dominant values are those held by the male head of the household in most American families." B) "The percentages of White European descent Americans are rising, while the percentages of other ethnicities are declining and this is projected to continue into the year 2050 at least." C) "Nurses maintain their original culture as they are socialized throughout the educational process." D) "America has become an amalgamation of people who have different values, ideals, and behaviors, rather than the melting pot that was once envisioned."

Ans: A Feedback: The beliefs and sanctions of the dominant or majority culture are called dominant values. The proportion of the population identified as White is projected to continue to fall below other ethnicities between 2010 and 2050. Nurses will still have the same culture as they did before they were socialized in the nursing educational process, but they may be able to see things differently. America is not the ideal melting pot once described, but rather an amalgamation of people who have different values, ideals, and behaviors.

3. Which of the following is most accurate about the concept of community? A) A community is a collection of people who share some important features of their lives. B) Community members live in the same geographic location. C) Community members are biologically related. D) A community is made up of people who do not necessarily interact with one another and do not necessarily share a sense of belonging to that group.

Ans: A Feedback: The broad definition of a community is a collection of people who share some important features of their lives. Community members may not live in the same geographic location as in a common-interest community or a community of solution. A population is made up of people who do not necessarily interact with one another and do not necessarily share a sense of belonging to that group.

21. A community health nurse is providing care to several cultural groups in the community. When providing transcultural nursing, which of the following would be the priority? A) Examining one's own culture carefully and recognizing that alternative viewpoints are possible B) Recognizing that cultural values, beliefs, and practices influence people's health and lifestyles C) Obtaining health-related information about a cultural group concerning their values, beliefs, and practices D) Actively and attentively listening to demonstrate respect while learning about other cultures

Ans: A Feedback: The first step in providing transcultural nursing is to develop cultural self-awareness by examining one's own culture carefully and recognizing that alternative viewpoints are possible. Next, the nurse would need to cultivate cultural sensitivity by recognizing that cultural values, beliefs, and practices influence people's health and lifestyle. Then the nurse would assess the client group's culture by obtaining health-related information and actively and attentively listening to demonstrate respect.

7. At which time did the focus of district nursing broadened to include the health and welfare of the general public? A) Beginning of 20th century B) In the late 19th century C) Prior to the 1850s D) By the early 1970s

Ans: A Feedback: The focus of district nursing broadened to include the health and welfare of the general public by the beginning of the 20th century or the early 1900s. In the late 19th century, district nurses were ill-prepared to cope with their clients' multiple health and social problems resulting from widespread immigration and filled tenement housing that led to inadequate sanitation, unsafe and unhealthy working condition, and barriers adding to poverty and disease. District nursing did not develop until after 1850. The early 1970s is associated with the emergence of community health nursing.

12. A community health nurse has identified the index case. The nurse is involved in which of the following? A) Contact investigation B) Screening C) Isolation D) Quarantine

Ans: A Feedback: The index case (diagnosed person) results from contact investigation and partner notification. Screening describes programs that deliver a testing procedure to detect disease in groups of asymptomatic apparently health individuals. Isolation refers to the separation of the infected person from others for a period of communicability to limit transmission; quarantine refers to restrictions placed on healthy contacts of an infectious case for the duration of the incubation period. Contact investigation and notification is one of two approaches to secondary prevention of communicable diseases.

1. A group of students are reviewing the various historical events associated with the evolution of community health nursing in preparation for a test. They identify the time from 1970 to the present as the era known as community health nursing based on the understanding that which of the following influences contributed most to this change? A) The settings and the nurses delivering health care in the community B) Decisions made by the American Nurses Association C) Decisions made by physicians in a variety of community settings D) The demand to eliminate the word "public" from health services

Ans: A Feedback: The numbers, increasing variety of settings, and many nurses coming to work in the community settings since the 1970s have contributed most significantly to the change. As a result, professional associations supported the broader term of community health nursing. Physician decisions played no role in the change. The term public health nursing still remains.

11. A group of community health nursing students design a health education program for a group of pregnant teens that includes teaching nutrition during pregnancy, demonstrating helpful exercises, and discussing their concerns. This is an example of which of the following? A) Health promotion B) Treatment of disorders C) Rehabilitation D) Evaluation

Ans: A Feedback: The student nurses are engaging in health promotion activities. Health promotion incorporates all efforts that seek to move people closer to optimal well-being or to higher levels of wellness. Treatment of disorders would include direct care for issues involving the group, such as complications that might arise in this population. Rehabilitation would involve activities to minimize disability or restore or preserve function. Evaluation would involve an analysis of the effectiveness of these activities.

7. A community health nurse is integrating the epidemiology of wellness into practice. Which of the following would the nurse include? A) Lifestyle with its self-created risks B) Communicable disease control C) The natural history of disease D) Vital statistics and reportable diseases

Ans: A Feedback: Today there is an increased focus on lifestyle behaviors and how they relate to a person's state of wellness or illness. It is a basic component of a wellness model. Communicable disease control focuses on an illness state, not a wellness state, and is not part of a wellness model. The four states of the natural history of a disease or health condition is not part of the wellness model. Vital statistics and reportable diseases are not part of the wellness model.

8. When discussing the concept of the health continuum with a class, the nurse educator would be certain to include which statement in the description? A) Wellness is a relative concept, not an absolute, and illness is a state of being relatively unhealthy. B) A client's placement on the health continuum is static throughout time. C) Health is best described as cyclic. D) The health continuum can only be applied to individuals.

Ans: A Feedback: Wellness is a relative concept, not an absolute, and illness is a state of being relatively unhealthy. The continuum can change. Because health involves a range of degrees from optimal health at one end to total disability or death at the other, it is often described as a continuum. The health continuum applies not only to individuals but also to families and communities.

3. Which of the following statements accurately describes important steps that a community health nurse must take prior to contacting an individual for an interview regarding communicable disease? Select all that apply. A) Review the information received from the news media reporter for completeness B) Review disease information including the reservoir, incubation period, infectious period, symptoms, and treatment C) Take all appropriate treatments to the interview site D) Investigate only laboratory confirmed communicable diseases E) Eradicate the disease

Ans: A, B Feedback: Steps to take prior to contacting an individual regarding communicable disease include reviewing the information received from the reporters for completeness (this refers to the individual reporting the communicable disease to the public health agency and not the news media reporter); clarifying that the disease is suspect or lab confirmed (some infections can be reported if they meet a set of clinical criteria or are part of a larger outbreak for which the case definition has been identified even without laboratory confirmation); review the case definition; review the disease information (including reservoir, incubation period, infectious period, symptoms, and treatment); and identifying the specific questionnaire for the reported disease or using a generic disease investigation form and reviewing the questionnaire. It is not appropriate for the community health nurse to take all treatments to the interview site as the goal of this interview is to assess. Community health nurses may investigate laboratory confirmed or suspected diseases. Eradication of the disease is the last step in investigating a disease, and interviewing an individual regarding communicable disease is one of the first steps in the process of investigation.

15. The community health nurse determines that the adult population in the community has an increased incidence of vaccine preventable disease. Which of the following are factors that may contribute to low vaccination levels among adults? Select all that apply. A) Lack of comprehensive vaccine delivery systems to the public and private sectors for adults (similar to the Vaccines for Children program for children) B) Lack of statutory requirements for vaccination of adults C) Health care providers may lack current information about recommended adult immunizations and may miss opportunities to vaccinate adults during contacts in offices, outpatient clinics, and hospitals. D) Adults fear injections for immunizations but do not worry about adverse effects after vaccination. E) A multitude of comprehensive vaccination programs exist in settings where healthy adults congregate such as workplaces and other locations.

