Community Exam II

Which of the following best describes most Americans‘ attitude toward immigrants?

Ambivalence, because there are no clear solutions about how to address their needs.

Earlier in the week, a nurse carefully taught a patient from a different culture exactly how much

medication to take and emphasized the importance of taking the correct amount. . However,

the patient is back in the hospital today with symptoms of an overdose although the patient

denies taking more than the label indicated. Which of the following is the most likely

explanation?

The patient was also taking folk medicines that had many of the same effects and

perhaps some of the same ingredients as the prescribed medication.

A nurse wishes to develop cultural competence. Which of the following actions should the nurse take first?

Consider how the nurse‘s own personal beliefs and decisions are reflective of his or her

culture.

A nurse is caring for a client of another culture. Which of the following actions would be the

most appropriate for the nurse to take?

Alter personal nonverbal behaviors to reflect the cultural norms of the client.

A male nurse had a habit of sitting with the lower part of one leg resting over the knee of his

opposite leg when collecting a client‘s history. He stopped doing this around specific clients

after being told that they were offended when he exposed the sole of his foot (shoe) to their

face. Which of the following was exhibited by the nurse when he changed his behavior?

Cultural skill

The nurse practitioner (NP) discovered that an immigrant client is not taking the penicillin

prescribed because his illness is “hot” and he believes that penicillin, a “hot” medicine, will not

provide balance. Which of the following terms best describes the action taken by the NP when the client‘s prescription is changed to a different yet equally effective antibiotic?

Cultural knowledge

An immigrant who takes metamizole (banned in the United States) for pain may experience life- threatening agranulocytosis. Which of the following actions would be taken by a nurse who employs cultural re-patterning?

Explain the harmful effects of metamizole and recommend an alternative medication

for pain.

A health care worker tells a nurse, “It does no good to try to teach those Medicaid clients about

nutrition because they will just eat what they want to no matter how much we teach them.” Which of the following is being demonstrated by this statement?

Stereotyping

An American nurse says, “I‘m not going to change the way I practice nursing based on where the client is from because research shows that Western health care technology and research is best.” Which of the following is being demonstrated by the nurse‘s statement?

Ethnocentrism

A nurse states, “The best way to treat a client from another country is to care for them the same way we would want to be cared for. After all, we are all humans with the same wants and

needs.” What does this statement reflect in relation to culture?

Blindness

A Spanish-speaking family comes to the public health department. No one in the family speaks

English, and nobody at the health department speaks Spanish. Which of the following actions

should be taken by the nurse?

Obtain an interpreter to translate.

A nurse who is explaining to an immigrant client why it is important to take medication states,

“The medication takes a couple of weeks to be effective, but then you should feel better.” When

the client is next seen, no medication has been purchased. Which of the following is the most

likely explanation?

The nurse emphasized that eventually the client would feel better, but the client needed

to feel better immediately so didn‘t bother with the drug.

A client is crying softly and saying, “What did I do to deserve this punishment, Lord?” Which

of the following responses by the nurse would be the most appropriate?

“What can I do to be helpful to you right now?”

A patient who identifies as Buddhist enters the hospital for diagnostic testing just before lunch

time. The nurse tells the aide to give a meal tray to the new patient, because no tests will be

done until later that evening. The aide gives the patient a meal of Salisbury steak, bread, green

beans, and potatoes with brown gravy. The patient eats nothing but a slice of bread and the

green beans. Which of the following considerations was omitted by the nurse?

The patient‘s Buddhist faith probably requires a vegetarian diet.

At a local hospital, the postpartum care policy requires that nurses observe the mother during

infant care to assess the mother‘s ability to care for the new baby and to promote bonding. A

new mother expresses concern that in her country, all infant care is provided by other family

members so that the mother can rest and recover. Which of the following actions would be

taken by a culturally competent nurse?

Allow family members to provide the newborn‘s care and assess the mother‘s

knowledge of child care through discussion.

For a bedridden Muslim patient, the nurse rearranges the room and moves the bed so that it

faces toward Mecca for the patient‘s daily prayers. Which of the following is the nurse

demonstrating through these actions? 

