COMMUNITY EXAM 2

The clinic clients respond negatively to the need for a yearly flu shot. They ask why the medical communities don't just create one shot that will last for several years. Which explanation should the nurse give?

A) Genetic changes in the bacteria that cause the flu require a rotating course of antibiotics.

B) Genetic changes make the flu virus resistant to the flu shot from year to year.

C) There is more than one strain of the flu virus and you must be protected from all of them.

D) The shots last only for 3 to 6 months and must be renewed on a yearly basis.

Ans: B

Feedback:

As microbes reproduce, genetic changes may result in pathogens that are

immunologically distinct from their parental strains. For example, antigenic drift, the

slow and progressive genetic changes that take place in DNA and RNA as organisms

replicate in multiple hosts, causes changes in influenza viruses each year. These

frequent changes that result from antigenic drift mean that there is a new seasonal

influenza vaccine each year. The flu is caused by the influenza virus, not bacteria, so

antibiotics would not be appropriate for treatment. One does not need to be protected

from all strains of the flu virus, only the ones prevalent in the client's area at the present

time. Vaccination shots typically last for years, not for 3 to 6 months.

Nursing students in an enclosed classroom begin to become ill with a gastrointestinal illness. The public health department identifies this occurrence as an emerging epidemic

and isolates the population that is ill. According to microbial adaptation, those who survive the illness will then do which of the following?

A) Recover with adaptive organism reintroduction into the environment

B) Develop improved defenses against reinfection

C) Become hosts to the organism, which is symbiotic in nature

D) Become carriers of the infection, ultimately leading to an epidemic

Ans: B

Feedback:

Three stages of microbial adaptation and change occur over varying periods of time.

During stage I, an epidemic occurs. The microbes enter a "virgin" population where

hosts have no prior exposure to the organism and have few defenses. This leads to

further spread in the population. Ultimately, survivors are usually left with improved

defenses against reinfection. During stage II, the infection becomes endemic or

continuously present in a geographic area or population of people. Routine childhood

diseases are an example of such infections. During stage III, symbiosis is possible.

Further adaptation occurs, resulting in mutual tolerance and sometimes mutual benefit

for both the microorganism and the host. This is the preferred outcome.

Three years after exposure to a virulent form of the flu, a population faces the same flu strain. The public health department recognizes that there are members of the population who have not been exposed to the flu strain. Which is most likely to happen?

A) The unexposed population will contract the illness

B) The unexposed population is not likely to contract the illness

C) The unexposed population will contract the illness and reinfect others

D) The flu will reach epidemic proportions and both populations will become ill

Ans: B

Feedback:

If a substantial proportion of people in a population are not susceptible to a

communicable disease, the few people who are susceptible are not likely to be exposed

and contract the illness. This is a process called herd immunity.

Which environmental factors are likely to affect the life cycle of disease pathogens and their vectors and thus disease outbreaks? (Select all that apply.)

A) Temperature

B) Geology

C) Precipitation

D) Humidity

E) Amount of daylight

Ans: A, C, D

Feedback:

Many infectious diseases have characteristic geographic distributions and seasonal

variations. Probably the most common is the influenza virus, which peaks each fall and

winter. Factors such as temperature, precipitation, and humidity affect the life cycle of

many disease pathogens and their vectors, and consequently they can affect disease

outbreaks. Geology, or the types of rocks present in the area, and the amount of daylight

are not likely to affect the life cycle of disease pathogens and their vectors.

Tent communities are constructed in a rural community by the American Red Cross after a disaster. Because of overcrowding, surrounding states create accommodations for the displaced and homeless. The survivors are accommodated in the cities of four

Southern states. Which factors may increase the possibility of disease emergence in the cities? (Select all that apply.)

A) Poor hygiene

B) Decreased socialization

C) Poor sanitation

D) Decreased viral load

E) Increased violence

Ans: A, C

Feedback:

Urban life, with malnutrition, overcrowding, and poor sanitation, enhances the major

pathways for transmission of infectious disease. The forced dislocation of large groups

of people and migration of such groups of people from rural areas to cities can be

accompanied by a breakdown of public health measures, leading to poor hygiene. These

have often been factors in disease emergence. Decreased socialization, decreased viral

load, and increased violence would not tend to increase the likelihood of disease

emergence.

An 80-year-old client is being treated for chronic urinary tract infections. She has received multiple antibiotics in the past 6 months. The physician orders a urine culture. The results of the urine culture are as follows: Staphylococcus aureus >100,000 colonies and demonstrated resistance to sulfamethoxazole and trimethoprim (Bactrim), penicillin, methicillin, and erythromycin. The client is diagnosed with methicillin-resistant

Staphylococcus aureus (MRSA) on the basis of the findings of her urine test. Based on the client's history, a cause of the MRSA might be microbial:

A) Rejection

B) Assimilation

C) Adaptation

D) Stagnation

Ans: C

Feedback:

Microbial adaptation and change in response to the overuse of antibiotics and

consequent accumulation in the environment will cause the rapid evolution of resistant

pathogens. MRSA is not associated with microbes being rejected, assimilated, or

stagnant.

The community health nurse works in a region where severe acute respiratory syndrome (SARS) has just been reintroduced into the environment. Which measure is imperative for the nurse to take to prevent spread of the disease?

A) Prophylactic antibiotics

B) Enhanced infection control measures

C) Use of alcohol cleansers

D) Report of clusters to the Centers for Disease Control and Prevention

Ans: B

Feedback:

The main lessons learned from SARS, the first new infectious disease to emerge in the

21st century, were that (1) astute healthcare providers are likely to be the key to early

detection and reporting of initial cases of SARS-coronavirus disease, (2) containment of

disease requires the diligent application of enhanced infection control measures at the

national and local levels, the same measures that will defeat SARS should it reemerge,

and (3) control of an emerging infection necessitates swift action by healthcare

providers as well as an adequate public health infrastructure. Prophylactic antibiotics

would not be effective against a virus. Use of alcohol cleansers would not be as

effective as full, enhanced infection control measures. Reporting clusters to the Centers

for Disease Control and Prevention can help in the early detection of the disease, but in

and of itself will not help contain it.

There is an outbreak of Middle East respiratory syndrome coronavirus (MERS-CoV)in the community. The nurse is responsible for the dissemination of the education plan

adopted by the public health department. Key components of the plan should include: (Select all that apply.)

A) Quarantining infected families in their homes

B) Respiratory hygiene

C) Hand hygiene

D) Droplet precautions for visitors in contact with affected clients

E) Contact precautions for all cases

Ans: B, C, D

Feedback:

To prevent the transmission of all respiratory infections, respiratory hygiene/cough

etiquette measures should be implemented at the first point of contact with a potentially

infected person and should be incorporated into standard precautions. This includes

covering the nose and mouth when coughing or sneezing, using tissues to contain

respiratory secretions and disposing of them in the nearest waste receptacle after use,

and hand hygiene (e.g., handwashing with nonantimicrobial soap and water, an

alcohol-based hand rub, or an antiseptic hand wash) after having contact with

respiratory secretions and contaminated objects/materials. In addition to standard

precautions, all individuals, including visitors and healthcare providers, in contact with

clients with an acute respiratory infection should use droplet precautions, which include

wearing a surgical mask when in close contact (i.e., within approximately 3 feet) and on

entering the room of the client. The 2013 World Health Organization guidelines for a

suspected or confirmed case of MERS-CoV infection called for placing the client in a

single isolation room with equal or greater than 12 air exchanges per hour, not

quarantining infected families in their homes. Contact precautions are only needed when

contact with blood, body fluids, secretions, or nonintact skin is anticipated.

International health experts indicate that the avian flu is the virus most likely to cause the next pandemic. What may improve its transmissibility to the public?

A) Increase in consumption of chicken

B) Increase in autoimmune disease incidence

C) Shift to zoonotic transmission

D) Antigenic shift

Ans: D

Feedback:

The H5N1 virus can improve its transmissibility among humans by two mechanisms.

The first is antigenic shift, a "reassortment" event, in which genetic material is

exchanged between human and avian viruses during coinfection of a human or an

animal such as a pig. Reassortment could result in a fully transmissible pandemic virus,

which could rapidly spread throughout the world. The second mechanism is a more

gradual process of antigenic drift, an adaptive mutation, whereby the capability of the

virus to bind to human cells increases during subsequent infections of humans. Nearly

all of the human infections with H5N1, which are the largest documented since its

emergence in humans in 1997, were a result of people having direct or close contact

with infected poultry or contaminated surfaces, but not a result of consuming chicken.

An increase in incidence of autoimmune diseases, which involve one's own immune

system attacking the body, is not related to the spread of avian influenza and would not

lead to a pandemic. The avian flu is already transmitted primarily in a zoonotic manner,

so any shift in transmission would be to human-to-human transmission, which would be

more likely to cause a pandemic than zoonotic transmission.

The nurse is responsible for the construction of an isolation unit during an H5N1 outbreak. The unit is designated for only those clients with a confirmed diagnosis of H5N1. Which unit would be easily adapted to client needs?