Ans: A, B, C Feedback: Low vaccination levels among adults are associated with several factors: limited comprehensive vaccine delivery systems that are available; lack of statutory requirements for vaccination of adults; and frequently missed opportunities for vaccinating adults during contacts in offices, outpatient clinics, and hospitals. Additionally there is a lack of comprehensive vaccination programs in settings where healthy adults congregate; and clients and providers may fear adverse reactions after vaccination.

12. The community health nurse is developing a plan of primary prevention activities. Which of the following might the nurse include? Select all that apply. A) Teaching about safe-sex practices to high school students B) Encouraging older adults to install safety devices in the bathroom C) Providing regular immunization programs for communicable diseases D) Participating in cholesterol screening programs at health fairs E) Providing skin testing for tuberculosis for children over 1 year of age F) Working with a group testing water samples for contamination

Ans: A, B, C Feedback: Primary prevention activities are those taken to keep illness or injuries from occurring. These include teaching about safe-sex practices, encouraging older adults to use safety devices in the bathroom, and providing regular immunization programs for communicable diseases. Cholesterol screening programs, skin tests for tuberculosis, and working with a group testing water samples for contamination are examples of secondary prevention activities.

20. Which of the following statements about the prevention of sexually transmitted diseases is true? Select all that apply. A) Many persons who have HIV infection can stave off AIDS by the use of medications during the HIV stage of the spectrum. B) Screening programs have actually reduced the incidence of Chlamydia as infected persons are identified and treated. C) The proper use of condoms prevents transmission of all sexually transmitted infections. D) Expedited partner treatment can prevent the spread of Chlamydia and gonorrhea. E) It is not possible for a person who has a HSV-2 infection to transmit the infection to other sex partners if sexual contact is only practiced when the person does not have any visible sores.

Ans: A, B, D Feedback: Many persons who have HIV infection can stave off AIDS by the use of medications during the HIV stage of the spectrum. Screening programs have actually reduced the incidence of Chlamydia as infected persons are identified and treated. Expedited partner treatment can prevent the spread of Chlamydia and gonorrhea. The proper use of condoms reduces the risk of sexually transmitted infection transmission but does not eliminate the transmission of all sexually transmitted infections. It is possible for a person who has HSV-2 infection to transmit the infection to other sex partners if sexual contact is practiced even when the infected partner does not have a visible sore.

19. Which of the following activities would be associated with a community health nurse? Select all that apply. A) Examining infants in a city well-baby clinic B) Caring for elderly stroke victims in their homes C) Providing emergency care in an acute care facility D) Carrying out epidemiologic research E) Participating in health policy analysis

Ans: A, B, D, E Feedback: Community health nurses work in every conceivable kind of community agency, from a state public health department to a community-based advocacy group. Their duties rang from examining infants in a well-baby clinic or teaching elderly stroke victims in their homes to carrying out epidemiologic research or engaging in health policy analysis and decision making. Providing care in an acute care facility would not be an activity associated with a community health nurse.

2. Which of the following are appropriate communicable disease prevention interventions that may be implemented by community health nurses? Select all that apply. A) Immunization of children and adults B) Disease investigation and case/contact finding C) Diagnosing cases of communicable diseases D) Prescribing treatment for communicable diseases E) Environmental interventions F) Community Education

Ans: A, B, E, F Feedback: Appropriate interventions that may be implemented by community health nurses include immunizations of children and adults, environmental interventions, community education, screening programs, and disease investigation and case/contact finding.

12. Which of the following statements about risk is true? Select all that apply. A) Risk is the probability that a disease or unfavorable health condition will develop. B) Risk means that the person who has the most negative influences will definitely develop the disease or unfavorable health condition. C) Risk refers to positive and negative influences on a person's likelihood of developing a specific disease. D) Risk can be measured using the relative risk ratio, which is based on the ratio of incidence in an exposed group to incidence rate in unexposed group. E) Risk is unimportant when determining the most effective points for community health intervention.

Ans: A, C, D Feedback: Risk is the probability that a disease or unfavorable health condition will develop. Risk also refers to positive and negative influences on a person's likelihood of developing a specific disease. Relative risk ratio is a calculation of risk consisting of the ratio of incidence in an exposed group to incidence rate in unexposed group. Risk does not mean that the person who has the most negative influences will definitely develop the disease or unfavorable health condition, but it refers to the probability that the person will develop the disease or unfavorable health condition. The relative risk ratio assists in determining the most effective points for community health intervention in regard to particular health problems.

5. Which of the following statements apply to the concept of causality? Select all that apply. A) Causality is the relationship between cause and effect. B) The chain of causation is the most recent theory of causality. C) The web of causation theory is the most recent theory of causality. D) The chain of causation clearly explains causation in noninfectious disease. E) Epidemiology has changed its view of causality over time.

Ans: A, C, E Feedback: Causality is the relationship between cause and effect. The web of causation theory is the most recent theory of causality. Epidemiology has changed its view of causality over time. The chain of causation was the first theory of causality. The chain of causation could not sufficiently explain causation in noninfectious disease because the chain of causation is too linear.

9. Which of the following are important contributions made by Lillian Wald to the profession of public health nursing? Select all that apply. A) Demonstrating the effectiveness of placing school nurses in public schools to reduce absenteeism and improve follow-up of problems identified in school children B) Promoting the use of birth control C) Convincing the Metropolitan Life Company that nurse intervention could reduce death rates D) Providing rural "frontier nursing" to serve mountain families in Kentucky E) Founding the National Organization for Public Health Nursing (NOPHN)

Ans: A, C, E Feedback: Lillian Wald contributed to the profession of public health nursing by demonstrating the effectiveness of placing school nurses in public schools to reduce absenteeism and improve follow-up of problems identified in school children, convincing the Metropolitan Life Company that nurse intervention could reduce death rates, and Founding the National Organization for Public Health Nursing (NOPHN).

4. Which of the following entities would the community health nurse know are required to report known or suspected cases of reportable diseases in every state in the United States? Select all that apply. A) Physicians, dentists, and nurses B) Laboratory directors C) Any individual who knows of or suspects the existence of a reportable disease D) Medical examiners E) Administrators of schools and child care centers

Ans: A, D, E Feedback: In most states, reporting known or suspected cases of a reportable disease is generally considered to be an obligation of physicians, dentists, nurses, and other health professionals; medical examiners; administrators of hospitals, clinics, nursing homes, schools, and child care centers. Some states also require or request reporting from laboratory directors; and any individual who knows of or suspects the existence of a reportable disease.

13. The community health nurse is preparing a presentation for a group of nursing students about the societal influences on the development of community health nursing. Which factors should the nurse include that have influenced the growth of community health nursing? Select all that apply. A) Advances in the technology B) The recognition that one single agent could be considered a cause of illness C) Access to education being limited to the privileged few D) Continued increase in the number of women entering nursing because it is recognized as a choice career for women and not men E) Consumer demand for quality services coupled with community health nurses provision of holistic care

Ans: A, E Feedback: Many factors have influenced the growth of community health nursing, including advances in technology, progress in causal thinking (relating disease or illness to its cause and recognition that many factors might contribute to a disease or health disorder), and the consumer movement with consumers demanding quality services. Education is now widely available and is considered a basic right and necessity for a vital society. Changing demographics and the role of women have influenced community health nursing; however, the number of women entering nursing has decreased.

10. The nurse educator knows that a nursing student understands the basics of immunity when the student nurse states A) herd immunity only pertains to cows. B) active immunity can be attained via the use of vaccines. C) passive immunity can be attained via the use of vaccines. D) cross-immunity is immunity that causes a person who is immune to one disease to be also immune to a completely different infectious agent.