Accommodation

A nurse gives detailed information on how to apply for Medicaid to a new mother who moved

to the United States from Russia about 10 years ago. The nurse‘s next client is anAfrican-

American mother of newborn twins who worked until the children were born. The nurse knows

the woman is eligible to maintain her insurance after her employment was lost and does not

discuss insurance options at all. Which of the following errors is being made by the nurse?

Overt intentional prejudice

A 40-year-old Bosnian, Muslim woman who does not speak English presents to a community

health center in obvious pain. She requests a female health care provider. Through physical

gestures, the woman indicates that the pain is originating in either the pelvic or genital region.

Which of the following interpreters would be the most appropriate in this situation?

A female who does not know the client

When teaching a nutrition class to a student group with a large Latino population, the school

nurse incorporates foods such as salsa and other healthy dishes familiar to students into the

presentation. Which of the following best describes the action taken by the nurse? 

Primary prevention

An undocumented immigrant comes to a primary care provider‘s office to receive care. Which

of the following services can the client receive? (Select all that apply.) 

a. Treatment for tuberculosis

c. Immunization for polio

e. Sutures for a laceration

A nurse recognizes that although a patient speaks English, the patient is from a culture with

which the nurse is unfamiliar. Therefore, a cultural assessment should be attempted. Which

of the following questions should the nurse ask? (Select all that apply.)

a. “Can you tell me where your family is from?”

b. “Do you practice a particular religious faith?”

d. “Is there anything special we need to know about your food preferences?”

e. “What do you think is causing your health problem?”

A nurse wants to have a better understanding of the physiological effects of selected chemicals. Which of the following individuals would provide the most useful information to the nurse?

Toxicologist

A nurse wants to find information about environmental threats that are present in the

community. Which of the following would be the best source of data for the nurse?

National Library of Medicine

A nurse is assessing potential environmental health risks in the community. Which of the

following would be the first step that the nurse should take?

Perform a windshield survey.

A community citizen reports to the public health nurse that the city water in one neighborhood

has had an unusual taste for the past few months. Which of the following actions should the

nurse take first?

Check the most recent consumer confidence report.

A nurse who works at the local hospital asks a public health nurse what might be causing

her hands to become very sore and sensitive. Which of the following statements would be

the most appropriate response by the public health nurse?

“Check the material safety data sheet on any chemicals you have used recently.”

Which of the following statements about children and environmental hazards is correct?

Children are more susceptible to environmental toxins because of their smaller size.

Which of the following actions represents the use of secondary prevention to reduce

environmental health risks?

Collecting blood specimens from preschool children to check for lead levels

An occupational health nurse at a local factory is using primary prevention strategies to reduce

the environmental health risks among the employees. Which of the following activities would

the nurse most likely implement?

Teaching new employees who will work outdoors about the signs and symptoms of heat-

related illness

A nurse wants to help keep the community environment safe. Which of the following is the

most appropriate action for the nurse to take?

Reduce, reuse, and recycle.

Which of the following best describes the purpose of local health departments making

unannounced inspections of local restaurants?

To ensure compliance

A city has announced its plans to build a city dump near a community of poor and .

predominantly African-American citizens. Which of the following principles would the nurse

be using when vocalizing opposition for this plan? 

Environmental justice

A nurse is completing a basic health assessment. Which of the following questions should be

asked by an environmentally aware nurse?

“What jobs have you held the longest?”

A high school student considering a job in the restaurant industry after graduation asks a nurse

about workplace safety issues. Which of the following acts would the nurse most likely discuss

with the student?

Occupational Safety and Health Act

The nurse is examining blood lead levels in school-age children 1 year after a . community-

wide education intervention. Which of the following phases of the nursing process is being

implemented?

Evaluation

A nurse practitioner has established a mobile clinic to vaccinate adults against influenza. Which

of the following phases of the nursing process is being implemented? 