A) 12-room unit with negative air pressure units

B) 15-room unit with a portable supply of PPEs

C) 8-room unit with four code carts

D) 12-room unit with four to six air changes per hour

Ans: A

Feedback:

For an outbreak of H5N1, place the client in an airborne isolation room (AIR). Such

rooms should have monitored negative air pressure in relation to the corridor, with 6 to

12 air changes per hour (ACH), and exhaust air directly outside or have recirculated air

filtered by a high-efficiency particulate air (HEPA) filter. If an AIR is unavailable, a

portable HEPA filter should be used to augment the number of ACH. Use a fit-tested

respirator, at least as protective as a National Institute of Occupational Safety and

Health (NIOSH)-approved disposable N-95 filtering face piece respirator, when

entering the room (DHHS, 2006). The Centers for Disease Control and Prevention

(CDC) has recommended nonpharmaceutical community interventions that use social

distancing strategies to reduce contact between people.

Ten documented cases of West Nile virus (WNV) have occurred recently in the community. To reduce the transmission of the virus, the nurse should educate the members of the community to: (Select all that apply.)

A) Avoid contact with birds

B) Avoid contact with mosquitoes

C) Avoid those with a confirmed diagnosis

D) Eliminate standing water

E) Avoid exposure to the environment during the daylight hours

Ans: B, D

Feedback:

WNV virus is not transmitted from person to person but from mosquito to person. No

isolation precautions are indicated other than standard precautions. The Centers for

Disease Control and Prevention (CDC) guidelines emphasize avian, animal, mosquito,

and human WNV surveillance, along with control and elimination of mosquito breeding

sites such as standing water in flowerpots, buckets, and old tires. The CDC recommends

using an insect repellent such as DEET (N, N-diethyl-m-toluamide) or picaridin when

outdoors, following the directions on the package. Because mosquitoes are most active

at dusk and dawn, in addition to an insect repellent, people should wear long sleeves and

pants when outdoors during these hours. Screens on windows and doors will keep

mosquitoes out.

The client is diagnosed with Lyme disease. He states that he is not a hiker and does not remember being bitten by a tick. As part of the education plan, the nurse should state:

A) "You must have been bitten by a tick and didn't recognize it as such."

B) "Did you spend time in a brushy or grassy area in the last 90 days?"

C) "Conduct a full-body tick check once a week during the summer."

D) "A history of a tick bite is not required."

Ans: D

Feedback:

Exposure to Lyme disease is defined as having spent time (less than or equal to 30 days

before onset of the initial skin lesion) in wooded, brushy, or grassy areas (i.e., potential

tick habitats) in a county in which Lyme disease is endemic. A history of tick bite is not

required. A county in which the disease is endemic is one in which at least two

confirmed cases have been previously acquired or in which established populations of a

known tick vector are infected with Borrelia burgdorferi. Those who are outdoors

should do a final, full-body tick check at the end of the day (not once a week) for adults,

children, and pets.

The nurse admits a client to the hospital with the diagnosis of Escherichia coli

O157:H7. The client is dehydrated and febrile. During the history phase of the

admission, the client states that he doesn't know how he could have gotten sick at the local county fair—the hamburger he bought was well done. Upon further discussion, the nurse suspects the transmission may have occurred because of:

A) Use of a gas barbecue

B) Improper cleaning of the cooking tools

C) Use of wood instead of charcoal to cook the meat

D) Animals roaming in the fair grounds

Ans: D

Feedback:

Recent cases of hemolytic-uremic syndrome (HUS) have been associated with outbreaks

of E. coli O157:H7 infections, which were apparently caused by contact with animals in

public settings, including fairs, farm tours, and petting zoos. Experience from these and

previous outbreaks underscores the necessity for adequate control measures to reduce

zoonotic transmission. The Centers for Disease Control and Prevention has developed

standardized recommendations for public health officials, veterinarians, animal

exhibitors, and visitors to animal exhibits; it established that hand washing is the single

most important prevention step for reducing the risk for disease transmission. Other

critical recommendations for venues with animals are the inclusion of transition areas

between animal and nonanimal areas (e.g., where food is sold) and proper care and

management of animals in public settings. Use of a gas barbecue, use of wood instead of

charcoal to cook meat, and improperly cleaned cooking tools are not associated with E.

coli infection.

Four employees at a local restaurant have positive purified protein derivative (PPD) tuberculin skin tests and have been diagnosed with latent tuberculosis (TB) infection. Which employee would be at the greatest risk for contracting active TB disease?

A) Works two jobs

B) Vacations in South America

C) Cooks the food

D) Takes immunosuppressants

Ans: D

Feedback:

In many people who have latent TB infection, the Mycobacterium tuberculosis bacteria

remain inactive for a lifetime without causing active TB disease. But in other people,

especially those who have weak immune systems, the bacteria become active and cause

TB disease. Working two jobs, vacationing in South America, and cooking food would

not put one with a latent TB infection at greater risk for contracting active TB disease.

The nurse assesses a client in the local neighborhood clinic. He exhibits signs and symptoms of tuberculosis (TB) yet has a negative tuberculin skin test result. The nurse suspects that the physician may further test the client because he:

A) Visited Central America recently

B) Is recovering from jet lag

C) Is HIV positive

D) Works in a factory setting

Ans: C

Feedback:

Active TB infection is characterized by a chronic productive cough, low-grade fever,

night sweats, and weight loss, along with a positive purified protein derivative (PPD)

tuberculin skin test result. People with active TB are contagious. However, certain

people who are anergic (lack an immune response to an antigen) may not have a

positive PPD (e.g., persons with HIV). Having visited Central America recently,

recovering from jet lag, and working in a factory setting would not produce a false

negative result on the tuberculin skin test.

The nurse is responsible for the directly observed therapy (DOT) program in the community. Which represent the best methods to ensure compliance with clients' drug regimens? (Select all that apply.)

A) Social service support

B) Housing assistance

C) Hospitalization

D) Isolation until treatment complete

E) Treatment enablers

Ans: A, B, E

Feedback:

Programs using DOT as the central element in a comprehensive, client-centered

approach to case management (enhanced DOT) have higher rates of treatment

completion than less intensive strategies. Each client's management plan should be

individualized to incorporate measures that facilitate adherence to the drug regimen.

Such measures may include, for example, social service support, treatment incentives

and enablers, housing assistance, referral for treatment of substance abuse, and

coordination of TB services with those of other providers. There is no need to

hospitalize a person solely because he or she is infectious. Outclients should be

instructed to remain at home, without visitors, until they are no longer thought to be

infectious. However, such isolation is not a method to ensure compliance with the drug

regimen but an infection control measure.

As the occupational health nurse in a factory finds that five employees out of 30 have positive tuberculin skin test results. One employee on the 3-to-11 shift has been diagnosed with active tuberculosis (TB). She asks if this means that the whole factory has been exposed. The nurse replies that the probability of infection depends upon:

(Select all that apply.)

A) Concentration of infectious droplet nuclei in the air

B) Duration of exposure to the infected person

C) Proximity to the infected person

D) The use of safety gloves by employees

E) Physical exertion required in the job

Ans: A, B, C

Feedback:

The probability that a person who is exposed to Mycobacterium tuberculosis will

become infected depends primarily on the concentration of infectious droplet nuclei in

the air and the duration of exposure to a person with infectious TB disease. The closer

the proximity and the longer the duration of exposure, the higher the risk of becoming

infected. Close contacts are people who share the same air space in a household or other

enclosed environment for a prolonged period (days or weeks, not minutes or hours) with

a person with pulmonary TB disease. A suspected TB client is a person in whom a

diagnosis of TB disease is being considered, whether anti-TB treatment has been started.

People generally should not continue to be suspected of having TB for more than 3

months. The use of safety gloves and physical exertion on the job do not affect the

probability of infection.

A man who lives in a homeless shelter is diagnosed with active tuberculosis (TB).The shelter keeps a list of those who are assigned beds, and the majority of those sleeping there are regulars. Which finding would indicate a positive tuberculin skin test result

using a two-step process?

A) 4-mm induration

B) 2-mm induration

C) 6-mm induration

D) 3-mm induration

Ans: C

Feedback:

All high- and medium-priority contacts who do not have a documented previous

positive tuberculin skin test result or previous TB disease should receive a baseline

purified protein derivative (PPD) tuberculin skin test. The reaction to the

intracutaneously injected PPD tuberculin skin test is the classic example of a delayed

(cellular) hypersensitivity reaction, which induces induration. Induration of 5 mm is

considered a positive result in people who have an initial induration of 0 mm.

Each employee in a small community hospital is informed that he or she needs a tuberculin skin test and of the date that the test is due. The kitchen employees tell the nurse that they don't need the test and never had to have it before. The nurse should

respond with:

A) The test does not need to be given if you do not have client contact.

B) Tuberculosis guidelines require testing of an entire healthcare setting.

C) The test will not hurt; we won't fire you if you test positive.

D) The tuberculosis guidelines state kitchen workers are at risk.

Ans: B

Feedback:

The 2005 tuberculosis (TB) infection control guidelines emphasize actions to maintain

momentum and expertise needed to avert another TB resurgence and to eliminate the

lingering threat to healthcare personnel, which is mainly from clients or others with

unsuspected and undiagnosed infectious TB disease. A sample recommendation is that

the term "tuberculin skin tests" be used rather than purified protein derivative. The

scope of settings in which the guidelines apply has been broadened to include

laboratories and additional outclient and nontraditional healthcare settings. These

recommendations also apply to an entire healthcare setting rather than to areas within a

setting.

