Question 1

A nurse has only a regular blood pressure cuff when conducting a health screening for all of the residents of a community.Which of the following may be lacking when obtaining blood pressure readings?
A) Reliability
B) Sensitivity
C) Specificity
D) Validity

Accepted Answer

Validity is the accuracy of a test or measurement,or how closely it measures what it claims to measure.With only one regular BP cuff,the nurse cannot obtain accurate measurements on those who are extremely obese or extremely thin.A thigh cuff and a pediatric cuff would allow the nurse to obtain accurate-that is,valid-measurements.Reliability refers to the consistency or repeatability of the measure.If the wrong size blood pressure cuff is used,it is likely that the same wrong blood pressure would be repeatedly obtained.Sensitivity and spcificity are the two ways that validity can be described.Sensitivity quantifies how accurately the test identifies those with the condition or trait.Specificity indicates how accurately the test identifies those without the condition or trait.With the wrong size blood pressure cuff,the sensitivity and specificity of the screening would be in question.

Question 2

A nurse advises a client with osteoporosis to have three servings of milk or dairy products daily.Which of the following levels of prevention is being used by the nurse?
A) Primary prevention
B) Secondary prevention
C) Tertiary prevention
D) Treatment, but not prevention

Accepted Answer

Interventions that prevent worsening of a condition are tertiary prevention activities.In this instance,the client already has a health problem (osteoporosis).By advising adequate dairy intake,the nurse aims to ensure that enough calcium is available to limit worsening of the osteoporosis.Primary prevention would focus on interventions the reduce the risk of one getting the disease.Secondary prevention addresses screening tests to detect the disease at the earliest stage possible.Treatment is not a level of prevention.

Question 3

A nursing staff has successfully screened for diabetes in the community.Which of the following might best persuade the health board to increase funding for diabetic clinics in this community?
A) An epidemic of diabetes is now recognized and must be addressed.
B) The incidence of diabetes is now higher than previously recognized in the community.
C) The prevalence of diabetes is now higher than previously recognized in the community.
D) The risk for diabetes in the community could decrease if funding is received.

Accepted Answer

Prevalence is a fairly stable number.Prevalence proportions reflect duration in addition to the risk for getting the disease.Prevalence is useful in planning health care services because it is an indication of the level of disease existing in the population and therefore the size of the population in need of services.An epidemic occurs when the rate of disease,injury,or other conditions exceeds the usual level of that condition.Incidence is affected only be factors related to the risk for developing the disease and not survival or cure.The nurse is proposing to increase funding for diabetic clinics,having more diabetic clinics would assist those who already have the disease,so it would have limited impact on decreasing the risk of developing the disease among members of the community.

Question 4

Which of the following statistics is used by countries to compare the success of their health care systems?
A) Attack rate
B) Infant mortality rate
C) Proportionate mortality ratio
D) Cause-specific mortality rate

Accepted Answer

Infant mortality is used around the world as an indicator of overall health and availability of health care services.The attack rate is the proportion of persons exposed to an agent who develop the disease.The cause-specific mortality rate is an estimate of the risk for death from some specific disease in a population.The proportionate mortality ratio is the proportion of all deaths resulting from a specific cause.

Question 5

Which of the following statements describes how nursing in the community is more challenging than nursing in an acute care setting?
A) There is limited access to information useful to the nurse in giving care in the community.
B) More paperwork and forms are required when giving care in the home.
C) It is more challenging to control the environment in the community.
D) Specialization isn't possible in the community setting.

Accepted Answer

In the community,nurses often use epidemiology,since the factors that affect the individual,family,and population group cannot be as easily controlled as in acute care settings.It is essentially impossible to control the environment in the community.Nurses working in the community have multiple resources that can be used to access information about the community.There may be additional paperwork and forms to complete in the home environment,but the lack of control of the environment is a larger challenge than the completion of paperwork.Community health nursing is recognizd as a specialty within nursing.

Question 6

Between 2010 and 2015,1000 of 10,000 young women age 17 to 20 years at a university tested positive for a sexually transmitted infection (STI).Of the 1000 diagnosed STIs,300 were gonorrhea and 500 were chlamydia.Which of the following statements best summarizes these findings?
A) The proportion of cases of gonorrhea to all STIs was 300:1300.
B) The proportion of cases of gonorrhea to chlamydia was 300:500.
C) The proportion of cases of gonorrhea to all STIs was 50%.
D) The proportion of STIs to the total population was 100:1000.