Intervention

A public health nurse is assisting the community in dealing with the effects of lead paint

poisoning. Which of the following activities would the nurse most likely complete? (Select all

that apply.)

c. Setting up a blood screening program with the local health department

d. Encouraging local landlords to improve the condition of their housing

e. Educating the public on the dangers of lead pain

Which of the following are the major sources of air pollution in the United States? (Select all

that apply.)

a. Burning of fossil fuels

b. Waste incineration

d. Motor vehicles

e. Coal-fired power plants

A nurse wants to use the principles of risk and outrage to improve an environmental hazard in the community. To accomplish this, which of the following actions would be taken by the nurse?

(Select all that apply.)

b. Communicate the correct information in a timely fashion.

d. Talk to those affected or those worried about the situation.

Which of the following strategies would a nurse expect to be implemented by a typical state

environmental agency? (Select all that apply.)

a. Acting, through unannounced inspections, to ensure compliance

c. Monitoring hazardous substances to uphold established standards

d. Obtaining and analyzing samples to confirm compliance

e. Involvement in the permitting process established by the state.

Which of the following actions would a nurse take when serving as an advocate for the

community? (Select all that apply.)

a. Asking questions related to health implications at policy meetings

c. Serving as a source of information at public meetings

d. Volunteering to serve on health-related committees

A nurse executive is implementing evidence-based practice at a community nursing center that

serves a large Cuban immigrant population. Which of the following actions would be the most

helpful for the nurse?

Invite Cuban immigrants from the community to serve on the center‘s advisory board

A community health nurse is determining the best way to address an outbreak of a new

infectious disease using evidence-based practice (EBP). Which of the following actions would

the nurse most likely take?

Review outcomes of clinical trials

A nursing administrator wants to develop a work environment conducive to the implementation

of evidence-based practice (EBP). Which of the following actions would best achieve this goal?

Purchasing computers and Internet access for use by employees

A busy school health nurse concerned over the rising incidence of obesity wants to implement

evidence-based practice (EBP) but faces barriers because of time constraints. Which of the following actions should the nurse take first?

Evaluate best practices to determine those that have the highest success rates for weight

control in children.

The nurse has been reading extensively on a particular clinical problem, using both the closest

medical library and the Internet. Which of the following would be the most helpful source?

A systematic review related to the clinical problem

A school health nurse plans to use evidence-based practice (EBP) to guide the development of

health education programs most likely to increase retention of learning in elementary

schoolchildren. Which of the following would be the best way to use EBP in this situation?

Compare and contrast randomized controlled trials related to learning in elementary

schoolchildren

After finding several studies related to the clinical problem, a nurse knows the studies must be

evaluated. Which of the following characteristics should be present in the literature?

Multiple high-quality studies with large sample sizes and consistent findings

A nurse is familiar with evidence-based practice (EBP) and wants to implement it into the care

of clients. Which of the following would present the biggest challenge?

Assessing one‘s current practice and accessing evidence-based resources

Which of the following groups is pressuring clinicians the most to use evidence-based practice

(EBP)?

Insurance companies

A nurse implements an education program that incorporates computer games to reinforce

learning for a group of older adults. Although the research demonstrates evidence of improved

retention of this information, the nurse experiences exactly the opposite with this group. Which

of the following is the most likely cause of such poor outcomes?

Failure to consider client and setting differences

A health care provider is concerned about the high number of clients with type 2 diabetes

mellitus who have poor glucose control. What would be the best reference for the provider to

implement evidence-based practice (EBP) in the management of this problem?

Current research findings

Staff members have agreed to implement evidence-based practice; they have chosen a specific problem and searched the literature. The group has selected the interventions that seem the easiest to implement. Which of the following actions would the staff take next? 

Assess the quality of the evidence in the literature.

A school nurse is developing a primary prevention strategy for school-aged children. Which of

the following interventions would the nurse most likely implement?

Drafting policy for increases in noncompetitive physical activity programs

Which of the following is the best way to increase the number of persons who come to their

screening test appointments?

Reminding clients via telephone, e-mail, or mail

A nurse manager wants to facilitate incorporation of evidence-based practice (EBP) in the

clinical setting. Which of the following would be the best strategy to accomplish this goal?

Support nurses using practice-oriented research findings in decision-making.

A nurse has decided to increase the evidence base of current nursing practice in an

agency. Which of the following describes a barrier that could be encountered by the nurse?

