Chapter 6 The Science of Prevention – Flashcards

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1. Which was the leading cause of death in the United States in 1900? A) Major cardiovascular-renal disease B) Influenza and pneumonia C) Tuberculosis D) Gastritis, duodenitis, enteritis, and colitis
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Ans: A Feedback: The leading cause of death in 1900 was major cardiovascular-renal disease followed by influenza and pneumonia; tuberculosis; and gastritis, duodenitis, enteritis, and colitis.
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2. Who first described pulmonary tuberculosis in detail? A) Hippocrates of Cos B) Aretaeus the Cappadocian C) Claudius Galen D) Susruta
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Ans: B Feedback: Aretaeus the Cappadocian described pulmonary tuberculosis in detail. Hippocrates of Cos was the first to record the relationship of the external environment to the health of individuals. Claudius Galen described the four humors, introduced many drugs derived from plants, and was the first to describe smallpox. Susruta was a Brahmin physician who associated malaria with the mosquito.
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3. Who is considered the first epidemiologist? A) Hippocrates of Cos B) Aretaeus the Cappadocian C) Claudius Galen D) Susruta
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Ans: A Feedback: Hippocrates of Cos was the first to record the relationship of the external environment to the health of individuals and is considered the first epidemiologist. Aretaeus the Cappadocian described pulmonary tuberculosis in detail. Claudius Galen described the four humors, introduced many drugs derived from plants, and was the first to describe smallpox. Susruta was a Brahmin physician who associated malaria with the mosquito.
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4. Which occurs in the epidemiologic process that is similar to the diagnosis phase of the nursing process? A) Data are gathered from reliable sources B) Healthcare needs and assets are identified C) Goals and objectives for care are established D) A tentative hypothesis is formulated
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Ans: D Feedback: During the diagnosis phase of the epidemiologic process, a tentative hypothesis is formulated. During the assessment phase of the epidemiologic process, data are gathered from reliable sources. During the diagnosis phase of the nursing process, healthcare needs and assets are identified and goals and objectives for care are established.
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5. Who in the history of epidemiology developed mortality surveillance systems, addressed basic epidemiologic concepts, and is considered the founder of modern statistics? A) William Farr B) John Graunt C) Florence Nightingale D) John Snow
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Ans: A Feedback: William Farr is considered the father of modern statistics. John Graunt analyzed weekly reports of births and deaths. Florence Nightingale used statistics to improve public health in England. John Snow performed epidemiologic research on transmission of cholera using natural experiments, mapping, and rates.
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6. Which most accurately describes how disease patterns have changed from 1900 to the present? A) Morbidity and mortality from infectious diseases have increased. B) Morbidity and mortality from unintentional injuries have decreased. C) Morbidity and mortality from chronic degenerative conditions have decreased. D) Morbidity and mortality from noninfectious diseases have increased.
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Ans:D Feedback: Primarily as a result of improved public health practices in the early 20th century, life expectancy in the United States, the United Kingdom, and European countries, as well as in other developed countries, rose. With it, a change in the patterns of disease occurred. No longer are infectious diseases the leading causes of death; the morbidity and mortality from noninfectious diseases and chronic degenerative conditions have increased.
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7. The community health nurse knows that early attempts to understand illness and disease focused on the study of the experiences of individual people. Using this knowledge, how would the nurse define epidemiology to a group of nursing students? A) An outbreak that occurs when there is an increased incidence of a disease beyond that which is normally found in the population B) Model based on the belief that health status is determined by the interaction of the characteristics of the host, agent, and environment C) Study of the distribution and determinants of states of health and illness in human populations D) Epidemiologic model that strongly emphasizes the concept of multiple causation while de-emphasizing the role of agents in explaining illness
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Ans: C Feedback: Epidemiology is the study of the distribution and determinants of states of health and illness in human populations. An epidemic is an outbreak that occurs when there is an increased incidence of a disease beyond that which is normally found in the population. The epidemiologic triad is a model based on the belief that health status is determined by the interaction of the characteristics of the host, agent, and environment. The web of causation is an epidemiologic model that strongly emphasizes the concept of multiple causation while de-emphasizing the role of agents in explaining illness.
