Question 1

Which of the following types of study should the nurse researcher choose if the goal is to identify the long-term benefits and risks of a particular nursing intervention for senior citizens living in the community?
A) Cross-sectional study
B) Ecological study
C) Clinical trial
D) Retrospective analysis

Accepted Answer

The goal of a clinical trial is to evaluate the effectiveness of an intervention.Clinical trials are generally the best way to show causality.A cross-sectional study provides a snapshot of a population or group.An ecological study is a bridge between descriptive and analytic epidemiolgy,looking at variations in disease rates by person,place,or time and trying to determine if there is a relation of disease rates to variations in rates for possible risk factors.A retrospective analysis relies on existing records to define a chort that has been exposed or unexposed at some point in the past.

Question 2

Two women seem to agree on almost everything from favorite music to favorite media stars to the best way to prepare a meal.Which of the following best explains this similarity in the two women?
A) They are both members of the same birth cohort.
B) They are close friends.
C) They attended the same school.
D) They both go the same church.

Accepted Answer

Being born at about the same time would mean both women have lived through similar social events and media occurrences and therefore would have much in common.Being close friends is probably the result of the similarity rather than the cause.Going to the same school or the same church,depending on the size of the institutions,might not result in any personal interaction whatsoever.

Question 3

The administration at a local medical center examines the trends in health problems when developing long-range plans for staffing and space allocation.Which of the following sources of information would be most helpful?
A) Local data drawn from a professional survey in the city
B) The National Health Interview Survey
C) The National Hospital Discharge Survey
D) The state's vital statistics

Accepted Answer

For many studies,however,the only way to obtain the needed information is to collect the required data in a study specifically designed to investigate a particular question.The National Health Interview Survey and the National Hospital Discharge Survey both provide information on the health status and behaviors of the national population.A state's vital statistics are the birth and death certificates within the state which would not give the administration the information that they are looking for in this community.

Question 4

A nurse is concerned about the high incidence of STDs in the community college population and sets up a special STD screening.Which of the following groups of students would be encouraged to attend?
A) Sexually active students currently receiving treatment for an STD
B) Sexually active students who had been screened the previous year
C) Students who are not sexually active and do not plan to become sexually active
D) Students who are sexually active but never "go all the way"

Accepted Answer

Those who are at risk to develop the problem should be encouraged to attend the screening.This should be anyone who could is or plans to be sexually active.Those already diagnosed with the problem are not at risk,because they already have the condition and are no longer at risk for developing it.Thus,it would not be beneficial for this population to attend the screening as they have already been diagnosed.Students who not sexually active do not need to attend the screening as they are not at risk for contracting an STD because they are not having sex.

Question 5

A nurse is investigating a bacterial illness that has caused a health problem in the community.Only some of the people exposed to the bacteria have become ill.Which of the following factors best explains why this would have happened?
A) Chemical agent factors
B) Environmental factors
C) Host factors
D) Physical agent factors

Accepted Answer

The epidemiologic triangle includes the agent,host,and environment.Only differences in host factors can explain why some became ill and some were able to fight off the bacterial infestation.The epidemiologic triangle includes the agent,host,and environment.The bacteria were the agent so chemical and physical agents are not relevant.The environment was apparently the same for everyone,since all were exposed to the bacteria.

Question 6

A nurse is planning to host a health screening at a large urban mall.Which of the following variables will help the nurse determine which screenings should be included?
A) Adequate space for persons to lie down after testing until side effects are reduced
B) Health problems for which the specific population is at risk
C) Whether adequate privacy can be obtained for the invasive or embarrassing procedures
D) Whether health care providers are available to follow up on any positive screening results

Accepted Answer

The screening tests should be reliable,valid,fast,and inexpensive.Results should be known immediately.Ethically,nurses should not screen for any problem unless they can refer those with positive results to a source for follow-up testing and treatment.The screening tests should have few side effects,be minimally invasive,and be capable of detecting enough new cases to warrant the effort and expense.No tests should be used that have negative side effects,are invasive,or cause embarrassment.