Ans: B Feedback: Active immunity can be attained via the use of vaccines. Passive immunity is immunity that is given to a person, either by maternally provided protection for newborn infants or from antibody products that provide temporary resistance. Herd immunity describes the immunity level that is present in a population group. Cross-immunity is immunity that causes a person who is immune to one disease to be also immune to a related infectious agent.

4. Which factor was the most significant feature associated with district nursing? A) Caring for the sick B) Teaching hygiene and cleanliness C) Preventing illness D) Gathering statistical data

Ans: B Feedback: Although district nurses primarily cared for the sick, they also taught cleanliness and wholesome living to their clients. This early emphasis on prevention and health became one of the distinguishing features of district nursing and later of public health nursing. Preventing illness and gathering statistical data were key contributions of Florence Nightingale during the Crimean War of the early 1850s.

7. Which one of the following statements made by a student would the nurse educator recognize as evidence that a student understands the health continuum? A) The distinction between health and illness is well demarcated. B) Illness refers to a state of being relatively unhealthy. C) The term health is limited to reflect an individual's state. D) Treatment of acute conditions reflects the current focus of health care.

Ans: B Feedback: Although society typically depicts an absolute line of difference between being either well or ill, health is considered a relative term. Thus, illness is viewed as a state of being relatively unhealthy. Health is typically described as a continuum that involves a range of degrees from optimal health at one end to total disability or death at the other. The line of demarcation is not clear. Health applies to individuals, families, and communities. Traditionally, most health care has focused on the treatment of acute and chronic conditions at the illness end of the continuum, but this emphasis is shifting to focus on the wellness end.

4. A group of students are reviewing material for a test on populations, communities, and aggregates. Which of the following indicates that the students understand these concepts? A) Members of a population share a sense of belonging. B) Communities and populations are types of aggregates. C) Individuals of a community are loosely connected. D) Members of an aggregate share a strong bond.

Ans: B Feedback: An aggregate refers to a mass of grouping of distinct individuals who are considered as a whole and who are loosely associated with one another. Communities and populations are types of aggregates. A population is made up of people who do not necessarily interact with one another and do not necessarily share a sense of belonging to the group. A community is a collection of people who chose to interact with one another because of common interests, characteristics, or goals, which form the basis for a sense of unity or belonging.

19. When applying the principles of transcultural nursing, which of the following must the nurse do first? A) Cultivate cultural sensitivity B) Develop cultural awareness C) Learn the client's group culture D) Demonstrate respect for culture

Ans: B Feedback: Applying the principles of transcultural nursing involves the following: (1) developing cultural self-awareness, (2) cultivating cultural sensitivity, (3) assessing the client group's culture, (4) showing respect and patience while learning about other cultures, and (5) examining culturally derived health practices.

10. A community health nurse working a large metropolitan city has a large Asian American client base. Which of the following would the nurse be least likely to assess in this population? A) Belief that illness results from a body imbalance B) Reliance on Western medical practices C) Use of traditional self-care practices D) A focus on patriarchal family structures

Ans: B Feedback: Asian Americans believe illness results from an imbalance of yin and yang forces. They use traditional healers and also exercise traditional self-care practices before using Western medical practices.

2. Before the mid-1800s, early home care nursing was best recognized by which of the following? A) Technical advances with the Industrial Revolution making major changes B) Care provided by family members, friends, and religious groups in the home C) Accomplishments stemming from the work of Florence Nightingale D) Formal organization of visiting nursing to provide care to the sick poor

Ans: B Feedback: Before the mid-1800s, early home care was characterized by care of the sick in the home by family members, friends, and religious groups. Technical advances came after 1850, as did the work of Florence Nightingale and the formal organization of visiting nurses to provide care to the sick poor.

4. As a community health nurse, you overhear a colleague say, "I don't understand why the Yang's take their young teenage daughters to the Hmong New Year celebration and have them play these match-making games. The girls meet boys every day at school and they are too young to be looking for husbands." Which of the following would be the most appropriate response? A) "The Yang's are very different from us; maybe in time we can convince them that their practices are not right." B) "Every culture has its differences; I think it is valuable that the Yang's are keeping their cultural practices alive." C) "I know what you mean, I was thinking the same thing. You wouldn't catch me doing something similar with my teens." D) "I feel sorry for those girls; they must feel funny in those cultural costumes. Let's talk to the parents and tell them how teens in America feel about such things."

Ans: B Feedback: Community health nurses need to develop cultural sensitivity, becoming aware of own biases and preconceived values and beliefs. This would be evidenced by the statement about every culture having differences. The celebration is a part of the family's culture, and the nurses should not attempt to convince them that it is not right nor should they attempt to impose their views, feelings, or beliefs on the family.

18. After a class that described the differences between acute care nursing and community health nursing, which statement by the class about community health nurses indicates successful teaching? A) Use a reactive approach. B) Seek out potential health problems. C) Concentrate on the illness end of the continuum. D) Emphasize curative care.

Ans: B Feedback: Community health nurses, in contrast to acute care nurses, seek out potential health problems, identifying high-risk groups and instituting preventive programs; use a proactive approach; concentrate on the wellness end of the health continuum; and put less emphasis on curative care.

7. After a community health nurse implements an educational program for a local community group about food safety, which statement indicates that the teaching was successful? A) "Handwashing is unnecessary if we use gloves." B) "After cooking the meat, we'll put it on the same platter that we used for the raw meat." C) "Our cooked foods should be cooled quickly." D) "If we peel the carrots, we don't need to wash them before eating."

Ans: B Feedback: Cooked foods should be cooled quickly. Surfaces, hands, and utensils should be washed in warm soapy water (even when gloves are used as gloves do not prevent cross-contamination by themselves). Foods when cooked should not come in contact with dishes, utensils, or containers used when the foods were raw and uncooked. Foods that are to be eaten raw and uncooked should be washed thoroughly in clean water. This includes foods (e.g., carrots) that are to be peeled that grow on the ground or come in contact with soil.

18. A community health nurse is preparing to carry out an experimental epidemiologic study. Which of the following would be most important for the nurse to do? A) Focus the study on evaluating the cause of a disease B) Ensure carefully controlled conditions during the study C) Expose both groups to the same factor or condition D) Ensure that there are a substantial number of subjects

Ans: B Feedback: Experimental studies are carried out under carefully controlled conditions. In human populations, experimental studies should focus on disease prevention or health promotion rather than testing the cause of disease. The investigator exposes an experimental group to some factor and simultaneously observes a control group similar in characteristics to the experimental group but without the exposure factor. An experimental study need not be elaborate to provide important data.

15. A community health nurse is providing care to a family in the community who are Muslim. Which of the following would be most important for the nurse to integrate when providing care for this family? A) Rules are stricter for boys than for girls. B) Modest dressing is key for both men and women. C) Most Arabic women work outside the home. D) Most adhere to the three tenets of Islam.

Ans: B Feedback: For Muslims, modesty in dress is a core value for both men and women, although it is expressed more evidently by women. Rules are stricter for girls than for boys and most Arabic women stay at home and are not in the workplace. All practicing Muslims adhere to the five tenets of Islam.

10. Which of the following statements about health promotion and disease prevention is the most accurate? A) Health promotion and disease prevention include all efforts that seek to move people closer to optimal well-being or higher levels of wellness. B) Disease prevention differs from health promotion in that disease prevention is targeted toward a specific disease or diseases. C) Health promotion can be described in terms of primary, secondary, and tertiary prevention. D) The goal of disease prevention is to raise levels of wellness for individuals, families, populations, and communities.

Ans: B Feedback: Health promotion includes all efforts that seek to move people closer to optimal well-being or higher levels of wellness. The goal of health promotion is to raise levels of wellness for individuals, families, populations, and communities. Disease prevention is targeted toward a specific disease or diseases and consists of primary, secondary, and tertiary prevention.