(Select all that apply.)

a. Colleagues who do not know how to search the literature or critique research

b. Dedication to the history and tradition of the agency

c. Little or no research published in the clinical area of concern

A nurse is using analytic epidemiology when conducting a research project. Which of the

following projects is the nurse most likely completing? 

Determining factors contributing to childhood obesity

A nurse is employed as a nurse epidemiologist. Which of the following activities would most

likely be completed by the nurse?

Evaluating the number of clients presenting with similar diseases

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

epidemiologist?

She demonstrated that a safer environment resulted in decreased mortality rate.

Which of the following statements describes how nursing in the community is more challenging

than nursing in an acute care setting?

It is more challenging to control the environment in the community.

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?

Community D—with 90 single teenage pregnancies in a city of 1500

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?

The proportion of STIs to the total population was 100:1000.

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?

The incidence of diabetes will increase in the community.

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 the most

useful for the nurses to use to determine if they are having any impact?

The incidence of diabetes is slowly decreasing during screening events.

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?

Prevalence

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?

The prevalence of diabetes is now higher than previously recognized in the community.

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?

90%

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?”

Case fatality rate

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

Infant mortality rate

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?

Epidemiologic triangle

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

Web of causality

Which of the following actions would a nurse take to reduce the high incidence of coronary

artery disease (CAD) in a community?

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

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?

Weighing students to identify those who are overweight

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?

Tertiary prevention

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?

Validity

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?

Decreased sensitivity

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?

The sensitivity of the test

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?

The positive predictive value of mammography

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?

Local data drawn from a professional survey in the city

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 cultural or ethnic concentration in the neighborhood

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?

They are both members of the same birth cohort.

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?

Encourage the parents to enroll their sons in Cub Scouts.

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?

Retrospective cohort study

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?

Clinical trial

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?

This method of data collection would result in selection bias.

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?

Host factors

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

public health? (Select all that apply.)

a. Americans are fearful of terrorists using biological agents.

c. Drug-resistant strains of old diseases have evolved

A nurse is concerned about the high incidence of sexually transmitted infection (STIs) in the

community college population and sets up a special STI screening. Which of the following

groups of students would be encouraged to attend? (Select all that apply.)

b. Sexually active students who had been screened the previous yeab. Sexually active students who had been screened the previous year

d. Students who are sexually active but never “go all the way”

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? (Select all that

apply.)

b. Health problems for which the specific population is at risk

d. Whether health care providers are available to follow up on any positive screening

results

A nurse believes a new mouth care procedure (MCP) is exacerbating a client oral tissue

problems. Which of the following must be present for the nurse to go to administration with

confidence that the MCP is causing problems? (Select all that apply.)

a. A plausible explanation of how the new MCP could cause harm

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

Which of the following is the number one cause of death worldwide?

Infectious diseases

Which of the following places best describes where the incidence of Vancomycin-resistant

Staphylococcus aureus (VRSA) and methicillin-resistant S. aureus (MRSA) is currently rising?

Areas where people share dressing or bathing facilities

During an outbreak of hepatitis A, nurses are giving injections of hepatitis A immunoglobulin to

selected susceptible persons. Which of the following best describes the type of immunity that

will follow the administration of these injections?

Passive immunity

A man loudly protests his increased property tax bill right after the public health department

has made a plea for more funds. “Why,” he asks, “should my tax dollars be used to pay for

their children to be immunized?” Which of the following would be the best response by the

nurse?

“Only by making sure most kids are immunized can we stop epidemics that might hurt

all of us.”

Which of the following components of the epidemiologic triangle contributes most to a female

client developing a vaginal infection caused by fungi after successful treatment of her strep

throat with antibiotics?

Environment

Which of the following best represents an example of infectious disease spreading via a vector?

Being bitten by an infected mosquito

Which statement made by the nurse best describes the effect vaccines have had on tuberculosis (TB)?

The treatment has helped greatly reduce the incidence of TB in the United States.

Which population is best protected against pertussis by the DTaP vaccine?

Young children

Which of the following data would most likely be collected in a syndromic surveillance

system?

Incidence of school absenteeism