Question 7

Statistics clearly demonstrate that there are significantly more cases of a disease in one particular neighborhood than in all the rest of the city.Assuming all else is the same,which of the following is the most likely explanation for a single neighborhood having such a different pattern of illness?
A) A cultural or ethnic concentration in the neighborhood
B) The geographic location of the neighborhood within the city
C) A statistical fluke without meaning
D) The time of year the different statistics were collected throughout the city

Accepted Answer

The most probable reason is that there is a cultural or ethnic concentration in that particular neighborhood that has a different lifestyle pattern,resulting in different health outcomes.The assumption is made that all things in the city are the same,thus the geographical location would not be a likely explanation for the difference.However,location may play a role at times with increased incidence of disease depending on exposure to certain environmental factors which could place the population at risk.A statistical fluke does not provide a likely explanation for the difference.There are times when there are cyclical patterns of disease.However,the question states that the assumption should be made that all else is the same,so one can assume that the data was collected within the city at the same time.

Question 8

Which of the following explains why contagious infections are becoming a central focus of public health?
A) Americans are fearful of terrorists using biological agents.
B) Awareness of human susceptibility to animal diseases has been publicized.
C) Drug-resistant strains of old diseases have evolved.
D) Media coverage exaggerates the dangers of exposure to crowds.

Accepted Answer

New infectious diseases and new forms of old diseases,such as drug-resistant strains of TB,have emphasized the dangers of infectious diseases.Potential threats from terrorist use of infectious agents have also emphasized infectious diseases.There has not been any increased awareness of human susceptibility to animal diseases that has caused contagious infections to become a central focus of public health.Also,media coverage has not exaggerated the danger of exposure to crowds when it comes to contagious infections.

Question 9

A principal comments to the school nurse that it seems there are a lot more problems with asthma among the students than there were before the school was remodeled a couple of years ago.The nurse investigates the principal's observation by reviewing all the school records to determine visits to the health office because of asthma by week and month for the past 5 years.Which of the following best describes the type of study the nurse is conducting?
A) Descriptive epidemiological study
B) Ecological study
C) Prospective cohort study
D) Retrospective cohort study

Accepted Answer

Retrospective cohort studies rely on existing records to define a cohort that is classified as having been exposed or unexposed at some time in the past.In this case,the issue is whether there is some health risk in the new building addition that is increasing frequency of visits to the school nurse because of asthma.In a descriptive epidemiological study,the disease is investigated in terms of person,place,and time.An ecological study is a bridge between descriptive and analytic epidemiolgy,looking at variations in disease rates by person,place,or time and trying to determine if there is a relation of disease rates to variations in rates for possible risk factors.A prospective cohort study,subjects who do not have the outcome under investigation are classified on the basis of the exposure of interest at the beginning of the follow-up period.

Question 10

A nurse reports that in comparison to all the children in a particular school,the children who are members of the Cub Scouts have 0.3 risk for obesity before entering the sixth grade.Which of the following recommendations would the nurse make to the new parents of two boys who had just moved into this school's neighborhood?
A) Discourage the parents from enrolling their sons in Cub Scouts because of the risk.
B) Don't say anything about Cub Scouts, because it isn't relevant to nursing care.
C) Encourage the parents to enroll their sons in Cub Scouts.
D) Share the finding and let the parents draw whatever conclusions they feel appropriate.

Accepted Answer

Relative risk is an estimation of the risk of acquiring a problem for those who are exposed compared with those who are unexposed.As the risk for obesity is less for those that are members of Cub Scouts,joining the group is protective and reduces the incidence among members.Parents should be encouraged to enroll their sons in Cub Scouts as joining the group is protective and reduces the risk for becoming obese.The finding should be interpreted for the parents and the protective aspect of joining the group should be explained.

Question 11

A woman is sitting in a corner of the clinical waiting room,crying audibly.The nurse asks,"What's wrong? Can I help?" The woman responds,"They just told me I have a positive mammogram and I need to see my doctor for follow-up tests.I know I'm going to die of cancer.How can I tell my family?" Which of the following information does the nurse need to know in order to help the woman cope with this finding?
A) The negative predictive value of mammography
B) The positive predictive value of mammography
C) The reliability of mammography
D) The validity of mammography

Accepted Answer

The 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.A negative predictive value is the proportion of persons with a negative test who are actually disease free.Reliability relates to the consistency or repeatabilty of the measure.Validity in a screening test is typically measured by sensitivity (how accurately it identifies those with the condition)and specificity (how accurately the test identifies those without the condition).