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8. Which most accurately defines "rate"? A) Course of a disease or condition from the onset to resolution B) Primary measurement used to describe either the occurrence or the existence of a specific state of health or illness C) Probability or likelihood that a disease or illness will occur in a group of people who presently do not have the problem D) Characteristic or event that has been shown to increase the probability that a specific disease or illness will develop
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Ans: B Feedback: Rate is the primary measurement used to describe either the occurrence or the existence of a specific state of health or illness. Natural history is the course of a disease or condition from the onset to resolution. Risk is the probability or likelihood that a disease or illness will occur in a group of people who presently do not have the problem. A risk factor is a characteristic or event that has been shown to increase the probability that a specific disease or illness will develop.
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9. Who was one of the first people to study patterns of disease in populations and analyzed the weekly reports of births and deaths in London, the results of these analyses becoming the precursor of modern vital statistics? A) William Farr B) John Graunt C) Florence Nightingale D) John Snow
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Ans: B Feedback: John Graunt analyzed weekly reports of births and deaths. William Farr is considered the father of modern statistics. Florence Nightingale used statistics to improve public health in England. John Snow performed epidemiologic research on transmission of cholera using natural experiments, mapping, and rates.
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10. Who was the best known epidemiologist of the 19th century and used population data and personal observations to investigate the epidemic of cholera that occurred from 1848 through 1854? A) William Farr B) John Graunt C) Florence Nightingale D) John Snow
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Ans: D Feedback: John Snow performed epidemiologic research on transmission of cholera using natural experiments, mapping, and rates. William Farr is considered the father of modern statistics. John Graunt analyzed weekly reports of births and deaths. Florence Nightingale used statistics to improve public health in England.
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11. In researching cases of West Nile virus in the community, the nurse explores how the interactions among people infected with this virus, mosquitoes, and the environment they share contribute to outbreaks of this disease. Which epidemiologic model is used in this case? A) Epidemiologic triad B) Wheel of causation C) Web of causation D) Natural history
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Ans: A Feedback: The epidemiologic triad is the classic model based on the belief that health status is determined by the interaction of the characteristics of the host, agent, and environment, not by any single factor. The wheel of causation de-emphasizes the agent as the sole cause of disease while emphasizing the interplay of physical, biological, and social environments. The web of causation is an epidemiologic model that strongly emphasizes the concept of multiple causation while de-emphasizing the role of agents in explaining illness. Natural history is the course of a disease or condition from the onset to resolution.
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12. The nurse explores all of the possible factors that contribute to coronary artery disease in the community as links in multiple interrelated chains. Which epidemiologic models is the nurse using? A) Epidemiologic triad B) Wheel of causation C) Web of causation D) Natural history
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Ans: C Feedback: The web of causation is an epidemiologic model that strongly emphasizes the concept of multiple causation while de-emphasizing the role of agents in explaining illness. The epidemiologic triad is the classic model based on the belief that health status is determined by the interaction of the characteristics of the host, agent, and environment, not by any single factor. The wheel of causation de-emphasizes the agent as the sole cause of disease while emphasizing the interplay of physical, biological, and social environments. Natural history is the course of a disease or condition from the onset to resolution.
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13. The community health nurse addresses an outbreak of viral spinal meningitis in the community. Referring to Leavell and Clark's natural history of disease model, which example of tertiary prevention might the nurse consider in this situation? A) Initiate vaccinations for all people who have not yet been infected. B) Familiarize yourself with the signs and symptoms of the disease so that you can provide early diagnosis and treatment of it. C) Encourage any who think they might have symptoms of the disease to come to the community health clinic to be assessed as soon as possible, to prevent associated disabilities. D) Refer clients who have experienced neurological deficits because of the disease to a neurologist to begin rehabilitation.
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Ans: D Feedback: Primary prevention measures specific to the disease can be implemented at this stage to prevent the onset in a population of well people. The period of pathogenesis begins when there are biological, psychological, or other responses within the host. Secondary prevention measures that focus on early diagnosis and prompt treatment, limiting resulting disabilities, are implemented during the early stages of the disease. Tertiary prevention follows with rehabilitation measures that enable the individual to function at his or her maximum capability.
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14. Which occurs in the epidemiologic process that is similar to the implementation phase of the nursing process? A) Data are gathered from reliable sources B) Actions are initiated to carry out the plan C) Actions are evaluated and report prepared D) Further research is conducted if necessary
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Ans: B Feedback: During the implementation phase of the epidemiologic process, actions are initiated to implement the plan. During the assessment phase of the epidemiologic process, data are gathered from reliable sources. During the evaluation phase of the epidemiologic process, actions are evaluated, a report is prepared, and further research is conducted if necessary.