5. A community health nurse is presenting a program about hepatitis prevention and risk reduction to a local community group. The nurse determines that the group has understood the program when they identify which method as the major mode of transmission for hepatitis B? A) Oral-fecal route B) Exposure to contaminated blood C) Airborne droplet nuclei D) Infected rodents, such as mice and rats

Ans: B Feedback: Hepatitis B can occur in certain high-risk groups, including injected drug users, heterosexuals with multiple partners, and homosexual men. Hepatitis A is transmitted by the fecal-oral route. TB is transmitted by airborne droplet nuclei. Hantavirus is transmitted via infected rodents.

12. The community health nurse is working in the health department of a major city that has a large Hispanic/Latino population. Which of the following would the nurse need to integrate into the plan of care for this population? A) View of the female as superior to the male B) Importance of an extended, cohesive family C) Males as the binding force of the family D) Adherence to strict time schedules

Ans: B Feedback: Hispanic people value extended, cohesive families. Families have been patriarchal, with male members perceived as superior and female members seen as a family-bonding life force. Many Latinos tend to be oriented to the present and are not as concerned as the mainstream culture about keeping time schedules or preparing for the future.

2. Which of the following statements would best describe the difference between public health nursing and community health nursing? A) Public health nursing is focused on the private aspects of health, and community health nursing is focused on the public aspects of health. B) In our textbook, the term community health practice refers to a focus on specific, designated communities and is a part of the larger public health effort. C) Public health nursing and community health nursing relate to the very same types of services and perspectives. D) Both public health nursing and community health nursing are practiced exclusively within institutions.

Ans: B Feedback: In this textbook, community health practice refers to a focus on specific, designated communities. It is a part of the larger public health effort and recognizes the fundamental concepts and principles of public health as its birthright and foundation for practice. Public health nursing is focused on the public aspects of health. Public health nursing and community health nursing have distinctive types of services and perspectives. Neither public health nursing nor community health nursing is practiced exclusively within institutions.

18. When developing an in-service program for a group of community health nurses about culture, which of the following would the presenter expect to include? A) All members of a cultural group are alike. B) Intraethnic variations underscore a population's cultural diversity. C) Ethnicity has a major impact on the effectiveness of health care. D) Ethnocentric attitudes are key to working with different cultures.

Ans: B Feedback: Intraethnic variations, differences within microcultures, underscore the range of culturally diverse clients served by community health nurses. Subcultures and microcultures have their own distinctive characteristics even within fairly homogenous cultural groups. Culture, not ethnicity, has a major impact on the effectiveness of health care. Ethnocentric attitudes are to be avoided. All members of a cultural group are not alike. In general, individuals who are members of a specific culture are more alike than unlike but still not totally alike.

8. A student is planning a presentation about the evolution of public health nursing. As part of the presentation, the student would identify which person as being the first one to use the term "public health nursing"? A) Jessie Sleet B) Lillian Wald C) Lina Rogers D) Margaret Sanger

Ans: B Feedback: Lillian Wald, a leading figure in the expansion of district nursing, was the first to use the term "public health nursing" to describe the specialty. Jessie Sleet was credited as being the first Black public health nurse. Lina Rogers was credited with being the first school nurse. Margaret Sanger was the nurse who opened the first birth control clinic in America that eventually resulted in the formation of the International Planned Parenthood Federation.

2. After a class describing the contributions of Florence Nightingale to epidemiology, the instructor determines that the class needs additional instruction when they state which of the following is associated with Nightingale? A) Establishment of the need for a clean environment B) A sophisticated coding system for medical conditions C) Proper wound cleansing and bandaging techniques D) Separation of infected individuals from those injured

Ans: B Feedback: Nightingale's colleague, William Farr, is credited for developing a more sophisticated system for coding medical conditions. Nightingale's contributions included establishing the need for a clean environment, properly cleaning wounds and bandaging them, and separating infected soldiers from those who were injured.

1. An instructor is discussing the worldwide distribution of AIDS. Which term would the instructor use to describe this situation? A) Epidemic B) Pandemic C) Endemic D) Pathogenicity

Ans: B Feedback: Pandemic is the term used to describe an epidemic that is distributed worldwide. An epidemic refers to a disease occurrence that clearly exceeds the normal or expected frequency in a community or region. Endemic is used to describe the continuing presence of a disease or infectious agent in a given geographic area. Pathogenicity refers to an agent's capacity to cause disease in a host.

2. The population that community health nurses serve in the United States is changing. Because of population shifts, nurses must become sensitive to the cultural differences and language differences among new community members. Which minority group currently represents the largest group? A) African Americans B) Hispanic Americans C) Asian Americans D) American Indians

Ans: B Feedback: Significant minorities include Hispanic Americans, numbering more than 35 million in 2000 and over 42 million in 2005 and currently representing over 14% of the population; African Americans, numbering over 37 million or approximately 12.8% of the population; Asian Americans, numbering more than 12 million or approximately 4.3% of the population; and American Indians and Alaska Natives, numbering 2.8 million or 1% of the population.

13. While visiting a family's home, the community health nurse finds out that the two children in the home were exposed to chickenpox. Assessment of the children reveals no signs of fever or lesions. The nurse determines that the children may be in which stage of the disease? A) Susceptibility B) Subclinical disease C) Clinical disease D) Resolution

Ans: B Feedback: The children have been exposed but have not yet developed the signs of chickenpox. Therefore, they are in the subclinical disease stage. During the susceptibility stage, the disease is not present and individuals have not been exposed. During the clinical stage, signs and symptoms are beginning to develop. During the resolution stage, the disease causes sufficient anatomic or functional changes to produce recognizable signs and symptoms.

13. A community health nurse is preparing a presentation for a group of nursing students about community health nursing. Which of the following descriptions about community health nursing would the nurse most likely include in the presentation? A) Focusing on addressing continuous needs B) Working with the client as an equal partner C) Engaging in tertiary prevention as the priority D) Encouraging clients to reach out to the nurse

Ans: B Feedback: The community health nurse works with the client as an equal partner, encouraging autonomy. At any time, the nurse deals with continuous and episodic needs simultaneously. Primary prevention is the priority for community health nurses. The community health nurse engages in primary prevention as the priority, having the obligation to actively reach out to all who might benefit from a specific activity or service.

15. A community health nurse who is teaching a group of nursing students about the various societal influences on community health nursing is explaining the effects of the consumer movement. Which of the following student responses would lead the community health nurse to determine that the teaching was successful? A) Individuals are considered passive members of the health care team. B) Consumers are demanding more coordinated comprehensive care. C) People are expecting community health nurses to develop new programs. D) Consumers are identifying a greater need for care by a variety of care providers.

Ans: B Feedback: The consumer movement has led to changes in community health nursing. Consumers are demanding more humane, personalized health care, seeking more comprehensive coordinated care. They are viewed as active members of the health care team. The need to develop new programs is a response to the economic forces that have affected the practice of community health nursing. Consumers desire more coordinated care, not care from a variety of care providers.

6. Which of the following would characterize the public health stage of community health nursing? A) Voluntary health agencies emphasizing disease prevention B) Family considered as the primary unit of care C) Service provision to the sick poor population D) Primary health care as the key to health for all

Ans: B Feedback: The public health nursing stage was characterized by service to the public, with the family targeted as a primary unit of care. Official health agencies, which placed a greater emphasis on disease prevention and health promotion, provided the chief institutional base. Primary health care as the key to health for all characterizes the community health nursing stage.