A nurse is studying the Institute of Medicine's convergence model to learn how four types of interrelated and overlapping microbe-human interactions can lead to

emerging/reemerging infectious diseases. These four types of interactions are: (Select all that apply.)

A) Genetic and biological

B) Physical/environmental

C) Spiritual and psychological

D) Ecological

E) Social, political, and economic

Ans: A, B, D, E

Feedback:

There are four types of interrelated and overlapping microbe-human interactions that

can lead to emerging/reemerging infectious diseases: (1) genetic and biological; (2)

physical/environmental; (3) ecological; and (4) social, political, and economic. Spiritual

and psychological are not types of interactions leading to infectious diseases

The nurse prepares to enter the room of a client with suspected Ebola virus disease (EVD). Which pieces of personal protective equipment (PPE) should the nurse wear? (Select all that apply.)

A) Fluid-resistant gown

B) Gloves

C) Respirator

D) Mask

E) Goggles

Ans: A, B, D, E

Feedback:

When entering the room of a client with or suspected EVD, all healthcare providers

should wear PPE, including a fluid-resistant gown, gloves, mask, and face

shield/goggles (CDC, Infection prevention and control recommendations for

hospitalized clients with known or suspected Ebola in U.S. hospitals). A respirator is not

necessary.

The nurse works with a female client who recently developed an infection of

Staphylococcus aureus while in the hospital. In this case, S. aureus is which component in the chain of infection?

A) Host

B) Environmental reservoir

C) Agent

D) Portal

Ans: C

Feedback:

The agent, or the microbe that causes the disease, is the "what" of the epidemiologic

triangle. The host, or the organism that is harboring the infectious agent, is the "who" of

the triangle. The environment, which includes those external factors that cause or allow

disease transmission, is the "where" of the triangle. Other necessary elements include a

portal of exit from the host, environmental reservoirs, transmission, and a portal of entry

to a new host.

A student nurse asks if an infectious disease is the same thing as a communicable disease. The nurse explains that an infectious disease is not necessarily a communicable

disease. Which must a communicable disease have that an infectious disease does not have to have? (Select all that apply.)

A) Pathogenic microorganism

B) Portal of exit from the infected person

C) Means of transmission

D) Portal of entry to a susceptible host

E) Organism that harbors the infectious agent

Ans: B, C, D

Feedback:

An infectious disease in a human host is one caused by the growth of pathogenic

microorganisms in the body. For a disease to be communicable, or contagious, there

must be a portal of exit from the infected person (or animal), a means of transmission,

and a portal of entry to a susceptible host. Thus, an infectious disease need not be

contagious, or communicable.

Infectious agents are biological agents capable of producing an infection or infectious disease. Which are considered biological agents? (Select all that apply.)

A) Fungi

B) Fomites

C) Bacteria

D) Viruses

E) Helminths

Ans: A, C, D, E

Feedback:

Infectious agents are biological agents capable of producing an infection or infectious

disease and include bacteria, viruses, rickettsiae, fungi, protozoa, and helminths.

Fomites are any substance that adheres to and transmits infectious materials. An

infectious disease need not be contagious or communicable.

In infectious disease epidemiology, just the presence of an infectious agent is not sufficient to produce an infectious disease. Which host factors determine whether a person is at risk for an infection or an infectious disease? (Select all that apply.)

A) Age

B) Sex

C) Occupation

D) Physical and emotional health

E) Immune status

Ans: A, B, D, E

Feedback:

There are several host factors that determine whether a person is at risk for an infection

or an infectious disease. These include age, sex, race, physical and emotional health, and

immune status. Occupation is not a host factor.

When an infectious agent enters the host and begins to multiply, an infection occurs. The time between exposure to an infectious agent and the manifestation of symptoms in

the host is known as:

A) Carrier time

B) Colonization

C) Incubation period

D) Latent period

Ans: C

Feedback:

The time between exposure to an infectious agent and the manifestation of symptoms in

the host is called the incubation period. Asymptomatic people are carriers of a virus and

can transmit the virus to others through percutaneous inoculation, exposure to mucous

membranes, and sexual contact. When an infectious agent is present and there are no

clinical signs of disease, colonization with the infectious agent is said to have occurred,

and the infected person is capable of transmitting the agent. The latent period is the

stage of a disease during which symptoms are hidden.

A client with tuberculosis sneezes in the waiting room and infects several other clients who are sitting on the other side of the room. Which mechanism of transmission is

involved in this case?

A) Airborne

B) Droplet

C) Direct contact

D) Indirect contact

Ans: A

Feedback:

Airborne transmission occurs when microorganisms are carried in the air in small

particles, called droplet nuclei, at distances that exceed a few feet. Droplet transmission

theoretically is a form of contact transmission; the mechanism of transfer of the

pathogen to the host is quite distinct from either direct or indirect transmission.

Therefore, droplet transmission is considered a separate route of transmission. Droplets

are generated from the source person primarily during coughing, sneezing, or talking

and are propelled a short distance (<3 feet) through the air and deposited on the

conjunctivae, nasal mucosa, or mouth of another person. Direct contact occurs through

direct body surface-to-body surface contact and physical transfer of microorganisms

between a susceptible host and an infected or colonized person (or animal). Indirect

contact involves contact of a susceptible host with a contaminated intermediate

inanimate object, called a vehicle, such as a contaminated surgical instrument, needle,

toy, soiled clothing, or bed linen.

The student-nurse discusses transmission that involves contact of a susceptible host with a vehicle. Based on the chain of infection links, which exemplifies a vehicle?

A) Animals

B) Insects

C) Reptiles

D) Water

Ans: D

Feedback:

Indirect contact involves contact of a susceptible host with a contaminated intermediate

inanimate object, called a vehicle, such as a contaminated surgical instrument, needle,

toy, soiled clothing, or bed linen. Vehicles also include food, water, and contaminated

hands that are not washed. Indirect contact also includes vector transmission. Vectors

are animal or insect carriers of infectious agents.

Chloroquine-resistant malaria occurs in most of Africa, the Middle East, and Asia and all of the South Pacific islands. This type of disease occurrence is known as:

A) Endemic

B) Epidemic

C) Pandemic

D) Outbreak

Ans: A

Feedback:

An endemic disease, infection, or infectious agent occurs when it becomes prevalent

within a population or geographic area. An epidemic or outbreak refers to a significant

increase in an infection or infectious disease beyond the expected (endemic) level in a

certain population and/or geographic area. A pandemic is an epidemic that generally

spreads worldwide. The use of "outbreak" in this text is synonymous with epidemic.

Person, place, and time characterize the description of an epidemiologic problem. Using knowledge of outbreak investigations, which occurs with propagated outbreaks?

A) Same person or vehicle as the reservoir or means of transmission

B) Infection transmitted from person to person over a short period of time

C) Generating secondary infections with intervals between peaks that approximate the usual incubation period for the infection

D) Generating tertiary infections following exposure to a primary case

Ans: C

Feedback:

A propagated outbreak is one where the infection is transmitted from person to person

over a longer period of time than with a common source outbreak, and it can generate

secondary infections with intervals between peaks that approximate the usual incubation

period for the infection. A common source outbreak is one that has the same origin.

Secondary infections are those that occur within the accepted incubation period

following exposure to a primary case.

Several levels of public health surveillance are necessary to protect the nation's health. At what level are healthcare providers and health facilities required to report certain

infectious diseases?

A) Local

B) State

C) Federal

D) International

Ans: B

Feedback:

Local reporting mechanisms are community specific. At the state level, healthcare

providers and health facilities are required to report certain infectious diseases to state

health departments. At the federal level, the Department of Health and Human Services

(DHHS) is the US public health infrastructure that develops policies to protect the

nation's health. The Centers for Disease Control and Prevention (CDC) also is a partner

with the World Health Organization (WHO) through the Global Outbreak Alert and

Response Network and the WHO Surveillance and Response system, which provide

international epidemic alerts and responses.

Which agency has an electronic surveillance system for the early notification of community-based epidemics?

A) Department of Health and Human Services

B) Centers for Disease Control and Prevention

C) World Health Organization

D) Department of Defense

Ans: D

Feedback:

The Department of Defense (DoD) has an electronic surveillance system for the early

notification of community-based epidemics (ESSENCE), which has been in operation

since 2001 to detect infectious disease outbreaks. At the federal level, the Department of

Health and Human Services (DHHS) is the U.S. public health infrastructure that

develops policies to protect the nation's health. The Centers for Disease Control and

Prevention (CDC) is a major DHHS agency that protects the nation's health by

developing guidelines that promote health and quality of life by preventing and

controlling disease, injury, and disability. The CDC is also a partner with the World

Health Organization (WHO) through the Global Outbreak Alert and Response Network

and the WHO Surveillance and Response system, which provide international epidemic

alerts and responses.

A client arrives on the unit, diagnosed with norovirus infection from eating shellfish. The client has been vomiting repeatedly and is now severely dehydrated. Which interventions are likely to be performed for this client? (Select all that apply.)