Question 12

Persons in an auditorium may have been exposed to a disease.If they are infected,it is crucial that they receive immediate treatment and not take the disease home to their families.Which of the following characteristics would be most important to consider when selecting the screening test to be used?
A) The negative predictive value
B) The positive predictive value
C) The sensitivity of the test
D) The specificity of the test

Accepted Answer

Because it is most important to identify every case,the sensitivity of the test is crucial.High sensitivity is needed when early treatment is important and when identification of every case is important.A negative predictive value is the proportion of persons with a negative test who are actually disease free.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.Specificity indicates how accurately the test identifies those without the condition or trait.

Question 13

A nurse believes a new mouth care procedure (MCP)is causing more mouth problems than it is helping to avoid.Which of the following must be present for the nurse to go to administration with confidence that the MCP is causing problems?
A) A plausible explanation of how the new MCP could cause harm
B) A strong feeling that the MCP is the cause
C) Consistently seeing mouth inflammation in many of the patients who have received the MCP
D) Documentation from patient records that mouth inflammation in clients did not occur until after the new procedure was implemented

Accepted Answer

Strength of association is suggested by the fact that patients who did not receive the MCP and patients seen on the floor before the new MCP did not have problems,whereas patients who received the new MCP are having problems.Seeing the problems in many of the patients suggests a consistency.The fact that those who had the procedure more often have worse problems suggests a dose-response relationship.A plausible explanation of how the new procedure could cause harm enhances the biological risk.Although one would hope that previous testing would have been done before the product was released to market,the product could be safe for healthy persons but a risky process for those with compromised immunity or those who are under stress.Feelings alone are not convincing.A study should be set up to confirm or dispute the nurse's hypothesis.

Question 14

A teacher recommends that surveys to obtain data on drug use be given to high school students when they meet for various school organizations.Which of the following best describes why the nurse would reject this suggestion?
A) This method of data collection would result in classification bias.
B) This method of data collection would result in confounding bias.
C) This method of data collection would result in personal bias.
D) This method of data collection would result in selection bias.

Accepted Answer

Any study is subject to bias resulting from selective choice.There may be a difference between students who choose to belong to an organization and students who choose not to join an organization.Selection bias occurs when selection procedures are not representative of the population as a whole.In this instance,the goal is to determine drug use of all students at the school.If only students who join school organizations are selected,those who do not join organizations will not be represented.Classification bias occurs once subjects are enrolled in the study and relates to how information is collected.Confounding bias results from the relationship between the outcome and the study factor and some third factor that was not accounted for.Personal bias deals with personal opinions and attitudes of the researcher which may interfere with the proper selection of the participants.

Quiz 9: Epidemiological Applications

Which of the following types of study should the nurse researcher choose if the goal is to identify the long-term benefits and risks of a particular nursing intervention for senior citizens living in the community?

Two women seem to agree on almost everything from favorite music to favorite media stars to the best way to prepare a meal.Which of the following best explains this similarity in the two women?

The administration at a local medical center examines the trends in health problems when developing long-range plans for staffing and space allocation.Which of the following sources of information would be most helpful?

A nurse is concerned about the high incidence of STDs in the community college population and sets up a special STD screening.Which of the following groups of students would be encouraged to attend?

A nurse is investigating a bacterial illness that has caused a health problem in the community.Only some of the people exposed to the bacteria have become ill.Which of the following factors best explains why this would have happened?

A nurse is planning to host a health screening at a large urban mall.Which of the following variables will help the nurse determine which screenings should be included?

Which of the following explains why contagious infections are becoming a central focus of public health?

A nurse believes a new mouth care procedure (MCP) is causing more mouth problems than it is helping to avoid.Which of the following must be present for the nurse to go to administration with confidence that the MCP is causing problems?

A teacher recommends that surveys to obtain data on drug use be given to high school students when they meet for various school organizations.Which of the following best describes why the nurse would reject this suggestion?