8. The nurse is examining the possibility that multiple factors are involved in the development of a disorder. The nurse is applying which of the following? A) Chain of causation B) Web of causation C) Strength of association D) Temporality

Ans: B Feedback: The web of causation is being used to apply the concept of multiple causes to explain the existence of health and illness states. It was a refinement of the chain of causation, such that it looked at the combination of multiple factors as implicated in the development of poor outcomes. The chain of causation focuses on one factor in the development of a condition. The strength of association is an element of causation in noninfectious disease that refers to the ratio of disease rates in those with and without the causal factor. Temporality, also involved with the causation of noninfectious disease, is an element in which the exposure to the suspected factor must precede the onset of the disease.

11. The nurse educator has just discussed education of aggregates using mass media with targeting health messages. Which of the following statements by the nursing student would demonstrate the student's ability to analyze and apply the information? A) Television would be the most important venue of mass media to educate the aggregate as everyone has a television. B) The target audience must be assessed for educational level, salience of the issue, involvement in the issue, and access to the media channel used. C) Pamphlets should be assessed to make sure they are at a twelfth grade reading level. D) It is unnecessary to consider culture when planning the health message.

Ans: B Feedback: To effectively deliver a health promotion and disease-prevention message, the message must reach the target (at-risk) population. This requires correct identification of the characteristics of the target audience in terms of educational level, salience of the issue, involvement of the target audience with the issue, and access of the target audience to the media channels used. Cultural issues affect people's interpretation of messages and must be considered in the presentation of a disease-prevention message to ethnic and racial minority groups. Television may not be the most important venue of mass media to educate the aggregate. Pamphlets may not be the best way to educate the aggregate, and the reading level of any literature must be specific for the target audience. Cultural issues affect people's interpretation of messages and must be considered in the presentation of a disease-prevention message to ethnic and racial minority groups.

6. When describing culture as shared, which of the following would be most accurate? A) It is acquired, not inherited. B) It is a product of aggregate behavior. C) It is interrelated and interdependent. D) It undergoes change.

Ans: B Feedback: When describing culture as shared, it means that it is a product of aggregate behavior, not an individual habit. The customs are phenomena shared by all members of the group. Culture is learned; that is, the patterns of cultural behavior are acquired, not inherited. Culture is integrated; that is, it is a functional, integrated whole where all parts are interrelated and interdependent. Culture is dynamic; that is, it is changeable and not entirely static.

10. Community health nurses practice within the three levels of prevention. Which of the following would the community health nurse engage in at the primary level of prevention for communicable disease control? Select all that apply. A) Providing TB skin test to children entering kindergarten B) Administering immunizations to senior citizens C) Teaching kindergarten students to wash their hands D) Encouraging parents to complete their children's immunizations E) Providing chest x-rays to people with positive TB skin tests F) Administering prompt treatment for the symptoms of gonorrhea

Ans: B, C, D Feedback: Primary prevention interventions include administering immunizations, teaching about hand washing, and encouraging adherence to the recommended schedule for childhood immunizations. Providing TB skin testing and chest x-rays, and promptly treating symptoms of gonorrhea are examples of interventions at the secondary level of prevention.

9. Which of the following statements about modes of transmission are true? Select all that apply. A) Direct transmission requires contact with a contaminated inanimate material. B) Indirect transmission is also known as vehicle-borne illness. C) Food- and water-related illnesses are considered to be spread by indirect transmission. D) Vector transmission requires contact with a nonhuman carrier such as an animal or insect. E) Airborne transmission commonly occurs from coughing and sneezing.

Ans: B, C, D, E Feedback: Direct transmission occurs by immediate transfer of infectious agents from a reservoir to a new susceptible host. Indirect transmission requires contact with a contaminated inanimate material and is also known as vehicle-borne illness. Food- and water-related illnesses are considered to be spread by indirect transmission. Vector transmission requires contact with a nonhuman carrier such as an animal or insect. Airborne transmission commonly occurs from coughing and sneezing.

9. A community health nurse is working with several Native American groups in Arizona. Which of the following would the nurse be most likely to assess? Select all that apply. A) The value of competition B) Respect for advancing age and elders C) Focus of living in the future D) Frequent dialogue and discussion E) Each tribe or nation has its own distinct language, beliefs, customs, and rituals.

Ans: B, C, E Feedback: Although there are differences among Native American tribes, most have respect for advancing age and they live in the present and not the distant future (making primary prevention activities more difficult). Each tribe or nation has its own distinct language, beliefs, customs, and rituals. Competition and frequent dialogue and discussion are not values held by Native Americans.

17. Which of the following is true about incidence and prevalence? Select all that apply. A) Prevalence is the number of new cases of a disease or health condition. B) Incidence is the number of new cases of a disease or health condition. C) Prevalence refers to all of the people with a particular health condition existing in a given population at a given point in time. D) Incidence refers to all of the people with a particular health condition existing in a given population at a given point in time. E) When determining if a disease is endemic in a specific area, the statistic that is most helpful is prevalence.

Ans: B, C, E Feedback: Incidence is the number of new cases of a disease or health condition. Prevalence refers to all of the people with a particular health condition existing in a given population at a given point in time. When determining if a disease is endemic in a specific area, the statistic that is most helpful is prevalence.

8. A community health nurse is teaching a group of clients about infection control and mentions the role of vectors in transmitting diseases. Which of the following would be examples of some common vectors? Select all that apply. A) Chemicals B) Mosquitoes C) Salmonella D) Fleas E) Roaches

Ans: B, D, E Feedback: A vector is a nonhuman carrier of disease organisms that can transmit diseases directly to humans. Examples would include mosquitoes, fleas, and roaches. Various chemicals are not vectors and Salmonella is an infectious agent.

22. Organize the following steps in the epidemiologic study from the first step to the last. A) Collect the data. B) Identify the problem. C) Analyze the findings. D) Disseminate the findings. E) Review the literature. F) Develop conclusions and applications. G) Design the study.

Ans: B, E, G, A, C, F, D Feedback: The proper order of the steps in the epidemiologic study from the first step to the last is to identify the problem, review the literature, design the study, collect the data, analyze the findings, develop conclusions and applications, and disseminate the findings.

18. A community health nurse desires to attain a tenure-track position at a local university to teach community health nursing. Which of the following would this nurse need? A) Certification B) Master's degree C) Doctoral degree D) Nurse practitioner license

Ans: C Feedback: A doctoral degree would be the required education needed to obtain a tenure-track teaching position at a university. Certification provides additional education for specialization and may result in a promotion or higher salary accompanied by additional responsibilities and opportunities. A master's degree can lead to management positions, private community health ownership, agency teaching, or research positions. Nurse practitioners can run well-child clinics and direct a school-based clinic if a school nurse. Advanced practice can open doors into leadership positions in community health nursing.

5. Which of the following would a community health nurse identify as a community of common interest? A) The global community B) Small rural town in a northern state C) National professional organization D) Counties addressing water pollution

Ans: C Feedback: A common-interest community shares a common interest or goal that binds the members together. Membership in a national professional organization is one example. The global community and a small rural town in a northern state would be examples of a geographic community. Counties addressing a water pollution problem would be an example of a community of solution.

23. A community health nurse is involved in a project to evaluate the health of a city. Which of the following findings would suggest that the city would most likely need additional programs? A) Citizens are actively involved in the city's department of recreation and after-school programs. B) The construction of affordable organized housing developments and communities is nearing completion. C) Approximately one third of the people are recently unemployed due to closure of the automotive factory. D) Several new recreational facilities for adults and children have been created at several locations.

Ans: C Feedback: A healthy city is one in which there is continual creation and improvement the physical and social environments with expansion of community resources so that people can mutually support one another. It is characterized by the meeting of basic needs for all of the city's people. This would include food, water, shelter, income, safety, and work. Loss of employment of one third of the city's workforce would be a threat to the health of the city and necessitate intervention. Active involvement in the city's functioning, affordable housing, and recreational facilities are suggestive of a healthy city.