Accepted Answer

A proportion is a ratio in which the denominator includes the numerator.If the proportion is small,we can express the number per 1000.The answer of 100:1000 correctly summarizes that 1000 of 10,000 (or 100:1000)young women had the problem.The answer of 300:1300 adds the total of the numerator to the denominator,which is unnecessary because the gonorrhea cases were already included in the denominator.In the answer of 300:500,the ratio comparing gonorrhea to chlamydia does not meet the epidemiological definition of proportion (i.e.,the denominator must contain the numerator).Although proportions may be expressed as percentages,in the answer of 50% the percentage reflects the number of gonorrhea cases to all STIs,which doesn't summarize the total STI problem.

Question 7

A school nurse wants to decrease the incidence of obesity in elementary school children.Which of the following describes a secondary prevention intervention that the nurse could implement?
A) Giving a presentation on the importance of exercise and physical fitness
B) Designing a game in which students select healthy food choices
C) Weighing students to identify those who are overweight
D) Putting students on a diet if they weigh greater than 20% of their ideal weight

Accepted Answer

Secondary prevention refers to interventions that increase the probability that a person with a condition will have the condition diagnosed early.Health screenings are the mainstay of secondary prevention.Weighing students and assessing whether the weight is higher than recommended will allow for early intervention so that obesity may be avoided.Giving a presentation and designing a game are both examples of primary prevention.Placing overweight students on a diet is an example of tertiary prevention.

Question 8

A nurse is administering a tuberculosis (TB)skin test to a client who has acquired immune deficiency syndrome (AIDS).Which of the following results should the nurse anticipate when using this screening test?
A) Decreased positive predictive value
B) Decreased reliability
C) Decreased sensitivity
D) Decreased specificity

Accepted Answer

Persons with immune deficiencies may have a negative tuberculosis skin test even though they are infected.Sensitivity is the extent to which a test identifies those individuals who have the condition being examined.AIDS is an acquired immune deficiency; thus,clients with AIDS may have a false-negative response to TB skin tests; that is,they have the disease but the test is not sensitive enough to detect infection in these individuals.Therefore,there is decreased sensitivity with those clients.A positive predictive value is the proportion of persons with a positive test who actually have the disease,interpreted as the probability that an individual with a positive test has the disease.In this case,it is likely that if the individual has the disease it will not be detected.Reliability relates to the consistency or repeatabilty of the measure.Because of the client's altered immune status,it is likely that the same results would be obtained if the test was to be repeated.Specificity indicates how accurately the test identifies those without the condition or trait.In this case,it is likely that a false-negative reading would be obtained,so the specificity not be accurate.

Question 9

A public health nurse found that out of the 70 people who ate the potato salad at a school picnic,63 developed symptoms of food poisoning.Which of the following best describes the attack rate?
A) 63%
B) 70%
C) 90%
D) 100%

Accepted Answer

The attack rate is the proportion of persons exposed to an agent who develop the disease.Because 63 of the 70 persons became ill,the attack rate is 63:70,or 90%.Sixty-three (63)is the number of clients who developed symptoms of food poisoining.Seventy (70)is the total number of people who ate the potato salad at the school picnic.These numbers need to be used as part of the formula to calculate the attack rate.One hundred (100)does not represent any part of the formula that would be used to calculate the attack rate.

Question 10

In a particular community,several high school students were diagnosed with diabetes mellitus Type 2 during the annual high school health fair.Over the next few years,the nursing staff developed and implemented educational programs about the risk factors for diabetes mellitus Type 2 and proper nutrition.Which of the following would be most useful for the nurses to use to determine if they are having any impact?
A) The epidemic of diabetes in the high school is gradually ending.
B) The incidence of diabetes is slowly decreasing during screening events.
C) The prevalence of diabetes is slowly decreasing during screening events.
D) The risk for diabetes is slowly increasing over time.

Accepted Answer

Incidence rates and incidence proportions are the measure of choice to study etiology because incidence is affected only by factors related to the risk of developing disease and not to survival or cure.If the educational programs are having the desired impact,the incidence of diabetes being diagnosed will decrease in future screenings.Prevalence is a fairly stable number over time,but incidence reacts more quickly to changes in risk factors or intervention programs.In order for an epidemic to have occurred,the rate of the illness would have had to exceed the usual level of that condition.There is no evidence in this question to support that the disease was at an epidemic level in this population.If the educational programs are effective,the risk for diabetes should be slowly decreasing over time.

Question 11

A nurse is using analytic epidemiology when conducting a research project.Which of the following projects is the nurse most likely completing?
A) Reviewing communicable disease statistics
B) Determining factors contributing to childhood obesity
C) Analyzing locations where family violence is increasing
D) Documenting population characteristics for healthy older citizens

Accepted Answer

Epidemiology refers not only to infectious epidemics but also to other health-related events.Analytic epidemiology looks at the etiology (origins or causes)of disease.It discusses the disease in terms of how and why.Descriptive epidemiology considers health outcomes in terms of what,who,where,and when.It discusses a disease in terms of person,place,and time.