A) Starting an intravenous line for fluid and electrolyte replacement

B) Encouraging the client and the client's family to practice good handwashing

C) Immediate disinfecting all potentially contaminated objects and surfaces

D) Isolating the client until 12 hours after the client has been symptom free

E) Administering a vaccination

Ans: A, B, C

Feedback:

Oral hydrating solutions should be given for attacks of norovirus, and in severe cases

intravenous fluid and electrolyte replacement may be necessary. At the first signs of this

acute gastroenteritis outbreak, good handwashing, thorough and immediate disinfection

with appropriate solutions, and isolation of sick people until 72 hours, not 12 hours,

after they are symptom free are critical. There is no vaccine currently for noroviruses.

A client presents with severe diarrhea. The client tells the nurse that she went to a chicken roast at church the previous weekend. The nurse suspects a foodborne illness. Which cause of bacterial foodborne illness should the nurse most suspect in this case?

A) Campylobacter

B) Listeria monocytogenes

C) Salmonella

D) Escherichia coli O157:H7

Ans: A

Feedback:

Campylobacter is the most common cause of bacterial foodborne illness in the United

States, and it is an important cause of diarrheal illness throughout the world regardless

of people's age. Consumption of contaminated poultry is the most common source of

Campylobacter infection, although undercooked meats, ground beef, pork, cheese, eggs,

shellfish, unpasteurized milk, and direct exposure to pets and farm animals have been

implicated. Other infectious organisms that commonly cause foodborne illnesses include

noroviruses, Listeria monocytogenes, nontyphoid Salmonella, and E. coli O157:H7.

A client arrives at the clinic reporting diarrhea and flu-like symptoms. On questioning, the client tells the nurse about a family gathering she attended recently where she had some smoked seafood. Which foodborne illness should the nurse most suspect in this

client?

A) Campylobacter

B) Listeria monocytogenes

C) Salmonella

D) Escherichia coli O157:H7

Feedback:

Nurses and other healthcare providers should suspect listeriosis in high-risk clients with

a recent history of eating delicatessen food, soft cheeses, or smoked seafood who

become ill with diarrhea and/or flu-like symptoms. Other infectious organisms that

commonly cause foodborne illnesses include noroviruses, Listeria monocytogenes,

nontyphoid Salmonella, and E. coli O157:H7. Campylobacter is the most common

cause of bacterial foodborne illness in the United States, and it is an important cause of

diarrheal illness throughout the world regardless of people's age.

The client reports diarrhea, fever, and abdominal cramps 24 hours following exposure to raw eggs while cooking. An efficient and effective homemade oral rehydration solution is to stir:

A) One level teaspoon of salt and eight level teaspoons of sugar into one quart or liter of clean drinking water

B) Eight level teaspoons of salt and one level teaspoon of sugar into one quart or liter of clean drinking water

C) One level teaspoon of salt and one level teaspoon of sugar into one quart or liter of clean drinking water

D) Eight level teaspoons of salt and eight level teaspoons of sugar into one quart or liter of clean drinking water

Ans: A

Feedback:

An efficient and effective homemade oral rehydration solution is to stir one level

teaspoon of salt and eight level teaspoons of sugar into one quart or liter of clean

drinking water or water that has been boiled and cooled.

A client reports symptoms of severe abdominal cramps, bloody diarrhea, and vomiting after eating commercially packaged salad. The nurse suspects Escherichia coli O157:H7. The client asks about the average time of resolution of these symptoms. What

time frame should the nurse provide?

A) 3 to 5 days

B) 5 to 7 days

C) 7 to 10 days

D) 12 to 14 days

Ans: C

Feedback:

Escherichia coli O157:H7, a deadly toxin-producing bacterium, produces symptoms of

severe abdominal cramps, bloody and nonbloody diarrhea, and vomiting that generally

resolve within 7 to 10 days.

Which criteria must be met to define a water-associated disease outbreak?

A) Two or more people with laboratory-confirmed primary amebic

meningoencephalitis

B) Two or more cases of chemical poisoning if water quality data indicate

contamination by the chemical

C) Two or more people having experienced a similar illness after exposure to water

D) Epidemiologic evidence implicating drinking water as the probable source of the illness

Ans: C

Feedback:

Two criteria must be met for an event to be defined as a water-associated disease

outbreak. First, two or more people must have experienced a similar illness after

exposure to water. Second, epidemiologic evidence must implicate recreational water

(not drinking water) or volatilization of water-associated compounds into the air

surrounding the water as the probable source of illness. Evidence of primary amebic

meningoencephalitis and chemical poisoning are not required for confirmation of a

water-associated disease outbreak.

A 16-year-old client visits the community health clinic with concerns that she may have a sexually transmitted infection (STI). She asks whether STIs are treatable. STIs that are

easily treated and curable include: (Select all that apply.)

A) Human papillomavirus

B) Herpes simplex

C) Chlamydia

D) Gonorrhea

E) Syphilis

Ans: C, D, E

Feedback:

Infections caused by bacteria can be treated and usually cured with antibiotics, but those

caused by viruses cannot be cured this way. Chlamydia, gonorrhea, syphilis—all

bacterial—and trichomoniasis—parasitic are easily treated with antibiotics and cured if

diagnosed early. Human papillomavirus and herpes simplex are viral infections that are

not treatable.

Which factors place an individual at high risk for acquiring a sexually transmitted infection (STI)? (Select all that apply.)

A) Having multiple sexual partners

B) Using a condom during sex

C) Having no other STIs

D) Having a sexual partner who has had an STI

E) Receiving a blood transfusion

Ans: A, D

Feedback:

Any person is in a high-risk group for STIs if they have multiple sexual partners, do not

use a condom during sex, have other STIs, and/or have a sexual partner who has had an

STD. Although once a risk for exposure to HIV, blood transfusions no longer place an

individual at high risk for acquiring an STI.

A client wants to know the best way to avoid sexually transmitted infections (STIs).The nurse should mention:

A) Abstinence

B) Monogamous relationship with an infected partner

C) Washing the genitals after sex

D) Use of latex condoms

Ans: A

Feedback:

Other than abstinence, a long-term mutually monogamous relationship with a partner

who has been tested and is known to be uninfected is the best way to avoid STIs. Sexual

partners should talk to each other about their STIs so that preventive action can be

taken. Prevention of STI transmission does not include washing the genitals, urinating,

or douching after sex. Latex condoms can reduce the risk of transmission but only when

used consistently (every time) and correctly.

A client presents with several ulcerative sores on his penis that are firm, round, and painless. He also has rough, reddish brown spots on his palms and the bottoms of his feet. He acknowledges that he is sexually active with multiple partners and is

inconsistent in his use of a condom. Which sexually transmitted infection should the nurse most suspect in this client?

A) Gonorrhea

B) Chlamydia

C) Syphilis

D) Human papillomavirus

Ans: C

Feedback:

Syphilis is primarily indicated by ulcerative sores occurring mainly on the external

genitals, vagina, anus, or in the rectum, although they can occur on the lips or in the

mouth. The sore is usually firm, round, and painless. Rashes associated with secondary

syphilis appear as rough, red, or reddish brown spots both on the palms of the hands

and/or the bottoms of the feet. Infections with Neisseria gonorrhoeae, like those

resulting from Chlamydia trachomatis, cause several clinical syndromes including

urogenital, pharyngeal, and rectal infections in males and females, and conjunctivitis in

adults and neonates. Chlamydia is known as a "silent" infection because most infected

people are asymptomatic and lack abnormal physical examination findings. Men who

are symptomatic typically have urethritis, with a mucoid or watery urethral discharge

and dysuria. A minority of infected men develop epididymitis (with or without

symptomatic urethritis), presenting with unilateral testicular pain, tenderness, and

swelling. Human papillomavirus infections, if manifest, are primarily indicated by

genital warts.

The nurse discusses home care options with an 85-year-old client who recently fractured her humerus in a fall in her house. She is recovering well now but says the experience has made her see that it is time for her to change her living arrangements. The client can still bathe herself and cook meals on occasion but says she would like to live where

nursing care is available onsite and where communal dining and recreation options are offered. Which of the following living arrangements could the nurse recommend?

A) Assisted living facility

B) Independent living in a senior living facility

C) Nursing home

D) Apartment located near a hospital

Ans: A

Feedback:

Assisted living is a type of community-based care that combines quasi-independent

living with the availability of nursing care onsite and through home care visits. It is

generally a level of care for people who cannot live on their own, but are not yet ready

for a nursing home. This type of living arrangement is different from living

independently in one's own apartment, such as living in a senior living facility, in that

many activities are provided communally (e.g., eating, recreation) and there is an

organized effort to create a "caring community" where residents' needs are supervised

and met.

A community care nurse at a healthcare agency assists in coordinating a plan for

providing health services in the most cost-effective way possible to a large number of members living in the region. This work is known as:

A) Case management

B) Home healthcare

C) Interdisciplinary collaboration

D) Care management

Ans: D

Feedback:

Care management is the coordination of a plan or process to bring health services

together as a common whole in a cost-effective way. Case management is the

development and coordination of care for a selected client and family. Home healthcare

is a provision of healthcare that occurs in the setting clients consider their home.

Interdisciplinary collaboration is the sharing of evidenced-based practice and skills as an

integration strategy with clients and families in homes and other healthcare settings.

The case manager works with a client who has type 2 diabetes and heart disease. In this role, which actions should the nurse take in managing the client's diseases? (Select all that apply.)

A) Provide weekly coaching sessions by telephone for blood glucose management.

B) Supervise cardiac stress tests in the exercise room of the local hospital.

C) Administer emergency insulin when the client arrives at the hospital in a diabetic coma.