14. Which of the following actions by the community health nurse exemplifies the societal influence of causality on the practice of community health nursing? A) Using computer-based education programs for client education B) Engaging in video conferencing to share research findings C) Identifying multiple factors associated with promoting wellness D) Developing a plan to address the rapid increase in older adult population

Ans: C Feedback: Causal thinking relates disease or illness to its cause and includes areas such as epidemiology; interactions among an agent, host, and environment; and recognition of multiple factors contributing to a disease, health disorder, or wellness. Using computer-based education programs and engaging in video conferencing are examples reflecting the advancement of technology. Developing a plan to address the rapid increase in the older adult population involves application of the change in demographics affecting community health nursing.

17. A prospective nursing student is interested in working in community health nursing after graduation. Which type of education would be most appropriate for this student to choose? A) Diploma program B) Associate degree C) Baccalaureate degree D) Graduate degree

Ans: C Feedback: Community health nursing is a challenging specialty in nursing. The demands of this type of nursing require additional courses in liberal arts and science, along with courses in community health nursing practice as a student. The minimum preparation for community health nurses in many states is a baccalaureate degree. The diploma and associate degree level prepares students for basic nursing practice. Students can build on this basic knowledge by entering a BSN completion program, which will prepare them to enter the specialty of community health nursing. In order to stay current and to build skills in this specialty, advanced courses or a graduate (masters) degree is needed.

16. When working in the community, the community health nurse adopts the teaching plan to ensure that the population understands the basic information provided to address which of the following? A) Self-care B) Health disparities C) Health literacy D) Episodic needs

Ans: C Feedback: Consumers are often intimated by health professionals and are uninformed about health and health care affecting the quality of care. Adopting a teaching plan to ensure that the population understands the basic information addresses health literacy, the ability to read, understand, and use health care information appropriately. Doing so helps to ensure that the teaching plan will be effective. Self-care refers to the process of taking responsibility for developing one's own health potential by actively participating in promoting one's own health. Health disparities reflect differences in all aspects of health care related to vulnerable populations. Episodic needs are one-time specific negative health events that arise and are not an expected part of life.

9. The nurse is reviewing a research article that describes the use of the bacille Calmette-Guerin (BCG) vaccine to prevent tuberculosis that was given to individuals who were exposed to leprosy. The individuals did not develop the leprosy. The nurse interprets this as most accurately demonstrating which type of immunity? A) Herd immunity B) Passive immunity C) Cross-immunity D) Active immunity

Ans: C Feedback: Cross-immunity refers to a situation in which a person's immunity to one agent provides immunity to a related agent as well. This immunity can be active or passive. Herd immunity describes the immunity level present in a population group. Passive immunity refers to short-term resistance acquired naturally or artificially. Active immunity is long-term and can be acquired naturally or artificially.

16. Which of the following most accurately reflects the response of community health nursing to economic forces? A) Decreased competition with other community health service providers B) Reduction in available programs and services C) Development of new services for generating revenue D) Switch to a more illness-oriented philosophy for service

Ans: C Feedback: Economic forces have led community health nursing to respond by developing new revenue-generating services to augment depleted budgets. Other responses include directly competing with other community health service providers and developing new programs and service emphases. Although some public health agencies have been drawn into more illness-oriented services, community health nursing continues to be resourceful in finding ways to foster the community's optimal health.

14. If an agency discards used needles and syringes in plastic milk jugs, which of the four key elements of an infectious waste management program that are applicable to community practice would the agency be violating? A) Health professionals must be able to correctly distinguish biohazardous waste from biomedical waste. B) The waste management program must have administrative support and authority to institute practice guidelines. C) Handling of the infectious wastes must be minimized. Containers should be rigid, leak resistant, and impervious to moisture. D) An enforcement or evaluation mechanism must be in place to ensure that the potential for exposure to infectious waste is met.

Ans: C Feedback: Handling of the infectious wastes must be minimized. Containers should be rigid, leak resistant, and impervious to moisture; they should have sufficient strength to prevent rupture or tearing under normal conditions; and they should be sealed to prevent leakage. Containers for sharps must also be puncture resistant. Other key elements of an infectious waste management program that are applicable to community practice include that health professionals must be able to correctly distinguish biohazardous waste from biomedical waste; the waste management program must have administrative support and authority to institute practice guidelines; and an enforcement or evaluation mechanism must be in place to ensure that the potential for exposure to infectious waste is met.

17. Which of the following statements about immunization is most accurate? A) Immunization is helpful in the spread of all communicable diseases. B) Immunization cannot provide herd immunity. C) Immunization is the process of introducing a form of a disease-causing organism into a person's system to promote the development of antibodies that will resist the disease. D) Immunization is the process of administering antibodies to a person.

Ans: C Feedback: Immunization is the process of introducing a form of a disease-causing organism into a person's system to promote the development of antibodies that will resist the disease. There are many communicable diseases that a vaccine is not known for. Immunization can help to promote herd immunity. Immunization does not involve the administration of antibodies to a person.

12. Which of the following nurses openly defied a law that she saw as unjust and eventually resulted in the formation of The International Planned Parenthood Federation? A) Lillian Wald B) Florence Nightingale C) Margaret Sanger D) Mary Brewster

Ans: C Feedback: Margaret Sanger openly defied a law that she saw as unjust (the Comstock Act that prohibited the provision of any information on contraception to women). This defiance eventually resulted in the formation of The International Planned Parenthood Federation. During the same period that Lillian Wald and her contemporaries were working to alleviate the suffering caused by disease and poverty, Margaret Sanger began a different battle. Florence Nightingale wrote a series of papers on the need for "home missioners" and "health visitors" and endorsed the view that prevention was better than cure. Mary Brewster was a nurse and a friend of Lillian Wald who both together started the Henry Street Settlement.

13. A group of nursing students are studying for a test about various cultural communities. The students demonstrate that they understand the material when they identify which cultural group as believing in predestination? A) Hispanic/Latinos B) African Americans C) Muslims D) Native Americans

Ans: C Feedback: Muslims believe in predestination, that life is determined beforehand, and they attribute the occurrence of disease to the will of Allah. Hispanic/Latinos believe that illness may be a form of punishment for sins. Some African Americans believe that illness is evidence of disharmony possibly due to evil spirits, punishment of God, or a hex placed on a person. Native Americans believe that health reflects living in total harmony with nature.

19. The community health nurse observes an increase in the development of multidrug-resistant tuberculosis. The nurse understands that a major reason for this occurrence for individual clients would most likely be A) political and social response to declining rates of TB over the past decade. B) a reduction in funding for surveillance and research. C) noncompliance with the therapy for the full, recommended period. D) a premature sense that TB has been defeated.

Ans: C Feedback: On an individual case basis, the most common means by which resistant organisms are acquired is by noncompliance with therapy for the full, recommended period. Factors that seem to contribute to the overall increase in multidrug-resistant tuberculosis include the political and social response to declining rates of TB over past decades, which has resulted in funding cuts for surveillance, treatment, and research, and a premature sense that TB was defeated.

16. A community health nurse would recommend pneumococcal vaccine for which group? A) 1-year-old children B) 30-year-old adults who have simple respiratory tract infections C) Adults over age 65 who have COPD D) Healthy adults in their 50s

Ans: C Feedback: Primary prevention includes a pneumococcal vaccine, especially for the high-risk groups, ages 2 years old and up, including those with chronic diseases, immune-suppressing health conditions, or those who are asplenic. Reimmunization is recommended only for high-risk children, or adults over 65 years old who had their first vaccination before age 65. The vaccine is not effective in children younger than 2 years of age and is not recommended for the healthy population between the ages of 2 and 65 years.