Question 12

A man is diagnosed with prostate cancer.Which of the following data should the nurse know to answer the man when he asks,"What are the chances I'll survive this thing?"
A) Attack rate
B) Case fatality rate
C) Cause-specific morbidity rate
D) Crude mortality rate

Accepted Answer

The case fatality rate (CFR)is the proportion of persons diagnosed with a particular disorder (i.e.,cases)who die within a specified period.The CFR is considered an estimate of the risk for death within that period for a person newly diagnosed with the disease.Persons diagnosed with a particular disease often want to know the probability of surviving.The CFR provides that information.The attack rate is the proportion of persons exposed to an agent who develop the disease.The cause-specific mortality rate is an estimate of the risk for death from some specific disease in a population.The crude mortality rate is an estimate of the risk for death for a person in a given population.

Question 13

A nurse is examining the various factors that lead to disease and suggests several areas where nurses could intervene to reduce future incidence of disease.Which of the following models would the nurse most likely use?
A) Epidemiologic triangle
B) Health promotion
C) Levels of prevention
D) Web of causality

Accepted Answer

The web of causality model recognizes the complex interrelationships of many factors interacting to increase or decrease the risk for disease.Causal relationships (one thing or event causing another)are often more complex than the epidemiologic triangle conveys.Levels of prevention are actions taken to improve health outcomes.Health promotion addresses health improvement not identification of where nurses could intervene to reduce future incidence of disease.

Question 14

Several small communities have applied for grant funding from the state department of health to help decrease their teenage pregnancy rate.Which of the following communities should the nurse suggest receive funding first?
A) Community A-with 23 single teenage pregnancies in a city of 500
B) Community B-with 45 single teenage pregnancies in a city of 1000
C) Community C-with 90 single teenage pregnancies in a city of 2000
D) Community D-with 90 single teenage pregnancies in a city of 1500

Accepted Answer

The pregnancy rates of A,B,and C are 45-46:1000,whereas the rate in Community D is 60:1000.Without doing any actual math,it should be fairly obvious that 23:500,45:1000,and 90:2000 are all about the same proportion but that 90:1500 is a larger proportion.

Question 15

This year 600 of 8000 young women age 17 to 20 years at a university health center tested positive for a sexually transmitted infection (STI).Which of the following terms best describes this data?
A) An epidemic
B) Incidence
C) Prevalence
D) Risk

Accepted Answer

Prevalence is the measure of existing disease in a population at a particular time.Because we do not have baseline data,we have no way to conclude that this is an epidemic with higher-than-normal results from the screening.Incidence refers to new cases,whereas prevalence means all cases.We don't know whether the finding represents the first time a woman was told she had an STI or whether she had previously been diagnosed with the problem.Therefore,we can't say whether these are new cases (incidence),but the results do represent all cases (prevalence).Risk is the probability of developing an STI,but no risk factors are discussed.

Question 16

A nurse is examining all of the various factors which can lead to disease.Which of the following models would the nurse most likely use?
A) Epidemiologic triangle
B) Health promotion
C) Levels of prevention
D) Natural history of disease

Accepted Answer

The epidemiologic triangle categorizes factors as agent,host,or environment.The model encourages the health care provider to examine all the influences that lead to increased risk.Levels of prevention are actions taken to improve health outcomes.Health promotion addresses health improvement,not the risk for disease.

Question 17

A nurse is employed as a nurse epidemiologist.Which of the following activities would most likely be completed by the nurse?
A) Eliciting the health history of a client presenting with an illness
B) Evaluating the number of clients presenting with similar diseases
C) Performing a physical examination of an ill client
D) Providing treatment and health education to a client with a disease

Accepted Answer

Epidemiology monitors the health of the population.Epidemiology differs from clinical medicine,which focuses on the diagnosis and treatment of disease in individuals.

Question 18

Which of the following actions by Florence Nightingale demonstrates her role as an epidemiologist?
A) She convinced other women to join her in giving nursing care to all the soldiers.
B) She demonstrated that a safer environment resulted in decreased mortality rate.
C) She obtained safe water and better food supplies and fought the lice and rats.
D) She met with each soldier each evening to say goodnight, thereby giving psychological support.

Accepted Answer

Nightingale examined the relationship between the environment and the recovery of the soldiers.Using simple epidemiological measures,she was able to show that improving environmental conditions and adding nursing care decreased the mortality rates of the soldiers.Nightingale used statistics to document decreased mortality rates when the environmental factors were improved.Asking other women to assist with providing nursing care,obtaining safe water,and meeting with each soldier are not interventions that demonstrate the use of epidemiology (the relationship between the health events and th determinants or factors that influence those patterns).