D) Demonstrate use of a glucose meter to the client.

E) Review heart-healthy and diabetic-friendly food options with the client and his family.

Ans: A, D, E

Feedback:

Disease management often focuses on chronic illness such as heart disease, heart failure,

diabetes, pulmonary disease, urinary incontinence, and asthma. In disease management

programs, in addition to medications, there is strong emphasis on the use of telephone

coaching, Internet resources, and intensive client and family teaching to advance

self-care and adherence to wellness care. Recently, to help clients and families manage

their health problems in an effective and efficient manner, there has been an effort to

bundle disease states together in light of many comorbidity patterns. Supervising a

cardiac stress test and administering emergency glucose are clinical interventions that

go beyond basic disease management.

The case manager works with a 10-year-old girl who has asthma. Because the client's family has trouble affording inhalers, the case manager researches client assistance programs through which they could receive free medications. This aspect of case management is known as:

A) Care management

B) Advocacy

C) Disease management

D) Interdisciplinary collaboration

Ans: B

Feedback:

Advocacy is always moving the needs of clients, families, and communities to a point of

awareness that will advance change and increase quality of a life and experience. Care

management is the coordination of a plan or process to bring health services together as

a common whole in a cost-effective way. Disease management is a system of

coordinated healthcare interventions and communications for groups of people with

conditions in which client self-care efforts are significant. Disease management

emphasizes prevention at the secondary and tertiary level using evidence-based practice

guidelines. Interdisciplinary collaboration is sharing of evidence-based practice and

skills by several disciplines as an integration strategy with clients and families in homes

and other healthcare settings.

The case manager for a 12-year-old boy who is obese and prediabetic. To help the client develop a diet that will promote weight loss and control of his glucose level, the case manager decides to consult with a dietician, who provides several current journal articles that present findings on various diets. This aspect of case management is known

as:

A) Care management

B) Advocacy

C) Disease management

D) Interdisciplinary collaboration

Ans: D

Feedback:

Interdisciplinary collaboration is sharing of evidence-based practice and skills by

several disciplines as an integration strategy with clients and families in homes and

other healthcare settings. Advocacy is always moving the needs of clients, families, and

communities to a point of awareness that will advance change and increase quality of a

life and experience. Care management is the coordination of a plan or process to bring

health services together as a common whole in a cost-effective way. Disease

management is a system of coordinated healthcare interventions and communications

for groups of people with conditions in which client self-care efforts are significant.

Disease management emphasizes prevention at the secondary and tertiary level using

evidence-based practice guidelines.

A student is considering becoming a home health nurse. In researching this type of nursing, the student finds that several key factors have played a part in the development of home healthcare as it is today? These include: (Select all that apply.)

A) Increase in the number of hospitals nationwide

B) Reduction in the incidence of chronic diseases

C) Development of health insurance

D) Rising costs in healthcare

E) Increase in medical and nursing specialization

Ans: C, D, E

Feedback:

The development of health insurance, rising costs in healthcare in general, and medical

and nursing specialization all have played a part in the development of home healthcare

as it is today. Hospitals have not increased in number nationwide in recent years and the

incidence of chronic diseases has increased, not decreased.

The nurse has recently been appointed to a community-based advisory board of an

agency that is interested in providing fiscally sound, high-quality care for clients they decide will be their service population. Any profit margin that is acquired is reinvested in the operations of the home healthcare service. Which type of agency is this?

A) Private/voluntary

B) Hospital based

C) Proprietary

D) Official

Ans: A

Feedback:

Voluntary agencies are generally established as not-for-profit entities, although they

operate with the same fiscal objectives as "for-profit agencies." A hospital-based agency

is a home health agency that is not freestanding in the community but is one of many

specialty services offered at a hospital setting. A proprietary agency is a home health

agency that is motivated by a for-profit philosophy. Official agencies are supported by

public monies that often come from taxes. The public monies can come from local,

state, or federal governments.

The nurse recently took a position in a national chain of home healthcare agencies directed at caring for clients who are on home hemodialysis. The services provided are often paid for privately by families, and any profit margin is used to benefit the owner

of the agency. Which type of agency is this?

A) Private/voluntary

B) Hospital based

C) Proprietary

D) Official

Ans: C

Feedback:

A proprietary agency is a private agency that plans to and wants to make a profit. It can

be part of a local, national, or international chain of home healthcare agencies directed

toward any group of clients with particular healthcare problems or challenges. A

voluntary agency is generally established as a not-for-profit entity, although it operates

with the same fiscal objectives as "for-profit agencies." A hospital-based agency is a

home health agency that is not freestanding in the community but is one of many

specialty services offered at a hospital setting. Official agencies are supported by public

monies that often come from taxes. The public monies can come from local, state, or

federal governments.

Which type of agency can be either profit or nonprofit?

A) Private/voluntary

B) Hospital based

C) Proprietary

D) Official

Ans: B

Feedback:

A hospital-based agency is a home health agency that is not freestanding in the

community but is one of many specialty services offered at a hospital setting. It can be

for profit or nonprofit depending on the philosophy of the hospital. Voluntary agencies

are generally established as not-for-profit entities, although they operate with the same

fiscal objectives as "for-profit agencies." A proprietary agency is a home health agency

that is motivated by a for-profit philosophy. Official agencies are supported by public

monies that often come from taxes. The public monies can come from local, state, or

federal governments.

The nurse takes care of a dependent family member whose husband is in the military. Which government funding is most likely going to be used for home healthcare services for this client?

A) Medicare

B) Medicaid

C) TRICARE

D) Veterans Administration

Ans: C

Feedback:

Government funding for home healthcare includes Medicare (federal), Medicaid (state),

TRICARE (federal funds for military personnel and their dependents), and the Veterans

Administration (federal funds for those who are currently serving or have served in the

armed services of the United States).

Who primarily regulates the provisions of home healthcare? (Select all that apply.)

A) Insurance companies

B) Local government

C) State government

D) Federal government

Ans: C, D

Feedback:

Home healthcare is regulated by the state and federal government. Insurance companies

generally align themselves with the regulations stipulated by these governments.

Which criteria must an individual meet to receive Medicare for home health services? (Select all that apply.)

A) Home bound

B) Specific plan of care

C) Skilled healthcare needs

D) Intermittent care needs

E) Continuous 24-hour necessity for care

Ans: A, B, C, D

Feedback:

Medicare has the following criteria for eligibility: (1) home bound, (2) a plan of care,

(3) skilled needs, (4) intermittent care needs, and (5) necessity.

The nurse provides care covered by Medicare for a client over 2 hours during the day, 3 days during the week, for 60 days. Which type of care is the nurse providing?

A) Interdisciplinary

B) Skilled

C) Intermittent

D) Part-time

Ans: C

Feedback:

Intermittent care refers to a situation in which skilled care is usually provided over

several hours during the day, several days during the week, for a specified time period.

Interdisciplinary care is that provided by several disciplines as an integration strategy

with clients and families in homes and other healthcare settings. Skilled care involves

the professional abilities of a registered nurse or her/his supervised designee. Necessity

means that the service given by a home care agency is reasonable based on the status of

the client.

The client wants to know how long Medicare will pay for skilled needs. How long can the nurse continue to provide this care before she must seek a renewal if skilled needs continue to exist?

A) 30 days

B) 45 days

C) 60 days

D) 90 days

Ans: C

Feedback:

Medicare requires the specified time period to be 60 days with appropriate renewals if

skilled needs continue to exist.

The nurse reviews the official document called the Scope and Standards of Home

Health Nursing Practice. Using knowledge about the document providing guidelines for nurses involved in home healthcare practice, which are included in the standards of care? (Select all that apply.)

A) Assessment by collecting data about home care clients

B) Implementation of nurse-centered actions in collaboration with physicians

C) Diagnosis through the analysis of data

D) Outcome identification that helps identify nurse-sensitive measures

E) Planning nurse-sensitive interventions directed at the identified outcomes

Ans: A, C, D, E

Feedback:

The standards of care include the following key elements of the nursing process: (1)

assessment by collecting data about home care clients; (2) diagnosis through the

analysis of these data; (3) outcome identification that helps home care nurses identify

nurse-sensitive measures; (4) planning in the form of nurse-sensitive interventions

directed at the identified outcomes; and (5) implementation of nurse-centered actions in

collaboration with clients and families, not with physicians.

What services is telehealth used to deliver? (Select all that apply.)

A) Chronic care and specialty consultations

B) Home telenursing

C) Electronic referrals to specialists in expert health facilities

D) Transmission of healthcare information to people in the same geographical area

Ans: B, C

Feedback:

Telehealth is a form of electronic communication used to deliver (1) acute (not chronic)

care and specialty consultations, (2) home telenursing, and (3) electronic referrals to

specialists in expert health facilities. According to Thede, it involves "using electronic

communications for transmitting healthcare information such as health promotion,

disease prevention, professional or lay education, diagnosis, or actual treatment to

people located at a different geographical area."

Using knowledge of the parish or faith community nurse, which interventions are likely to perform on the basis of the key roles of this type of nurse? (Select all that apply.)