23. When implementing an epidemiologic research study, which of the following would the community health nurse complete as the final step? A) Analyze the data B) Design the study C) Disseminate findings D) Review the literature

Ans: C Feedback: The last step in the research process is to disseminate the findings. After identifying the problem and reviewing the literature, the researcher designs the study, collects the data, analyzes the findings, and develops conclusions and applications.

1. When reporting the identification of a communicable disease and need for investigation, which of the following must be notified first? A) Centers for Disease Control (CDC) B) State health department C) Local health department D) National Reported Disease list

Ans: C Feedback: The local health department is the initial point of notification of a communicable disease investigation. Each local health department or agency will investigate the specific disease. The CDC is the federal agency that provides guidance and recommendations for each state health department. The state health department may be the primary agency or the guiding agency for local disease control policies. States use the National Reported Disease list as the guidance for State reportable diseases.

5. What is the most serious negative effect of a nurse maintaining ethnocentric views but not recognizing or acknowledging this? A) The nurse fails to understand the views of other cultures because of his or her ethnocentrism. B) The nurse does not communicate effectively with members of other cultures because of his or her ethnocentrism. C) The nurse's ethnocentrism causes damage to interpersonal relationships and interferes with the effectiveness of nursing interventions. D) Nurses are immune to the effects of ethnocentrism.

Ans: C Feedback: The most negative effect of nurses maintaining ethnocentric views but not recognizing or acknowledging this is that the nurse's ethnocentrism causes damage to interpersonal relationships and interferes with the effectiveness of nursing interventions. The nurse who is ethnocentric and doesn't realize it will fail to understand the views of other cultures, but this is not the most serious negative effect. If the nurse is ethnocentric, he or she may not communicate effectively because of his or her ethnocentrism, and this can lead to impaired relationships and interference with the effectiveness of nursing interventions. All nurses hold ethnocentric views, but it is important for the nurse to be aware of them and acknowledge them to avoid having it damage relationships and interfere with the effectiveness of nursing interventions.

22. A community health nurse is assessing a family during a home visit. The nurse is examining the mother who is pregnant with her second child. The nurse asks the mother to raise her arms above her head. The mother replies, "I can't do this because it will cause the umbilical cord to strangle the baby." The nurse interprets this statement as reflective of which of the following? A) Home remedy B) Herbalism C) Folk medicine D) Alternative therapy

Ans: C Feedback: The mother's statement reflects folk medicine, a body of preserved treatment practices that has been handed down verbally from generation to generation. One example is not reaching above your head if you are pregnant, because doing so will cause the umbilical cord to strangle the baby. Home remedies are caregiving practices passed down between families, for example, ice on a cold sore, baking soda paste on a bee sting. Herbalism involves the use of medicinal herbs. Alternative therapy or complementary therapy is designed to promote comfort, health, and well-being and includes, for example, aromatherapy, music therapy, acupuncture, and yoga.

11. While visiting an Asian American family in their home, the community health nurse inspects the skin of the 3-year-old child and notices a bruise-like lesion on the child's abdomen. The mother states that the child has been experiencing diarrhea for 2 days. Which of the following would the nurse do next? A) Report the family to the local child abuse agency B) Recognize this as a normal skin variation C) Question the family about the use of cupping D) Obtain a blood test for clotting function

Ans: C Feedback: The nurse needs to gather additional information about the lesion. Practicing transcultural nursing would require the nurse to perform a cultural assessment and question the family about their use of dermabrasive techniques such as cupping that would leave a bruise-like lesion on the skin and be mistaken for physical abuse. The nurse would report the family to the local child abuse agency if further investigation provides additional information to support that decision. The lesion is not a normal skin variation. Obtaining a blood test for clotting function would be warranted only if further assessment reveals additional bruising or other signs of clotting problems.

21. While interviewing a client, which of the following statements would a nurse identify as reflecting an objective dimension of health? A) "I'm feeling better since I started taking that medication." B) "Life is pretty good right now, except for an occasional upset stomach." C) "I'm able to wash myself in the mornings with just a bit of help." D) "Sometimes when I wake up, I don't even want to face the day."

Ans: C Feedback: The objective dimension of health involves one's ability to function in daily activities. The statement about being able to care for one's self is an example. The statements of feeling better with medication, life being pretty good, and not wanting to face the day are examples of the subjective dimension of health, which involves how people feel.

6. A community health nurse is explaining the chain of causation to a family that includes a child who has developed Lyme disease. The nurse correctly describes the opening in the child's skin caused by the actual tick bite as the A) reservoir. B) mode of transmission. C) portal of entry. D) host.

Ans: C Feedback: The opening in the child's skin caused by the actual tick bite is the portal of entry in the chain of causation. The mode of transmission would be the tick biting the child. The reservoir would refer to the tick. The host would be the child who has been bitten by the tick.

3. When applying the epidemiologic triad model to a community's plan of care, which of the following would the community health nurse address? A) Incidence, prevalence, and case fatality B) Health, illness, and injury C) Host, agent, and environment D) Immunity, causation, and risk

Ans: C Feedback: The purpose of this model is to demonstrate the relationship among host, agent, and environment. Each component has to be present to a certain degree in order for any disease, illness, or injury to exist or happen. If one component is missing, illness or injury will not occur. Incidence, prevalence, case fatality, health, illness, injury, immunity, causation, and risk are terms used in epidemiology but do not refer to the epidemiologic triad model.

15. The nurse is reviewing actual census data for information for use in an epidemiologic study. Which of the following would the nurse be least likely to find? A) Occupational status B) Housing quality C) Births recorded D) Educational level

Ans: C Feedback: Vital statistic data provides information about the number of births recorded. Census data includes information about age, sex, race, ethnic background, type of occupation, income gradient, marital status, educational level, and other standards such as housing quality. If the nurse is reviewing actual census data, the nurse would be least likely to find births recorded, which is vital statistics.

24. When working with immigrant groups in community health care, which of the following would be least appropriate for the community health nurse to do? A) Permit ample time for interviewing to allow time to evaluate beliefs B) Develop educational programs to correct misconceptions C) Assume that the client has a basic understanding of health issues D) Ensure an appropriate interpreter for communication if needed

Ans: C Feedback: When working with immigrant groups in the community, do not make assumptions about a client's understanding of health care issues; permit more time for interviewing; allow time to evaluate beliefs and provide appropriate interventions; provide educational programs to correct any misconceptions about health issues; provide an appropriate interpreter to improve communication with immigrants who do not speak English well.

14. A community health nurse is working with other members of a team that will be implementing a citywide immunization program. The nurse is coordinating the services and addressing the needs of the population groups to ensure which of the following? A) Involvement of the community B) Client participation C) Continuity of service D) Plan for follow-up

Ans: C Feedback: Working in cooperation with other team members and coordinating services and addressing the needs of population groups are essential to interprofessional collaboration. In doing so, the community health nurse is preventing fragmentation and gaps thereby ensuring continuity of service. Involvement of the community and client participation are important but these help to ensure that the clients are viewed as equal partners of the health care team. A plan for follow-up may or may not be appropriate. In addition, it is the only aspect that may be addressed with the program.

11. When assessing several populations, the nurse notes each population's relative risk. Using the relative risk ratios below, which population would require a major emphasis for risk reduction intervention? A) 0.59 B) 1.13 C) 1.79 D) 2.45

Ans: D Feedback: A relative risk >1.0 indicates that those with the risk factor have a greater likelihood of acquiring the disease than do those without it. For example, a relative risk ratio of 2.45 means that the exposed group is 2.45 times more likely to acquire the disease than the unexposed group. Therefore, interventions to reduce this population's risk would be most important.