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15. Which best describes a risk factor? A) Course of a disease or condition from the onset to resolution B) Primary measurement used to describe either the occurrence or the existence of a specific state of health or illness C) Probability or likelihood that a disease or illness will occur in a group of people who presently do not have the problem D) Characteristic or event that has been shown to increase the probability that a specific disease or illness will develop
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Ans: D Feedback: A risk factor is a characteristic or event that has been shown to increase the probability that a specific disease or illness will develop. An outbreak is a course of a disease or condition from the onset to resolution. Rate is a primary measurement used to describe either the occurrence or the existence of a specific state of health or illness. Risk is the probability or likelihood that a disease or illness will occur in a group of people who presently do not have the problem.
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16. Which represents the correct order of the three stages of the natural history of disease? A) Pathological onset, manifestation of clinical disease, presymptomatic B) Presymptomatic, pathological onset, manifestation of clinical disease C) Pathological onset, presymptomatic, manifestation of clinical disease D) Manifestation of clinical disease, presymptomatic, pathological onset
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Ans: C Feedback: Epidemiologic research has established the natural history of most illnesses. This refers to the course of a disease or condition from the onset to resolution. It includes (1) the pathological onset stage, (2) the presymptomatic stage, and (3) the manifestation of clinical disease.
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17. The nurse has been requested to investigate the outbreak of H1N1 in the community. In documenting the outbreak, which should be included in its description? Select all that apply. A) The names of all people who have been infected by the virus B) The geographical area within which the outbreak has occurred C) A brief history of all of the other viral outbreaks that have occurred in the community in recent years D) The time of onset and duration of the outbreak E) The anticipated economic impact of the outbreak on the community
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Ans: A, B, D Feedback: The nurse should describe the outbreak according to person, place, and time. A history of other viral outbreaks and the economic impact of the outbreak are not necessary for the nurse to document.
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18. In researching an outbreak of malaria in the developing nation where the nurse currently works, the nurse decides to not focus on the role of mosquitoes in transmitting the disease but on how the physical environment of the community, biological aspects of the community, and social customs interact to affect the prevalence of this disease. Which epidemiological model is the nurse using? A) Epidemiologic triad B) Wheel of causation C) Web of causation D) Natural history
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Ans: B Feedback: The wheel of causation de-emphasizes the agent as the sole cause of disease while emphasizing the interplay of physical, biological, and social environments. The epidemiologic triad is the classic model based on the belief that health status is determined by the interaction of the characteristics of the host, agent, and environment, not by any single factor. The web of causation is an epidemiologic model that strongly emphasizes the concept of multiple causation while de-emphasizing the role of agents in explaining illness. Natural history is the course of a disease or condition from the onset to resolution.
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19. The nurse is in charge of the flu vaccination program in the community. Which actions should the nurse take when planning and evaluating this program? Select all that apply. A) Measure epidemiologic statistics before and after administering the flu shots. B) Plan and evaluate influenza vaccinations regularly. C) Interview clients regarding their perception of the effectiveness of the vaccinations and use these data in planning future vaccinations. D) As new data regarding influenza vaccinations become available, modify the intervention accordingly. E) Evaluate the success of your program by comparing its results with those in other communities.
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Ans: A, B, D Feedback: The primary way to demonstrate prevention or control of a health problem is to compare epidemiologic statistics before and after the implementation of the health service. Planning and evaluation are continuous processes. As new data become available, modification in health services may be necessary, and those modifications require evaluation. Evaluation of the program and planning of future interventions should not be based on the clients' perception of its effectiveness, which is likely to not be accurate. Because factors may vary significantly from community to community, it would be more appropriate to compare before and after statistics in your own community rather than statistics with other communities.
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20. Who used statistics to improve public health in England? A) William Farr B) John Graunt C) Florence Nightingale D) John Snow
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Ans: C Feedback: Florence Nightingale used statistics to improve public health in England. William Farr is considered the father of modern statistics. John Graunt analyzed weekly reports of births and deaths. John Snow performed epidemiologic research on transmission of cholera using natural experiments, mapping, and rates.
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21. You have heard rumors in the hospital where you work of an Ebola outbreak in your community and you would like to investigate it further. Which of the following should be your first step in the investigation? A) Identify the names of the people infected by the virus B) Formulate and test hypotheses as to the most probable causative factors C) Implement a plan for control of the outbreak D) Establish the existence of the outbreak
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Ans: D Feedback: Because you have only heard rumors, you should first establish the existence of the outbreak before identifying those infected, formulating and testing hypotheses, and implementing a plan for control of the outbreak.
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