Question 19

Which of the following actions would a nurse take to reduce the high incidence of coronary artery disease (CAD)in a community?
A) Introduction of a heart-healthy curriculum beginning in the first grade, presentations on diet and exercise for the community at large, and special education sessions for high-risk populations
B) Provision of online activities related to prevention of cardiac disease, smoking reduction programs, and blood pressure screenings
C) Distribution of handouts, including age-appropriate games, self-assessments, and education on heart-healthy lifestyles; availability of community screenings for hyperlipidemia in persons age 35 and older; and walking programs for those affected with CAD
D) Enrollment of clients with CAD into cardiac rehabilitation programs, routine evaluation of effectiveness of CAD treatment regimens, and participation in clinical trials that evaluate interventions for those diagnosed with CAD

Accepted Answer

Distributing handouts includes all three levels of prevention to target all members of the population.Targeting all members of the population and implementing all levels of prevention increase the likelihood of positive outcomes for the community as a whole.Education in schools,the community,and high-risk populations focuses only on primary prevention activities.Online activities focus only on primary and secondary prevention.Efforts focused only on those who already have CAD are not primary prevention.

Question 20

The nursing staff has attempted to screen the entire African American population in the community for diabetes.Which of the following would provide immediate verification of the success of the nursing staff's efforts?
A) An epidemic of diabetes will be recognized.
B) The incidence of diabetes will increase in the community.
C) The prevalence of diabetes will decrease in the community.
D) The risk for diabetes in the community will increase.

Accepted Answer

If the screening has been successful,more diabetes will be diagnosed and,hopefully,treated.Thus,the incidence of new cases will increase.Overall,prevalence will also increase,but that is not one of the answer options.An epidemic occurs when the rate of disease,injury,or other conditions exceeds the usual level of that condition.The prevalence (measure of existing disease in a population at a particular time)of diabetes would also increase.The risk for diabetes would not increase rather it would be more likely that the disease would be detected.

Quiz 9: Epidemiological Applications

A nurse has only a regular blood pressure cuff when conducting a health screening for all of the residents of a community.Which of the following may be lacking when obtaining blood pressure readings?

A nurse advises a client with osteoporosis to have three servings of milk or dairy products daily.Which of the following levels of prevention is being used by the nurse?

A nursing staff has successfully screened for diabetes in the community.Which of the following might best persuade the health board to increase funding for diabetic clinics in this community?

Which of the following statistics is used by countries to compare the success of their health care systems?

Which of the following statements describes how nursing in the community is more challenging than nursing in an acute care setting?

Between 2010 and 2015,1000 of 10,000 young women age 17 to 20 years at a university tested positive for a sexually transmitted infection (STI) .Of the 1000 diagnosed STIs,300 were gonorrhea and 500 were chlamydia.Which of the following statements best summarizes these findings?

A school nurse wants to decrease the incidence of obesity in elementary school children.Which of the following describes a secondary prevention intervention that the nurse could implement?

A nurse is administering a tuberculosis (TB) skin test to a client who has acquired immune deficiency syndrome (AIDS) .Which of the following results should the nurse anticipate when using this screening test?

A public health nurse found that out of the 70 people who ate the potato salad at a school picnic,63 developed symptoms of food poisoning.Which of the following best describes the attack rate?

A nurse is using analytic epidemiology when conducting a research project.Which of the following projects is the nurse most likely completing?

A man is diagnosed with prostate cancer.Which of the following data should the nurse know to answer the man when he asks,"What are the chances I'll survive this thing?"

A nurse is examining the various factors that lead to disease and suggests several areas where nurses could intervene to reduce future incidence of disease.Which of the following models would the nurse most likely use?

Several small communities have applied for grant funding from the state department of health to help decrease their teenage pregnancy rate.Which of the following communities should the nurse suggest receive funding first?

This year 600 of 8000 young women age 17 to 20 years at a university health center tested positive for a sexually transmitted infection (STI) .Which of the following terms best describes this data?

A nurse is examining all of the various factors which can lead to disease.Which of the following models would the nurse most likely use?

A nurse is employed as a nurse epidemiologist.Which of the following activities would most likely be completed by the nurse?

Which of the following actions by Florence Nightingale demonstrates her role as an epidemiologist?

Which of the following actions would a nurse take to reduce the high incidence of coronary artery disease (CAD) in a community?

The nursing staff has attempted to screen the entire African American population in the community for diabetes.Which of the following would provide immediate verification of the success of the nursing staff's efforts?