A) Teaching a class to faith community members on managing high blood pressure

B) Providing counsel on preventing upper respiratory illness to member

C) Referring a faith community member to a nutritionist for dietary counsel

D) Assisting an obstetrician in the birth of a faith community member's child

E) Administering vaccinations at a local health clinic

Ans: A, B, C

Feedback:

The seminal work of Westberg identified seven key roles of the parish or faith

community nurse: (1) health educator, (2) personal health counselor, (3) referral agent,

(4) coordinator of volunteers, (5) developer of supportive groups, (6) integrator of faith

and health, and (7) health advocate. A faith community nurse would not likely assist an

obstetrician with a birth or administer vaccinations at a local health clinic.

The home care agency has just received a client referral from a physician and assigned the case. Within how many hours from receiving the referral should the nurse plan to make the initial visit to this client, on the basis of typical agency policy?

A) 12 hours

B) 24 hours

C) 36 hours

D) 48 hours

Ans: B

Feedback:

Generally, home care agencies make sure that an initial visit is made within 24 hours

after receiving a referral.

The community health nurse can receive a referral to a home health agency at any time. Which phases are included in a home visit? (Select all that apply.)

A) Plan personal safety of visit

B) Initiating a visit

C) Preparation

D) Actual visit

E) Termination of the visit

Ans: B, C, D, E

Feedback:

There are five phases to a home visit: (1) initiating the visit, (2) preparation, (3) the

actual visit, (4) termination of the visit, and (5) postvisit planning.

The home health nurse has to ensure that a safety plan is in place to address falls. Using knowledge that 55% of fall-related injuries occur with falls inside the home, a total of more than 60% of these falls occur in which two rooms?

A) Living room and hallway

B) Kitchen and bathroom

C) Hallway and bedroom

D) Living room and bedroom

Ans: D

Feedback:

The most common rooms where people fall include the living room (31%), bedroom

(30%), kitchen (19%), bathroom (13%), and hallway (10%).

The nurse works with 68-year-old client who is having great difficulty managing his blood glucose level. The nurse finds that the client is not following the diet that he had agreed to follow and is eating portions that are far too large. He apologizes and explains that he is grieving the loss of his wife, who died 2 weeks ago. The nurse shares condolences with him on his loss and explain that it is perfectly understandable to have trouble following a new diet while grieving. In this scenario, the nurse is using which principal approach in motivational interviewing?

A) Expressing empathy

B) Supporting self-efficacy

C) Rolling with resistance

D) Finding a discrepancy

Ans: A

Feedback:

Empathy is an approach to clients that involves trying to see clients' lives through their

own lens and trying to think about their experiences as they would think about them.

Self-efficacy is the belief on the part of the client that change is possible. In

motivational interviewing, the home care nurse does not fight client resistance but "rolls

with it." Home care nurses also work to develop opportunities for clients to discover

discrepancies between their current behavior and what they want to accomplish through

changed behaviors.

Community assessment is a critical process for the future because it can:

A) Identify the need for a community commission

B) Identify a method to improve the health of at-risk clients

C) Provide a means of grant funding for clinics

D) Provide a client base for at-risk neighborhoods

Ans: B

Feedback:

Community assessment has been called a critical process for the future that can be used

as a means for understanding the interactions between people, health, and environment

in a community, as well as finding a way to improve both the health status of at-risk

populations and outreach activities.q

The nurse conducts a community assessment in a town once supported by multiple paper factories. The factories closed 2 years ago and most of the population is now out of work. The school nurse notes that 68% of the students are behind schedule in their physicals and immunizations. On the basis of this community assessment, the nurse should recommend:

A) Initiation of neighborhood clinics at low or no cost to the community

B) Creation of a task force to assess the impact of low income on immunization compliance

C) A formal petition to the local government to mandate immunizations by imposing

monetary fines on parents whose children are not immunized

D) A tax relief program for new companies wishing to settle in the community

Ans: A

Feedback:

Whenever nurses conduct an assessment of a community, they examine biological,

psychological, and sociocultural influences of the environment of a group of people who

share specific characteristics. Knowledge gained from this endeavor provides valuable

insight into the ways that people's health behaviors directly and indirectly influence the

overall health and well-being in their community. The neighborhood clinics meet the

immediate need for childhood immunizations. The assessment has already determined

that immunization compliance is low, so there is no need to create a task force to assess

this. A mandate from the local government to either immunize one's children or pay a

fine would only place a further financial burden on the parents and would likely not

improve immunization rates, as the parents would be no more able to afford it than

before. Although it would be beneficial in the long term to attract companies to the

community to provide jobs, there is no indication that a tax relief program would

provide adequate incentive to achieve this goal, as taxes are likely not the primary

barrier to new employers' coming. Moreover, even if it did succeed, it might be several

years before such an effort produced the jobs and income needed to address the barrier

to immunization, and in the meantime many children would go without being

immunized.

While completing a community assessment, the nurse notes that the computer companies in the community hire a disproportionate number of their employees from

local suburban communities rather than the community in which the company is housed. To create an accurate assessment, the nurse should collect data on:

A) All of the company's employees but count those living outside the community separately, as outliers

B) Only the employees that live in the community, disregarding the others as statistically irrelevant

C) All of the company's employees and include those living outside the community as part of the aggregate

D) Only the employees that live in the community in your initial assessment; then collect data on the others as part of a separate assessment for the community in

which they live.

Ans: C

Feedback:

The group of people, or an aggregate as it is often called in the literature, consists of

those who live within the boundary of the geopolitical community. However, these

borders are really ambiguous. The aggregate could also include people who work within

the community who do not necessarily live there, as well as those living close to

community boundaries who visit the communities to purchase goods or use facilities for

nonwork activities. Thus, the nurse should collect data on all of the company's

employees and include those living outside the community as part of the aggregate.

Many in the community have developed cancer. The EPA has discovered a leak of biohazardous waste from a local factory that has leached into the water table. The area is decontaminated and cleaned. The community identifies the need for a local hospice for

those with cancer who are dying. Area communities participate in the fund drive. This type of community effort may best be described as:

A) Geopolitical community

B) Epidemiologic model

C) Community of solution

D) Developmental model

Ans: C

Feedback:

A community of solution is formed by an aggregate specifically to address health

concerns within a particular area. Communities of solution are composed of persons not

only from the area of need but also members of neighboring communities who have a

vested interest in a challenge the community faces. These communities can form in

response to a health threat, such as contaminated water or industrial air pollution. A

geopolitical community is a group of people who live within identified boundaries and

governing systems. An epidemiologic model is a process used to assess a community

using data collected from descriptions and statistical relationships to evaluate the level

of health and well-being within a community to address identified healthcare needs. A

developmental model is a retrospective, historical analysis of system parameters such as

the physical environment, education, safety and transportation, politics and government,

health and social services, communication, economics, and recreation in a community.

At an international nurses' conference, nurses from all around the world make contact. The various communities represented at this conference most likely: (Select all that apply.)

A) Vary significantly in composition

B) Have no shared interests and goals related to health and safety

C) Are challenged in their attempts to identify its members

D) Thought of as members of a global community

E) Do not need to assess their communities' needs because they are obvious

Ans: A, C, D

Feedback:

The international community or global community encompasses all nations. Although

the overall composition of the communities that make up this global community may

differ, some have strikingly similar characteristics, with shared interests and goals,

including members' health and safety. To continue to advance the goals of health and

safety, there must be a thorough way of understanding each of the communities

described, especially if nurses are to accurately target ways to address goals for change.

The first step in any plan to help a community is to assess the community's needs. The

amorphous nature of the community can create some challenges to the identification of

its members and to the assessment of their immediate needs.

The nurse conducts a community assessment. The community is large and the members range from affluent executives to poor migrant workers. To most accurately assess the community, the nurse should:

A) Use a questionnaire written on a fifth-grade reading level

B) Use multiple methods or perspectives

C) Interview a subpopulation of each group represented

D) Analyze census data

Ans: B

Feedback:

Triangulation is the use of multiple methods or perspectives to collect and interpret data

about some phenomenon for the purpose of constructing an accurate representation of

reality. When trying to answer a question about a community, the nurse should consider

the question from different perspectives.

The community health nurse assesses the neighborhood in which the clients live. When observing the physical environment, the nurse notes that most of the homes in the

neighborhood are well kept and the children playing in the yards are wearing clean clothing. The children appear well nourished. The nurse determines that the neighborhood has little need for a well-child clinic. This assessment is based on:

A) Subjective data

B) Objective data

C) Cognitive analysis

D) Valid data

Ans: A

Feedback:

Community health nurses often use informal assessments, such as windshield surveys,

to learn about the neighborhoods in which their clients live. These surveys involve

subjectively observing the physical community on foot or through the windshield of a

car. In this way, the nurse can assess the level of economic development of the

community on the basis of its physical environment, educational systems, safety and

transportation, health and social services, communication, and recreation. This type of

assessment is not based on objective or "valid" data, as the means of the assessment are

purely subjective. It also does not involve cognitive analysis.

The community health nurse is responsible for the general health of the community on

multiple levels. The nurse discovers an increase in the number of sick days used by children aged 7 to 11 years at the local elementary school in recent weeks. Research indicates that the families of asthmatic children tend to be less educated and less likely

to comply with current treatment plans. Using the epidemiologic approach, the next step in the care plan should be to:

A) Conduct a broad-based survey of all families with asthmatic children within several communities

B) Determine trends that interfere with family problem-solving techniques

C) Develop school-based education programs for both the children and their caregivers

D) Submit a proposal to the town for neighborhood asthma clinics

Ans: C

Feedback:

Principles of epidemiology are used throughout the development, planning,

implementation, and evaluation phases of the community assessment process.