18. A family member has developed tuberculosis (TB) and the remainder of the family members are undergoing tuberculosis skin testing to determine their status. The nurse assesses the indurations and determines that a family member with which size induration is positive for TB? A) 2 mm B) 3 mm C) 4 mm D) 5 mm

Ans: D Feedback: An induration of 5 mm or more is considered positive for individuals in close contact with others who have TB. Indurations <5 mm are not considered positive.

20. The term health can be described in many different ways. A community health nurse would view health as which of the following? A) The absence of disease B) The potential to lead a productive life C) An environment free of toxins D) A holistic state of well-being

Ans: D Feedback: Community health nurses view health as a holistic state of well-being, which includes soundness of mind, body, and spirit. Along with this foundational view is the emphasis on wellness, which includes the definition of health as well as the capacity to develop a person's potential to lead a fulfilling and productive life. Health is more than just the absence of disease or an environment free of toxins.

19. A community health nurse is participating in a case-control observational study. Which of the following would most likely explain this type of study? A) Description of patterns of occurrence of illness and injury in a population B) Investigation of development of health-illness conditions over a long period of time C) Studying of a cohort with evaluation of variables associated with the disease or injury D) Comparison of persons with and without a health-illness condition

Ans: D Feedback: Comparing persons with and without a certain condition is known as a case-control study. A study that describes patterns of occurrence in a population is a descriptive study. Following people over a long period of time is a longitudinal study. And cohorts are groups studied over time.

21. When using descriptive epidemiology, which type of study would the community health nurse expect to include? A) Prevalence study B) Case-control study C) Cohort study D) Count study

Ans: D Feedback: Descriptive epidemiology includes investigations that seek to observe and describe patterns of health-related conditions that occur naturally in a population. The simplest measure of a description is a count. Prevalence, case-control, and cohort studies are types of studies involved with analytical research.

16. A community health nurse is providing care to an Asian American family who believes that a member's current illness is due to an excess of yin. The nurse integrates knowledge of this belief, expecting the family to avoid which foods? A) Rice B) Eggs C) Chicken D) Fruits

Ans: D Feedback: If the imbalance is an excess of yin, then "cold" foods, such as vegetables and fruits, are avoided, and "hot" foods, such as rice, chicken, eggs, and pork, are offered.

20. A community health nurse implements a plan of care that combines aromatherapy and acupuncture with medication therapy and surgery. The nurse is applying which of the following? A) Holistic health care B) Folk medicine care C) Herbalistic health care D) Integrated health care

Ans: D Feedback: Integrated health care is defined as the combination of complementary therapies such as aromatherapy and acupuncture with biomedical or Western health care such as medication therapy and surgery. Holistic health care vies the world as being in harmonious balance in which all facets of the individual's natures (physical, mental, emotional, and spiritual) must be in balance. Folk medicine involves treatment practices that have been handed down from generation to generation. Herbalism is the use of medicinal herbs.

1. After teaching a group of nursing students about the similarities and differences between public health and community health, which of the following statements by a nursing student would indicate knowledge of the similarities and differences between public health and community health? A) "Community health nursing is defined as nursing care that is provided in a community setting, rather than an institutional setting." B) "Public health nursing is defined as nursing care that is provided in an institutional setting." C) "Public health nursing is focused on the health of individuals." D) "Community health nursing can shape the quality of community health services and improve the health of the general public."

Ans: D Feedback: Operating within an environment of rapid change and increasingly complex challenges, this nursing specialty holds the potential to shape the quality of community health services and improve the health of the general public.

21. Which one of the following statements is true about the consequences of biologic terrorism with anthrax and smallpox? A) Anthrax is not usually spread by person to person contact and so is not a good agent of biological terrorism. B) Smallpox is globally eradicated and therefore does not present a problem. C) Most adults are immune to smallpox due to routine immunization. D) As many as one in five persons who become ill with cutaneous anthrax die and inhalation anthrax can cause death in 3 to 5 days.

Ans: D Feedback: The case-fatality rate for cutaneous anthrax is 5% to 20%. Inhalation anthrax initial symptoms are mild and nonspecific but progress to respiratory distress, fever, shock, and expected death within a matter of days. Anthrax is not usually spread by person to person contact, but it has been demonstrated to be an agent of biologic terrorism via spores that were placed in mail right after the 2001 terrorist attacks. Many adults are not immune to smallpox as it has not been used for routine immunization for 40 years.

15. A community health nurse works to ensure the greatest good for the greatest number of people by applying which of the following? A) Secondary prevention activities B) Autonomy C) Justice D) Utilitarianism

Ans: D Feedback: The ethical theory of utilitarianism promotes the greatest good for the greatest number. Primary prevention activities, not secondary prevention, are the priority. Autonomy refers to the freedom of choice. Justice involves treating people fairly.

3. Community health nursing has a long history of contributing to the health of populations. Which of the following forms of service would the nurse identify as being most recent? A) Voluntary home nursing care for the sick poor via district nursing B) Care provided termed public health nursing C) Lay and religious groups providing care to the sick poor in their homes D) Focus on populations with community health nursing seen as a specialty field

Ans: D Feedback: The four stages of community health nursing followed from lay and religious groups providing care in the early years before 1850, the more specialized "health nurses" or district nursing after the mid-1800s, concern for the health of the general public from 1900s to 1970, and finally community health nursing as a specialty with a focus on populations since 1970.

4. Which of the following would the community health nurse identify as a key component of the host? A) Infectivity B) Antigenicity C) Virulence D) Inherent resistance

Ans: D Feedback: The host, a susceptible human or animal, can sometimes have an ability to resist pathogens. This is called inherent resistance. Infectivity, antigenicity, and virulence are characteristics of the agent.

17. What is the most important reason for the nurse to conduct a cultural assessment? A) Because it is often assigned by nursing faculty B) Because usually there is some culturally based reason that causes clients to engage in or avoid certain actions C) To meet the nurse's professional learning needs D) Because understanding the values, beliefs, and practices of a designated cultural group is critical to effective nursing action

Ans: D Feedback: The most important reason for the nurse to conduct a cultural assessment is that because understanding the values, beliefs, and practices of a designated cultural group is critical to effective nursing action. There is usually some culturally based reason that causes clients to engage in or avoid certain actions but that is not the most important reason for the nurse to conduct a cultural assessment. The nurse does not necessarily collect a cultural assessment to meet his or her own needs primarily.

13. The three main approaches to the tertiary prevention of communicable disease include which of the following? A) Education, immunization, and screening B) Screening, immunization, and isolation and quarantine C) Case and contact investigation, notification, and treatment D) Care and treatment, isolation and quarantine, and safe handling and control of infectious wastes

Ans: D Feedback: The three main approaches to the tertiary prevention of communicable disease include care and treatment, isolation and quarantine, and safe handling and control of infectious wastes. The primary prevention techniques for communicable disease include education, immunization, and screening. The secondary prevention techniques for communicable disease include case and contact investigation, notification, and treatment.

23. When working with different cultural groups in the area of health care practices, the nurse acts as an effective advocate for the client. Which of the following must the nurse do first? A) Prepare to teach clients about the limits and benefits of cultural health practices B) Assess the client or family adequately to ascertain their belief system and choices C) Individualize caregiving for the client within his or her culture D) Be knowledgeable about health care practices and choices

Ans: D Feedback: When working with different cultural groups in the area of health care practices, the community health nurse can be an effective advocate for the client. First, however, the nurse must be prepared to speak knowledgeably about health care practices and choices. The nurse also must be able to assess the client or family adequately so as to know what belief system motivates their choices. Finally, the nurse must be prepared to teach clients about the limits and benefits of cultural health care practices. The community health nurse should always individualize assessment and caregiving for the client within his or her culture and should not generalize about the client based on cultural group norms.