Epidemiologic methods can help identify patterns of health and social inequity and

determine trends in three ways: (1) by describing the disease or disability, (2) by

determining relationships that can predict health or health disparities, and (3) by

developing and testing interventions. By noting that families of asthmatic children tend

to be less educated and less likely to comply with current treatment plans, you have

already determined relationships that can predict the health disparity. Therefore, the

next step would be to develop and test an intervention on the basis of these findings.

The school-based education program is the only intervention listed that directly

addresses the cause of the health disparity and that may be tested.

The school nurse notifies the community nurse that there have been five confirmed cases of pertussis in the sixth-grade classes. In addition to responding to the cluster of cases, the community nurse should immediately:

A) Recommend that the school be closed

B) Research the vaccine compliance in the school

C) Recommend that notes be sent home to the parents regarding a pertussis epidemic

D) Consult with the infection control physician at the local hospital

Ans: B

Feedback:

Existing (secondary) data can often be used to identify the community's strengths and

weaknesses, to determine assets and liabilities, and to describe, along with available

community resources, the amount of disease/disability or health in a population. The

data that identify the "who, what, where, and when" related to disease, disability, and

exemplars of health must then be systematically organized and analyzed. In this case,

the nurse should gather further data regarding the vaccination history of students in the

school before initiating an intervention. If the pertussis is only affecting children who

have not been vaccinated and 98% of the children in the school are vaccinated, then the

nurse may focus efforts on getting those few children vaccinated who are not already. If,

however, the disease is affecting children already vaccinated or if a significant number

of children are not vaccinated, then the nurse might consider recommending that the

school be closed, recommending that notes be sent home to the parents regarding an

epidemic, or consulting with the infection control physician at the local hospital.

There are 12 students with confirmed cases of the H1N1 flu in grades 6 to 8 at the local middle school in the community. The community nurse advises the caregivers of the ill

children to keep the children home for a minimum of 5 to 7 days. Which should be the nurse's next step?

A) Recommend closing the school for 6 weeks

B) Implement education in the school setting regarding respiratory and hand hygiene

C) Require each child in the school to undergo a physical evaluation by the school nurse

D) Initiate a system of discipline in the school setting for improper hand washing

Ans: B

Feedback:

Association means that events of illness or disability have a strong tendency to occur

together rather than just by chance. The school setting is a common site where illness

occurs by association. Education can prevent or limit the transmission of this disease.

Because the children with known cases of H1N1 are being kept at home now and will

not be contagious on return, there is no need to close the school. A mandatory physical

evaluation of each child in the school would be both impractical and unnecessary, as

most children will not have the virus and those who do may not yet be symptomatic.

Although children should be educated on methods of proper hand washing, simply

punishing those who fail to perform proper hand hygiene would be neither appropriate

nor effective.

The new community health nurse introduces herself to the local minister and attends various neighborhood meetings. The nurse learns about the ethics, values, and culture of the neighborhood. The community is vocal about the need for public safety and the care

of the homeless, especially in the winter. Which is the best rationale for considering all of the influences in the neighborhood affecting their health and well-being?

A) The information can be used to obtain funds to create shelters for the homeless

B) A neighborhood watch may be created with police support

C) The information will help to effectively assess the community

D) It will help the nurse create a controlled clinical environment

Ans: C

Feedback:

It is necessary to consider the history, demographics, ethnicity, and values and beliefs of

the entire community because these factors can be used as part of a systems approach by

teams to effectively assess a community. Although interventions such as a homeless

shelter and a neighborhood watch may result from this study of the community, the

primary purpose of the study is to inform the assessment of the community, which will

in turn lead to appropriate interventions. The purpose of considering these influences is

not to create a controlled clinical environment.

The community health nurse learns that there are statistically high levels of obesity and elevated cholesterol in the community. In addition, the community has a disproportionately high number of fast food restaurants, compared with surrounding

communities. Which would be the most appropriate next step, based on these data?

A) Gather support in the community to ban fast foods

B) Gather further information regarding trans fats

C) Target education and support programs

D) Create local exercise programs

Ans: C

Feedback:

Information such as that gathered in the scenario above is best used to help target

education and support programs that can help members of populations obtain the

information they need to make health promotion decisions. In addition, it helps ensure

access to reasonably inexpensive screening and follow-up. The other answers do not

thoroughly address the root causes of high cholesterol and obesity.

The community health nurse explores pedestrian access to all healthcare facilities in the community. Which tool would be most helpful in performing this task?

A) Geographic information systems

B) Functional health pattern

C) Epidemiologic model

D) Developmental model

Ans: A

Feedback:

A geographic information system (GIS) is a system of hardware and software used for

storage, retrieval, mapping, and analysis of geographic data. Spatial features are stored

in a coordinate system that refers to a particular place on the earth. The GIS tool assists

in determining locations of disease incidence, characteristics of surrounding

environments, locations of healthcare facilities, the geographic boundaries of the

communities, and other essential community infrastructures. A functional health pattern

is a systematic and deliberate approach to community assessment that involves

evaluating the behavior patterns of community dwellers that occur sequentially over

time. An epidemiologic model is a process used to assess a community using data

collected from descriptions and statistical relationships to evaluate the level of health

and well-being within a community and to address identified healthcare needs. A

development model is a retrospective, historical analysis of system parameters such as

the physical environment, education, safety and transportation, politics and government,

health and social services, communication, economics, and recreation in a community.

Which type of assessment considers a configuration of behaviors that occur sequentially over time?

A) Asset-based assessment

B) Epidemiologic model

C) Collaborative model

D) Functional health pattern

Ans: D

Feedback:

Functional health pattern (FHP) assessment may be used for individual, family, or

community assessment. It involves a systematic and deliberate format and considers a

configuration of behaviors that occur sequentially over time. Understanding community

patterns provides insight into how groups respond to problems and take action. A key

factor of the asset-based assessment model is building coalitions and active partnerships

with the community during the assessment phase. Collaboration with community

members shifts the focus from dependency on experts to empowerment of all, working

together toward a goal. An epidemiologic model is a process used to assess a

community using data collected from descriptions and statistical relationships to

evaluate the level of health and well-being within a community and to addressidentified

healthcare needs. A collaborative model of assessment involves nurses, social workers,

and other public health experts working with each other and with community residents

to assess the community in an interdisciplinary manner.

The nurse assesses a community undergoing change. Five years ago, a series of setbacks caused the local foundry to close. Through interviews, the nurse discovers that generations of families worked at the foundry. Research indicates that no other

businesses have been able to provide work for those who no longer work at the foundry. Developmental data gathered through this research into the community's history will help the nurse: (Select all that apply.)

A) Determine what resources were available before the foundry closed

B) Determine what variables may have enhanced or detracted from community development

C) Develop an understanding of the community's strengths and resources today

D) Understand cultural changes within the community over time

E) Identify where in the community health clinics are most needed

Ans: A, B, D

Feedback:

Both historical informants and mined data (i.e., data that are examined through

extensive and rigorous searches) can help describe the cultural changes within a

community or aggregate over time to inform the future. In this way, developmental data

are obtained and then compared to determine what variables may have enhanced or

detracted from development and what resources were available at the time. Historical

research would not help you develop an understanding of the community's strengths and

resources today; an assets-based approach would help you do that. Historical research

would also not help you identify where in the community health clinics are most

needed; a windshield survey or use of geographic information systems would help you

do that.

The community is concerned about public safety and the care of their elders living at home. When the nurse assesses the community, the nurse finds there is potential to solve

their problems within the community setting without outside resources. The plans to meet the community needs are accepted by the members of the community. Which action has been most successfully demonstrated in your assessment of this community?

A) Make the assessment process empowering to the community

B) Assess the community through interview and share findings in a timely manner

C) Involve the community when there is difficulty with the assessment

D) Create an environment of change within the community

Ans: A

Feedback:

When attention is directed to community strengths and resources, better relationships

can be developed between all those working on the assessment, especially when the

community is part of the process. Working relationships are enhanced when community

members realize that the assessment process has the potential to be an empowering

experience; the strengths and positive aspects of the community are measured in

conjunction with what is needed or not actualized. There is no evidence of interviewing

or creating change within the community in the scenario. There is also no evidence that

there was any difficulty with the assessment.

When the community collaborates in a plan to create services and education to enhance their health and well-being, the plan is most likely to:

A) Create an environment that fosters change

B) Have an increased rate of success

C) Empower the community but diminish the rate of success

D) Shift the focus from dependency to empowerment

Ans: D

Feedback:

Collaborating with community members shifts the focus from dependency on experts to

empowerment of all together working toward a goal. Using an assets model requires

taking a different philosophic approach to the assessment process. Interaction with the

community is the primary approach. Although this approach may also help create an

environment that fosters change and leads to an increased rate of success, the most

likely result is the focus shifting from dependency to empowerment. It is not likely that

the approach would empower the community but diminish the rate of success.

The community health nurse works in a community recently devastated by a tornado. Many of the survivors are cared for in their homes. Care is needed for those who are ill,

recovering, or in hospice. To provide the most holistic and effective care to the community, the nurse should:

A) Refer the clients to an outreach center

B) Consult with the hospice nurse and the social worker

C) Provide care according to the physician's orders

D) Collaborate with other health care workers and the clients

Ans: D

Feedback:

Beyond interdisciplinary expert collaboration, another approach used in community

assessment is the collaboration between experts and those with health concerns. For

members of a population to have an active voice and part in identifying issues and

making decisions about what is needed, community health nurses need to engage

participants with a "we can do it together" approach rather than a "we/they" approach.

Following a hurricane, the disaster team chooses to use a collaborative model to assess the needs of the community. Each team member is given a community analysis and

assigned the task to create a tentative plan of action. Why would the use of a collaborative model hamper the progress of the assessment and plan in a disaster? (Select all that apply.)

A) Individual decision-making creates bias.

B) Assessment is time-consuming.

C) Approach to problem solving is linear.

D) Approaches must be preestablished.

E) Collaboration is limited.

Ans: B, D

Feedback:

The collaborative model has distinct drawbacks. This form of assessment is

time-consuming and logistical, and systematic approaches must be preestablished to

maintain clarity in the approach for all those involved. The collaborative model is

characterized by a group decision-making process, not an individual one. Problem

solving would be multidisciplinary and simultaneous, not linear. Collaboration would be

enhanced, not limited.

The nurse is approached by the health department to investigate and assess the rise in developmental disabilities in an isolated section in the community. To begin the assessment, the nurse should gather objective data from which source?

A) Client interview—aggregate data

B) Internet—aggregate data

C) Internet—Wikipedia

D) Direct observation of the area

Ans: B

Feedback:

By exploring data available on the Internet, community health nurses can not only

describe trends but also identify resources that address the trends and determine where

gaps may exist. The aggregate data from these resources include local demographics,

such as death rates, causes of death, marital status, gender, age, ethnicity, and density of

the population. Depending on the purpose of the community assessment, records in

health facilities may be examined. Client interviews and direct observation of the area

would render subjective data, not objective. Wikipedia is not an authoritative source.

Which rationales are appropriate for performing community assessments in the school setting? (Select all that apply.)

A) To learn about an outbreak of lice

B) To assess effectiveness of children with type I diabetes managing insulin shots at school

C) To stage a student's brain tumor

D) To assess students for food allergies

E) To provide education on preventing the spread of influenza

Ans: A, B, E

Feedback:

Appropriate rationales for performing community assessments in the school setting

include the following: to learn about the outbreak of specific communicable infectious

disease (lice); to learn about healthcare practices associated with a specific chronic

disease (asthma); and to learn how best to protect children and adolescents, as well as

their families, from the spread of infectious disease in a school setting. The staging of a

brain tumor would not be appropriate for a community assessment and should be

performed by a specialist in a provider's office or in a hospital. Assessing students for

food allergies would also not be an appropriate community assessment as it does not

pose an immediate threat to the health of the public, is not infectious, and is not

communicable.

1. A group of teens develop their own method of texting in a language that they feel is all their own. The change is subtle, but the meanings and the feelings associated with the text are known only to a select few. This behavior is an example of:

A)Culture

B)Cultural competence

C)Cultural safety

D)Ethnocentrism

A)Culture

2.The nurse is caring for a client who refuses the food as served. He states that the food is foreign to him and will make him ill. All food must be blessed. The personal care attendant is upset by this behavior and states that the client should eat the food anyway. The client's behavior is most likely a result of:

A)Psychosocial deficit

B)Cultural belief

C)Allergies

D)Hygiene

B)Cultural belief

3. The nurse is present when a mother begins cupping her child. She states that it will help to heal the child's respiratory tract infection. The nurse understands that the cultural belief that cupping will aid in the healing process is a:

A)Shared instinct

B)Learned behavior

C)Private idiosyncrasy

D)Genetically programmed idea

B)Learned behavior

4. A Mexican-American client arrives at the emergency department. He reports abdominal pain and has been vomiting for 5 days. The nurse notes that he is exhibiting symptoms of dehydration, and his vital signs and labs confirm this. The nurse asks the client why he waited so long to seek medical care. He states that he is being treated by the Curandero and wishes to continue while in the hospital. The nurse recognizes the different cultural assumptions regarding care. This situation is an example of:

A)Cross-cultural nursing

B)Ethnocentrism

C)Cultural safety

D)Transcultural bias

A)Cross-cultural nursing

5. The nurse conducts a well-child clinic in your community. The client population is culturally diverse, and, although the clinic is busy, it runs smoothly because it has an interpreter. In addition to the interpreter, it is important that the nurses treat each client that reflects his or her individual cultural needs. This is cultural:

A)Bias

B)Artwork

C)Competence

D)Beliefs

C)Competence

6.A nurse, new to the community health agency, works in a culturally diverse area of the community. The nurse is responsible for providing holistic care to clients and to be culturally competent. The health agency requires the nurse to demonstrate which competency to exhibit cultural competence? (Select all that apply.)

A)Value diversity

B)Adopt the client's cultural values

C)Acquire cultural knowledge

D)Adapt to diversity

E)Speak the language of the client

A,C,D

7.The nurse is called to make an unscheduled visit to a new client in her home. The purpose of the visit is to admit the client and treat an abdominal wound. The nurse discovers that the client is from a culture unfamiliar to her. In this situation, the nurse should demonstrate cultural competence and awareness by: (Select all that apply.)

A)Being open to the client's ideas and way of life

B)Obtaining objective data when caring for the client

C)Exhibiting respect and patience

D)Being aware of your own culture

E)Assuming that you have enough knowledge to get by

A,C,D

8.The nurse is caring for a client who is a refugee from Haiti. The client's family has been displaced because of an earthquake in their country. The client has healing fractures on his right arm as well as fractured ribs. He tells the nurse that, before care begins, the nurse must consult with his Voodoo healer. Which is the nurse's best response?

A)Teaching the client that he is in the United States and should abide by Western medical practices

B)Informing the physician that the client is noncompliant

C)Consulting with the healer and updating the physician regarding treatment and any herbal medications that may be used

D)Encouraging the client to use a complementary approach to his care

C)Consulting with the healer and updating the physician regarding treatment and any herbal medications that may be used

9.The nurse is caring for a client who is from a culture for which the nurse has a limited knowledge base. The nurse conducts the admission interview using cultural humility. Which should the nurse ask in the interview? (Select all that apply.)

A)Yes or no questions

B)About traditions

C)Open-ended questions

D)How the client has addressed the illness

E)If the cause of the illness is spiritual

B,C,D

10.During a conference after rounds, a nurse states, "They are in the United States now; you would think that they would act like us." This nurse is exhibiting:

A)Cultural humility

B)Ethnocentrism

C)Cultural competence

D)Cross-cultural nursing

B)Ethnocentrism

11.During an ice storm, people in one neighborhood banded together and shared the home of a neighbor who still had power and heat. Other neighbors provided food, water, and bedding. In another neighborhood the neighbors did not know one another and weathered the storm alone. Both neighborhoods are part of the same community. What characteristic did the people in the first neighborhood share that made them a subculture that those in the second neighborhood lacked?

A)Belief in the value of cooperation

B)Religion

C)Socioeconomic status

D)Geography

A)Belief in the value of cooperation

12.The nurse enters a client's home to provide care to a wound and teach the client's wife how to care for the wound. The nurse is comfortable with the client's culture and the fact that it is matriarchal in nature. As teaching begins, the husband interrupts and states that the woman does not change bandages according to his culture. He asks if the nurse is familiar with his culture and then says that all members of his neighborhood follow its principles. The nurse should suspect that the client is a member of:

A)A cult

B)An orthodox religious group

C)A subculture

D)An occupation

C)A subculture

13.To demonstrate true cultural sensitivity and awareness, the nurse must:

A)Travel to other countries on occasion

B)Become bilingual

C)Be competent in his or her own cultural heritage

D)Know the practices of all major cultures in one's region of the country

C)Be competent in his or her own cultural heritage

14.A client, diagnosed with hypertension, is prescribed a no-added-salt, low-fat diet. He agrees and repeats the teaching principles. At the next visit, the nurse notices salted meat on the counter and the client shows the nurse his food diary. The diet in the past week does not reflect the physician's orders. What cultural component may have contributed to the noncompliance with the diet order?

A)Diet may be too lean

B)Wife cooks according to the husband's preferences

C)Diet may not meet the cultural criteria for food choices

D)Food tastes bland and unappetizing

C)Diet may not meet the cultural criteria for food choices

15.A client is admitted to the hospital. On admission, it is noted that the client does not speak English. It will take 20 minutes for the hospital interpreter to arrive. The nurse decides to wait for the interpreter rather than relying on the client's husband. Appropriate rationales for this decision include that the interpreter is: (Select all that apply.)

A)More likely to be fluent in both languages

B)More likely to be familiar with the client's symptoms

C)Trained in ethics and will be better at explaining cultural differences

D)More likely to understand the client's needs

E)More likely familiar with technical healthcare terms

A,C,E

16.The nurse cares for a client in a community health clinic. The nurse is uncomfortable because the client remains very close when communicating. This discomfort makes it difficult to concentrate on the interview. When the nurse backs away, the client stops speaking and leaves. This is an example of:

A)Differing views of personal space

B)Treatment limitation

C)Aggressive behavior

D)Cultural bias

A)Differing views of personal space